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PubMed1986

Initial bone marrow findings in multiple myeloma. Significance of plasma cell nodules.

A retrospective review of bone marrow specimens from 235 patients with multiple myeloma and 148 patients with reactive plasmacytosis was performed in an attempt to evaluate the usefulness of bone marrow sections in distinguishing between these conditions. Although the presence of large homogeneous nodules and/or infiltrates of plasma cells in bone marrow sections remains the best criterion for the diagnosis of myeloma, a few specimens (2%) from patients with reactive plasmacytosis also showed this feature. In addition, 26% of the patients with myeloma had bone marrow sections that were considered nondiagnostic in that they lacked recognizable homogeneous nodules and/or infiltrates of plasma cells. Finally, distinguishing multiple myeloma from bone marrow involvement by lymphoplasmacytic lymphomas can be very difficult, if not impossible, based on findings in the sections alone.

Bone Marrow↗
PubMed1972

The second international reference preparation of erythropoietin, human, urinary, for bioassay.

A collaborative study of the second international Reference Preparation of Erythropoietin, Human, Urinary, for Bioassay was carried out in 10 laboratories. Combined potency estimates obtained by comparison with the International Reference Preparation, indicate that ampoules of the second Preparation contain 10.0 IU (weighted mean potency) or, taking the unweighted mean potency, 9.8 IU, with fiducial limits (P=0.95) of 8.4-11.5 IU. The second Preparation could be used as a standard in estimating the potency of a preparation of sheep plasma erythropoietin (68/307) although, as with the International Reference Preparation, there was a tendency for the sheep plasma preparation to produce log-dose-log-response regression lines that were steeper than those produced by the second Preparation.In accelerated degradation studies of the second Preparation stored as the dry product in ampoules for up to 1 year, there was no consistent trend to indicate instability of the preparation.Following its establishment in 1971, the Second International Reference Preparation was allocated a potency of 10 IU/ampoule.

Animals↗
PubMed1984

[Immunotherapy with bestatin for acute non-lymphocytic leukemia (ANLL) in adults].

A cooperative randomized controlled study of immunotherapy with bestatin for ANLL in adults was conducted at 16 institutions. After complete remissions were induced and consolidated with combination chemotherapy, patients were randomly allocated into two groups, one with maintenance chemotherapy alone (C) and the other with the same maintenance chemotherapy plus bestatin (B). Out of 115 patients entered in this study, 101 (B): 48, C: 53) were eligible. The 50% remission duration was 20.4 months for B compared with 11.1 months for C, and comparable 50% survivals were 33.3 and 18.9 months respectively. B had significantly longer remission duration and survival time than C. Remission duration and survival time in patients under 49 years of age were not significantly different in both groups. But in patients over 50 years of age B had significantly longer remission duration and survival time than C. Side effects of bestatin were mild and transitional. These data suggest the usefulness of bestatin for the treatment of adult acute non-lymphocytic leukemia.

Acute Disease↗
PubMed1989

Allocating resources to health care: RAWP (Resources Allocaton Working Party) is dead--long live RAWP.

In England, according to the White Paper, "Working for Patients' the RAWP formula (Resources Allocation Working Party) is to be abandoned. Instead, according to the Working Papers, allocations are to be based on populations weighted for their health and age distributions. In the distributions from the centre to the Regions, SMRs (Standardized Mortality Ratios) are to be retained as a proxy for morbidity albeit with a different weight. This is based, partly, on the analysis carried out by Coopers and Lybrand for the RAWP Review which is shown to be inadequate both conceptually and empirically. The criteria to be used for distributing to Districts and General Practitioners are unclear but "allowance will be made for local and social factors' which suggests that some deprivation index will be incorporated into the process. The most likely choice is the Jarman index and this is shown to be equally inappropriate. The criteria used in allocation, as well as being conceptually coherent and empirically practicable, should be clear and comprehensible to all concerned. The proposals in the White Paper fulfil none of these criteria.

Health Services Needs and Demand↗
PubMed1988

Recovery of neuromuscular function and postoperative morbidity following blockade by atracurium, alcuronium and vecuronium.

Recovery of neuromuscular function and postoperative morbidity were studied in 51 fit female patients who had nonemergency gynaecological laparoscopy as inpatients. They were allocated randomly to one of three groups to receive either atracurium 0.31 mg/kg, alcuronium 0.25 mg/kg, or vecuronium 0.06 mg/kg as part of an otherwise standard anaesthetic technique. There were neither differences in intubation conditions nor in the occurrence of postoperative diplopia whichever muscle relaxant was used. Deficits in grip strength and expiratory force were seen at one hour after reversal with atropine 1.2 mg and neostigmine 2.5 mg in all patients, deficits which persisted for 3 hours in those who received alcuronium. The recovery of inspiratory force was slower and less complete at up to 3 hours in those who received alcuronium and there was a high incidence of minor postoperative morbidity at up to 24 hours in each of the three groups. The only statistical difference in symptomatic morbidity was an increase in muscle weakness in those who received alcuronium compared with atracurium at 3 hours after laparoscopy. Only 25%, 20% and 31% of the patients who received atracurium, alcuronium and vecuronium respectively said that they would have liked to be day stay patients.

Adult↗
PubMedDate not supplied

Liver transplantation. Patient selection and organ allocation.

Liver transplantation represents a major advancement in treating selected patients with advanced liver disease. The keys to successful outcome include: 1) early evaluation and listing for transplantation before the patient develops severe complications of cirrhosis; 2) control of comorbid conditions; and 3) a cooperative and dynamic interchange between the transplant center and other physicians involved in the care of the patient.

Adult↗
PubMed1990

Preanesthetic medication with rectal midazolam in children undergoing dental extractions.

Three different dosages (0.25, 0.35, and 0.45 mg/kg) of rectally administered midazolam were compared with each other and with placebo for preanesthetic medication in children undergoing dental extractions. Eighty patients between the ages of 2 and 10 years were randomly allocated into four groups in this double-blind study. The results from this trial show that 30 minutes after rectal administration of all doses of midazolam, good anxiolysis, sedation, and cooperation were obtained in most patients. A high prevalence (23%) of disinhibition reactions was observed, particularly in the 0.45 mg/kg group. For this reason, 0.25 or 0.35 mg/kg appears to be the dose of choice when rectal midazolam is used for premedication in children.

Administration, Rectal↗
PubMed1984

The effects of chenodiol on biliary lipids and their association with gallstone dissolution in the National Cooperative Gallstone Study (NCGS).

The National Cooperative Gallstone Study was a double-masked trial conducted to determine the efficacy and safety of chenodeoxycholic acid (chenodiol) for dissolution of cholesterol gallstones. Patients with radiolucent gallstones were randomly allocated to either a high dose (750 mg/d, n = 305) or low dose (375 mg/d, n = 306) of chenodiol or placebo (n = 305) administered for 2 yr. Specimens of gallbladder bile were obtained for biliary lipid analysis on 50% of all white obtained for biliary lipid analysis on 50% of all white patients at base line and after 3-mo therapy, on 45% at 12 mo, and on 36% at 24 mo. Among these specimens, 20% were inadequate for analysis. For analysis of data, available values during therapy were averaged up to time of dissolution, study exit, or study termination. In the high-dose group, percent chenodiol (molar percent of all bile acids) increased markedly and remained high during the 2 yr of follow-up. Also, molar percent cholesterol decreased significantly and remained low during the 2 yr of follow-up. In the low-dose group, percent chenodiol increased and remained significantly increased. Percent cholesterol saturation decreased at 3 mo, but at 24 mo it was not different from that in the placebo group, suggesting a physiological adaptation to the low dose by 2 yr. 79% of patients on high dose had greater than 70% chenodiol. Among these, half showed unsaturated bile (less than 100% cholesterol saturation) while the remainder were supersaturated; in the former group with unsaturated bile, 23% had complete dissolution and 51% had partial (greater than 50% reduction in stone size) or complete dissolution. In contrast, those with over 70% chenodiol and supersaturated bile had only 5% complete dissolution. Thus, development of unsaturated bile was a major factor associated with gallstone dissolution. The data also indicate that values for percent cholesterol saturation were a better predictor of gallstone dissolution than molar percent chenodiol, although a high percent chenodiol usually was required to obtain unsaturation.

Bile↗
PubMed1998

Acceptance and safety of directly observed versus self-administered isoniazid preventive therapy in aboriginal peoples in British Columbia.

OBJECTIVE: To document experience with directly observed chemoprophylaxis (DOPT) compared to self-administered isoniazid (INH) among aboriginal persons in British Columbia. DESIGN: DOPT was compared to self-administered delivery (SAD) over a 3-year period. All aboriginal persons who received INH chemoprophylaxis in British Columbia between 1992 and 1994 were evaluated. Therapy completion rates and adverse outcomes associated with SAD were compared with DOPT. Treatment allocation was by patient choice. RESULTS: Of 608 people who received INH prophylaxis, 443 received SAD (mean age 31.6 years) and 165 received DOPT (mean age 23.9 years). Two hundred and seventy (60.9%) SAD compared to 124 (75.2%) in the DOPT group completed 6 months of INH (P = 0.0011). The 12-month completion rates were 162/443 (36.6%) for the SAD group and 84/165 (50.9%) for the DOPT group (P = 0.0014). Adverse reactions requiring discontinuation of medication occurred in 13.5% of the patients on SAD and 9.7% of those receiving DOPT (P = 0.202). The most common reason cited for failure to complete therapy was non-cooperation in both groups. There were three deaths in the SAD group, one of which was due to suicide by self-ingestion of INH. CONCLUSIONS: These data demonstrate that in aboriginal people compliance with preventive therapy can be improved by DOPT. Non random allocation to treatment groups might have influenced our findings, and further prospective randomized trials and cost-effectiveness analyses are required.

Adult↗
PubMed1994

Cardiac transplant donor heart allocation based on prospective tissue matching.

The present priority scheme for the allocation of donor hearts based on patient acuity and waiting time contributes to the escalating costs of heart transplantation, ignores the potential outcome advantages of prospective tissue matching, and is vulnerable to manipulation. Costs have trebled in recent years, as recipients frequently spend weeks before transplantation as inpatients in intensive care units and become more susceptible to nosocomial complications. The findings from an international cooperative study suggest that patient survival is correlated with the level of histocompatibility (ie, human lymphocyte antigen [HLA]) matching. We observed a similar inverse association between retrospective fortuitous HLA matching and the risk of rejection in 39 patients undergoing heart transplantation over a 29-month period (p = 0.03 by nonparametric analysis). These observations prompted us to consider the feasibility of donor heart allocation based on the degree of HLA matching and waiting time alone. Current methods permit the accurate determination of HLA type in a matter of hours using donor peripheral blood alone. Human lymphocyte antigen typing, therefore, could be performed locally before organ harvesting, making issues of donor heart preservation irrelevant. We evaluated the extent of HLA matching that might be achieved practically. Forty-seven patients on our waiting list during calendar year 1991 were tested retrospectively for HLA matching with all geographically accessible 1991 heart donors identified by the United Network for Organ Sharing for all donors from hospitals east of the Mississippi River.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2004

The role of research in a technical assistance agency: the case of the 'German Agency for Technical Co-operation'.

Technical assistance agencies have a sustainable impact on the health systems of the countries they are operating in. As well as policy-makers at the national level, technical assistance agencies see themselves confronted that their interventions should be based on evidence, usually meaning the results of research. This study has the aim to analyse role of research in the implementation of technical assistance. We sent a questionnaire to all health project managers of the 'German Agency for Technical Co-operation' and performed a qualitative case study in one of the health projects. Forty-seven of 80 (58.8%) of the questionnaires were completed and sent back. The managers considered publications of International Organisations (IOs), scientific articles and local research as most important for their work. The case study showed application problems in the daily work. Research use not only depends on the relevance of the data but also on analytical skills, linguistic barriers and technical access to research by the potential users. The role of knowledge and information management has to be clearly defined in an organisation of technical assistance. The specific needs at the different levels have to be analysed so that skills and resources can be allocated adequately.

Cooperative Behavior↗
PubMedDate not supplied

Canada and global health research: 2005 update.

From a global perspective, large disparities persist between the focus of health research investments and the global burden of illness. Over the past four years, Canadian efforts to address these disparities have steadily increased. The objectives of this paper are to present these recent achievements and to highlight continuing challenges. We summarize the activities of two complementary Canadian initiatives, both aimed at increasing Canada's investment and involvement in global health research. They are the Global Health Research Initiative--a partnership involving four federal agencies; and the Canadian Coalition for Global Health Research--a not-for-profit membership organization. Several achievements include: increased investment in global health research; increased knowledge production and use through "South-Canada" partnerships; stronger advocacy and increased awareness; enhanced capacity development; and improved coordination and communication. Based on these achievements, important current and future challenges are identified. They include: more coherent resource allocation; more focussed health research priorities; and the need to maintain and build momentum.

Awareness↗
PubMed1989

[Allocation of additional funds for development of public health].

The Gorky N. A. Semashko Regional Clinical Hospital has the long-term experience in drawing additional means into patients' treatment at the expense of enterprises and collective farms on the strength of the agreement on cooperation. In order to expand cost accounting in public health it is necessary to determine cost indices in the work of curative and preventive facilities. Total cost of the provision of various types of medical services and that per patient have been calculated in the Gorky Regional Hospital. Besides current expenditure they involve the main funds, estimated by annual indices. Complete cost of 306 diagnostic and treatment procedures have been determined. Proceeding from the data obtained complete actual costs of diagnostic and treatment procedures per patient on 105 nosologic forms have been identified along with the expenditure on these nosologic forms that is necessary for modern diagnostic and treatment care.

Adult↗
PubMed2003

The impact of the nurse-physician relationship on barriers encountered by nurses during pain management.

The aim of the current investigation was to examine the barriers encountered by Tasmanian registered nurses when attempting to provide optimal pain management. The impact of nurse satisfaction with their professional relationship with physicians during pain management on the types of barriers encountered was also examined. A total of 1,015 registered nurses completed a 21-item survey that examined the types of barriers encountered during pain management. In addition, data were gathered on nurses' satisfaction with their professional relationship with physicians during pain management. More than one-third of the respondents indicated that they had encountered at least one type of barrier to providing optimal pain relief, including insufficient cooperation by physicians and inadequate prescriptions of analgesic medications. Nurses who did not feel adequately consulted by physicians were significantly more likely to encounter barriers such as insufficient cooperation by patient's physicians and inadequate prescription of analgesic medications. The barriers to effective pain management encountered by nurses were affected by their relationship with physicians. Education, for both nurses and physicians, concerning the role of the nurse in the workplace will help to ensure that nurses encounter fewer barriers during pain management. Optimal pain management practice will result if guidelines for dealing effectively with barriers are tailored to the specific type of institution and the unit within those institutions.

Adult↗
PubMed1987

Effect of high-dose glucocorticoid therapy on mortality in patients with clinical signs of systemic sepsis.

We conducted a multicenter randomized, double-blind, placebo-controlled trial of early short-term, high-dose methylprednisolone sodium succinate in 223 patients with clinical signs of systemic sepsis and a normal sensorium (112 received glucocorticoid and 111 placebo). Patients also received antibiotics and intravenous fluids. Glucocorticoid or placebo was administered intravenously by a bolus (30 mg per kilogram of body weight over 15 minutes) followed by infusion of 5 mg per kilogram per hour for nine hours. The average time between the diagnosis of sepsis and infusion was 2.8 hours. The principal end point was 14-day mortality, which was similar in the placebo (22 percent) and glucocorticoid (21 percent) groups (P = 0.97). Mortality was also not significantly different between those receiving placebo and those receiving glucocorticoid in subgroups with evidence of sepsis (21 vs. 19 percent), gram-negative bacteremia (27 vs. 7 percent), gram-positive bacteremia (18 vs. 26 percent), or all gram-negative infections (25 vs. 17 percent). Resolution of secondary infection within 14 days was significantly higher in patients receiving placebo (12 of 23) than in those receiving glucocorticoid (3 of 16) (P = 0.03), but mortality rates were similar in both treatment groups for those with unresolved infection (36 vs. 31 percent). We conclude that early high-dose glucocorticoid therapy does not reduce mortality significantly in patients with systemic sepsis who have a normal sensorium, and therefore should not be used as adjunctive therapy.

Clinical Trials as Topic↗
PubMed2003

Competition and cooperation in the five-factor model: individual differences in achievement orientation.

The authors investigated the relationship between basic achievement orientations of competition and cooperation and the five-factor model of personality as measured by the Revised NEO Personality Inventory (NEO-PI-R; P. T. Costa & R. R. McCrae, 1992). They examined 2 types of competition: hypercompetition (R. M. Ryckman, B. Thornton, & J. C. Butler, 1994) and personal development competition (R. M. Ryckman, M. Hammer, L. M. Kaczor, & J. A. Gold, 1996), as conceptualized by K. Horney (1937). In a sample of 251 young adults, 14% to 38% of the variance in achievement orientations was collectively predicted by NEO-PI-R domain scales. Of NEO-PI-R predictors, Agreeableness was most important in characterizing differences between various achievement orientations; Agreeableness was negatively related to hypercompetition, positively related to cooperation, and unrelated to personal development competition. Extraversion was positively related to both cooperation and personal development competition but was unrelated to hypercompetition. In contrast, Openness and Conscientiousness were least helpful in differentiating among achievement orientations. These findings support the useful application of the NEO-PI-R in achievement research and highlight competition and cooperation as interpersonally laden achievement orientations.

Achievement↗