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Biomedical subjects

S Graham

Publications and source records attributed to S Graham.

342 records · Page 19Linked to original sources
PubMedDate not supplied

Outpatient cardiac infusion units: impact in elderly patients with refractory heart failure.

BACKGROUND: The use of intermittent intravenous infusions of inotropic drugs is under evaluation in the management of patients with refractory heart failure. OBJECTIVES: We investigated the impact of intermittent outpatient infusions of inotropes on hospital admissions, emergency room visits, functional class, and symptom-free interval after administration of inotropes to elderly patients with advanced heart failure symptoms. METHODS: This retrospective analysis involved 24 elderly outpatients with a New York Heart Association class of III or IV and refractory heart failure symptoms. RESULTS: Seven patients with class III heart failure (age 74A+/-4 years; left ventricular ejection fraction 27A+/-9%) and 17 patients of class IV (age 73A+/-4 years; LVEF 21A+/-10%) were included. Twenty patients were males. A total of 365 outpatient treatment sessions were administered, with 15A+/-9 sessions per patient (range, 6-43). Eleven patients improved and were discharged; seven patients died; three discontinued treatment; two patients remain on therapy; and one patient required continuous infusion. During this treatment, there were only three emergency room visits and six hospital admissions due solely to heart failure. Fourteen patients required no emergency room visits or hospitalization. Of the patients discharged from the program, the interval without heart failure symptoms ranged from 60-356 days, with an improvement in NYHA class from 3.5A+/-0.6 to 1.4A+/-0.5 and no emergency room visits or hospital admissions. CONCLUSIONS: This type of therapy is well tolerated among elderly patients with refractory heart failure symptoms and its use deserves further investigation.

Aged↗
PubMedDate not supplied

A follow-along study of postsecondary outcomes for graduates and dropouts with mild disabilities in a rural setting.

Eighty-six students with mild disabilities living in a rural area who had graduated (n = 52) or dropped out of (n = 34) high school were interviewed at two points in time (7 months apart) about their employment, residential status, and participation in postsecondary education and training programs. Information was also collected on students' high school experiences (educational, vocational, and work) and the reasons they dropped out of school. Of the students who had graduated (Caucasian = 26, black = 25, and other = 1), 31 were male and 21 were female. Of the students who had dropped out (Caucasian = 18, black = 15, and other = 1), 22 were male and 12 female. It was found that the majority of graduates and dropouts were employed full-time at both interviews, and held jobs that paid above minimum wage and provided employee benefits, as well. Nevertheless, by the time of the terminal interview, graduates had worked proportionally more time since high school than dropouts and had been employed in their current job more than twice as long. Neither group of former special education students was particularly active in pursuing postsecondary education or training programs. Finally, these former students had participated in a limited range of educational and vocational experiences during high school, both in terms of diploma tracks and vocational education programs. The implications of the findings for long-term employment and community adjustment are discussed.

Adolescent↗
PubMedDate not supplied

The effects of goal setting and self-instruction on learning a reading comprehension strategy: a study of students with learning disabilities.

This study examined the contributions of instruction in goal setting and self-instruction, separately and combined, on the acquisition, maintenance, and generalization of a reading comprehension strategy by fourth-through sixth-grade students with learning disabilities. A previously validated strategy involving the use of story structure to analyze and remember story content was taught to 47 students with learning disabilities using the self-regulated strategy development (SRSD) model. Comparisons were made among students with learning disabilities in four conditions (strategy instruction, strategy instruction plus goal setting, strategy instruction plus self-instruction, and strategy instruction plus goal setting and self-instruction). Result indicated that instruction in the reading strategy produced meaningful, lasting, and generalizable effects on students' story comprehension skills. Furthermore, the comprehension performance of the students with learning disabilities after strategy instruction was indistinguishable from that of a social comparison group of normally achieving students. Explicit instruction in goal setting and self-instruction, however, did not augment the comprehension performance of students with learning disabilities.

Analysis of Variance↗
PubMedDate not supplied

Isometry of the posterior cruciate ligament. Effects of functional load and muscle force application.

The effects of functional load and muscle force application on isometry of the posterior cruciate ligament were determined. Eight fresh-frozen cadaver knees were mounted in a custom-designed rig. A full range of motion and muscle forces were applied through the quadriceps, hamstring, and gastrocnemius tendons during a simulated static squat maneuver. The low-load isometric posterior cruciate ligament point was located 5.63 mm proximal and 0.18 mm anterior to the anatomic center of the posterior cruciate ligament origin on the femur. The high-load state, with no gastrocnemius and hamstring muscle forces applied, shifted the isometric point 6.32 mm proximal and 6.72 mm anterior (P < 0.05). Loading the hamstring and gastrocnemius muscles also shifted the isometric point (P < 0.05). This study indicated that the most isometric region of the posterior cruciate ligament femoral attachment changed significantly when functional loads and muscle forces were applied to the knee. This finding may have implications for both surgical reconstruction and rehabilitation of the posterior cruciate ligament-injured knee.

Cadaver↗
PubMedDate not supplied

Recent developments in the toxicology of anabolic steroids.

Anabolic steroids are extensively abused as ergogenic aids by athletes (and others). A number of features of anabolic steroid use and toxicology have been recently reviewed in the Journal, and a large body of data has accumulated concerning their toxic nature. The lipoprotein profile induced by anabolic steroids carries a markedly adverse cardiovascular risk. Glucose metabolism is significantly altered and includes peripheral insulin resistance, hyperinsulinaemia and attenuated responses to glucagon. Hypertension has been noted. Psychiatric and psychological alterations are major toxicities of anabolic steroids, and probably constitute the major mechanism of their action. Hepatic neoplasia occurs in the setting of abuse of this class of drugs, and may be related to their use, although there is no convincing evidence that other malignancies are induced in athletes who abuse them. Gross disturbance of reproductive function occurs in both sexes: hypogonadal states are common and prolonged. The anabolic steroids are toxic drugs with both long and short term effects. Their abuse by athletes is to be decried, particularly in view of the frequent and prolonged use by the young.

Anabolic Agents↗
PubMedDate not supplied

Effect of topical nasal pharmaceuticals on sodium and chloride transport by human airway epithelia.

The human airway epithelium lines the respiratory tract from the nasal mucosa to the bronchioles. Electrolyte transport by these epithelia is crucial in maintaining the appropriate volume and salt composition of the airway surface fluid. When this epithelium becomes functionally impaired, the airways are more prone to respiratory infections. We studied the effect of six common topical agents that are commonly used to treat rhinorrhea and nasal inflammation on the transepithelial resistance, sodium, and chloride transport of primary cultures of human airway epithelia grown at the air-liquid interface. The pharmaceuticals fluticasone propionate, cromolyn sodium, ipratropium bromide, azelastine, oxymetazoline, and normal saline were used and the electrical function of the epithelia was studied in Ussing chambers. Azelastin and ipratropium bromide-treated epithelia were found to have a significant decrease in transepithelial resistance. Both normal saline and fluticasone propionate resulted in significant increases in amiloride-sensitive short circuit currents that reflect sodium transport. Finally, normal saline resulted in a significant increase in bumetanide-sensitive short circuit current that reflects chloride transport across the epithelia. The data presented may explain a mechanism by which some topical pharmaceuticals help reduce rhinorrhea, and may point to some unwanted side effects of some pharmaceuticals on the electrolyte transport of the airway epithelia. In summary, several of the common topical nasal agents alter the electrolyte transport of the nasal airway epithelia. The in vivo significance of these findings is to be determined.

Administration, Topical↗
PubMedDate not supplied

Malignant round cell tumor of bone with neural differentiation (neuroectodermal tumor).

A malignant round cell tumor primary in bone is reported in a young girl, showing histologically rosette formation and pseudoalveolar spaces. Vimentin, NSE, and S-100 were positive. Electron microscopy demonstrated abundant glycogen and neural features such as cell processes, microtubules, and occasional dense-core granules. Whether this neuroectodermal tumor represents a separate entity or is a variant of Ewing's sarcoma should wait for further experience, in the light of recent evidence suggesting that Ewing's sarcoma arises from primitive multipotential cells.

Adolescent↗
PubMedDate not supplied

Visual impairment in children.

This article examines the paediatric ophthalmic nurse's role in treating and managing several common ocular conditions.

Cataract↗
PubMedDate not supplied

Cigarette smoking and risk of clinical relapse in patients with Crohn's disease.

Risk of clinical relapse among cigarette smokers and nonsmokers was examined in a cohort of 74 adult Crohn's disease (CD) patients who were identified and followed at monthly intervals for six months. We measured clinical activity by a weighted symptom index used previously. Relapse at any point during the study was defined by the index score exceeding 150. Approximately 50% of nonsmokers experienced clinical relapse during the study period. Current smokers experienced a relapse risk 1.6 times that of nonsmokers (P less than .01). The risk estimates correspond to mean overall clinical activity scores of 142 +/- 34 for smokers compared to 119 +/- 26 for nonsmokers. Adjustment for confounding effects did not substantially alter the association shown between cigarette use and clinical relapse. We observed no increase in the likelihood of relapse among former smokers. The statistically significant finding that current smoking increases the risk of relapse for CD patients is of clinical importance, given the high prevalence of smoking (42%) among CD patients in this sample.

Adult↗
PubMedDate not supplied

Corticosteroid injection for osteoarthritis of the knee: peripatellar compared to intra-articular route.

Intra-articular injection of micro-crystalline corticosteroid is used to treat symptomatic osteoarthritis (OA) of the knee, but its duration of effect and efficacy are uncertain. From the observation that pain in OA of the knee can often be blocked by infiltration of the soft tissues at the patella margin with local anaesthetic, this study investigated an injection technique in which corticosteroid was infiltrated around the patella. Thirty-eight patients with radiologically demonstrable and painful OA of the knee were treated either with peripatellar or intra-articular methylprednisolone in a randomised double blind study. Assessments of response to either injection were made at one week, one month and three months. Eleven of 15 measures improved significantly over time in both groups, but the differences between groups were not statistically significant. Analysis of individual responses showed that the majority of good outcomes were in the peripatellar group. Five patients receiving intra-articular injections but only one receiving a peripatellar injection withdrew because of treatment failure. Peripatellar injection is an alternative method of local administration of corticosteroid which is highly effective in a proportion of patients and merits further evaluation.

Aged↗
PubMedDate not supplied

Can-Dial. An experiment in health education and cancer control.

A dial-access public information system providing information about cancer to the populace has been developed by Roswell Park Memorial Institute. The system is comprised of a tape library consisting of 36 pre-recorded tapes in English on a variety of cancer-related topics and Spanish translations of 28 of the tapes. Interested persons can select and listen to topics of their choice over the telephone. Telephones are manned by operators 16 hours a day, 7 days a week. Persons who call are asked to volunteer certain descriptive information such as name, address, telephone number, sex, age, occupation, and source of information about Can-Dial. These data are used in evaluating the program. Two types of evaluation are being conducted. The first entails a constant monitoring of the system based upon information collected by operators concerning each call. The second type consists of interviews with a sample of callers and a sample of noncallers for the purpose of comparing the characteristics of both groups and ascertaining the impact of Can-Dial on the behavior of its users. Preliminary assessments indicate that Can-Dial is being used by all socioeconomic status groups, by more urban than rural residents, and by the younger rather than older age groups. In its first 23 months of operation, the system handled more than 68,700 calls, at an average cost of $1.58 per call. A tentative conclusion is that Can-Dial is fulfilling a public need and may have a favorable impact in improving health behavior.

Communication↗
PubMedDate not supplied

[Gastric acidity during recovery from malnutrition].

Considering the importance gastric acidity shows on the regulation of the bacterial flora of the intestine, the investigation of the secretory function of the stomach in response to histamine in malnourished infants was set forth as a necessity. Weekly semilongitudinal studies were carried out during recovery in 15 infants complaining of severe malnutrition; in 5 cases, the study was practiced only once during the 4 weeks of investigation. The findings showed a poor secretory response during the early stage of recovery which gradually improved along the course of the dietetic treatment. Comparable values with those in normal infants are reached by the fourth week of receiving diets generous in proteins and calories.

Child, Preschool↗
PubMedDate not supplied

[Towards dracunculosis eradication in Cameroon?].

Dracunculiasis is endemic in the Mayo-Sava region, Province of Extreme North, Cameroon. Its incidence has been reduced by half (from 778 cases in 1990 to 394 cases in 1991) thanks to the national eradication program (wells, distribution of filters, use of temephos to treat water collections, sanitary education, cases containment).

Adolescent↗