Clinical and laboratory procedures for the construction and maintenance of the convertible periodontal prosthesis (I).
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The first results in routine syphilis serology with the new solid-phase hemadsorption assay (SPHA) are presented. Sera (63019) were screened by the VDRL test and by the automated hemagglutination assay with Treponema pallidum antigen (AMHA-TP). Samples reactive to one or both of these tests were further examined by the FTA-ABS test, the IgM-FTA-ABS test, the 19S IgM-FTA-ABS test (IgM-FTA-ABS test performed with the 19S fraction of the serum after gelfiltration) and the IgM-SPHA test. IgM-SPHA reactive sera derived from patients who were in the early stage or in the phase of latency (of undefinable duration), further from patients with active neurosyphilis and from 26 patients after reinfection. Erroneous results in the IgM-FTA-ABS test caused by a competitive inhibition of IgM by IgG can be eliminated by the IgM-SPHA method. The agreement between 19S IgM-FTA-ABS test and IgM-SPHA test is above 96.3%. As compared to the fluorescence test, the IgM-SPHA test is simpler to perform and can be easily automated.
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Six prototype strains of human adenoviruses (Ad 1, 4, 7, 8, 12, 19) were passed and titrated comparatively in four strains of human diploid fibroblast cultures. The viruses were readily passed 5 times with cytopathic effect; no signs of adaptation or dimunition of CPE were apparent. The virus yield was about equal in fibroblasts and in HeLa cells. High and low passage fibroblasts were of equal susceptibility. In endpoint titrations, fibroblast cultures showed an about 10-fold lower susceptibility towards Ad1 and Ad7; however, they compared favorably for Ad4, 8, 12, and 19 with HeLa or (for Ad8) with human amnion cell cultures. In some instances differences in the susceptibility between fibroblast strains were observed. Fibroblast cultures and human amnion cells showed equal susceptibility for Ad8 from 9 original conjunctival specimens, while results with other types varied. For adenovirus isolation, fibroblast cultures are suitable as an adjunct to HeLa cell cultures, particularly for Ad8. However, the long duration till the appearance of CPE which sometimes exceeds 50 days is a disadvantage.
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Selecting an HLA matched unrelated bone marrow donor is a labour-intensive step-by-step procedure, with highly specialized techniques. To be successful immunohematologists and clinicians have to work closely together. Because so much is still unknown lymphocytes and serum of patient and donor should be stored to enable future analyses.
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Studies were carried out to assess whether various methodological procedures adopted while conducting experiments, or, maintaining M. leprae under different conditions affected the number of organisms made available or their viability. Results of mouse foot-pad experiments showed that bacilli survived for one day at 37 degrees C, 7 days at 20 degrees to 30 degrees C and for 90 days in lyophilized conditions. Repeated daily exposure of the material preserved in refrigerator at +4 degrees C, to room temperatures showed that bacilli survived for only up to five days; whereas, with single exposure they survived up to 14 days. M. leprae were found to lose infectivity after 30 minutes of exposure to various disinfectants and ultra violet light. Centrifugation at high speed did not affect the viability of M. leprae.
Part 1 of this article covered the applications, preparation requirements, and procedures through divesting for the pressable ceramic system. The O.U. (opacity units) system was also described, and how it relates to the proper selection of core material.
All-ceramic restorations have been recognized and accepted as being esthetically superior to porcelain-fused-to-metal or all-cast restorations. However, gains in esthetics achieved with an all-ceramic crown often meant sacrifices in strength, fit or both. Recent developments in the pressed ceramic format continue to secure the pressed all-ceramic restoration as a viable alternative to porcelain-to-metal and all-cast restorations. This article focuses on the most updated techniques and considerations of this type of system and its effectiveness in providing esthetics, strength and fit through "technician-friendly" procedures, materials and equipment.
UNLABELLED: Certain resuscitative procedures can be lifesaving, but are performed infrequently by emergency medicine (EM) residents on human subjects. Alternative training methods for gaining procedural proficiency must be explored and tested. OBJECTIVE: To test whether animal laboratory training (ALT) is associated with sustained improvement in procedural competency and speed. METHODS: After watching an educational videotape of saphenous cutdown (SAPH), thoracotomy (THOR), and cricothyroidotomy (CRIC), EM residents were randomized to receive either a tutored ALT session on live anesthetized pigs (Group A) or no ALT session (Group B). Residents were tested six months later by performing procedures on live anesthetized pigs. Videotaped procedures were evaluated by blinded examiners for the number of critical steps, complications, and procedure times. RESULTS: Group A (n = 10) achieved a higher number of critical steps compared with Group B (n = 8) for SAPH (15.4 +/- 0.7 vs. 9.0 +/- 1.8, p = 0.03) and THOR (17.4 +/- 0.6 vs. 12.3 +/- 1.6, p = 0.009), but not CRIC (18.1 +/- 0.4 vs. 16.2 +/- 1.0, p = 0.1). Group A completed procedures in less time than Group B for SAPH (Wilcoxon chi(2) = 4.0, p = 0.04) and THOR (chi(2) = 4.4, p = 0.04), but not CRIC (chi(2) = 0.9, p = 0.3). There was no difference in the number of complications for any of the procedures. CONCLUSION: Residents with animal laboratory training six months prior to testing demonstrated improved procedural competency and speed in the performance of resuscitative procedures.
The economic burden of lung cancer was examined with a retrospective case-control cohort study on a database containing inpatient, outpatient and drug claims for employees, dependents and retirees of multiple large US employers with wide geographic distribution. Patients were followed for maximum of 2 years from first cancer diagnosis until death, health benefits dis-enrollment or study end (31 December 2000). Compared with controls (subjects without any cancer), patients with lung cancer (n = 2040) had greater health care service utilization and costs for hospitalization, emergency room visits, outpatient office visits, radiology procedures, laboratory procedures and pharmacy-dispensed drugs (all P < 0.05). Regression-adjusted mean monthly total costs were US dollar 6520 for patients versus US dollar 339 for controls (P < 0.0001), and overall costs across the study period (from diagnosis to death or maximum of 2 years) were US dollar 45,897 for patients and US dollar 2907 for controls (P < 0.0001). The main cost drivers were hospitalization (49.0% of costs) and outpatient office visits (35.2% of costs). Monthly initial treatment phase costs (US dollar 11,496 per patient) were higher than costs during the secondary treatment phase (US dollar 3733) or terminal care phase (US dollar 9399). Failure of initial treatment was associated with markedly increased costs. Compared with patients requiring only initial treatment, patients experiencing treatment failure accrued an additional US dollar 10,370 per month in initial treatment phase costs and US dollar 8779 more per month after starting the secondary and/or terminal care phase. Over the course of the study period, these patients had total costs of US dollar 120,650, compared with US dollar 45,953 for those receiving initial treatment only. Thus, the incremental costs associated with treatment failure were US dollar 19,149 per month and US dollar 74,697 across the study period. Other types of clinical and epidemiological analysis are needed to identify risks for treatment failure. The economic burden of lung cancer on the US health care system is significant and increased prevention, new therapies or adjuvant chemotherapy may reduce both resource use and healthcare costs. New strategies for lung cancer that reduce hospitalizations and/or prevent or delay treatment failure could offset some of the economic burden associated with the disease.
Although effects of stress on the stomach have been extensively investigated in children and adults, our knowledge about effects of fetal distress (FD) on the fetal stomach is quite limited. Therefore, an experimental study was planned to evaluate the effects of FD on fetal gastric physiology and histology. In this study, a model of FD was created by way of intermittent maternal aortic occlusion in pregnant rabbits. In total, 21 fetuses of 6 pregnant rabbits were available for surgical and laboratory procedures. Laboratory examinations showed that (1) fetal gastric acid secretion was 4.24 +/- 2.68 muEq/h in the control group and 18.08 +/- 6.34 muEq/h in the distress group (p < 0.01) and (2) fetal gastric PGE2 level was 16.59 +/- 6.15 mg/g wet weight in the control group and 9.86 +/- 3.46 mg/g wet weight in the distress group (p < 0.05). Histopathologically, there were mild hemorrhagic and errosive changes in the distressed fetuses, but not in control fetuses. These findings support that FD adversely affects fetal gastric physiology through two mechanisms consisting of increased gastric acid secretion and decreased fetal gastric protection in rabbits. Consequently, gastric injury should be noted as a potential problem among hypoxia-associated abnormalities encountered in the distressed fetus.
These regulations set forth the rules for sanctions that HCFA may impose on laboratories that are found not to meet Federal requirements. These include the principal sanctions of suspending, limiting, or revoking the laboratory's certificate issued under the Clinical Laboratory Improvement Amendments of 1988 (CLIA), and cancelling the laboratory's approval to receive Medicare payment for its services, and the alternative sanctions that may be imposed instead of or before the principal sanctions. These amendments are necessary to conform HCFA regulations to changes made in the law by the Omnibus Budget Reconciliation Act of 1987 (OBRA '87) and the 1988 amendments to section 353 of the Public Health Service Act (PHS Act). The latter are commonly referred to as "CLIA 88". The purpose of the amendments is to ensure that functioning laboratories are capable of providing accurate and reliable test results and that the health of individuals served by the laboratory and that of the general public is not adversely affected by laboratory operations and by testing procedures that do not meet the standards set forth in other subparts of part 493 of the HCFA regulations.
OBJECTIVE: Emergency-procedure laboratories are not a standardized part of the curriculum for emergency medicine residency programs. The authors evaluated the efficacy of an emergency-procedure laboratory to teach medical students and residents the performance of tube thoracostomy. METHODS: A prospective repeated-measures study of tube thoracostomy placement training was performed in an animal-laboratory setting. Participants were six first-postgraduate-year emergency medicine residents and six fourth-year medical students. Each participant was given a written pretest on tube thoracostomies followed by lectures on tube thoracostomy, venous cutdown, peritoneal lavage, and surgical airway. The procedure laboratory, using an anesthetized canine model (20-25 kg), was then conducted. Tube thoracostomies were timed from skin incision to passage of the tube into the thoracic cavity with subsequent tube fogging. Four attempts per participant were documented. Eighteen days later, an identical procedure laboratory was conducted for the same students including a written posttest identical to the pretest. RESULTS: The written test scores improved for every participant (p < 0.0001). Mean times for procedures completion improved from 121 sec to 39 sec (p = 0<.001) during the first session and improved from 58 sec to 28 sec (p = 0.005) during the second session. Retention of skills was indicated by significant shortening of the time to completion from the first attempt of the first session to that of the second session (121 sec to 58 sec, p = 0.002). CONCLUSION: This procedure laboratory, which emphasized skill repetition, led to improvement in procedural speed and retention of tube thoracostomy skills over time. This approach to teaching clinical procedures should be considered for emergency medicine residency programs and for continuing medical education courses that emphasize acquisition of clinical procedural skills.
In the February 28, 1992 issue of the Federal Register (FR Doc. 92-4050) (57 FR 7218), we established rules for sanctions that HCFA may impose on laboratories that are found not to meet Federal requirements. This notice corrects both typographical and technical errors made in that document.