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Biomedical subjects

T Ashikaga

Publications and source records attributed to T Ashikaga.

107 records · Page 6Linked to original sources
PubMed1978

A model for health care delivery with an illustration of its application.

A framework for conceptualizing the process of health care delivery is presented. The framework identifies broad categories of activities by which the functions of a health care provider can be organized, and has practical application to studies of the roles of a variety of health care personnel. By permitting clear identification of each component of a health professional's role, the model provides a method for quantitatively determining what an individual or group of individuals does. The utility of the model in operationalizing investigations of health care roles is illustrated by its application to a study of nurse practitioners. In this study, the conceptual model was used to structure a questionnaire for obtaining information about professional nursing roles. By providing a theoretical framework for the relationships between specific role components and certain outcome variables the model was also used in the generation of hypotheses and the design of statistical analyses. Results of some of these analyses are summarized.

Attitude of Health Personnel↗
PubMed1978

Multiple daily insulin injections in the treatment of diabetic retinopathy. The Job study revisited.

Data based on the prospective study of Job et al. are reanalyzed while initial number of microaneurysms and duration of patient follow-up are controlled. The reported statistical difference in the rate of microaneurysm increase between the single- and the multiple-daily-injection groups may be due to a difference in a subgroup who had a larger number of microaneurysms initially and who were studied for a shorter period of time. No uniform difference was observed in the results of their treatment between the groups given a single injection and those given multiple injections. While this does not invalidate the conclusions of the study, it does point out the need for greater control in conducting future studies.

Analysis of Variance↗
PubMed1977

Side effects of minocycline: different dosage regimens.

The incidence of side effects due to two dosage regimens of minocycline was examined over a 5-day period. A total of 60 normal women volunteers were randomly assigned in a double-blind manner to either a group who took 100 mg of minocycline twice a day or a group who took 75 mg of minocycline twice a day for 5 days. Both groups were comparable from the standpoints of age, size, race, and the use of oral contraception, nicotine, and ethanol. They were seen on a daily basis, and symptoms were evaluated by both volunteers (from diaries) and physicians. Minocycline serum concentrations were determined on blood samples taken 2 h after the a.m. dose. Volunteers taking 150 mg of minocycline per day had significantly lower serum antibiotic concentrations than those taking 200 mg per day. However, both low- and high-dose groups exhibited similar incidence and prevalence of recorded symptoms, with the single exception of nausea, where the low-dose group had fewer symptoms than the high-dose group (P = 0.035). Symptomatic volunteers did not have higher serum concentrations of minocycline than their asymptomatic counterparts. When either weight or surface area was examined with antibiotic serum concentration there was a significant inverse correlation between the two on day 2 for both groups and also on day 4 for the low-dose group. It is concluded that, in women, a dose of 150 mg of minocycline per day is associated with the same degree of side effects as a dose of 200 mg per day.

Adolescent↗
PubMedDate not supplied

Community education programs to promote mammography participation in rural New York State.

BACKGROUND: Rural women are less likely to receive screening mammography at recommended intervals. This study evaluated efforts to promote screening mammography among women in rural communities through community education interventions and low-cost mobile mammography van services. METHODS: Two matched sets of communities were identified in an isolated rural region. One area received community education programs in addition to the mammography van for 2 years; the second area received only the van services. The educational programs were designed using diagnostic research methods; they included recruitment of opinion leaders to organize small group breast screening education sessions, an information campaign using direct mail, and primary health care provider education. RESULTS: A household telephone survey conducted 6 months after completion of these programs indicated that mammography utilization and perceived mammography norms were higher among women in the Program area than among women in the Comparison area. Process data were consistent with these findings. Clinical examination and self-examination behaviors were not influenced by the programs. CONCLUSIONS: This study showed that well-focused educational interventions for rural women can increase utilization of screening mammography when access and cost barriers also are reduced.

Adult↗
PubMedDate not supplied

Detection of intravascular epidural catheters using 2-chloroprocaine. Influence of local anesthetic dose and nalbuphine premedication.

BACKGROUND AND OBJECTIVES: Detecting the intravascular placement of epidural catheters is essential to avoid local anesthetic toxicity. Small doses of intravenous local anesthetics produce changes in sensorium and are often used to test newly placed epidural catheters. Many parturients receive nalbuphine for analgesia prior to epidural catheter placement. This study examines how nalbuphine premedication influences symptoms following intravenous 2-chloroprocaine. METHODS: Thirty-one volunteers were randomized to receive premedication with placebo or 0.15 mg/kg of nalbuphine intravenously. Starting 10 minutes later, intravenous injections of 0.0, 0.3, 0.6, 0.9, 1.2, and 1.5 mg/kg of 2-chloroprocaine were given in random order at 10 minute intervals. After each injection, volunteers were asked to report changes in hearing, taste, or other symptoms. RESULTS: Symptoms reported (in decreasing order of frequency) were auditory changes, taste changes, dizziness/ lightheadedness, tingling in the extremities, and visual changes. The probability that volunteers will report symptoms is proportional to the dose of 2-chloroprocaine administered (auditory symptoms, P < .001; taste symptoms, P = .01; any symptoms, P < .001). Nalbuphine-premedicated volunteers were more likely to report symptoms (auditory symptoms, P = .004; taste symptoms, P = .004; any symptoms, P = .02). A dose of at least 1.5 mg/kg appears to be necessary to produce a 90% probability that patients will report symptoms when they receive 2-chloroprocaine intravenously. CONCLUSIONS: This study suggests that patients who receive nalbuphine for analgesia prior to epidural placement will be more likely to report symptoms after receiving intravenous 2-chloroprocaine during epidural test dosing.

Adult↗
PubMedDate not supplied

Comparison of indolidan analog binding sites of drug antibody and sarcoplasmic reticulum with inhibition of cyclic AMP phosphodiesterase.

Dihydropyridazinone(DHP) derivatives such as indolidan are positive inotropic agents that show inhibition of cyclic AMP phosphodiesterase(PDE) activity. Indolidan inhibition is selective for PDE3 among the seven PDE gene families. DHP derivatives and related analogs have been used to define critical regions of the active site of PDE3 isoforms and radiolabeled analogs have been used to define indolidan sarcoplasmic reticulum (SR) receptor sites. We report here studies comparing the structure-activity relationships (SAR) for PDE3 inhibition with indolidan binding to two types of sites: canine SR and a monoclonal antibody derived against indolidan conjugated to a hemocyanin. SR and monoclonal antibody binding both fit singlesite, high affinity models (IC50 = 1.2 and 62 nM) that were near 52 and 360 times that of SR PDE3. Indolidan and thirteen analogs showed similar competition with either SR 3H-LY186126 binding or SR PDE3 inhibition. Antibody binding maintained selectivity but showed a different rank order potency for SR binding. Indole ring C3 methylation increased and DHP ring C4' methylation decreased indolidan monoclonal antibody binding while both substitutions increased SR binding. These studies support the hypothesis that SR PDE3 is a cardiotonic receptor site in myocardial membranes and indicate that models of the structural features of binding sites derived from inhibitor data alone could produce models with limited topography relative to the natural ligand.

3',5'-Cyclic-AMP Phosphodiesterases↗
PubMedDate not supplied

Sentinel node biopsy for breast cancer: showtime or dress rehearsal?

INTRODUCTION: Sentinel lymph node biopsy (SLNB) may prove superior to axillary node dissection (AND) for breast cancer staging. At issue is whether existing clinical data support performance of SLNB without AND at this time. DISCUSSION: The various methods of SLNB are discussed in detail. SLNB using radiocolloids and surgical probes (with or without blue dye) yields superior SLN localization rates as compared to blue dye alone. However, the incidence of false-negative SLNB is variable with all methods and frequently 10% or higher (11.4% in the only published multicenter study). CONCLUSIONS: Outside of a clinical trial, SLNB should be performed in addition to, not instead of, AND. The sensitivity of pathological staging is enhanced and nonaxillary SLNs are identified, while concomitant AND apprehends all false-negative SLNBs. Two prospective randomized cooperative trials provide excellent educational, training and research opportunities for North American breast surgeons as they gain experience with this new, promising staging procedure.

Biopsy↗
PubMedDate not supplied

Educational program evaluation: the University of Vermont family nurse practitioner program.

Graduates of the Family Nurse Practitioner (FNP) Program at the University of Vermont, Burlington, were surveyed to determine if the FNPs had enlarged their nursing roles following completion of the program. A sample of Vermont nurses served as a control group. Results of a questionnaire, used to obtain information about the nurses' training, functions, and attitudes, indicated that FNPs performed activities associated with an expanded nursing role more frequently than did their nonpractiioner counterparts. There was evidence that the two groups differed in their attitudes toward various aspects of their nursing roles. The evaluation is an ongoing study; as the number of program graduates increases, further characterization of their roles will be possible.

Attitude of Health Personnel↗