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T Lee

Publications and source records attributed to T Lee.

467 records · Page 26Linked to original sources
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Factors influencing long-term home care utilization by the older population: implications for targeting.

This research was designed to explore factors that affect the choice of long-term care modalities in the older population and to discuss the appropriate target population of home health care services within the entire long-term care system. The study subjects' activities of daily living limitations, cognitive status, and sociodemograhic data at the time of admission were obtained from retrospective chart reviews. The sample included 134 older subjects who were receiving long-term care from a Long-Term Home Health Care Program or a nursing home in New York City. The results indicated that Long-Term Home Health Care Program use by older persons was characterized by a higher rate of being admitted from private homes, less cognitive impairments, less limitations in activities of daily living, and younger age than older patients who were nursing home residents. Consequently, in the choice of different care modalities, health-related factors of the older population were found to be more important predictors than sociodemographic characteristics or support system. The implication to both nurses and researchers is the development of eligibility criteria that captures the unique characteristics of disabled older persons in each of the different long-term care programs to serve them better in a cost-effective manner.

Activities of Daily Living↗
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The relationship between severity of physical impairment and costs of care in an elderly population.

The cost-effective use of long-term care options in a resource-scarce environment depends on targeting services to people who could be cared for most efficiently in specific settings. This study identified subgroups with a high potential for reduced costs of care in different settings by using some measures of physical impairment. The findings indicated that, for elderly people with physical impairment scores below 12 (possible range of 0 to 14), the cost of care was lower with home care than in the nursing home setting. However, for elderly people with physical impairment scores above 12, the cost of care was higher with home care than in a nursing home.

Activities of Daily Living↗
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Phantom and animal tissues for modelling the electrical properties of human liver.

The dielectric properties of human liver were characterized over the frequency range of 0.3-3 GHz for freshly excised tissue samples of primary hepatocellular carcinoma, metastatic colorectal carcinoma, and normal liver tissues resected from the tumour margin. On average, the dielectric constant (epsilon(r)) of freshly excised human liver tumour was 12% higher than that of surrounding normal liver, and the electrical conductivity (sigma) of tumour was 24% higher. In order to establish suitable tissue models for human liver, the electrical properties were compared to measurements of homogenous phantom mixtures, in vitro bovine liver, and in vivo canine and porcine liver tissues. The data demonstrate that there are several animal tissues that can be used to model the average dielectric properties of human liver reasonably accurately, and use of the most readily available bovine liver appears well-justified, even when stored for up to 10 days in a refrigerator. Additionally, the dielectric properties of in vitro liver remained stable over a large temperature range, with sigma rising only 1.1%/ degrees C in porcine liver (15-37 degrees C) and 2.0%/ degrees C in bovine liver (10-90 degrees C), and epsilon(r) decreasing < or =0.2%/ degrees C in both tissues. This effort identifies homogeneous solid and liquid phantom models and several heterogeneous in vitro tissues that adequately model the dielectric properties of human liver tumours for use in quantitative studies of microwave power deposition in liver.

Animals↗
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The risks of multimedia methods: effects of actor's race and gender on preferences for health states.

OBJECTIVE: While the use of multimedia methods in medical education and decision support can facilitate learning, it also has certain hazards. One potential hazard is the inadvertent triggering of racial and gender bias by the appearance of actors or patients in presentations. The authors hypothesized that race and gender affect preferences. To explore this issue they studied the effects of actors' race and gender on preference ratings for health states that include symptoms of schizophrenia. DESIGN: A convenience sample of patients with schizophrenia, family members of patients, and health professionals was used. Participants were randomly assigned to rate two health states, one portrayed by either a man of mixed race (Hispanic-black) or a white man and the second portrayed by either a white woman or a white man. MEASUREMENTS: Visual analog scale (VAS) and standard gamble ratings of health state preferences for health states that include symptoms of mild and moderate schizophrenia. RESULTS: Studies of the effects of the race of the actor (n = 114) revealed that racial mismatch between the actor and the participant affected the participant's preferences for health states. Ratings were lower when racial groups differed (mean difference, 0.098 for visual analog scale ratings and 0.053 lower in standard gamble, P = 0.006 for interactions between the race of the subject and the actor). In studies of the effects of a female actress on ratings (n = 117), we found no evidence of a corresponding interaction between the gender of the actor and the study participant. Rather, an interaction between actor's gender and method of assessment was observed. Standard gamble ratings (difference between means, 0.151), but not visual analog scale ratings (difference, 0.005), were markedly higher when the state was portrayed by the actress (P = 0.003 for interactions between actor's gender and method of preference assessment). Differential effects on standard gamble ratings suggest that an actor's gender may influence the willingness of viewers to gamble to gain health benefits (or risk attitude). CONCLUSIONS: Educators and researchers considering the use of multimedia methods for decision support need to be aware of the potential for the race and gender of patients or actors to influence preferences for health states and thus, potentially, medical decisions.

Analysis of Variance↗
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CytoView. A prototype computer image-based Papanicolaou smear proficiency test.

OBJECTIVE: To develop and assess CytoView, a prototype computer image-based cytology proficiency testing (PT) system, as an alternative to glass-slide cervical cytology PT. STUDY DESIGN: The computer-based PT consists of 10 cases taken from 10 Pap smears, each of which had received a consensus Clinical Laboratory Improvement Amendments-category diagnosis from three pathologists. Each CytoView "case" was the digital representation of > 8,000 microscopic fields, captured from a selected 5 x 10-mm rectangle of a Pap smear. The 5 x 10-mm capture rectangle was selected from the slide's most representative area for its diagnostic category. The CytoView project team developed each case through a multistep process that included image capture, image alignment, correlation of 10x and 40x images, and image display. The 10-slide CytoView PT prototype was then assessed by groups of cytopathologists and cytotechnologists. RESULTS: The CytoView prototype PT system was developed and assessed. CONCLUSION: Preliminary evaluation of CytoView indicated potential for this format as a valid and logistically feasible alternative to the traditional glass slide PT format.

Evaluation Studies as Topic↗
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Taurolidine 2% as an antimicrobial lock solution for prevention of recurrent catheter-related bloodstream infections.

BACKGROUND: This case report describes our preliminary data on the use of taurolidine as a lock technique. Taurolidine is a novel antimicrobial agent that has found a niche in Europe for prevention of bacteremia in home parenteral nutrition (HPN) patients who have multiple catheter-related blood-stream infections. METHODS: A 29-year-old male with short bowel syndrome was admitted 18 times in 9 years for treatment of Gram-positive, Gram-negative, and yeast-associated catheter-related bloodstream infections. Management consisted of conventional antibiotic treatment in accordance with blood culture and sensitivity results as well as catheter removal in 10 cases. Ten months before the last infection, the patient was instructed to instil 1.5 mL taurolidine 2% daily into his central line after finishing his HPN infusion and has continued to do so 2 years to date. RESULTS: The incidence of catheter-related bloodstream infections decreased from 8.5 to 1.5 infections per 1000 catheter days. CONCLUSIONS: These data support previous observations made outside North America and suggest that taurolidine may prove to be an effective and safe antimicrobial agent for the prevention of recurrent catheter-related bloodstream infections.

Adult↗
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Time for a rethink.

Explore the source record for details and available documents.

Education, Nursing, Continuing↗
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Generalized intraperitoneal seeding of hepatocellular carcinoma after microwave coagulation therapy: a case report.

We first describe a case of generalized intraperitoneal seeding of hepatocellular carcinoma (HCC) after microwave coagulation therapy (MCT). A 61 year-old man underwent operative MCT for an exophytic HCC, 60 mm in diameter, in segment IV of his cirrhotic liver. Despite successful tumor ablation, the serum alpha-fetoprotein levels continuously rose after MCT. Five months later, radiographic examinations delineated several perihepatic masses with hypervascularity, and the patient presented with constipation. At the second laparotomy, there were numerous small peritoneal metastases involving the entire peritoneal cavity and slightly bloody ascites. An omental mass, 50 mm in diameter, involved the transverse colon. Most of these intraabdominal masses were removed together with the involved colon. Histologically, the initial tumor was a moderately differentiated HCC, and the peritoneal masses were poorly differentiated HCCs. The patient died of rapid tumor progression and bleeding 2 months later. In conclusion, we should be aware of the possible occurrence of peritoneal seeding after MCT for HCC. Every effort should be made to prevent this serious complication, particularly in cases of superficial, large, and less differentiated HCCs.

Carcinoma, Hepatocellular↗
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Rapid determination of total trans fat content--an attenuated total reflection infrared spectroscopy international collaborative study.

Interest in trans fat labeling has prompted efforts to develop new, more efficient methods for rapidly and accurately determining trans fat content of foods. A novel and rapid (5 min) attenuated total reflection-Fourier transform infrared (ATR-FTIR) spectroscopic procedure was recently developed and applied to food products. This procedure was voted official method AOCS Cd 14d-99 by the American Oil Chemists' Society in 1999 after testing in a 12 laboratory international collaborative study. The results of the study are described in this paper. Analytical ATR-FTIR results exhibited high accuracy in the range 5-40% trans; results tended to have <2% high bias relative to the gravimetrically determined values. The precision of this internal reflection method was found to be superior to the precision of transmission infrared official methods. It is recommended that the applicability of the ATR-FTIR method be limited to trans levels of >5% (as percent of total fat).

Fatty Acids↗
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Mechanism for antagonism of paraoxon by hemicholinium-3 analogues.

In a newly synthesized series of DMAE analogues (bis-diethyl analogue of hemicholinium-3), selected chemicals (TL-402 = NAM-242 greater than JGC-VII-110) showed significant protection of mouse lethality after acute toxic doses of paraoxon (in vivo). DMAE and NAM-250 (like hemicholinium-3) showed minimal or no antagonism against paraoxon-induced toxicity in mice. Studies with DMAE analogues demonstrate weak anticholinesterase activity. The pattern for the neuromuscular inhibition of TL-402, NAM-242 and JGC-VII-110 is different from that of hemicholinium-3. LD50 studies identified compounds with less inherent toxicity (TL-402, NAM-242 and JGC-VII-110) and showed significant antagonism in contrast to DMAE and NAM-250. These chemicals (DMAE and NAM-250) are as toxic as the parent compound hemicholinium-3. All compounds in this series showed potent antinicotinic activity in different nicotinic-receptor preparations. The antinicotinic activity correlates with their action on the acetylcholine receptor-ion channel complex at frog neuromuscular junctions (in vitro). Electrophysiological studies demonstrate that the antinicotinic agents significantly depressed both the end plate current (EPC) amplitude and the time constant of decay (tau EPC) at the end plate of frog. In presence of paraoxon, voltage- and concentration-dependent shortening of tau EPC is observed which is more prominent than the decrease of the amplitude of EPC. The antinicotinic agents which showed significant antagonism of paraoxon both in vivo and in vitro (TL-402, NAM-242 and JGC-VII-110) also produced profound tetanic rundown after neurally or ionophoretically evoked EPC. These effects are voltage-dependent. The marked shortening of tau EPC, linear relationship between 1/tau vs DMAE analogue concentrations and potential-dependent tetanic rundown suggest that these analogues produce antagonism of paraoxon primarily by reducing end plate permeability by blocking nicotinic ACh-R associated ion channels in their open form. The antinicotinic activity of these agents is related to acetal or corresponding ether substitution.

Animals↗
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Simple method for derivatization of monoglycerides and diglycerides.

A method has been developed for derivatization of monoglycerides and diglycerides to their propyl esters by using propionic anhydride in the presence of pyridine. The derivatives are volatile and thus can be separated and identified by gas chromatography (GC). Completion of the reaction is monitored by thin-layer chromatography. Monoglyceride propyl esters were positively identified by gas chromatography and by gas chromatography/mass spectrometry. No side products were observed in the derivatization reaction which requires 35 min at 75 degrees C. GC analysis of the mono- and diglyceride propyl esters can be completed in approximately 30 min.

Chemical Phenomena↗
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Type I fetal cystic adenomatoid malformation of the lung with hydrops at 18 weeks' gestation: a case report.

Fetal cystic adenomatoid malformation, type I, is a rare pulmonary anomaly that has been diagnosed after 20 weeks' gestation. The prognosis of this malformation is usually dependent on whether it is microcystic, types II and III, or macrocystic, type I. We report a case of severe macrocystic fetal cystic adenomatoid malformation diagnosed at 18.4 weeks' gestation. This case demonstrates that fetal cystic adenomatoid malformation can be diagnosed at 18 weeks and that hydrops with oligohydramnios may be part of the natural history of type I lesions this early in pregnancy.

Adult↗
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The effect of ethnicity on physician estimates of pain severity in patients with isolated extremity trauma.

OBJECTIVE: To determine whether physician estimates of pain severity are influenced by patient ethnicity. DESIGN: Prospective cohort study. SETTING: UCLA Emergency Medicine Center, a level I trauma center, Los Angeles, Calif. PARTICIPANTS: Hispanic and non-Hispanic white patients presenting to the emergency department with extremity trauma when research assistants were present. Exclusion criteria were patient refusal, altered mentation, or severe injury interfering with the interview process. MAIN OUTCOME MEASURES: The difference between patient and physician estimates of pain severity as assessed on a visual analog scale for Hispanics and non-Hispanic whites. RESULTS: A total of 138 non-Hispanic white and 69 Hispanic patients participated in the study. The groups differed in language use, insurance status, and proportions suffering occupational injury. There were no differences between non-Hispanic white and Hispanic patients in patient pain assessments (mean, 39.8 mm vs 39.0 mm, respectively; P = .86), physician pain assessments (mean, 33.6 mm vs 29.7 mm; P = .23), or the disparity between patient and physician pain assessments (mean 6.1 mm vs 9.4 mm; P = .38). The degree of disparity between patient and physician pain assessments remained similar for both groups even after controlling for multiple potential confounders. CONCLUSIONS: Physician ability to assess pain severity does not differ for Hispanic and non-Hispanic white patients. Other explanations for a difference in analgesic practice as a function of ethnicity should be explored.

Adult↗
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Fat emulsions as an ideal nonprotein energy source under surgical stress for diabetic patients.

We studied the possibility of fat emulsions being a major calorie source, and if possible, a new infusion protocol without glucose for diabetic patients undergoing surgery. High dosages of fat emulsions and amino acids (HFHA infusions) were investigated as a substitute for conventional glucose-based infusions for 7 days after surgery. Without insulin and glucose, blood glucose was kept within the normal range, in spite of the fact that patients were recovering from major surgeries. Blood triglyceride and fatty free acids (FFA) increased after the start of the HFHA infusions but remained within normal range. Liver function tests and nutritional states estimated by nitrogen balance or rapid turnover proteins were no different from those of the conventional glucose-based infusion, but the significance of the HFHA infusion lies in the fact that it was applied to patients in whom it was impossible to administer enough calories by using the conventional glucose-based infusion, even if insulin was used. This HFHA infusion, which enables easy blood glucose control, sufficient calorie supply without complications, and is also nutritionally equivalent to the conventional glucose-based infusion, can be a new nutritional option for postoperative patients with impaired glucose tolerance.

Adult↗
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Multi-centre clinical respiratory research: a new approach?

BACKGROUND: Recruitment to clinical trials organised by the research committee of the British Thoracic Society (BTS) has declined. We suspected that this was due to increasing workloads for consultant physicians in the National Health Service (NHS). We investigated possible causes in study 1 and a possible solution in study 2. METHODS: Study 1--a questionnaire was sent to BTS members listing possible factors that might deter them from entering patients into trials. These were scored on a 0-5 scale. Study 2--we set up 13 panels of experts to cover all major fields of respiratory medicine. They were asked to design projects that would address the most important research questions that could be answered by multi-centre clinical trials. We sent 11 projects for scoring to consultant members of the BTS who were asked to score them on scientific merit and on their ability to contribute patients to the study. RESULTS: Study 1--of the 59% of consultants who responded, 77% said that competition with increasing demands on their time was the major reason for not participating. Study 2--40% of consultants returned project scores. Three projects were subsequently selected for grant application. CONCLUSIONS: Clinical research in the UK is under threat from increasing workloads on consultants. One solution to this problem is a national approach to commission major projects. The most important clinical research questions might then still be answered in the limited time available to consultants.

Attitude of Health Personnel↗