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PubMed1992

Netilmicin plus ceftriaxone versus amikacin plus ceftriaxone in the treatment of infections in granulocytopenic patients.

For the treatment of febrile episodes in granulocytopenic cancer patients, a combination of bactericidal and intravenously administered broad spectrum agents is recommended. An aminoglycoside plus a beta-lactame (piperacillin, azlocillin or IIIrd generation cephalosporins) are the drugs of first choice in an empiric approach. Because of frequent parenteral interventions (e.g. catheters, cannulations) in thrombopenic patients with multifactorial immunosuppression, we consider the application of once daily drugs, such as ceftriaxone, netilmicin or amikacin. For single dose treatment (1st day two applications), we used ceftriaxone in combination with netilmicin or amikacin as the first approach and retrospectively evaluated 47 patients for efficacy and safety.

Adult↗
PubMed1993

Schizophrenic autism. 2. Proposal for a nomothetic definition.

Since its introduction by E. Bleuler in 1911, the so-called 'basic symptom' autism has often been considered cardinally important within schizophrenic symptomatology. A lack of precise definition and hence of reliability, however, has eroded the former importance of this term, which cannot be found in modern diagnostic systems. Using a specific text-analytical method, we evaluated all accessible publications on schizophrenic autism, focusing on the descriptive-empirical approach. The entire material was then summed up in five essential points, providing a possibly more reliable (nomothetic) explication of the complex term of autism.

Affective Symptoms↗
PubMed2004

Embolic protection with filtering or occlusion balloons during saphenous vein graft stenting retrieves identical volumes and sizes of particulate debris.

BACKGROUND: Distal embolization of plaque particulate liberated during stenting may cause periprocedural complications. The number, size, and volume of debris released during stenting, however, have not been quantified, rendering embolic protection approaches empiric. We used a novel method of microparticle size assessment to measure volume and characterize individual sizes of particles captured by the PercuSurge GuardWire balloon or a vascular filter during saphenous vein graft stenting. METHODS AND RESULTS: Braided nitinol filters (average distal pore size 100 microns) were used in 47 saphenous vein grafts in 44 patients. The PercuSurge GuardWire was used in 17 saphenous vein grafts in 16 patients. Particulate debris was subjected to microparticle size analysis (RapidVue, Beckman Coulter). All samples contained particulate debris. For both filter and GuardWire populations, most particles were <100 microm in longest dimension (87% and 90% of particles, respectively), and the distribution of particle sizes was identical. Total embolic load per lesion for both filters and GuardWire aspirates was also similar: median embolic load per filter was 16 mm3 (range 2 to 84 mm3). Median embolic load per GuardWire was also 16 mm3 (range 7 to 42 mm3). Histopathologic analysis demonstrated that most samples contained plaque elements and platelet-rich thrombus. CONCLUSIONS: During saphenous vein graft interventions, particulate retrieved with a vascular filtering device or an occlusion balloon was similar in amount and character. This supports the notion that unless soluble mediators play an important role in adverse acute clinical events after stenting, the clinical efficacy of filtering devices may be equal to that of occlusion devices.

Alloys↗
PubMed2003

Trefoil factor-2 is an allergen-induced gene regulated by Th2 cytokines and STAT6 in the lung.

Asthma, a complex chronic inflammatory pulmonary disorder, is on the rise despite intense ongoing research, underscoring the need for new scientific inquiry. In an effort to provide unbiased insight into the pathogenesis of this disease, we took an empirical approach involving transcript expression profiling of lung tissue from mice with experimental asthma. Employing asthma models induced by different allergens (ovalbumin [OVA] and Aspergillus fumigatus), we found strong induction of trefoil factor-2 (TFF2), a gene involved in epithelial restitution and mucosal secretion in the gastrointestinal tract. Using a combination of pharmacologic delivery and transgenic overexpression, TFF2 was demonstrated to be strongly induced in the lung by interleukin (IL)-4 and IL-13. Notably, TFF2 induction by both OVA and pharmacologic delivery of IL-4 and IL-13 was dependent upon signal transducer and activator of transcription (STAT)6. However, the upregulation of TFF2 by both chronic expression of IL-4 and Aspergillus fumigatus antigen was independent of STAT6. These results establish that TFF2 is an allergen-induced lung gene product differentially regulated by Th2 cytokines and STAT6. Given the important role of trefoil factors in wound healing, epithelial restitution, and maintenance of mucosal integrity in the gastrointestinal tract, these results support a potential role for TFF2, in both the acute and chronic phase of experimental asthma, via separate induction pathways.

Allergens↗
PubMed2006

Eotaxin-3 and a uniquely conserved gene-expression profile in eosinophilic esophagitis.

Eosinophilic esophagitis (EE) is an emerging disorder with a poorly understood pathogenesis. In order to define disease mechanisms, we took an empirical approach analyzing esophageal tissue by a genome-wide microarray expression analysis. EE patients had a striking transcript signature involving 1% of the human genome that was remarkably conserved across sex, age, and allergic status and was distinct from that associated with non-EE chronic esophagitis. Notably, the gene encoding the eosinophil-specific chemoattractant eotaxin-3 (also known as CCL26) was the most highly induced gene in EE patients compared with its expression level in healthy individuals. Esophageal eotaxin-3 mRNA and protein levels strongly correlated with tissue eosinophilia and mastocytosis. Furthermore, a single-nucleotide polymorphism in the human eotaxin-3 gene was associated with disease susceptibility. Finally, mice deficient in the eotaxin receptor (also known as CCR3) were protected from experimental EE. These results implicate eotaxin-3 as a critical effector molecule for EE and provide insight into disease pathogenesis.

Animals↗
PubMed1980

Interpersonal factors in the psychiatry clerkship: new findings.

The authors took an empirical approach to determining ingredients of a successful psychiatry clerkship. They collected measures of clinical, didactic, and interpersonal experiences throughout the clerkship and correlated these with a range of outcomes. Correlations showed that positive relationships with supervisors, fellow students, and patients were strongly related to favorable attitudes and opinions at the end of the clerkship and to improvements in self-rated clinical skills. Only outcomes related to formal knowledge were independent of these factors. These findings highlight the importance of structuring a positive interpersonal environment for the psychiatry clerkship.

Attitude of Health Personnel↗
PubMed1983

Different definitions of alcoholism, I: Impact of seven definitions on prevalence rates in a community survey.

The authors applied seven different sets of diagnostic criteria for alcoholism to data obtained by using the Schedule of Affective Disorders and Schizophrenia (SADS) in a community sample. They found that the different diagnostic schemes for alcoholism are hierarchical in the sense that some definitions identify smaller groups of subjects as alcoholic than do other definitions. This study illustrates a potentially useful empirical approach to comparing diagnostic criteria for psychiatric disorders in epidemiologic or clinical studies.

Adult↗
PubMed2003

Mental health.

OBJECTIVE: Only in the last 30 years has psychiatry begun to develop empirical approaches to conceptualizing and assessing positive mental health. Six models of mental health are reviewed here. METHOD: The author points out pitfalls in research on mental health, e.g., equating average with healthy, failing to distinguish trait from state, overlooking cultural norms, and conversely, blindly accepting the culture's values. He describes the six models and provides history and research needs for each. RESULTS: The first model, being "above normal," is epitomized by DSM-IV's axis V, the Global Assessment of Functioning Scale. High scores represent "superior functioning in a wide range of activities, life's problems never seem to get out of hand, is sought out by others because of his or her many positive qualities." The goal of the second model, positive psychology, is intervention to maximize positive qualities, such as self-efficacy. Maturity and Erikson's four developmental tasks (identity, intimacy, generativity, integrity) are the basis of the third model. The author adds two other tasks: career consolidation and "keeper of the meaning." The fourth model is emotional or social intelligence, the ability to read other people's emotions. Surprisingly, subjective well-being, the fifth model, is as much a characteristic of temperament as of a benign environment. The last model, resilience, is epitomized by DSM-IV's Defense Function Scale, which categorizes coping mechanisms in terms of adaptational value. CONCLUSIONS: As with the blind men and the elephant, each model describes only some aspects of mental health. Further research may reveal the contribution of each.

Achievement↗
PubMed2006

The gender structure of adolescent peer influence on drinking.

The interactions of adolescent peers are the subject of both parental angst and scholarly attention. Peer influence is the most consistent predictor of adolescent drinking patterns when controlling for other background characteristics. This study extends these findings to incorporate a theoretical argument derived from status characteristics theory. Using 2980 best-friend dyads constructed from the National Longitudinal Study ofAdolescent Health ("Add Health"), I show that the peer influence process differs by the gender structure of the friendship. Adolescents in same-sex best friendships influence one another mutually, consistent with prior theoretical and empirical approaches to adolescent problem behavior: By contrast, boys in mixed-sex best friendships have influence over their female friends' drinking patterns, while the girls do not have any effect on their male friends' drinking behavior a finding consistent with status characteristics theory. The results indicate that peer influence models that do not take gender into account in the structure of the friendship misrepresent the unequal influence dynamics between boys and girls.

Alcohol Drinking↗
PubMed2003

A validity study of expert judgment procedures for setting cutoff scores on high-stakes credentialing examinations using cluster analysis.

This study compares an expert judgment process--minimal performance levels (MPL) using the Nedelsky and Ebel procedures--for setting cutoff scores for pass/fail on licensure examinations with an empirical approach--cluster analysis. Data from all three components of the Canadian Standard Assessment in Optometry (CSAO) examinations (knowledge, clinical judgment, and clinical skills) from 243 candidates were obtained. Results indicate that for the written components of the exams employing the Nedelsky method of MPL setting, there was a mean agreement of pass/fail of 81% with the cluster analysis approach on pass/fail categorization. For the performance exams using the Ebel method, the mean agreement of pass/fail with the cluster analysis was 93%. Thus the subjective approaches to setting cutoff scores (i.e., expert judgment methods) converge with the objective method (i.e., cluster analysis) of classifying test takers in the same categories.

Canada↗
PubMed1983

The effect of nonlinear transformations on a Likert scale.

The analysis of data collected from behavioral assessment instruments is typically conducted using parametric statistics, with little or no reference given to the underlying nature of the scale being used. If the nature of the distances between the scale points is not understood, the concept of normality of the distribution becomes clouded. An empirical approach to studying this problem was developed, using responses to a clinical performance evaluation instrument that uses a four-point behaviorally-anchored scale. Various combinations of nonlinear transformations were applied to the evaluation responses. The factorial structure of the fifteen items constituting the evaluation form was minimally affected by the transformations, suggesting that parametric statistics can be applied to behaviorally-anchored rating scales.

Clinical Clerkship↗
PubMedDate not supplied

Using explicit decision rules to manage issues of justice, risk, and ethics in decision analysis: when is it not rational to maximize expected utility?

Concepts of justice, risk, and ethics can be merged with decision analysis by requiring the analyst to specify explicity a decision rule or sequence of rules. Decision rules are categorized by whether they consider: 1) aspects of outcome distributions beyond central tendencies; 2) probabilities as well as utilities of outcomes; and 3) means as well as ends. This formulation suggests that distribution-based decision rules could address both risk (for an individual) and justice (for the population). Rational choice under risk if choices are one-time only (vs. repeated events) or if one branch contains unlikely but disastrous outcomes might ignore probability information. Incorporating risk attitude into decision rules rather than utilities could facilitate use of multiattribute approaches to measuring outcomes. Certain ethical concerns could be addressed by prior specification of rules for allowing particular branches. Examples, including selection of polio vaccine strategies, are discussed, and theoretical and practical implications of a decision rule approach noted.

Beneficence↗
PubMedDate not supplied

Cost-effectiveness of repeat medical procedures: kidney transplantation as an example.

The constraints on medical-care resources can give rise to the question of the cost-effectiveness of permitting repeat medical procedures when some patients may die without undergoing even a first procedure. Using kidney transplantation as an example, this study estimates the cost-effectiveness of patients' having available the option of a repeat medical procedure in the event the first procedure fails. Specifically, the analysis examines the effect on transplant candidates of having the option of kidney retransplantation, if and when retransplantation might be needed. Data sources include the U.S. Renal Data System (USRDS) Case-Mix Severity Study, Health Care Financing Administration (HCFA) data, and a MEDLINE search. Outcome measures include life expectancy, quality-adjusted life expectancy, lifetime costs of medical care, and marginal cost-effectiveness from a societal perspective. By avoiding lifelong dialysis after graft failure, first-transplant candidates gain an average of 47 quality-adjusted days with a retransplantation policy, despite the prolongation of time to first transplant by an average of 30 quality-adjusted days. The lifetime cost of medical care per first-transplant candidate is $1,210 higher with a retransplantation policy compared with the no-retransplantation policy; its societal cost-effectiveness is estimated to be $9,656 per quality-adjusted life-year saved. The retransplantation policy provides the greatest improvement in quality-adjusted life expectancy for younger candidates. In the case of kidney transplantation, the cost-effectiveness of a repeat transplant, on average, compares favorably with those of other medical strategies in common practice. As resources become increasingly constrained, this study demonstrates a framework for considering the cost-effectiveness of repeat medical procedures.

Adolescent↗
PubMed1989

DSM-III in residency training: results of a Canadian survey.

The authors surveyed directors of residency training as well as residents across Canada to determine the extent to which DSM-III has been incorporated into the Canadian psychiatric residency training programs, how this has been accomplished, and the respondents' assessment of certain effects of DSM-III on residency training. This study is a replication of an earlier study done by another team in the United States. Our study indicates that, in most cases, the attitude towards DSM-III was positive: 100% of respondents described the system as useful or somewhat useful in the training settings. The most frequently selected positive features were its value as a common language, an aid in differential diagnosis, its empirical approach and specificity or clarity of the criteria. The criticisms frequently centred on the DSM-III's potential to induce a false impression of all encompassing theoretical knowledge, to be misused in a mechanistic manner as a "cookbook", and on the DSM-III's inadequacy with some patients (for example, children, neurotic disorders, and personality disorders).

Attitude of Health Personnel↗
PubMed2000

Prenatal and breast milk morphine exposure following maternal intrathecal morphine treatment.

A case of an infant who had morphine exposure during and following pregnancy while her mother was treated with intrathecal (i.t.) morphine is presented along with a review of the relevant literature. Successful maternal pain management was achieved during pregnancy and while breastfeeding. Minimal maternal serum and breast milk levels in the first 7 postpartum weeks were found. Also, infant sleep and arousal behavior and general development at 2 and 7 months were unremarkable, illustrating the possible safe and efficacious use of i.t. morphine during and following pregnancy. Further work is required to understand opioid pharmacology during breastfeeding, which will be used to develop an empirical approach to breastfeeding and morphine use.

Adult↗
PubMed2001

The principle of respect for autonomy in the care of nursing home residents.

Respect for autonomy is well known as a core element of normative views on good care. Most often it is interpreted in a liberal way, with a focus on independence and self-determination. In this article we argue that this interpretation is too narrow in the context of care in nursing homes. With the aim of developing an alternative view on respect for autonomy in this setting we described four interpretations and investigated the moral intuitions (i.e. moral judgements) of caregivers regarding these approaches. We found that these caregivers seemed to value different notions relating to respect for autonomy under different circumstances. There was no significant difference in moral judgements between men and women or between doctors and nurses. We conclude that a multidimensional understanding of this principle would best fit this context. We end this article with a description of a modest theory of respect for autonomy in nursing homes.

Adult↗
PubMed1983

Adjusting heparin infusion rates from the initial response to activated coagulation time.

A mathematical description of the dose-response curve of heparin to the activated coagulation time is applied retrospectively to 20 patients treated with continuous heparin infusion. The adjusted heparin dose was compared with a calculated prediction using the theoretical mathematical model. The main actual dose was 28 U/kg/h, and the mean predicted dose was 25.8 U/kg/h. The correlation coefficient was 0.862 (p3 0.05). These data are used to develop a dosing adjustment chart. Special considerations prior to using the calculation or dosing adjustment chart are discussed. The use of this model may allow the clinician to determine more rapidly a therapeutic heparin dosage than previous empiric approaches.

Adult↗