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At least 415 records · Page 23Linked to original sources
PubMed1984

Dexamethasone: pharmacokinetics in neurological patients.

A high performance liquid chromatographic assay has been used to measure the time courses of plasma dexamethasone concentrations in patients with various neurological disorders being treated with this steroid. The pharmacokinetics of the drug in these circumstances differed from the kinetics in healthy volunteers. In particular whole body clearances were higher, causing a substantially impaired mean oral bioavailability of the drug with considerable interindividual variation in bioavailability. The clearance of dexamethasone was increased by concurrent phenytoin therapy, and dexamethasone and phenytoin are often given together in neurosurgical practice. The previously unrecognized bioavailability limitation of oral dexamethasone may explain individual instances of apparent steroid-resistant neurological disease, and suggests the desirability of monitoring plasma dexamethasone levels when using the steroid therapeutically. Some preliminary evidence has been obtained suggesting that it may be possible to avoid adrenal suppression from long-term high-dosage dexamethasone therapy, if plasma dexamethasone levels can be allowed to fall to zero between consecutive dexamethasone doses.

Adult↗
PubMed1982

Guidelines for providing medical care to Southeast Asian refugees.

Almost 500,000 Southeast Asian refugees have arrived in the United States since 1975. While these refugees have not presented substantial public health problems, they have important personal health problems frequently requiring medical attention. Medical care providers in this country need to be aware of disease patterns and prevalence among these refugees. As well, they need to be aware of the cultural and religious backgrounds and previous medical practices of this refugee population, particularly as these practice influence the refugees' ability to obtain and maintain medical services provided in this country. Historical, cultural, religious, ethical, and medical information is provided to help US health care facilities develop culturally appropriate medical care services for Southeast Asian refugees.

Acculturation↗
PubMed1982

Risk of ectopic pregnancy following tubal sterilization.

To determine the impact of tubal sterilization on the overall incidence of ectopic pregnancy, the authors compared reported incidence rates of ectopic pregnancy after tubal sterilization with the rates associated with other contraceptive methods or no contraception. For each contraceptive method they then calculated the cumulative lifetime risk of ectopic pregnancy from the age at which a final contraceptive choice was made. Tubal sterilization was found to be associated with a lower cumulative lifetime risk of ectopic pregnancy than no contraception or use of an intrauterine contraceptive device. Tubal sterilization carries a somewhat higher risk of ectopic pregnancy than do barrier methods of contraception. Oral contraceptives are associated with a much lower ectopic pregnancy for most than any other contraceptive method or no contraception. Overall, however, the risk of an ectopic pregnancy for most women undergoing tubal sterilization in the United States is estimated to be lower than if they had not been sterilized and had continued their previous contraceptive practices.

Adult↗
PubMed1995

Seizure classification in dogs from a nonreferral-based population.

On initial evaluation for onset of seizure disorders at nonreferral veterinary practices, 50 previously healthy dogs were enrolled in a study to determine the probability of identifying a specific cause for the seizures. Treatment was not administered prior to entry of dogs in the study. On the basis of antemortem and postmortem test results, 22 dogs (44%) were classified as having primary epileptic seizures (PES; idiopathic or without identifiable cause), 23 (46%) had secondary epileptic seizures (SES; identifiable intracranial cause), and 5 (10%) had reactive epileptic seizures (RES; metabolic or transient noxious cause). Forty-one dogs (82%) had 2 or more seizures before evaluation, with 37 (90%) of these dogs classified as having epilepsy on the basis of an underlying chronic brain disorder. For these 41 dogs, 17 (41%) had PES, 20 (49%) had SES, and 4 (10%) had RES. Among the 9 dogs (18%) with nonrecurring seizures, 5 had PES, 3 had SES, and 1 had RES. Generalized seizures were the most common first-observed seizure type associated with all etiologic classifications in all dogs with recurring and nonrecurring seizures. Diagnosis of SES was statistically more probable when the dog was less than 1 or more than 7 years old at the first seizure, when the first seizure was a partial seizure, or when the first seizure occurred between midnight and 8 AM. A diagnosis of RES was statistically more probable only when the interval between the first and second seizure was brief (< or = 4 weeks).(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMedDate not supplied

Effect of catheter composition on sperm quality.

Bladder catheterization for collection of retrograde ejaculates is commonly practiced, although previous studies have shown that materials used in the manufacture of the catheters may be toxic to sperm. Potential toxicity is particularly relevant to electroejaculation, as sperm from anejaculatory individuals undergoing this procedure characteristically exhibit poor motility and viability. To determine the effect of short-term exposure to various catheter materials on sperm quality, donor semen was diluted with BWW medium and aliquots incubated for 1 and 5 minutes with segments of four different catheters. The catheters were composed of latex, silicone rubber, polytetrafluoroethylene (Teflon), and radio-opaque Teflon, respectively. Following incubation, eosin-nigrosin staining for viability was performed and sperm motility assessed using computer-assisted sperm analysis (Cellsoft, Cryo Resources, Ltd). In the second phase of the study, donor semen was incubated with catheter segments coated with 0.3 ml of a water-soluble, nontoxic lubricant (Cellulosagel, Lederle) to evaluate whether the combination adversely affects sperm. Percent motility and viability for the semen specimens incubated with the four catheters alone did not differ significantly from control values either at 1 or at 5 minutes (P = 0.3, motility; P = 0.6, viability). The addition of lubricant did not change the catheter data significantly, indicating the absence of independent or synergistic toxicity (P = 0.5, motility; P = 0.4, viability). This study provides substantial evidence that brief exposure to conventional catheters, with or without a nontoxic lubricant, does not adversely affect sperm motility or viability.(ABSTRACT TRUNCATED AT 250 WORDS)

Catheters, Indwelling↗
PubMed1998

Prevention and treatment of tuberculosis among patients infected with human immunodeficiency virus: principles of therapy and revised recommendations. Centers for Disease Control and Prevention.

These guidelines update previous CDC recommendations for the diagnosis, treatment, and prevention of tuberculosis (TB) among adults and children coinfected with human immunodeficiency virus (HIV) in the United States. The most notable changes in these guidelines reflect both the findings of clinical trials that evaluated new drug regimens for treating and preventing TB among HIV-infected persons and recent advances in the use of antiretroviral therapy. In September 1997, when CDC convened a meeting of expert consultants to discuss current information about HIV-related TB, special emphasis was given to issues related to coadministration of TB therapy and antiretroviral therapy and how to translate this information into management guidelines. Thus, these guidelines are based on the following scientific principles: * Early diagnosis and effective treatment of TB among HIV-infected patients are critical for curing TB, minimizing the negative effects of TB on the course of HIV, and interrupting the transmission of Mycobacterium tuberculosis to other persons in the community. * All HIV-infected persons at risk for infection with M. tubercu losis must be carefully evaluated and, if indicated, administered therapy to prevent the progression of latent infection to active TB disease and avoid the complications associated with HIV-related TB. * All HIV-infected patients undergoing treatment for TB should be evaluated for antiretroviral therapy, because most patients with HIV-related TB are candidates for concurrent administration of antituberculosis and antiretroviral drug therapies. However, the use of rifampin with protease inhibitors or nonnucleoside reverse transcriptase inhibitors is contraindicated. Ideally, the management of TB among HIV-infected patients taking antiretroviral drugs requires a) directly observed therapy, b) availability of experienced and coordinated TB/HIV care givers, and in most situations, c) use of a TB treatment regimen that includes rifabutin instead of rifampin. Because alternatives to the use of rifampin for antituberculosis treatment are now available, the previously recommended practice of stopping protease inhibitor therapy to allow the use of rifampin for TB treatment is no longer recommended for patients with HIV-related TB. The use of rifabutin-containing antituberculosis regimens should always include an assessment of the patient's response to treatment to decide the appropriate duration of therapy (i.e., 6 months or 9 months). Physicians and patients also should be aware that paradoxical reactions might occur during the course of TB treatment when antiretroviral therapy restores immune function. Adding to CDC's current recommendations for administering isoniazid preventive therapy to HIV-infected persons with positive tuberculin skin tests and to HIV-infected persons who were exposed to patients with infectious TB, this report also describes in detail the use of new shortcourse (i.e., 2 months) multidrug regimens (e.g., a rifamycin, such as rifampin or rifabutin, combined with pyrazinamide) to prevent TB in persons with HIV infection. A continuing education component for U.S. physicians and nurses is included.

AIDS-Related Opportunistic Infections↗
PubMed2001

Combination chemotherapy of irinotecan plus cisplatin for advanced gastric cancer: efficacy and feasibility in clinical practice.

BACKGROUND: A previous phase II study showed that a combination of irinotecan (CPT-11) with cisplatin (CDDP) was effective for advanced gastric cancers, but was associated with substantial neutropenia and diarrhea. The aim of this retrospective study was to evaluate the efficacy and feasibility of the combination in clinical practice. METHODS: The subjects comprised 65 patients with advanced gastric cancer treated with CPT-11 (70mg/m2, day 1, day 15) and CDDP (80mg/m2, day 1) as first-line chemotherapy between April 1993 and March 1999. Patient backgrounds, response rates, response durations, times to progression, and survival rates were investigated retrospectively. RESULTS: The overall response rate and the response rates for measurable metastatic lesions and primary sites were 43% (28/65), 48% (31/64), and 24% (10/42). Leucopenia of grade 4 and diarrhea of grade 3 or 4 were observed in 6 (9%) and 5 (8%) patients, respectively. Among the 19 patients with peritoneal metastasis, leucopenia of grade 4 and diarrhea of grade 3 or 4 were observed in only 1 of the 18 patients who received sufficient oral intake (6%). There were no treatment-related or early deaths within 30 days from the last treatment day. The median survival times of all patients, patients with an intestinal type of adenocarcinoma, and patients with a diffuse type were 365, 472, and 291 days, respectively. Multivariate analysis showed that the histological type of cancer was a significant independent prognostic factor (P = 0.0169). CONCLUSION: This retrospective study confirmed the efficacy and feasibility of this combination therapy in clinical practice.

Adenocarcinoma↗
PubMed2004

What happens to patients with positive tissue transglutaminase and endomysium antibody results in general practice?

BACKGROUND: A previous study showed that many patients with positive gut related antibodies (anti-tissue transglutaminase (TTG) and/or anti-endomysium (EMA) antibodies), indicative of coeliac disease, were not offered a duodenal biopsy, despite the recommendation of the British Society for Gastroenterology guidelines. AIMS/METHODS: To investigate whether the addition of a comment on the advisability of referral to a gastroenterologist and biopsy to each positive gut related antibody result would improve the referral rate to investigate possible coeliac disease. RESULTS: The referral rate improved from 30.1% of patients who were referred and 18% subsequently biopsied before the addition of the comment, to 79.8% who were referred after the introduction of a specific laboratory comment attached to positive antibodies to TTG and/or EMA. All patients with these positive antibodies who were referred for consultant opinion were subsequently biopsied. CONCLUSIONS: To ensure that British Society for Gastroenterology guidelines are followed, laboratories should incorporate more explicit details on the recommended course of action for general practitioners on their receipt of positive gut antibodies to TTG/EMA.

Autoantibodies↗
PubMed1992

Remediating the thinking of pupils with autism: principles into practice.

We take previously developed principles of a problem-solving approach to teaching pupils with (Jordan & Powell, 1990a, 1990b, 1991), and analyze their application within the normal teaching routine of a specialist school for such pupils. We note the kinds of pedagogical judgment made, and the structures needed by individual pupils to enable them to function as problem solvers. We identify reflection as a key factor in enhancing the potential of pupils as learners and discuss ways of increasing pupils' awareness of their own ways of handling learning situations. The study is set against the background of issues concerned with possibilities of developing a 'theory of mind' in pupils with autism.

Adolescent↗
PubMed1990

Dental procedures and endocarditis prophylaxis: experiences from 108 dental practices.

In a previous survey, we analyzed a questionnaire to 220 patients, who underwent cardiac surgery with insertion of prosthetic heart valves in the period 1978-1982. Of the 147 patients with their own natural teeth, 136 gave us permission to contact their regular or casual dentists. Of the 108 dentists (79%), who responded to a questionnaire, two thirds were well aware that their patients had prosthetic heart valve and the vast majority of dentists believed that antibiotic prophylaxis is justified in connection with (certain) dental procedures. However, only 15 dentists (14%) prescribed prophylactic antibiotics, i.e. before scaling. The dosage route, frequency and duration of antibiotic administration used by more than half of the dentists was not in accordance with modern principles of antibiotic prophylaxis to prevent bacterial endocarditis. Proposals for antibiotic regimens have to be linked to better education/information of the patients, doctors and dentists and should be linked to recommendations to ensure the highest level of dental care in risk patients.

Anti-Bacterial Agents↗
PubMed2003

Maternal recall of exclusive breast feeding duration.

BACKGROUND: Both the pattern and duration of breast feeding are important determinants of health outcomes. In vertical HIV transmission research, reliable documentation of early breast feeding practices is important in order to correctly attribute postnatal transmission to feeding pattern. AIMS: To validate methods of collecting data on the duration of exclusive breast feeding (EBF) in an area of South Africa with a high HIV prevalence rate. METHODS: A total of 130 mothers were interviewed weekly, postnatally. At every interview a 48 hour and a seven day recall breast feeding history were taken. A subset of 70 mothers also received two intermediate visits per week during which additional 48 hour, non-overlapping, recall interviews were conducted. Ninety three infants were revisited at 6-9 months of age when mothers' recall of EBF duration from birth was documented. The different methods of recalling EBF status were compared against an a priori "best comparison" in each case. RESULTS: Reported breast feeding practices over the previous 48 hours did not reflect EBF practices since birth (specificity 65-89%; positive predictive value 31-48%). Six month EBF duration recall was equally poor (sensitivity at 2 weeks 79%; specificity 40%). Seven day recall accurately reflected EBF practices compared with thrice weekly recall over the same time period (sensitivity 96%, specificity 94%). CONCLUSIONS: 48 hour EBF status does not accurately reflect feeding practices since birth. Long term recall data on EBF are even more inaccurate. We recommend that data on duration of EBF be collected prospectively at intervals of no longer than one week.

Adult↗
PubMed1973

The psoas sign, hepatic angle, normal patients, and everyday practice.

While extensive previous references in the literature leave little doubt that disease in the posterior pararenal space can obliterate the psoas margin either in its entirety or in part, little work has been done to evaluate the frequency of when the psoas cannot be visualized in normal individuals. The data presented here indicate that as the right psoas can be expected to be absent in normal patients from 16 to 43% of the time, therefore one cannot ;lean' heavily on it as a clinical tool. On the other hand, absence of the left psoas margin on a single film in the proper clinical setting may be sufficient to draw one's attention to the retroperitoneal space, more particularly the posterior pararenal space, as a possible site of abnormality. However, ancillary radiographic signs such as mass displacement, gas, calcium, or abnormal depositions of fat, should be carefully sought. Preservation of either or both psoas margins certainly does not exclude by any means significant extraperitoneal disease, as can be seen even in our small anecdotal series. The hepatic angle is absent with such frequency in normal patients that it too can only be of questionable value as a primary radiographic sign. In our normal group of patients the splenic angle was absent more frequently than it was present.

Adolescent↗
PubMed1999

Evolving trends in critical care nursing practice: results of a certification role delineation study.

BACKGROUND: In 1997, the AACN Certification Corporation, in conjunction with Professional Examination Service, undertook a role delineation study as 1 component of a large-scale, comprehensive, and systematic study of practice to update previous data. Focus groups made up of practicing critical care nurses were used to determine trends and changes in adult, pediatric, and neonatal critical care nursing practice. METHODS: Sixteen focus groups (6 adult, 5 pediatric, and 5 neonatal) used specially prepared protocols to guide discussions. Questions were designed to elicit descriptions of changes in critical care nursing practice in the preceding 5 years. Qualitative comments of the participants were analyzed across all the focus groups, rather than separately for the adult, pediatric, and neonatal focus groups. Then data for the focus groups for each patient-age range were aggregated and reviewed to abstract themes. RESULTS: Trends and changes in practice for adult, pediatric, and neonatal critical care nurses were determined. Common themes include ethical and legal issues, changes in the population of patients, psychosocial factors, and the impact of managed care. CONCLUSIONS: The results of these focus groups can be used to update the test blueprints that underlie the CCRN certification examination programs for adult, pediatric, and neonatal critical care nurses. Critical care nursing practice is changing. Specific knowledge of the changes is important for educators, managers, and clinicians. The results of this role delineation study can be used to teach, adapt systems, and validate practice.

Adult↗