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Biomedical subjects

S Reynolds

Publications and source records attributed to S Reynolds.

At least 19 recordsLinked to original sources
PubMed1995

Effects of treatment duration and severity of depression on the maintenance of gains after cognitive-behavioral and psychodynamic-interpersonal psychotherapy.

One hundred four clients completed a mailed follow-up 1 year after completing 8 of 16 sessions of treatment, either cognitive-behavioral (CB) or psychodynamic-interpersonal (PI) psychotherapy. Although mean scores on outcome measures at 1 year suggested that gains were, in general, well maintained, only 29% of clients were asymptomatic on all 3 occasions of testing (end of treatment, 3 months and 1 year later) without recourse to further treatment. However, only 11% of those asymptomatic at end of treatment experienced relapse or recurrence of depression, albeit on the limited evidence of just two follow-up assessments. The results of comparisons among treatment conditions at 1 year differed substantially from those obtained earlier: Eight-session PI treatment now appeared less efficacious than the other 3 treatment conditions, and there was now no measurable benefit of 16-session over 8-session CB, irrespective of initial severity of depression. These findings confirm the importance of follow-up in evaluation of psychotherapies for depression.

Adult↗
PubMed1995

Analysis of preventable trauma deaths and inappropriate trauma care in a rural state.

OBJECTIVE: The goal of this study was to determine the rate of preventable mortality and inappropriate care in cases of traumatic death occurring in a rural state. DESIGN: This is a retrospective case review. MATERIALS AND METHODS: Deaths attributed to mechanical trauma throughout the state and occurring between October 1, 1990 and September 30, 1991 were examined. All cases meeting inclusion criteria were reviewed by a multidisciplinary panel of physicians and nonphysicians representing the prehospital as well as hospital phases of care. Deaths were judged frankly preventable, possibly preventable, or nonpreventable. The care rendered in both preventable and nonpreventable cases was evaluated for appropriateness according to nationally accepted guidelines. MEASUREMENTS AND MAIN RESULTS: The overall preventable death rate was 13%. Among those patients treated at a hospital, the preventable death rate was 27%. The rate of inappropriate care was 33% overall and 60% in-hospital. The majority of inappropriate care occurred in the emergency department phase and was rendered by one or more members of the resuscitation team, including primary contact physicians and surgeons. Deficiencies were predominantly related to the management of the airway and chest injuries. CONCLUSIONS: The rural preventable death rate from trauma is not dissimilar to that found in urban areas before the implementation of a trauma care system. Inappropriate care rendered in the emergency department related to airway and chest injury management occurs at a high rate. This seems to be the major contributor to preventable trauma deaths in rural locations. Education of emergency department primary care providers in basic principles of stabilization and initial treatment may be the most cost-effective method of reducing preventable deaths in the rural setting.

Adolescent↗
PubMed1995

Adults in the pediatric emergency department: a fish out of water?

UNLABELLED: Adults (> 17 years) occasionally seek care in pediatric emergency departments (PED). We reviewed the records of adults treated in our PED from September 1992 to August 1993 to better understand their needs. Patients were classified based on their relationship to our hospital: 1) no previous medical care association (new), and 2) adult patients followed in our clinics for chronic diseases (chronic). Data were analyzed using frequencies and comparison of means by Student's t test or chi 2. A follow-up phone call or written survey was used to assess quality of care and satisfaction. Of 40,895 patients, 384 were adults (0.9%). Ages ranged from 18 to 73 years (median = 21 years, mean = 25 years) with 49% men. Most adults were seen between 3:00 PM and 10:59 PM; 84% were triaged as urgent or emergent. There were 140 new, and 230 chronic, patients. Fourteen were not classified because of lack of information. The mean age of new adults was 33 years, median 29 years; 53% were hospital employees. Forty percent of new adults had preexisting illnesses. Most common problems were cardiac/hypertension (27%), blunt trauma (22%), eye splash (13%), and lacerations (9%). Forty eight percent were transferred to an adult hospital, and 20% of transferred patients were admitted overnight. Chronic adult patients were younger (mean 21 years, P < 0.001); fever/infection (37%), minor trauma (17%), and gastro-intestinal problems (12%) predominated; 36% were admitted. The average time in the PED was 70 minutes for new and 202 minutes for chronic patients (P < 0.001). CONCLUSIONS: Chronic patients present with problems much like those of their younger counterparts, and the PED is prepared to manage them. New adult patients present with adult problems: chest pain, hypertension, blunt trauma, and eye foreign body, and the PED should be prepared to manage these.

Adolescent↗
PubMed1994

Effects of treatment duration and severity of depression on the effectiveness of cognitive-behavioral and psychodynamic-interpersonal psychotherapy.

A total of 117 depressed clients, stratified for severity, completed 8 or 16 sessions of manualized treatment, either cognitive-behavioral psychotherapy (CB) or psychodynamic-interpersonal psychotherapy (PI). Each of 5 clinician-investigators treated clients in all 4 treatment conditions. On most measures, CB and PI were equally effective, irrespective of the severity of depression or the duration of treatment. However, there was evidence of some advantage to CB on the Beck Depression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961). There was no evidence that CB's effects were more rapid than those of PI, nor did the effects of each treatment method vary according to the severity of depression. There was no overall advantage to 16-session treatment over 8-session treatment. However, those presenting with relatively severe depression improved substantially more after 16 than after 8 sessions.

Adult↗
PubMed1994

Associations of sleep with everyday mood, minor symptoms and social interaction experience.

Although there are strong popular beliefs about the value of a good night's sleep, there is very little documented evidence of day-to-day relations between sleep and well-being. In this study, covariations between sleep and both prior and subsequent daily states of well-being were studied in a healthy, employed sample. Thirty volunteers used pocket computers to complete a daily sleep diary and self-rating scales of mood, minor symptoms and social interaction experience. These were recorded every 2 hours for 14 days except during sleep periods. A pooled regression analysis showed small but significant relationships between many of the sleep and well-being measures. Sleep appeared to be more strongly related to subsequent well-being than prior well-being. An earlier onset of sleep was associated with better mood and social interaction experience the following day and was a better predictor than sleep duration. This result was interpreted to be consistent with the phase angle model of chronobiologic mood disorders. In general, the results suggest that the sleep disturbances found in affective disorders may not be pathological but instead represent the extremes of normal relationships between sleep and well-being.

Adaptation, Psychological↗
PubMed1993

Effect of moderate exercise on proliferative responses of peripheral blood mononuclear cells.

We studied the effects of 30 minutes of exercise on T lymphocyte counts and proliferative responses of peripheral blood mononuclear cells (PBMC) in 25 runners. Exercise resulted in a T lymphocytosis in the immediate post-exercise period in all subjects (p < 0.001), and reduced CD4+/CD8+ ratios in 22/25 subjects (p = 0.001). The change was due primarily to a 2.2-fold increase in CD8+ cells (p < 0.001). Exercise also reduced PBMC mitogenic responses to phytohemagglutinin (PHA) in 13/14 subjects (p = 0.049), and to pokeweed mitogen (PWM) in 11/14 subjects (p = 0.022), but not to concanavalin A. Postrun sera from 5 of 6 subjects inhibited PHA but not PWM responses of resting autologous PBMC with normal CD4+/CD8+ ratios (p < or = 0.05): indomethacin and monocyte depletion blocked the serum inhibition (p = 0.003, p = 0.0006, respectively). We conclude that post-exercise suppression of mitogenic responses to PHA is due to the release of a serum factor(s) capable of inducing prostaglandin synthesis by circulating monocytes, whereas exercise-induced suppression of PWM responses depends primarily on the reversal of CD4+/CD8+ ratios.

Adult↗
PubMed1992

Wind-induced accidents of road vehicles.

This paper describes the results of a project that collected and collated data for wind-induced vehicle accidents that occurred in the United Kingdom during the major storm of 25 January 1990. The results of this data analysis are used to determine which vehicles are most at risk during windy periods, the nature of the accidents that were caused, and the likely values of accident wind speeds. Also the adequacy of a computer program that can predict such wind speeds (the program BLOWOVER) is assessed as far as the available data allows.

Accidents, Traffic↗
PubMed1992

A randomised trial of dexamethasone, lorazepam and prochlorperazine for emesis in patients receiving chemotherapy.

To define further the place of dexamethasone in antiemetic combinations, lorazepam, prochlorperazine and placebo (LP) were compared with lorazepam, prochlorperazine and dexamethasone (DLP) in a randomised, double-blind, crossover study. Both patient and observer assessments were documented in 84 patients receiving both cisplatin and non-cisplatin chemotherapy. The addition of dexamethasone significantly reduced the severity of nausea (P = 0.002) and vomiting (P less than 0.0001), duration of nausea (P = 0.01) and vomiting (P = 0.002) and the number of vomiting episodes (P = 0.003). DLP was the superior regimen in subsets of patients receiving cisplatin and the non-cisplatin chemotherapy. The improvements produced by the dexamethasone regimen were large and of major benefit to our patients. Patients documented significantly improved tolerance to chemotherapy with DLP courses (P = 0.0006). Overall, significantly more patients preferred DLP (P less than 0.0001). Patient assessments produced results similar to observer assessments but gave a broader understanding of their experience. The addition of dexamethasone to prochlorperazine and lorazepam significantly improved our patients' experience while receiving chemotherapy.

Adult↗
PubMed1992

Effect of abdominal compression on diaphragmatic tendon organ activity.

Previous studies suggest that afferents in the diaphragm participate in the reflex reduction in phrenic nerve efferent activation when the length of the diaphragm is increased by abdominal compression. The present study determined the response of tendon organ afferents in the diaphragm to increases in abdominal pressure. Five cats were anesthetized with thiopental sodium (60 mg/kg ip to induce, supplemented intravenously). Extracellular recordings from nine individual tendon organ afferents were made from right cervical dorsal root ganglia 5 and 6. Right crural electromyographic activity was recorded. The right extrathoracic phrenic nerve was isolated and stimulated to identify tendon organs on the basis of conduction velocity and response to twitch. The response to ramp-and-hold stretch of the diaphragm was used as an additional test to differentiate tendon organs from muscle spindles. The mean level of activity of the tendon organs during the 1st s of the inspiratory phase was 47 +/- 10 (SD) Hz. Abdominal compression was associated with a significant increase in the activity of these afferents to 61 +/- 11 Hz. Results indicate that increases in the activity of diaphragmatic tendon organs are associated with moderate increases in abdominal pressure and are likely the result of elevations in the active tension developed by the diaphragm. Combined with results from previous studies, it is possible that diaphragmatic tendon organs may play a role in the attenuation of respiratory muscle activation when abdominal pressure is increased.

Abdomen↗
PubMed1990

Activation of K-ras by codon 13 mutations in C57BL/6 X C3H F1 mouse tumors induced by exposure to 1,3-butadiene.

1,3-Butadiene has been detected in urban air, gasoline vapors, and cigarette smoke. It has been estimated that 65,000 workers are exposed to this chemical in occupational settings in the United States. Lymphomas, lung, and liver tumors were induced in female and male C57BL/6 X C3H F1 (hereafter called B6C3F1) mice by inhalation of 6.25 to 625 ppm 1,3-butadiene for 1 to 2 years. The objective of this study was to examine these tumors for the presence of activated protooncogenes by the NIH 3T3 transfection and nude mouse tumorigenicity assays. Transfection of DNA isolated from 7 of 9 lung tumors and 7 of 12 liver tumors induced morphological transformation of NIH 3T3 cells. Southern blot analysis indicated that the transformation induced by 6 lung and 3 liver tumor DNA samples was due to transfer of a K-ras oncogene. Four of the 7 liver tumors that were positive upon transfection contained an activated H-ras gene. The identity of the transforming gene in one of the lung tumors has not been determined but was not a member of the ras family or a met or raf gene. Eleven 1,3-butadiene-induced lymphomas were examined for transforming genes using the nude mouse tumorigenicity assay. Activated K-ras genes were detected in 2 of the 11 lymphomas assayed. DNA sequencing of polymerase chain reaction-amplified ras gene exons revealed that 9 of 11 of the activating K-ras mutations were G to C transversions in codon 13. One liver tumor contained an activated K-ras gene with mutations in both codons 60 and 61. The activating mutation in one of the K-ras genes from a lymphoma was not identified but DNA sequence analysis of amplified regions in proximity to codons 12, 13, and 61 demonstrated that the mutation was not located in or near these codons. Activation of K-ras genes by codon 13 mutations has not been found in any lung or liver tumors or lymphomas from untreated B6C3F1 mice. Thus, the K-ras activation found in 1,3-butadiene-induced B6C3F1 mouse tumors probably occurred as a result of genotoxic effects of this chemical. The oncogenes most frequently detected in human pulmonary adenocarcinomas are K-ras genes. Activated K-ras genes have also been found in some human lymphomas. This suggest that activation of K-ras may be important in the induction of human pulmonary adenocarcinomas and lymphomas.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1990

Purpura and dermal thinning associated with high dose inhaled corticosteroids.

OBJECTIVE: To assess the effect of high dose inhaled corticosteroids on skin. DESIGN: Cross sectional study of patients receiving treatment for chest diseases. SETTING: Outpatient chest clinic in a teaching hospital. PATIENTS: 68 Patients divided into four groups of similar age--namely, 15 receiving long term oral prednisolone, 21 receiving high dose inhaled corticosteroids, 15 receiving low dose inhaled corticosteroids, and 17 controls. MAIN OUTCOME MEASURES: Skin thickness at three sites measured by A scan ultrasound and clinical assessment of purpura. RESULTS: Compared with controls patients in both the oral prednisolone treated group and the high dose inhaled corticosteroid treated group had significantly thinner skin at all three sites (group median thicknesses: prednisolone treated group 28-33% less than controls; high dose inhaled corticosteroid treated group 15-19% less than controls). Differences in skin thicknesses between the low dose inhaled corticosteroid treated group and the controls were trivial. The prevalence of purpura was significantly greater in patients receiving oral prednisolone (12/15 patients) and high dose inhaled corticosteroids (10/21) than in controls (2/17). CONCLUSION: Skin thinning and purpura represent further evidence of systemic effects of high dose inhaled corticosteroids.

Administration, Inhalation↗
PubMed1990

Effect of exercise on complement activity.

Complement measurements of C1, C1q, C2, C3, C4, C5; the anaphylatoxins, C3a, C4a, and C5a; and total hemolytic activity of the classical and alternative pathways were made in 26 experienced adult runners before and after shortterm aerobic exercise. The baseline results were compared with those of nonexercising age-matched controls. In most subjects tested, running resulted in nanogram increases in C3a and C4a with corresponding decreases in the hemolytic activity of C4 (C4H). Baseline values of C3 and C4H were decreased significantly in runners when compared with nonexercising controls. Preliminary studies measuring the effect of exercise on C3a levels were also done in three asthmatic runners. Mean resting and postexercise levels, and exercise-induced increases in C3a anaphylatoxin in the asthmatic subjects were significantly higher than in the nonasthmatic subjects. The findings indicate that short-term exercise results in the activation of C3 and C4 and subsequent generation of C3a and C4a anaphylatoxins, and suggest that both activation of the classical pathway of complement and a selective downregulation of C3 production may occur in persons regularly engaged in aerobic exercise. The exaggerated generation of C3a by asthmatic subjects during exercise raises the possibility that anaphylatoxins play an etiologic role in exercise-induced asthma.

Adult↗
PubMed1989

Identification of the source of haematuria by automated measurement of red cell volume.

The mean corpuscular volume (MCV) of urinary erythrocytes was measured by a Coulter Counter in 42 patients with asymptomatic haematuria. All patients had the source of haematuria established by a renal biopsy, cystoscopy or radiology. The mean urine MCV was significantly less in those with glomerular disease (n = 21) than in those with non-glomerular haematuria (n = 21). In every patient with glomerulonephritis, urinary erythrocytes were smaller than those in their own venous blood. Conversely, urinary red cells larger than venous blood were confined to patients with a non-glomerular source. Coulter analysis of urine provides a simple and objective aid to the diagnosis of haematuria.

Erythrocyte Indices↗