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PubMed2003

The risk of death for Jehovah's Witnesses after major trauma.

BACKGROUND: Trauma surgeons are faced with life-threatening blood loss in patients such as Jehovah's Witnesses. We assessed and compared the risks of death after major trauma for Jehovah's Witnesses and other religious groups. METHODS: A retrospective cohort study was conducted between August 1992 and September 1999 in a Level I academic trauma center. Statistical methods included Tukey's one-way analysis of variance, chi2 analysis, and bivariate and multivariate logistic regression analyses. RESULTS: The cohort consisted of 556 patients: 82 Jehovah's Witnesses (14.7%), 52 Baptists (9.4%), 101 Catholics (18.2%), and 321 patients belonging to other religious groups (57.7%). Mean Injury Severity Scores for 433 patients were 10.3 +/- 9, 8.9 +/- 10, 10.3 +/- 11, and 11.3 +/- 14, respectively. There were no significant differences in mean Injury Severity Scores between religious groups, and no statistically significant associations between religion and Injury Severity Scores were identified. Significant predictors of mortality were age, systolic blood pressure at admission, Glasgow Coma Scale score, and type of trauma. Jehovah's Witnesses were 6% more likely to die after major trauma than Baptists, 20% more likely than Catholics, and as likely as patients from any other religious groups. CONCLUSION: After controlling for age, race, systolic blood pressure, Glasgow Coma Scale score, and type of trauma, Jehovah's Witnesses have a nonsignificant increased risk of death after major trauma compared with other religious groups.

Adolescent↗
PubMed1995

Long-term survival of patients with coronary artery disease during the 1970s. A cohort study.

STUDY OBJECTIVE: This study was undertaken to determine the effects of altered risk factors and treatment modalities on the short- and long-term survival of patients with documented coronary artery disease whose conditions were diagnosed from 1972 through 1982. STUDY DESIGN: The study was a retrospective database analysis of clinical, angiographic, and follow-up information. SETTING: Data from all patients referred for cardiac catheterization at the Baptist Memorial Hospital, Memphis, Tenn, were studied. PATIENTS: Risk factors and survival of patients who underwent cardiac catheterization from 1972 through 1982 and who were followed up for at least 5 years were evaluated. Cohort A included 1,821 patients studied from 1972 through 1977; cohort B included 5,369 patients studied between 1977 and the end of 1982. Each cohort was subdivided based on type of therapy (medical or surgical) that the patients received. MEASUREMENTS AND RESULTS: The 30-day (short-term) and 5-year (long-term) survival rates were compared by life table methods. Short-term survival improved significantly in both medical (from 94.9% to 97.5%, p < 0.001) and surgical (from 95.5% to 97.6%, p < 0.001) groups from cohort A to cohort B. Long-term survival, however, did not differ significantly between the two cohorts. In the medical group, 5-year survival in cohort A was 86.3% and in cohort B it was 86.9% (p = NS); in the surgical group, cohort A it was 89.1% while in cohort B it was 89.4% (p = NS). Prevalence of both cigarette smoking and hypercholesterolemia declined significantly from cohort A to cohort B in both surgical and medical groups. However, advanced age, female gender, and previous myocardial infarction were significantly more common in cohort B than in cohort A for both treatment groups. CONCLUSIONS: These results indicate that during the study period, a significant decline in short-term mortality occurred for patients with angiographically documented coronary artery disease. Long-term survival did not, however, improve possibly due to a complex interplay between factors that promote coronary artery disease, eg, cigarette abuse and hypercholesterolemia, and factors that determine survival, eg, increase in age and history of prior infarction and advances in medical and surgical therapy.

Aged↗
PubMed2000

Pioneers in the scientific study of neonatal jaundice and kernicterus.

Neonatal jaundice must have been noticed by caregivers through the centuries, but the scientific description and study of this phenomenon seem to have started in the last half of the 18th century. In 1785 Jean Baptiste Thimotée Baumes was awarded a prize from the University of Paris for his work describing the clinical course in 10 jaundiced infants. The work by Jaques Hervieux, which he defended for his doctor of medicine degree in 1847, was, in many respects, a landmark. He had autopsied 44 jaundiced infants and apparently had clinical observations on many others. His descriptions of pathoanatomical findings were very detailed and systematic. A number of his clinical observations are still thought to be accurate today, such as the essentially benign nature of neonatal jaundice in most cases, the appearance of neonatal jaundice during the first 2 to 4 days of life as well as its disappearance within 1 to 2 weeks, and the cephalocaudal progression of jaundice. He described jaundice of the brain in 31 of his 44 autopsied cases, with variable intensity of staining. Johannes Orth was an assistant to the famous Virchow in Berlin, when in 1875 he published the results of an autopsy of a jaundiced term infant. The brain was notable for an intense yellow staining of the basal ganglia, the wall of the third ventricle, the hippocampus, and the central parts of the cerebellum. While the contribution of Orth was limited to this single case report, in 1903 Christian Schmorl presented the results of his autopsies of 120 jaundiced infants to the German Society for Pathology. All of these infants' brains were jaundiced, but only 6 cases demonstrated a staining phenomenon similar to that previously described by Orth. Schmorl coined the term kernicterus (jaundice of the basal ganglia) for this staining pattern. Although the following century of scientific study has added an enormous amount of information about the epidemiology and pathophysiology of neonatal jaundice and kernicterus, the contributions of Hervieux, Orth, and Schmorl will undoubtedly continue to be seen as historical landmarks in our quest for understanding of these phenomena.

France↗
PubMed2003

[Normalization of blood pressure and lipids in patients with diabetes].

Especially the macrovascular risk and the reduced life expectancy emphasize that besides the optimal glycemic control in diabetes, the associated factors of metabolic syndrome, namely hypertension and hyperlipidemia, have to be treated with equal intensity. This will minimize additional diseases (e. g., atherosclerosis, nephropathy, retinopathy) and take some of the strain from our health care system in the long run. This article contains the current guidelines for the optimal treatment of hypertension and hyperlipidemia in diabetic patients.

Antihypertensive Agents↗
PubMed2005

The effect of disease life history on the evolutionary emergence of novel pathogens.

We present a general analytical result for the probability that a newly introduced pathogen will evolve adaptations that allow it to maintain itself within any novel host population, as a function of disease life-history parameters. We demonstrate that this probability of "evolutionary emergence" depends on two key properties of the disease life history: (i) the basic reproduction number and (ii) the expected duration of an infection. These parameters encapsulate all of the relevant information and can be combined in a very simple expression, with estimates for the rates of adaptive mutation, to predict the probability of emergence for any novel pathogen. In general, diseases that initially have a large reproductive number and/or that cause relatively long infections are the most prone to evolutionary adaptation.

Adaptation, Physiological↗
PubMed2003

Glucagon-like peptide 1 and gastric inhibitory polypeptide: potential applications in type 2 diabetes mellitus.

Although the insulinotropic actions of gastric inhibitory polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) have been known for almost 2 decades, the incretin hormones have not yet become available for clinical application. This can be explained by their unfavourable pharmacological properties. Both hormones are rapidly inactivated by the enzyme dipeptidyl peptidase IV (DPP IV), yielding biologically inactive fragments. There have been several attempts to make use of the antidiabetogenic potential of the incretin hormones. Various analogues of GLP-1 and GIP have been generated in order to achieve resistance to DPP IV degradation. The natural GLP-1 receptor agonist exendin-4, found in the saliva of the Gila monster, has a longer biological half-life after subcutaneous injection than GLP-1, and inhibition of DPP IV using, for example, pyrrolidine derivatives provides elevated concentrations of intact, biologically active GIP and GLP-1 endogenously released from the gut. A continuous intravenous infusion of native GLP-1 for a limited time may be suitable in certain clinical situations. Numerous clinical studies are currently underway to evaluate these approaches. Therefore, an antidiabetic treatment based on incretin hormones may become available within the next 5 years.

Diabetes Mellitus, Type 2↗
PubMed2005

[Anemia in lung cancer patients].

Anemia and fatigue are frequent in lung cancer patients. Anemia is due to cancer and platinum-based chemotherapy. Anemia leads to a wide range of symptoms and affects health-related quality of life. Anemia also worsens outcome of therapy and prognosis. Efficient treatment exist: blood transfusion and recombinant erythropoietin. Early treatment of anemia is recommended as soon as diagnosis is made. But few patients receive optimal treatment. Its cost and unsolved question regarding therapeutic strategies may explain this phenomenon. This debate should not preclude correct treatment prescription. Clinical trials have to be preformed to clarify unsolved questions. As EPO administration can affect survival, this point should be of particular interest in future trials.

Anemia↗
PubMed1993

Clinical programme management: a model of promise?

As professionals working within a rapidly changing health care environment, it becomes critical to recognize alternatives for the management of clinical services to maximize the use of resources. However, it is also critical to remain constantly aware of the needs of valued and valuable employees, ensuring that the quality of working life is considered whenever any decisions are being made which will affect the work place. This paper reviews some of the literature related to decentralized structural models for health care institutions, and details the selection and implementation of one model in a major teaching hospital. The process of development from the initial idea through to the actual operationalization of a clinical programme management model is outlined, providing a critique of strengths and weaknesses of the model in the context of this particular organization.

Centralized Hospital Services↗
PubMed1989

Current experiences with the continent intestinal reservoir.

From November 1986 through October 1987, 71 patients received a continent intestinal reservoir at the Mississippi Baptist Medical Center. The mean age was 37 years (a range of 13 to 65 years). Coloproctectomy was necessary because of ulcerative colitis in 60, Crohn's colitis in eight and familial polyposis in three. A conventional ileostomy was converted to a continent intestinal reservoir in 54, while 13 received a continent intestinal reservoir at the time of the coloproctectomy. In four, the continent intestinal reservoir was constructed after removal of an ileoanal J pouch. Operative maneuvers of importance during valve construction included an intestinal collar, an isoperistaltic valve, stapling of the valve and electrocautery scarification of the serosa. Two patients experienced valve dessusception. The over-all operative revision rate for valve and pouch problems was 7 per cent. There were no deaths and no reservoirs have been removed. An improved quality of life was reported by almost all of those patients converted from a conventional ileostomy. The continent intestinal reservoir represents an attractive option for certain patients after coloproctectomy.

Adenomatous Polyposis Coli↗
PubMed1993

Vancomycin pharmacokinetics in neonates and infants: a retrospective evaluation.

OBJECTIVE: To evaluate the frequency with which current loading and maintenance vancomycin dosages achieve target serum concentrations based on pharmacokinetic parameters obtained after the initial dose. Also, to identify the daily vancomycin dosage necessary to achieve target serum concentrations at steady-state and to determine if any relationships exist between vancomycin pharmacokinetic parameters and various patient characteristics. SETTING: Neonatal intensive care unit (NICU) at Georgia Baptist Medical Center. PATIENTS/METHODS: Twenty-three infants with suspected or documented gram-positive infection who received intravenous vancomycin between July 1990 and November 1991 were included in this retrospective analysis. Gestational age range from 23 to 41 weeks and postconceptional age (PCA) at the time of the study ranged from 26 to 46 weeks. Vancomycin therapy was initiated with a loading dose of 15 mg/kg, followed by a maintenance dosage of 20-30 mg/kg/d, which was usually given as 10 mg/kg q8-12h. All vancomycin doses were administered using a syringe pump. Peak and trough serum concentrations were obtained following the first dose. Vancomycin pharmacokinetic parameters were determined using a one-compartment model. Infants receiving indomethacin within two weeks prior to study were analyzed separately (group 2, n = 4). All other infants were included in group 1 (n = 19). RESULTS: For group 1, vancomycin clearance (Cl), volume of distribution (Vd), and half-life were (mean +/- 1 SD) 0.072 +/- 0.032 L/kg/h, 0.52 +/- 0.08 L/kg, and 5.6 +/- 1.6 hours, respectively. For both groups, loading doses provided 1-hour postinfusion peak concentrations of 25-35 mg/L in one of every two infants studied, whereas only three percent of initial maintenance doses were projected to provide desired peak and trough concentrations at steady-state. For group 1, the mean daily dosage necessary to provide target peak (25-35 mg/L) and trough (5-10 mg/L) concentrations at steady-state was larger than that initially prescribed (29.6 +/- 13.1 vs. 22.2 +/- 4.7 mg/kg/d). For group 2, the mean daily dosage required to achieve target peak and trough concentrations at steady-state was smaller than that initially prescribed (14.8 +/- 4.3 vs. 20.0 +/- 0.1 mg/kg/d) and was exactly half of that required for group 1. Excellent correlations were observed between PCA and vancomycin Cl (L/h) (r = 0.92; p < 0.0001), body weight and Vd(L) (r = 0.94; p < 0.0001), body weight and vancomycin Cl (L/h) (r = 0.85; p < 0.0001), PCA and Vd (L) (r = 0.89; p < 0.0001), and body surface area and Vd (L) (r = 0.93; p < 0.0001) for group 1. Moderate correlations were also noted between PCA and Cl relative to body weight (L/kg/h), postnatal age and Cl (L/kg/h), and PCA and vancomycin dosage requirements (mg/kg/d). No linear correlation was observed between any patient characteristic and Vd standardized for body weight. CONCLUSIONS: Our data demonstrate the need for a more accurate method of estimating initial vancomycin dosage requirements in this NICU population. Although some of the relationships revealed in this study could be used to determine vancomycin dosage for infants in the range of approximately 30-36 weeks PCA, we hesitate to suggest this approach presently because of the potential limitations of our study design. Further prospective study is needed to confirm these observations. In addition, further study is necessary to describe the time course of the interaction between vancomycin and indomethacin in infants with successful and unsuccessful closure of their patent ductus arteriosus.

Female↗
PubMed2005

Current status of clinical trials for acute spinal cord injury.

Acute spinal cord injury (ASCI) occurs as a result of physical disruption of spinal cord axons through the epicenter of injury leading to deficits in motor, sensory, and autonomic function. This is a debilitating neurological disorder common in young adults that often requires life-long therapy and rehabilitative care, placing a significant burden on our healthcare system. While no cure exists, research has identified various pharmacological compounds that specifically antagonize primary and secondary mechanisms contributing to the etiology of ASCI. Several compounds including methylprednisolone (MPSS), GM-1 ganglio-side, thyrotropin releasing hormone (TRH), nimodipine, and gacyclidine have been tested in prospective randomized clinical trials of ASCI. MPSS and GM-1 ganglioside have shown evidence of modest benefits. Clearly trials of improved neuroprotective agents are required. Promising potential therapies for ASCI include riluzole, minocycline, erythropoietin, and the fusogen polyethylene glycol, as well as mild hypothermia.

Clinical Trials as Topic↗
PubMedDate not supplied

Modification of bed systems and use of accessories to reduce the risk of hospital-bed entrapment.

Despite the long history of hospital-bed use, only in the past decade have bed-related patient-safety hazards, including falls and life-threatening entrapment, been discussed publicly. Entrapment is an event in which a patient is caught, trapped, or entangled in hospital-bed components, including the bed rail, mattress, or hospital-bed frame. Since 1995, the Food and Drug Administration and the Joint Commission on Accreditation of Healthcare Organizations have issued patient-safety alerts about entrapment. While new beds are being manufactured without large gaps that would allow an individual's head, neck, or chest to become entrapped, it is incumbent upon healthcare providers, including rehabilitation nurses, to ensure the safety of older beds in use. This article describes a facility-based approach for identifying and managing risk related to hospital bed-entrapment to be used in rehabilitation settings.

Accident Prevention↗
PubMed2026

Age and early life adversity shape heterogeneity of the epigenome across tissues in macaques.

Age and early life adversity (ELA) are key determinants of health, but whether they affect similar physiological mechanisms across tissues is unknown. We generated DNA methylation (DNAm) profiles across 14 tissues in 237 semi-free-ranging rhesus macaques with naturally occurring ELA. Age-associated DNAm was predominantly tissue dependent, yet tissue-specific epigenetic clocks showed that epigenetic aging was relatively consistent within individuals. ELA effects were adversity dependent, but each ELA exerted coordinated effects across tissues. Although ELA targeted many of the same loci as age, the directions of effects differed, which indicates that ELA does not uniformly increase epigenetic age. Instead, ELA leaves a coordinated, cross-tissue epigenetic signature that is distinct from-yet intertwined with-age-related differences, which advances our understanding of how early environments sculpt the molecular foundations of aging and disease.

Animals↗
PubMed1990

Designing services for the elderly.

Even after careful planning and a successful launch, even the best geriatric care program can not always expect smooth sailing, according to industry executives. Allen Mathies, president and chief executive officer at Huntington Memorial Hospital, cited a paradoxical side effect stemming from the success of his hospital's geriatric outreach programs. "On the one hand, by moving patients through a continuum of outpatients services, our program has helped to reduce the extraordinary costs associated with acute care hospitalization," he said. "On the other hand, those patients who are hospitalized tend to be more acutely ill. They use tremendous resources, but at a fixed reimbursement. There is a lack of recognition of our real costs by the payer." Why, then, do Huntington Memorial Hospital, Baptist Medical Center of Oklahoma, Morton F. Plant Hospital, Northwestern Memorial Hospital and other hospitals intend to continue their efforts on behalf of their communities' aging populations? The answer is that, reimbursement problems notwithstanding, benefits can be derived from making a commitment to geriatric care. "We have 19,000 people enrolled in our elder care program," Hupfeld said. "That's a powerful force. They vote. They lobby on our behalf. They support the hospital philanthropically. If you do a good job of reaching the older adults in your community, you'll find they are a powerful marketing force. They can do a lot for your image when it comes to reaching other market segments."

Aged↗
PubMed2002

Low molecular weight fucoidan prevents neointimal hyperplasia in rabbit iliac artery in-stent restenosis model.

OBJECTIVE: Smooth muscle cell (SMC) proliferation within the intima is regulated by heparan sulfates. We studied a low molecular weight (LMW) fucoidan (sulfated polysaccharide from brown seaweed) on SMC proliferation in vitro and intimal hyperplasia in vivo. METHODS AND RESULTS: In vitro study revealed that LMW fucoidan reduces rabbit SMC proliferation and is internalized in SMC perinuclear vesicles. On rabbit iliac arteries perfused in vivo with fluorolabeled LMW fucoidan after angioplasty, the labeling was mainly located on sites of injury. Pharmacokinetic studies showed that LMW fucoidan exhibited in rats an elimination half-life of 56+/-25 minutes (n=8) after intravenous administration and a constant plasma rate for > or =6 hours after intramuscular administration. After stent implantation in their iliac arteries, rabbits were also treated with LMW fucoidan (5 mg/kg IM twice a day). Histomorphometric analysis at day 14 indicated that LMW fucoidan reduced intimal hyperplasia by 59% (1.79+/-0.4 versus 0.73+/-0.2 mm2, P<0.0001) and luminal cross-sectional area narrowing by 58% (0.38+/-0.08 versus 0.16+/-0.04, P<0.0001). Blood samples showed no anticoagulant activity due to LMW fucoidan. CONCLUSIONS: This natural polysaccharide with high affinity for SMCs and sustained plasma concentration markedly reduced intimal hyperplasia, suggesting its use for the prevention of human in-stent restenosis.

Angioplasty, Balloon↗
PubMed1994

Lifestyle and morbidity among blacks.

This descriptive study used the questionnaire method to investigate health lifestyle patterns of two Southern Black religious denominations. Baptists and Seventh-day Adventists (SDAs). The entire sample numbered 105 persons from urban centers. Responses of Baptists (N = 46) were compared with responses of Seventh-day Adventists (N = 59) on the seven health promoting practices identified in the studies of Belloc and Breslow (1972): hours of sleep, appropriate body weight, regularity of exercise, moderate alcohol consumption, smoking abstinence, regularity of breakfast and moderation of between meal snacks. This was the first research focusing on these health behaviors in a Black population in the South. Findings showed the groups to be significantly different only in smoking behavior, SDAs were more often nonsmokers. The salient implications for practice in this study are in the health education area for the individual, the family, the community and ethnic groups. This investigator submits that the church as a wider support system needs to be utilized by practitioners as a vehicle for client education. Several suggestions for further research are presented.

Adult↗
PubMed2006

Gas nuclei, their origin, and their role in bubble formation.

Gas bubbles are the primary agent in producing the pathogenic effects of decompression sickness. Bubble formation during decompression is not simply the consequence of inert gas supersaturation. Numerous experiments indicate that bubbles originate as pre-existing gas nuclei. Radii are on the order of 1 microm or less. Heterogeneous nucleation processes are involved in generating these gas entities. Musculoskeletal activity could be the main promoter of gas nuclei from stress-assisted nucleation. The half-life and faculty for nuclei to initiate bubble formation during decompression depend on many factors. Oxygen window and surface tension are involved in resolving bubbles. Two factors have been proposed to stabilize gas nuclei against dissolution: gas nuclei trapped in hydrophobic crevices and gas nuclei coated with surface-active molecules such as surfactants. Diffusion and surface tension could play an important role in the formation of gas nuclei crevices. However, while the concept of in vivo hydrophobic crevices remains a theoretical possibility, none have yet been identified in tissues and/or in microcapillaries. Moreover, while surfactants seem present in numerous tissues and could play a role in gas nuclei stabilization, they could also be involved in bubble elimination. The understanding of such mechanisms is of primary importance to neutralize nuclei and for modeling bubble growth. Here we present in a single document a summary of the original findings and views from authors in this field.

Animals↗
PubMed1993

Managing diverse occupational therapy resources in a creative, corporate model.

Two occupational therapy departments were amalgamated into a corporate whole and charged with the development of a workable, corporate structure. The departmental model which was developed served to enhance the concepts of quality of working life, employee autonomy, management team and quality circle theory. This paper provides a background from business and organizational literature, and outlines the development of the departmental model, in concert with the adoption of the client-centred model of occupational performance as a department basis for practice. This development was taking place concurrently with larger, institutional changes into a decentralized clinical programme management model. Discussion highlights the level of staff satisfaction with the changes, areas of concern during the development of the system and plans for the future growth. During this period of massive and critical change in the delivery of health care services, there has been a trend in restructuring health care institutions towards decentralized models. This paper will describe the experience of one occupational therapy department in developing an innovative departmental structure involving participatory management amalgamation. It is believed that the experience of the past occupational therapy work units with one viable option for a renewed management model. Staff skill sets can be maximized and optimal potential realized while faced with inevitable resource shrinkage and service reorganization.

Health Facility Merger↗