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Biomedical subjects

S C Smith

Publications and source records attributed to S C Smith.

At least 109 records · Page 6Linked to original sources
PubMed1998

What is happening in the real world in lipid therapy and is it appropriate? The need for a paradigm shift.

Cardiovascular disease is now the leading cause of death and disability in our society. Current strategies in the United States have been very effective in treating the symptomatic manifestations of severe obstructions but have done little to alter the long-term outcome of cardiovascular disease. Although lipid-lowering therapies have proven beneficial in secondary prevention for patients with cardiovascular disease, they are not as widely employed in contemporary practice as they should be. Better implementation of lipid-lowering therapies, including such major issues as clear treatment guidelines, physician and patient compliance, and delivery of healthcare and quality of care, must be addressed to shift thinking about the treatment of cardiovascular disease as we advance into the next century.

Journal Article↗
PubMed1998

An immunocytochemical study of the distribution of proline-4-hydroxylase in normal, osteoarthritic and rheumatoid arthritic synovium at both the light and electron microscopic level.

The monoclonal antibody 5B5 reacts with the beta subunit of proline-4-hydroxylase, the enzyme which catalyses the formation of 4-hydroxyl proline in collagen and other proteins with collagen-like amino acid sequences. This study aims to assess the production and tissue distribution of this enzyme in normal and diseased synovia from patients with various joint diseases, on the basis that it is a putative marker of collagen-producing cells and, therefore, in this context, of fibroblasts. Sections from five normal, 10 osteoarthritic (OA) and 26 rheumatoid arthritic (RA) synovia were labelled with a mouse monoclonal antibody to proline-4-hydroxylase. The enzyme was found to be expressed by a proportion of synovial intimal cells and by fibroblasts in the underlying connective tissue in normal, OA and RA synovia. Labelling was more pronounced in OA and RA cases. The intimal cells labelling positively showed type B synoviocyte morphology, which was confirmed by subsequent double immunolabelling with 5B5 and antibody against type IV collagen using immunocytochemistry and immunoelectron microscopy.

Antibodies, Monoclonal↗
PubMed1998

Improvement scaling (rehabilitation version). A new approach to measuring progress of patients in achieving their individual rehabilitation goals.

OBJECTIVES: Accurate measurement of clinically relevant change in individual patients undergoing rehabilitation has been an elusive goal. Simple, clinically meaningful, patient-centered measures of individual patient change are urgently needed. The purpose of this research was the development and testing of Improvement Scaling (Rehabilitation Version)(IMS), a new approach to measuring the progress that rehabilitation patients make during treatment. METHODS: Research and clinical staff developed the 65 IMS scales and applied them to all admissions to an an inpatient rehabilitation unit. Date were collected on 292 consecutively admitted rehabilitation patients who were aged 50 or older. An Improvement Score indicates the degree to which each patient achieves the expected level of outcome on his or her unique set of IMS goals. Improvement scores were compared to Goal Attainment Scores and to scores from more traditional measures. Interrater reliability was assessed. RESULTS: IMS scores correlated r = .78 with comparable Goal Attainment Scores. IMS and Goal Attainment Scores had the same pattern of correlations with other measures. Interrater reliability of IMS scores was r = .91. CONCLUSIONS: IMS appears to be a practical, reliable, valid, and clinically useful technique for measuring individual patient change. What is needed now is replication and more information on factors which may influence IMS scores. Versions of IMS are being developed for home health care and mental health. Applications of IMS for quality assurance, quality improvement, and documentation of patient change for third parties is discussed.

Activities of Daily Living↗
PubMed1998

Survival and growth of Campylobacter jejuni after artificial inoculation onto chicken skin as a function of temperature and packaging conditions.

Campylobacter jejuni is one of the major causes of food poisoning in humans. C. jejuni is also widespread in food animals, and meat and meat products derived from food animals are the most common vector of bacterial transmission to humans. To determine the role of packing and storage conditions on the replication of C. jejuni on chicken, the virulent strain C. jejuni 81116 was artificially inoculated onto chicken skin pieces (1 cm2) and stored at different temperatures and under various packaging conditions. C. jejuni 81116 remained viable at -20 and -70 degrees C and was able to replicate at 4 degrees C and at ambient room temperature. C. jejuni 81116 was also inoculated onto chicken skin and subjected to repeated freeze thawing and the viability of the inoculum was quantified. C. jejuni 81116 could withstand repeated freeze thawing similar to that which may occur in the domestic home. Under all freezing conditions, C. jejuni 81116 retained a high level of viability and quickly replicated to levels which exceeded Australian food authorities' permitted bacteria level on raw food products after the sample was thawed.

Animals↗
PubMed1998

Diabetic retinopathy.

This article describes and differentiates between the two primary forms of diabetic retinopathy, specifically, background and proliferative retinopathies. Current therapeutic treatment modalities are discussed in detail. Signs and symptoms that might prompt urgent referral by the nurse practitioner are overviewed and appropriate patient education strategies to foster optimal understanding and outcomes are discussed.

Diabetic Retinopathy↗
PubMed1998

Aging, physiology, and vision.

This article provides an overview of the normal, physiologic changes in vision that are a part of the aging process. Associated symptoms noted by and worrisome to many patients also are discussed. Clear explanations of the rationale and cause of these concerning complaints reduces anxiety and enables people to function more safely in environments in which visual loss is likely to have a deleterious effect. Likewise, accurate understanding of normal versus pathological vision symptoms assists health care providers, such as nurse practitioners, to better triage, assess, and treat ophthalmic-related problems.

Aged↗
PubMed1997

Review of recent clinical trials of lipid lowering in coronary artery disease.

Early trials with lipid-lowering therapy in patients with established coronary artery disease revealed favorable trends in cardiovascular events but did not yield significant reductions in total mortality. Recent clinical trials using hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitor ("statin") therapy have shown significant decreases in total mortality, cardiovascular events, hospitalizations, and the need for revascularization procedures, with its usage (1) to lower low-density lipoprotein (LDL) cholesterol after myocardial infarction (secondary prevention); and (2) in high-risk patients without evidence for coronary artery disease (primary prevention). Secondary prevention benefits have been seen for both men and women, in the young and elderly, and among diabetic and nondiabetic patients. The beneficial effects of LDL-cholesterol reduction occur early and are additive to other risk-reduction therapies. Lipid-lowering therapy should be part of the comprehensive treatment of all patients with atherosclerotic vascular disease and patients at high risk.

Anticholesteremic Agents↗
PubMed1997

Performance assessment model for guideline-recommended pharmacotherapy in the secondary prevention of coronary artery disease and treatment of left ventricular dysfunction.

The Agency for Health Care Policy and Research, the National Heart Lung and Blood Institute of the National Institutes of Health, the American Heart Association, and the American College of Cardiology have all developed guidelines for improving the care of patients with cardiovascular disease. The guidelines include recommendations for intensive lipid-lowering therapy in patients with coronary artery disease (CAD) and angiotensin-converting enzyme (ACE) inhibitors in those patients with symptomatic heart failure and asymptomatic left ventricular dysfunction. Despite clinical trial evidence and consensus that these therapies improve survival in high-risk patients, data suggest that there is wide variation in the delivery of guideline-based care. To investigate whether evidence-based assessment of provider practice patterns can impact the delivery of quality cost-effective care, Merck and Company, in conjunction with leading cardiology group practices, the University of North Carolina at Chapel Hill, and Medical Review of North Carolina developed an ambulatory medical record abstraction study. This quality assurance initiative was conducted at practices beginning in the spring of 1996 and continues. Medical records and administrative claims of patients with ischemic heart disease or heart failure were abstracted by a healthcare consulting organization to maintain patient and physician confidentiality. As of mid-July 1997, 626 group practices had completed the medical record abstraction process, with > 1,136 practices participating at some stage of the project; >6,000 physicians participated in the project and >270,000 patients charts were abstracted. Analysis of these data will provide insight and benchmark patterns of care in the pharmacologic management of heart failure and CAD. This project represents a unique collaboration between a pharmaceutical company, an academic institution, a Peer Review Organization, and practicing physicians, to support evidence-based best medical practices.

Aged↗
PubMed1997

Clinical significance of mitral regurgitation after acute myocardial infarction. Survival and Ventricular Enlargement Investigators.

BACKGROUND: Mitral regurgitation (MR) may complicate acute myocardial infarction (MI). However, it is not known whether mild MR is an independent predictor of post-MI outcome. METHODS AND RESULTS: The study cohort consisted of 727 Survival and Ventricular Enlargement Study patients who underwent cardiac catheterization, including left ventriculography, up to 16 days after MI. Left ventriculograms were analyzed for diastolic and systolic volumes, global left ventricular sphericity, extent of wall motion abnormality, and endocardial curvature. The presence of MR was related to the risk of developing a cardiovascular event during 3.5 years of follow-up. MR was present in 141 patients (19.4%). Severe (3+) MR was present in only 2 patients. Patients with MR were more likely to have a persistently occluded infarct artery (MR versus no MR, 27.3% versus 15.2%; P=.001). Although the ejection fractions were similar, MR patients had larger end-systolic and end-diastolic volumes and more spherical ventricles than patients without MR. Sphericity change from diastole to systole was also significantly reduced in MR patients. Patients with MR were more likely to experience cardiovascular mortality (29% versus 12%; P<.001), severe heart failure (24% versus 16%; P=.0153), and the combined end point of cardiovascular mortality, severe heart failure, or recurrent myocardial infarction (47% versus 29%; P<.001). The presence of MR was an independent predictor of cardiovascular mortality (relative risk, 2.00; 95% CI, 1.28 to 3.04). CONCLUSIONS: Mild MR is an independent predictor of post-MI mortality. As such, it adds important information for risk stratification of post-MI patients.

Aged↗
PubMed1997

Effects of exercise during long-term support with a left ventricular assist device. Results of the experience with left ventricular assist device with exercise (EVADE) pilot trial.

BACKGROUND: Long-term implantation of a left ventricular assist device (LVAD) may be a future alternative treatment for end-stage heart failure. The objective of the present study was to determine the hemodynamic effects of supine bicycle exercise and functional capacity during upright treadmill exercise in 10 patients after LVAD implantation placed for refractory heart failure as a bridge to cardiac transplantation. METHODS AND RESULTS: With supine bicycle exercise, 46 +/- 25 days after device placement, heart and LVAD rates increased in parallel from 87 +/- 12 to 117 +/- 14 bpm and 82 +/- 18 to 107 +/- 21 bpm, respectively. Peak O2 consumption was 8.2 +/- 1.7 mL O2.kg-1.min-1. Fick Systemic blood flow rose from 5.0 +/- 1.2 to 7.8 +/- 2.5 L/min. Right atrial and pulmonary capillary wedge pressures increased from 6 +/- 4 and 5 +/- 3 mm Hg to 12 +/- 5 and 13 +/- 8 mm Hg, respectively. End-diastolic left ventricular dimension increased from 3.9 +/- 1.3 to 4.8 +/- 1.6 cm; however, right ventricular dimension decreased from 3.2 +/- 1.0 to 2.3 +/- 0.9 cm. With upright treadmill exercise, peak O2 consumption was 14.1 +/- 2.9 mL O2.kg-1.min-1. CONCLUSIONS: This study indicates that exercise during long-term LVAD support is safe and is not limited by right heart decompensation. It also justifies a larger study to examine how exercise after LVAD implantation compares with that after cardiac transplantation.

Adult↗