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Biomedical subjects

S Clark

Publications and source records attributed to S Clark.

396 records · Page 22Linked to original sources
PubMedDate not supplied

Tolmetin-induced hemolysis.

A case of drug-associated immune hemolysis in a patient taking tolmetin for arthritic pain is described. Serologic tests showed that in the absence of tolmetin, the patient had a negative antibody screening test but a strongly positive direct antiglobulin test. An eluate prepared from the patient's red cells caused agglutination of all cells tested. However, addition of tolmetin revealed a high-titered tolmetin-dependent antibody in the patient's serum; the addition of tolmetin did not affect the results obtained with the eluate. within 3 months after the patient discontinued tolmetin, his hematocrit had increased to 45 percent, and his jaundice and bilirubinuria had disappeared. These results are similar to those described for zomepirac, another of the group of nonsteroidal anti-inflammatory medications.

ABO Blood-Group System↗
PubMedDate not supplied

Particle settling after lead-based paint abatement work and clearance waiting period.

This study investigated the evolution of airborne particle concentration and size distribution following abatement work in a controlled environment utilizing direct real-time particle monitoring and used it to project potential lead loadings as those particles settle. An 860 ft3 environmental test chamber with sophisticated ventilation and air purifying systems was built. Wooden doors with lead-based paint were dry sanded or scraped to generate the highest feasible airborne lead concentrations. Size-fractional airborne particle concentrations decreased exponentially with time in all tests, even with no air exchange, consistent with the stirred model of constantly mixed air, which predicts longer settling than for tranquil settling. Very low levels of air mixing generated by temperature gradients and initial room air turbulence affected particle settling. About 90% of airborne lead mass settled within 1 hour after active abatement, before final cleaning began. During the second waiting period of 1 hour, which followed cleaning of the floor, additional dust settled so that the additional potential lead loading from remaining airborne lead was less than 20 microg/ft2. For this worst case scenario, the underestimate of the lead loading done by the clearance sampling did not exceed about 30%. For more realistic conditions, the underestimates are projected to be much lower than the new 40 microg/ft2 Housing and Urban Development (HUD) clearance standards for floor dust lead. These results were obtained for the first waiting period (between the end of active abatement and the beginning of cleaning) of 1 hour, as recommended by HUD guidelines. Thus, this study demonstrates no need to increase either the first or second waiting period.

Air Pollutants, Occupational↗
PubMedDate not supplied

The hearing-impaired infant: patterns of identification and habilitation.

The 1982 Position Statement by the Joint Committee on Infant Hearing recommends that infants at risk for hearing impairment be screened by 3 mos of age and that the diagnostic process be completed an habilitation begun by 6 mos of age. How close to this ideal actual practice comes in an urban setting is the subject of this study, Data on 88 infants referred to a hospital-based parent-infant program were retrospectively examined to determine the occurrence of risk factors and at what ages: (1) hearing loss was first suspected, (2) hearing loss was diagnosed, and (3) habilitation was initiated. Results indicate that over one-quarter of all hearing-impaired infants will not manifest any of the risk factors proposed in the 1982 Position Statement and that regardless of whether the infant graduates from a neonatal intensive care unit or well-baby nursery, the median age for enrollment in a parent-infant program is a year or more later than the 1982 recommendation.

Age Factors↗
PubMedDate not supplied

Evaluation of an enzyme immunoassay (Chlamydiazyme) with confirmatory test for the detection of chlamydial antigen in urine from men.

First catch urine specimens from 312 male patients were examined for the presence of chlamydial antigen by an enzyme immunoassay (Chlamydiazyme). Positive results were repeated and confirmed using a blocking assay. In addition, urethral swabs were examined by cell culture for Chlamydia trachomatis. Discrepant results were further analysed by direct immunofluorescence (IF) of the spun urine deposit. Paired specimens were positive from 26 subjects, and negative from 276 subjects. Eight paired specimens were urethral culture positive, and urine EIA negative. Two specimens, urine EIA positive but urethral culture negative, were positive on direct IF. The sensitivity, specificity, predictive value of a positive result, and predictive value of a negative result for urine EIA against cell culture and/or direct IF were 77.8%, 100%, 100% and 97.2% respectively.

Chlamydia Infections↗
PubMedDate not supplied

Insurance and quality of care for children with acute asthma.

BACKGROUND: Increasing attention has been paid to the role of insurance in determining quality and outcomes of care. Pressures to reduce health costs and to improve quality have prompted attempts by managed care organizations to decrease the use of the emergency department (ED) for acute asthma, but performance comparisons between insurance types remain rare. METHODS: We used prospective data from the Multicenter Airway Research Collaboration on 965 children with acute asthma presenting to 36 EDs. We compared measures of quality of pre-ED care, acute severity, and short-term outcomes (length of stay, percent relapse, and percent with ongoing symptoms) across 4 different insurance categories: managed care, indemnity, Medicaid, and uninsured. We used multivariate regression to control for differences in education, estimated income, race/ethnicity, and chronic asthma severity and acute asthma characteristics. RESULTS: Children with managed care and indemnity had similar demographic and asthma characteristics, but these children differed significantly from Medicaid and uninsured patients. Managed care and indemnity insured children had similar ratings on all 7 quality measures, with Medicaid and uninsured children ranking significantly lower on most measures, including (1) percent with primary care provider (PCP) (P <.001), (2) percent using ED as usual site of asthma care (P <.001), (3) percent using ED for prescriptions (P <.001), (4) percent with a ratio of >1 of ED visits to acute office visits within the past year (P =.003), and (5) percent visiting their PCP within the week prior to ED visit (P <.001). Children with managed care were more acutely ill than were indemnity, Medicaid, or uninsured children on presentation to the ED (pulmonary index of 4.6, 4.0, 4.2, and 3.9, respectively, P =.007). There were no significant differences in length of hospital stay, relapse, and ongoing exacerbation. CONCLUSIONS: Our results indicate similar quality of care, greater severity of acute asthma, and no worse outcomes for children with managed care compared to children with indemnity insurance. We found uninsured children to have consistently poorer quality of care than insured patients.

Analysis of Variance↗
PubMedDate not supplied

Developing an integrated nursing team approach.

Nursing Standard recently published a literature search that explored different models of integrated nursing and more traditional models of community nursing in primary care (Baileff 2000). Models of change for implementing integrated nursing were also examined. This article aims to explore the development of an integrated nursing team in a healthcare centre in Northampton.

Community Health Nursing↗
PubMedDate not supplied

Heart transplantation in a Jehovah's Witness.

Heart transplantation has been successfully performed without blood products in a 45-year-old Jehovah's Witness. Management of this patient is described. The medical, ethical, and religious issues involved in the decision to offer transplantation and to accept it are discussed.

Blood Transfusion, Autologous↗
PubMedDate not supplied

Hydroxyproline centiles for normal adolescent boys and girls.

Centiles for 24 hour urinary total hydroxyproline are useful in monitoring growth and the effect of treatment in children with orthopedic diseases such as scoliosis, where growth is difficult to measure by anthropometric means. The centiles have been calculated from the data of a 5 year longitudinal study on 100 normal adolescent schoolchildren. Hydroxyproline estimations and assessments of growth were done 3 times a year. The rate of growth (height velocity) can be correlated with hydroxyproline levels found in adolescents.

Adolescent↗