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Biomedical subjects

S M Banks

Publications and source records attributed to S M Banks.

At least 37 records · Page 2Linked to original sources
PubMed1999

Increasing doses of pentoxifylline as a continuous infusion in canine septic shock.

We investigated effects of pentoxifylline during septic shock. Two-year-old (10-12 kg), purpose-bred beagles were infected i.p. with Escherichia coli 0111:B4 (1.2-1.5 x 10(9) colony-forming units per kilogram b.wt.) in a fibrin clot and then immediately treated with one of five doses of pentoxifylline (0.5-20 mg. kg-1. h-1 i.v.) as a 36-h continuous infusion or placebo. All animals received antibiotics and fluid resuscitation. Pentoxifylline levels increased in a dose-dependent manner during (p =.001) and were undetectable 12 h after stopping the infusion. During infusion of pentoxifylline at all doses, there were increases (p =.003), and once the infusion was stopped, there were decreases (p =.049) in endotoxin levels compared with controls. After clot implantation, at all pentoxifylline doses there was a significant increase in tumor necrosis factor levels, compared with controls (p =.025). The relative risk of death was significantly increased with pentoxifylline therapy in a dose-dependent fashion (20 >/= 10 >/= 5.0 >/= 1.0 >/= 0.5 mg. kg-1, p =.008). One hypothesis consistent with these data is that high pentoxifylline levels slowed endotoxin clearance, resulting in high levels of endotoxemia and increased proinflammatory mediator release and death. Pentoxifylline, used as a long-term continuous infusion as is commonly done clinically, can be harmful during Gram-negative septic shock.

Analysis of Variance↗
PubMed1998

Using incarceration rates to measure mental health program performance.

This article introduces a more refined conceptualization of the criminal justice involvement of clients of mental health programs than is evident in the existing literature, and demonstrates a research methodology that provides program administrators with standardized measures of program performance in this area. The conceptualization of the criminal justice involvement of people served by community mental health programs distinguishes between three distinct areas of concern: (1) program accessibility to people with a history of criminal justice involvement, (2) criminal justice outcomes, and (3) quality of program performance. The methodology makes use of existing data resources to provide a valid and reliable measure of program performance in these three areas.

Adult↗
PubMed1998

Personal privacy versus public accountability: a technological solution to an ethical dilemma.

The tension between personal privacy and public accountability produces one of the major ethical dilemmas facing behavioral health program evaluators and service system researchers. This article discusses the source of this tension and introduces a research methodology that allows program evaluators to fully and equally respect both ethical principles. This methodology uses contemporary computer and statistical technology in conjunction with aggregated, de-identified information derived from existing databases to provide valid and reliable measures of the performance of treatment programs while it protects the personal privacy of individuals.

Codes of Ethics↗
PubMed1998

Practice patterns and hospitalization rates.

Basic indicators of community support program treatment outcome as well as the degree to which the programs conform to practice guidelines for major depression are evaluated. Hospitalization rates subsequent to treatment are measured, and the correlation between hospitalization rates and practice patterns is determined. Data sets that describe outpatient and inpatient services over a 4-year period, but do not include common person identifiers were analyzed using probabilistic population estimates. Results indicate that there is substantial variation among the community programs in practice patterns and hospitalization rates, and the two are negatively correlated.

Adult↗
PubMed1998

Response of the septic vasculature to prolonged vasopressor therapy with N(omega)-monomethyl-L-arginine and epinephrine in canines.

OBJECTIVE: To investigate the effect of blocking nitric oxide production on cardiovascular function and survival in canine septic shock treated with or without a conventional vasopressor. DESIGN: Randomized, controlled trial. SETTING: An animal research laboratory at the National Institutes of Health. SUBJECTS: Sixty purpose-bred beagles. INTERVENTIONS: Fibrin clots containing Escherichia coli were surgically placed into the peritoneal cavity. N(omega)-monomethyl-L-arginine (L-NMMA) 10 mg/kg followed by 0.5, 1.0, or 4.0 mg/kg/hr), epinephrine (1 microg/kg/min), both, or neither were infused for 24 hrs beginning 6 hrs after the onset of infection. All animals received fluid and antibiotic therapy. MEASUREMENTS AND MAIN RESULTS: Serum nitric oxide metabolites, nitrite and nitrate, increased with infection (p = .024) and decreased with L-NMMA (p = .004, all doses combined). Myocardial nitric oxide synthase activity was ranked as follows: nonsurvivors > survivors > noninfected controls (p < .01). Other tissues examined showed the same pattern. L-NMMA produced sustained increases in systemic vascular resistance index and mean arterial pressure 9 and 24 hrs after the onset of infection (p < or = .04). Left ventricular ejection fraction was depressed by septic shock (p = .01) and further decreased by L-NMMA (p = .02). However, control and L-NMMA cardiac index values were similar (p > .4), perhaps because L-NMMA increased pulmonary artery occlusion pressure (p = .02). From 9 to 24 hrs, epinephrine, in the absence or presence of L-NMMA, blunted recovery of cardiac index (p < .02) and had a diminishing vasopressor effect (p = .05). Neither L-NMMA nor epinephrine, individually or combined, significantly altered survival rates at the doses investigated (p > or = .69). CONCLUSIONS: The tested doses showed that nitric oxide production was inhibited by L-NMMA in canine septic shock, but mortality and myocardial depression were unaffected. These results suggest that if L-NMMA has a beneficial effect on survival rates in septic shock, it is small.

Animals↗
PubMed1998

Cardiopulmonary effects of inhaled nitric oxide in normal dogs and during E. coli pneumonia and sepsis.

We investigated the effect of inhaled nitric oxide (NO) at increasing fractional inspired O2 concentrations (FIO2) on hemodynamic and pulmonary function during Escherichia coli pneumonia. Thirty-eight conscious, spontaneously breathing, tracheotomized 2-yr-old beagles had intrabronchial inoculation with either 0.75 or 1.5 x 10(10) colony-forming units/kg of E. coli 0111:B4 (infected) or 0.9% saline (noninfected) in one or four pulmonary lobes. We found that neither the severity nor distribution (lobar vs. diffuse) of bacterial pneumonia altered the effects of NO. However, in infected animals, with increasing FIO2 (0.08, 0.21, 0.50, and 0.85), NO (80 parts/million) progressively increased arterial PO2 [-0.3 +/- 0.6, 3 +/- 1, 13 +/- 4, 10 +/- 9 (mean +/- SE) Torr, respectively] and decreased the mean arterial-alveolar O2 gradient (0.5 +/- 0.3, 4 +/- 2, -8 +/- 7, -10 +/- 9 Torr, respectively). In contrast, in noninfected animals, the effect of NO was significantly different and opposite; NO progressively decreased mean PO2 with increasing FIO2 (2 +/- 1, -5 +/- 3, -2 +/- 3, and -12 +/- 5 Torr, respectively; P < 0.05 compared with infected animals) and increased mean arterial-alveolar O2 gradient (0.3 +/- 0.04, 2 +/- 2, 1 +/- 3, 11 +/- 5 Torr; P < 0.05 compared with infected animals). In normal and infected animals alike, only at FIO2 < or = 0.21 did NO significantly lower mean pulmonary artery pressure, pulmonary artery occlusion pressure, and pulmonary vascular resistance index (all P < 0.01). However, inhaled NO had no significant effect on increases in mean pulmonary artery pressure associated with bacterial pneumonia. Thus, during bacterial pneumonia, inhaled NO had only modest effects on oxygenation dependent on high FIO2 and did not affect sepsis-induced pulmonary hypertension. These data do not support a role for inhaled NO in bacterial pneumonia. Further studies are necessary to determine whether, in combination with ventilatory support, NO may have more pronounced effects.

Administration, Inhalation↗
PubMed1998

Effects of L-NMMA and fluid loading on TNF-induced cardiovascular dysfunction in dogs.

We investigated the effects of N(omega)-monomethyl-L-arginine (L-NMMA) and fluid loading on tumor necrosis factor (TNF)-induced cardiovascular dysfunction in awake dogs. L-NMMA (40 mg x kg(-1) given intravenously over a period of 10 min, and followed by dosing at 40 mg x kg(-1) x h(-1) for 6 h) and TNF (20 or 45 microg x kg(-1) given intravenously for 20 min), given alone or in combination, significantly decreased stroke volume, cardiac index, oxygen delivery, and left-ventricular (LV) function plots over a period of 6 h. Of note was that the cardiac-depressant effects of TNF and L-NMMA given together were significantly less than additive. Thus, the combination was beneficial (or significantly less harmful to cardiac performance than expected), possibly because L-NMMA augmented cardiac preload as shown by significant increases in both pulmonary capillary wedge pressure (PCWP) and central venous pressure (CVP). Fluid challenges at 6 h (Ringer's solution at 80 ml x kg(-1) given over a period of 30 min) also significantly increased PCWP and CVP, and abolished the beneficial preload effect of L-NMMA on cardiac performance. Thus, after fluid loading, the cardiac-depressant effects of TNF and L-NMMA given together became equal to the sum of those produced by TNF and L-NMMA given separately. Although L-NMMA significantly decreased serum nitrite/nitrate levels, TNF did not increase these end products of nitric oxide (NO) production relative to controls. Therefore, after preload abnormalities were eliminated with fluid loading, L-NMMA had no beneficial effect on TNF-induced cardiac depression, and TNF did not increase end products of NO production. These findings are not consistent with NO being the mechanism of TNF-induced acute cardiac depression.

Animals↗
PubMed1998

Interrater agreement among psychiatrist in psychiatric emergency assessments.

OBJECTIVE: The authors' purpose in this study was to investigate the interrater agreement among psychiatrists in psychiatric emergency service settings. The interrater reliability of many of the key concepts in psychiatric emergency service settings has not been studied. METHOD: Videotapes of 30 psychiatric emergency service patient assessment interviews conducted by psychiatrists were shown to eight experienced psychiatric emergency service psychiatrists. The eight psychiatrists rated each videotape on dimensions such as severity of depression and psychosis and recommended a disposition for each patient. Interrater reliability was then explored. RESULTS: The level of agreement (intraclass correlation coefficient) among the reviewing psychiatrists was higher for psychosis and substance abuse but lower for psychopathology, impulse control problems, danger to self, and disposition. The reviewers' disposition recommendations did not match well with the assessing psychiatrist's actual disposition, but comparisons with actual practice should be considered only suggestive. CONCLUSIONS: Psychiatric emergency service assessments need improvement. This may be accomplished by exploring the underlying structure of psychiatric emergency service concepts, the creation and validation of structured assessment tools, and the creation of practice guidelines.

Adult↗
PubMed1998

The use of state and general hospitals for inpatient psychiatric care.

OBJECTIVES: This paper explores the relationship of state hospital and general hospital psychiatric caseloads in a statewide system of care. METHODS: Probabilistic population estimation was applied to general hospital and state hospital data sets. RESULTS: General hospitals provide inpatient psychiatric services to more people than do state hospitals, and a significant number are served in both sectors. There were notable differences in use patterns related to patient gender and age. CONCLUSIONS: These results demonstrate that probabilistic methodologies can significantly enhance the value of existing databases for epidemiological research.

Adult↗
PubMed1997

Tyrphostin AG 556 improves survival and reduces multiorgan failure in canine Escherichia coli peritonitis.

Tyrosine kinase-dependent cell signaling is postulated to be a pivotal control point in inflammatory responses initiated by bacterial products and TNF. Using a canine model of gram-negative septic shock, we investigated the effect of tyrosine kinase inhibitors (tyrphostins) on survival. Animals were infected intraperitoneally with Escherichia coli 0111: B4, and then, in a randomized, blinded fashion, were treated immediately with one of two tyrphostins, AG 556 (n = 40) or AG 126 (n = 10), or with control (n = 50), and followed for 28 d or until death. All animals received supplemental oxygen, fluids, and antibiotics. Tyrphostin AG 556 improved survival times when compared to controls (P = 0.05). During the first 48 h after infection, AG 556 also improved mean arterial pressure, left ventricular ejection fraction, cardiac output, oxygen delivery, and alveolar-arterial oxygen gradient compared to controls (all P < or = 0.05). These improvements in organ injury were significantly predictive of survival. Treatment with AG 556 had no effect on clearance of endotoxin or bacteria from the blood (both P = NS); however, AG 556 did significantly lower serum TNF levels (P = 0.03). These data are consistent with the conclusion that AG 556 prevented cytokine-induced multiorgan failure and death during septic shock by inhibiting cell-signaling pathways without impairing host defenses as determined by clearance of bacteria and endotoxin.

Animals↗
PubMed1997

A global measure of access to mental health services for a managed care environment.

The growing influence of managed care in mental health services has raised important questions about access to services. This article introduces and demonstrates a global measure of access that is based on the relationship between service utilization and the need for services. This measure has become practical because of recent advances in measurement technology that provide more valid and reliable estimates of the prevalence of mental illness in general populations and of the number of people who receive mental health services across service sectors. The methodology is used to produce a report card type profile of access to inpatient mental health services (in state, general, private, and veterans hospitals) by residents of one state. This global measure can provide a powerful and efficient tool for monitoring and comparing the impact of managed care plans on access to mental health services.

Adolescent↗
PubMed1997

Outpatient geriatric evaluation and management: is there an investment effect?

The effectiveness and efficiency of outpatient geriatric evaluation and management (GEM) was compared to usual outpatient primary care (UPC). Although GEM had no overall impact on health care utilization or cost of care for the entire study period, significant reductions were found during the sixteen- to twenty-four-month study period, suggesting a possible investment effect. In the first eight months of the study, GEM patients incurred 34.8% more in health care costs than UPC patients, but in the final eight months of the study the cost of care for UPC patients exceeded that for GEM patients by 37.8%.

Aged↗
PubMed1997

Engaging and retaining women in outpatient alcohol and other drug treatment: the effect of referral intensity.

Women with alcohol or other drug (AOD) problems experience a range of barriers to inpatient treatment. Although research in the general population shows that high-intensity referrals are more effective than low-intensity referrals at engaging and retaining individuals in outpatient AOD treatment, the impact of referral intensity has not been assessed for women only. To examine this issue, a secondary analysis was conducted using an existing data set that included a sample of 109 women. Although intensity of referral was not related to entry into or relapse during treatment, high-intensity referral was associated with completion of treatment. In addition, women who relapsed during treatment were less likely to complete it, underscoring the need for relapse prevention training.

Adult↗
PubMed1997

An examination of variation in long-term community tenure after psychiatric hospitalization in eight states.

The influence of seven personal and clinical characteristics on the community tenure of discharged state hospital patients in eight states is analyzed and discussed. Previous admission to a state hospital and a diagnosis of schizophrenia were associated with shorter community tenure. Older patients had longer community tenure than younger. These findings were consistent across the states and are consistent with previous work that focused on much narrower populations. The relationship of these risk factors to community tenure are discussed from an individualistic perspective, a treatment oriented perspective, and a community integrationist perspective, and implications for further research are explored.

Age Factors↗
PubMed1996

Effects of recombinant soluble type I interleukin-1 receptor on human inflammatory responses to endotoxin.

Effects of soluble recombinant human type I interleukin-1 receptor (sIL-1RI) were evaluated in 18 volunteers given intravenous endotoxin and randomized to placebo (n = 6), low-dose (n = 6), or high-dose (n = 6) sIL-1RI. Soluble IL-1RI decreased IL-1 beta (P = .001), but decreased IL-1ra (P = .0001), and resulted in 10-fold and 43-fold dose-related increases in sIL-1RI-IL-1ra complexes compared with placebo (P < or = .001). High-dose sIL-1RI was associated with increased levels of immunoactive tumor necrosis factor-alpha (P = .02), IL-8 (P = .0001), and cell-associated IL-1 beta (P = .047). C-reactive protein levels were higher after sIL-1RI than placebo (P = .035). Soluble IL-1RI decreased the severity of chills (P = .03), but did not alter other symptoms, changes in temperature, systemic hemodynamic responses, or changes in leukocyte and platelet number. Thus, sIL-1RI had no discernable antiinflammatory effect following endotoxin administration due in part to low levels of circulating IL-1 beta and neutralization of IL-1ra inhibitory function. This latter interaction represents an indirect mechanism of agonist activity elicited by sIL-1RI and may contribute to increases in inflammatory mediators, limiting therapy with sIL-1RI during endotoxemia.

Acute-Phase Reaction↗
PubMed1996

Child, family, and system outcomes of intensive case management in New York State.

New York State's Children and Youth Intensive Case Management (CYICM) was implemented in 1988 as one of several community-based initiatives for children with serious emotional disturbance (SED). Underlying this program is the goal of maintaining children with SED in the least restrictive environment appropriate to their needs. This paper presents CYICM child, family, and system outcomes over six years, describes program refinements, and explores continuing research efforts. Data are supportive of the positive outcomes associated with intensive case management for children with SED. Associated with enrollment in CYICM are a decrease in symptoms, improvement in functioning, and fewer hospitalizations in state-operated psychiatric centers, which translates into cost savings and a possible reduction in hospital beds.

Adolescent↗