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Biomedical subjects

R Small

Publications and source records attributed to R Small.

36 records · Page 2Linked to original sources
PubMed1992

To stay or not to stay: are fears about shorter postnatal hospital stays justified?

Common concerns raised during a Ministerial Review of Birthing Services in Victoria, Australia about the potential detrimental effects of shorter hospital stays after birth were examined in a study of women's actual experiences of and opinions about their hospital stays. Just under one in four women left hospital within five days of the birth, with the greater majority staying five days or more. Satisfaction with length of stay was high in the sample, with 82% of women feeling their stay had been about right, 11% feeling it had been too long and only 7% of women feeling their stay had been too short. A number of the concerns about the consequences of shorter lengths of stay were not borne out. Women who left hospital earlier than the traditional 5-7 day stay were not less likely to breast feed, nor were they more likely to be depressed 8-9 months after the birth. They were also much more likely to feel confident about looking after their baby when they went home than women who stayed five days or more. Implications for further research and for policy development concerning length of stay are considered.

Adult↗
PubMed1991

Critical issues for practice in residential treatment: the view from within.

A large proportion of children in residential treatment engage in extreme acting-out behavior and suffer from severe attachment disorders and abuse reactivity. At the same time, practice is increasingly alienated from theory and public policy. The challenges to practitioners posed by these difficulties are described and illustrated by vignettes, their impact on residential group care practice is discussed, and their implications for the redesign of practice and for the development of a new theoretical base are examined.

Acting Out↗
PubMed1991

Methotrexate in rheumatoid arthritis: effects on disease activity in a multicenter prospective study.

One hundred and twenty-three patients with rheumatoid arthritis (RA) who successfully completed a randomized trial comparing oral methotrexate (MTX) to auranofin enrolled in a longterm prospective study of oral MTX. Of the 91 patients who completed 24 months of therapy, a significant (p = 0.0001) improvement was noted compared to baseline in all clinical disease variables and the Westergren erythrocyte sedimentation rate (ESR). Marked improvement occurred in 94 (76%) and 98 (80%) of the patients in the joint pain/tenderness index and joint swelling index at the last evaluable visit (mean 26 months). Of the 77 patients with an elevated ESR at baseline, 29 (38%) patients normalized it (less than 20 mm/h) while receiving therapy (p less than 0.01). A significant reduction in prednisone dose was also seen. Adverse events occurred frequently but were generally mild in severity. Twenty-seven patients (22%) withdrew during the study. Four (3%) withdrew due to lack of efficacy, and 6 (5%) because of adverse experiences. The overall probability of continuing therapy in the study for 48 months was projected at 72%. This large prospective study supports the observation of earlier smaller studies that MTX is an effective drug in the treatment of RA.

Administration, Oral↗
PubMed1989

High-risk patients treated with enalapril maleate: safety considerations.

The safety of 738 high-risk patients treated with enalapril under various clinical programs was evaluated. High risk was defined as the presence of a collagen vascular disease; a renal disease, including renovascular hypertension; or either hypertension or refractory cardiac failure with serum creatinine greater than or equal to 1.7 mg/dl at baseline. Essential hypertension was the primary diagnosis in most of these patients. Treatment with enalapril in these patients usually continued without interruption for the length of the particular protocol. The incidence of adverse reactions resulting in discontinuation of treatment was comparable to that observed with other standard antihypertensive therapies in patients with milder forms of disease. No enalapril-related neutropenia, proteinuria, dysgeusia or ageusia were reported in these high-risk patients. The incidence of discontinuation due to rash was less than 0.5%. Resolution and/or improvement of captopril-related adverse effects was observed in many patients crossed over to treatment with enalapril. In patients with collagen vascular diseases and those with severe impairment of renal function (serum creatinine greater than or equal to 3.0 mg/dl), the incidence of discontinuation due to adverse experiences or death as well as the profile of reported adverse experiences was similar to those for the total group of high-risk patients. The data suggest that enalapril is efficacious and well tolerated by the high-risk patients.

Adolescent↗
PubMed1988

Pharmacokinetics of procainamide in continuous ambulatory peritoneal dialysis.

Procainamide (PA) and N-acetylprocainamide (NAPA) pharmacokinetics were examined in six patients undergoing continuous ambulatory peritoneal dialysis (CAPD) following a single oral dose of 625 mg of procainamide HCl. Peak serum PA concentrations occurred between 1 and 3 h after drug administration whereas peak NAPA levels were reached 14 to 48 h following the administration of PA. NAPA levels 1.2 mcg/ml or greater were present for 72 h and in four of the six subjects little further decline occurred at 96 h. PA total body clearance (TBC) averaged 143 ml/min; TBC for NAPA was 29.8 ml/min. PA and NAPA half-lives were considerably prolonged averaging 26.0 and 42.8 h, respectively. V beta for PA was 4.1 l/kg and for NAPA was 1.46 l/kg. PA and NAPA dialysance varied from 0.28 to 5.55 ml/min and from 1.74 to 7.20 ml/min, respectively. This, in turn, represented less than 5 and 25% of the TBC for each drug.

Acecainide↗
PubMed1987

Small bone grafts of an ulna nonunion.

The treatment of nonunions of the ulna has included direct current, compression plating, and bone-grafting. A case of compression plating and bone grafting of an ulnar nonunion in which the bone graft was obtained from the iliac crest with a Craig biopsy needle is described. This procedure allows bone graft to be harvested quickly with minimal postoperative morbidity. The procedure can be used in primary plating of fractures as well as in nonunions.

Biopsy, Needle↗
PubMed1984

Quality control.

Explore the source record for details and available documents.

Emergency Medical Services↗
PubMed1983

Severe head injury. Clinical assessment and outcome.

A prospective study of 213 patients with severe head injury and Glasgow Coma Scores of 8 or less was conducted to identify, at 24 hours postinjury, the favorable and unfavorable clinical factors that relate to outcome one year later. According to the Glasgow Outcome Scale, 35 percent were classified Moderate Disability or Good Recovery, 13 percent were classified Severe Disability or Vegetative State, and 52 percent had died. The presence of intact brain-stem reflexes 24 hours postinjury in comatose patients with head injury is a prognostic sign for a good recovery. Favorable clinical signs include eye opening, pupillary reactivity, spontaneous eye movement, intact oculovestibular reflexes, and motor responses such as localizing. A prognosis of poor recovery is associated with nonreactive pupils, absent oculovestibular reflexes, and motor response of extension or no response at all. These negative signs, when present individually, were associated with only a 3 to 4 percent Moderate Disability or Good Recovery rate and an 85 to 91 percent mortality rate. The Glasgow Outcome Scale was also used to define recovery patterns at intervals during the first year after injury. Ninety percent of patients reached their highest outcome category by six months. The most frequent one-month outcome category for survivors was Severe Disability. By six months postinjury, 68 percent of these patients had made sufficient neurological progress to change their classification to Moderate Disability or Good Recovery. The 16 percent of patients classified at one month as in a persistently Vegetative State had a prognosis of poor outcome. Only 28 percent of these patients progressed in one year to the Severe Disability classification.

Adolescent↗
PubMed1981

Tenosynovial chondromatosis of the shoulder.

Two cases of tenosynovial chondromatosis of the shoulder are presented, the literature on this rare lesion is reviewed, and the differential diagnosis, diagnosis, and treatment are discussed. Synovial chondromatosis is a benign monoarticular lesion. It may also be found in tendon sheaths de novo and secondary to local extension. The two cases presented show tenosynovial chondromatosis involving both the shoulder joint and extension into the bicipital groove.

Adult↗
PubMed1977

Production of 5-hydroxyindoleacetic acid from serotonin by cultured endothelial cells.

Endothelial cells cells from bovine aorta and human umbilical vein and fibroblasts from human foreskin were cultured and subsequently evaluated for ability to metabolize serotonin (5-HT) to 5-hydroxyindoleacetic acid (5-HIAA). Cells were incubated for three hours with 4 X 10(-6) M [14C] 5-HT creatinine sulfate. [14C] 5-HIAA was separated from labeled 5-HT by column chromatography and measured for scintillation counting. Production of 5-HIAA by bovine aorta cells was 39.0+/-7.5 (S.E.M., n=6) nmoles per 10(9) cells per hour. Production of 5-HIAA was markedly inhibited by the presence of 10(-4) M iproniazid (an inhibitor of monoamine oxidase) or 10(-4) M imipramine (an inhibitor of amine transport). 5-HIAA was the only product of 5-HT metabolism detected by thin layer chromatography. Production of 5-HIAA by human umbilical vein endothelial cells was 5.4+/-2.0 nmoles per 10(9) cells per hour (n=5) and by human foreskin fibroblasts was 3.9+/-1.4 nmoles per 10(9) cells per hour (n=5). The results obtained during incubation in the presence and absence of inhibitors indicate that bovine aorta endothelial cells maintained in tissue culture are able to transport serotonin with subsequent production of 5-HIAA. By contrast, human umbilical vein endothelial cells and fibroblasts exhibited relatively low rates of 5-HT uptake and metabolism.

Animals↗
PubMed1977

Severe head injuries in three countries.

Methods for assessing early characteristics and late outcome after severe head injury have been devised and applied to 700 cases in three countries (Scotland, Netherlands, and USA). There was a close similarity between the initial features of patients in the three series; in spite of differences on organisation of care and in details of management , the mortality was exactly the same in each country. This data bank of cases (which is still being enlarged) can be used for predicting outcome in new cases, and for setting up trials of management.

Adolescent↗
PubMed1976

One-stage dermal pedicle flap reconstruction of the oropharynx (an experimental and clinical study).

A single stage dermal pedicle graft method for reconstruction of oropharyngeal defects is presented. Its successful clinical use is described. The advantages of the method include large surface-to-surface anastomosis which appears to minimize breakdown secondary to hypovascularity of an irradiated recipient bed. Other advantages include its single stage feature, persistent blood supply, avoidance of external tubed pedicles and intermediate salivary fistulas. A histologic study in pigs preceded its clinical use in humans. Findings of both aspects of the study are discussed.

Animals↗
PubMed1976

Pharmacological investigations of virosecurinine.

This study reports some biological studies on the alkaloid virosecurinine isolated from the plant Securinega Virosa. Virosecurinine is an isomer of the securinine group of alkaloids present in plants used in traditional medicines in many areas, including the Central District of Papua New Guinea. Virosecurinine is mildly toxic to mice with an LD50 of 73 milligrams per kilogram body weight. Death results from violent tonic convulsions and paralysis similar to those observed with strychnine poisoning. Virosecurinine had no effect on the growth of the following bacteria, E. coli, S. aureus, and B. subtilis, or the fungi, F. monoliforme, P. viridicatum, A. niger, R. solani, R. stolonifer and C. lunata.

Alkaloids↗
PubMedDate not supplied

Tolerability of long term therapy with enalapril maleate in patients resistant to other therapies and intolerant to captopril.

Patients with severe hypertension and/or congestive heart failure (n = 281) who were unresponsive to other therapies and intolerant to captopril received enalapril treatment (mean dose 19.5 mg/day) under study conditions as part of a Compassionate Use Program. Many of these patients had serious concurrent disorders known to predispose them to a greater risk of adverse experiences and death. The mean duration of enalapril treatment was 29 weeks, with a range of 1 day to approximately 3.5 years. Enalapril was generally well tolerated, and the estimated long term probability of patients terminating enalapril therapy because of adverse effects was low. 20 patients had discontinued captopril treatment because of low white blood cell counts; during subsequent enalapril treatment these reactions resolved in 14 patients, persisted in 2 patients, and could not be evaluated in 4 patients. Captopril-related proteinuria improved or resolved in 9 and persisted in 2 of 15 patients, taste disturbances resolved in 35 and persisted in 2 of 38 patients; and rash resolved in all but 7 of 178 patients during enalapril treatment. 18 patients (6%) discontinued enalapril treatment because of lack of efficacy; 6 of these 18 patients died due to a progression of heart failure, and another 11 patients died for other reasons. The deaths were considered unrelated to therapy with enalapril. Adverse reactions were the reason for discontinuation of enalapril treatment in 53 patients (19%). The most common adverse experiences that resulted in discontinuation of enalapril were: impairment of renal function (5%), hypotension (2%) and rash (2%). No neutropenia, proteinuria, or new taste disturbances were recorded as reasons for discontinuation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗