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At least 811 records · Page 45Linked to original sources
PubMed1996

A predictive model to identify Clostridium difficile toxin in hospitalized patients with diarrhea.

OBJECTIVES: Although Clostridium difficile is a common pathogen in hospitalized patients with diarrhea, no study has attempted to develop a predictive model to estimate the likelihood of C. difficile positivity. METHODS: We conducted a cross-sectional study at a single hospital of 271 patients with diarrhea for whom stool was tested for C. difficile toxin. The sample was randomly divided into a subset to derive the model (n = 180) and another to validate it (n =91), and independent predictors of toxin positivity were identified using logistical regression analysis. RESULTS: C. difficile toxin was present in 81 patients and absent in 190. In the derivation set, a positive toxin was independently predicted (p < 0.0005) by readmission within 2 wk of prior hospitalization, by a white blood cell count > or = 10,000/mm3, and by presence of fecal leukocytes. In the validation set, C. difficile toxin was present in 24, 29, and 77% of patients with 0, 1, and > or = 2 risk factors, respectively. CONCLUSION: If validated prospectively and/or other centers, the model could identify patients who should be considered for empirical management while awaiting results of toxin assays.

Aged↗
PubMed1991

[Population-based heart infarct register in the Augsburg region: possibilities and limitations].

Special procedures were developed to establish the Augsburg Coronary Event Register in accordance with the German data confidentiality laws. Contracts with the 26 hospitals in the study region and the adjacent ares (registration of 95% of all acute myocardial infarctions (AMI)) were specified to ensure their cooperation with the MONICA Project (WHO project Monitoring Trends and Determinants in Cardiovascular Disease). Written consent of the patients, declaring their participation in the project is required. Fatal events with suspected AMI within the study region (4% of male and 7% of female coronary deaths occur outside the region) are selected from the information in the anonymous death certificates provided by the three regional health departments. Each health department allocates an identification (ID) number to each event and sends a questionnaire for cause of death validation (MONICA questionnaire) to the last attending physician and/or the coroner. The register receives this information in anonymous form and links the MONICA questionnaire and the death certificate by means of the ID number. While data confidentiality laws do not impair case finding, they do restrict the validation of the diagnosis and person-based registration. The inclusion of fatal events with insufficient data on cause of death (25% of all registered fatal events) seems prudent to avoid underestimating attack rates and mortality, i.e. the AMI risk for the resident study population.

Cause of Death↗
PubMed1989

Dexamethasone in the treatment of acute mountain sickness.

Cerebral edema occurs in fatal cases of acute mountain sickness. Dexamethasone, commonly used to treat cerebral edema due to other causes, also reduces the symptoms of acute mountain sickness when given prophylactically. However, the efficacy of dexamethasone in the treatment of established acute mountain sickness remains uncertain. To investigate this question, we exposed six men in a hypobaric chamber to a simulated altitude of 3700 m (barometric pressure, 64 kPa [481 mm Hg]) for 48 hours on two occasions. Acute mountain sickness was diagnosed with use of a symptoms questionnaire, and dexamethasone (4 mg every six hours) or placebo was then given in a randomized, double-blind, crossover fashion. Dexamethasone reduced the symptoms of acute mountain sickness by 63 percent (P less than 0.05), whereas placebo had a minimal effect (reduction by 23 percent; P not significant). In spite of this response, one subject had mild cerebral edema on brain CT after both placebo and dexamethasone. Dexamethasone had no effect on fluid shifts, oxygenation, sleep apnea, urinary catecholamine levels, the appearance of chest radiographs or perfusion scans, serum electrolyte levels, hematologic profiles, or the results of psychometric tests. Dexamethasone treatment was complicated by mild hyperglycemia in all subjects (mean [+/- SE] glucose level, 7.3 +/- 1.3 mmol per liter [132 +/- 23 mg per deciliter]). We conclude that dexamethasone effectively reduces the symptoms of acute mountain sickness. However, it did not improve objective physiologic abnormalities related to exposure to high altitudes. We therefore recommend that dexamethasone be used only when descent is impossible, or to facilitate cooperation in evacuation efforts.

Acute Disease↗
PubMed1990

Random dot stereogram E in vision screening of children.

The random dot stereogram E (RDE) has been shown to be a simple and effective test for the detection of binocular abnormalities and defective visual acuity in children. We determined the validity of the RDE as a screening test for reduced visual acuity, amblyopia and strabismus in two separate populations of children. A nonselective group of 100 school children (aged 5 to 15 years) who presented consecutively to the ophthalmology department at Auckland Public Hospital were tested with the RDE. All cases of amblyopia and strabismus were detected by the RDE. Similar screening with the RDE test of 168 preschool children (aged three to four years) in the community resulted in an unacceptably high over-referral rate. The test was unreliable in the preschool age group because of difficulty in distinguishing between test failure and non-cooperation with the test. The low positive predictive value of the test in the younger age group suggests the test to be unsuitable for preschool vision screening.

Adolescent↗
PubMed2006

The questionable effectiveness of science spending by international conservation organizations in the tropics.

The general context of conservation in the tropics--in the Amazon basin and elsewhere--is stagnant or declining funding and rapidly growing threat levels. For conservation programs this makes strategic deployment of limited conservation resources all the more important. International conservation organizations active in the tropics increasingly define themselves as science driven and expend considerable resources on science-based activities such as ecoregional analysis, field research, and monitoring of ecological variables. l argue that an overemphasis on science has generated a series of unintended but serious problems for conservation in the tropics. Spending on monitoring and ecoregional analysis has effectively starved protection and threat analysis of resources. A decoupling of biology from serious cost-benefit analysis has led to the privileging of small-scale and local analyses, rather than the systemic analyses essential for the strategic allocation of scarce conservation resources. Successful conservation in the tropics depends on the crossing of biogeography with sophisticated threat analysis to identify priority geographies for protection. This should be combined with much more systematic engagement with the principal drivers of tropical deforestation, especially agribusiness. Caution and a sense of proportion are required when balancing the financial demands of science and those of protection. I suggest that conservation organizations should cooperate far more in assembling and analyzing information on conservation spending and on threat levels and biogeography at the continental, national, and regional levels. Site selection should follow rather than precede this kind of strategic analysis, and sites should be considered elements of a network rather than stand-alone projects. More attention should be paid to market-driven conservation through techniques such as certification and responsible supply-chain management.

Brazil↗
PubMed1975

A comparative study of daily followed by twice or once weekly regimens of ethambutol and rifampicin in retreatment of patients with pulmonary tuberculosis. The results at 1 year. A cooperative tuberculosis chemotherapy study in Poland.

The present report concerns the results at 1 year of a co-operative controlled clinical study carried out in Poland of the retreatment of patients with active, chronic, polyresistant far-advance pulmonary tuberculosis with an oral regimen of daily followed by intermittent ethambutol and rifampicin. A comparison was made of once- and twice-weekly supervised intermittent regimens of rifampicin 1200 mg plus ethambutol 50 mg/kg body weight under out-patient conditions after an initial inpatient phase of rifampicin 600 mg and ethambutol 25 mg/kg daily for 12 weeks. Patients were allocated at random to the regimens. Of 247 patients admitted to the study, 201 (81 per cent) completed 1 year's treatment as prescribed by the protocol, 46 (19 per cent) patients terminated their treatment prematurely before 1 year. After the daily phase of 12 weeks' treatment, 82 per cent were negative on smear and 85 per cent on culture; in the continuation intermittent phase, 98 per cent of patients in the once-weekly (E1R1) regimen were negative on culture at 28 weeks and 98 per cent in the twice-weekly (E2R2) regimen. The corresponding proportions at 52 weeks were 97 per cent and 97 per cent. At 12 months, 96 per cent of 101 ER/E1R1 and 96 per cent of 100 ER/E2R2 patients who completed 1 years' treatment were culture-negative.

Adolescent↗
PubMed2004

Methods and design considerations for randomized clinical trials evaluating surgical or endovascular treatments for cerebrovascular diseases.

OBJECTIVE: The results of clinical trials affect the practice of surgery and endovascular therapy for cerebrovascular diseases. The purpose of this report is to review the basic components of the designs and methods for randomized clinical trials and to describe the influence of those components on the interpretation of trial results. METHODS: The goal of an optimal clinical trial of a new procedure is to provide the most objective and rigorous evaluation of the safety and effectiveness of that procedure. Anything in the design, performance, or analysis that impairs such an assessment decreases the ability of the trial to achieve its goal and answer the research question. To highlight the components of a clinical trial, this report uses examples of Phase III clinical trials that have influenced the practice of cerebrovascular surgery and endovascular therapy in the past three decades, including the International Cooperative Study of Extracranial/Intracranial Arterial Anastomosis, the North American Symptomatic Carotid Endarterectomy Trial, the Asymptomatic Carotid Atherosclerosis Study, the Prolyse in Acute Cerebral Thromboembolism II study, and the International Subarachnoid Aneurysm Trial. RESULTS: The research question (objective) of the trial must be clearly defined, with an objective measure of efficacy and a specified quantitative difference to define the superiority of one intervention over another, in a relatively homogeneous patient population. Allocation concealment, randomization with or without stratification, and blinding (or masking) are important strategies to prevent differences in the study populations that could adversely affect the conclusions of the study. The primary end point must correspond to the specific aims of the trial. It should be objectively defined, quantifiable, reliable, and reproducible. Commonly defined end points in surgical trials include changes from baseline illness or disease severity scores, morbidity and mortality rates, and relative risks of reaching an end point with time. The statistical methods used for interim and final analyses are important. The effects of dropouts, crossovers, and missing data should be understood in the context of the final analysis. Additional concepts, such as intention-to-treat analysis and use of actual versus predicted outcomes, are important with respect to interpretation of the final results of the study. CONCLUSION: The neurosurgical and neuroendovascular communities are currently planning or conducting several clinical trials to evaluate new procedures for the treatment of cerebrovascular diseases. It is hoped that a better understanding of the components of clinical trials will facilitate the design and implementation of effective studies.

Angioplasty↗
PubMed1994

Diabetes-associated mesenteric vascular hypertrophy is attenuated by angiotensin-converting enzyme inhibition.

In experimental diabetes, the mesenteric vascular tree undergoes hypertrophy, and this is associated with an increase in mesenteric angiotensin-converting enzyme (ACE) levels. The aim of this study was to determine if inhibition of mesenteric ACE by ACE inhibition would influence diabetes-associated mesenteric vascular hypertrophy. Control or streptozocin-induced diabetic rats were randomized to receive no drug or the ACE inhibitor perindopril. In addition, other diabetic rats were randomized to receive either low-dose insulin that does not alter glycemic control or high-dose insulin, administered as a silastic pellet to achieve euglycemia. After 3 weeks, animals were killed for measurement of mesenteric ACE, vessel weight, and wall:lumen ratio. Diabetes was associated with increased mesenteric ACE levels, increased vessel weight, and an increase in the wall:lumen ratio. ACE inhibition, despite no effect on glycemic control, food intake, urinary urea excretion, or gut weight, prevented the increase in mesenteric ACE levels and attenuated mesenteric vascular hypertrophy as assessed by weight or wall:lumen ratio. The increase in staining by an antibody to the endothelial product, von Willebrand factor, in diabetic rats was totally prevented by perindopril treatment. Euglycemia but not low-dose insulin therapy in the diabetic rats normalized mesenteric vessel ACE, weight, and wall:lumen ratio. In conclusion, ACE inhibition may have a specific role in preventing diabetes-associated vascular hypertrophy, an important process in the genesis of micro- and macrovascular diabetic complications.

Angiotensin-Converting Enzyme Inhibitors↗
PubMedDate not supplied

From discord to accord.

Explore the source record for details and available documents.

Congresses as Topic↗
PubMed1990

[Effect of recombinant human granulocyte colony-stimulating factor (rG-CSF) on chemotherapy-induced neutropenia in patients with lung cancer].

In an attempt to evaluate rG-CSF for preventing and reducing the period of chemotherapy-induced neutropenia, phase II studies of the agent, KRN 8601, have been conducted in patients receiving chemotherapy for lung cancer. In the cooperative study, 53 patients with lung cancer were fully evaluated. The chemotherapy regimen for the patients enrolled in the study was not specified, but an identical regimen with an identical dose and schedule was mandatory for the first cycle in which the patients did not receive the rG-CSF, and for the following cycles in which they received it after completion of chemotherapy for 14 days consecutively. Patients were allocated to receive the agents either at a dose of 100, 200 or 400 micrograms/m2 via intravenous drip infusion; or at as ub cutaneous dose of 25, 75, or 125 micrograms. In the author's study, all the 9 patients with non-small cell lung cancer received a 3-drug combination of vindesine, ifosfamide, and cisplatin(VIP) at an identical dose throughout the cycles. The rG-CSF was administered on the second and the following cycles at a dose of 100 micrograms/m2, subcutaneously, in the same manner as the above. Myelogram and neutrophil functions, i.e., superoxide anion production, chemotactic, and phagocytic activity, were serially determined in these patients. With intravenous dose of 100 micrograms/m2, the rG-CSF considerably elevated the nadir count of neutrophils and significantly reduced the duration of neutropenia. Subcutaneously administered rhG-CSF at 75 micrograms doses did as with intravenous infusion. The optimal dose of the agent in conventional chemotherapy was estimated to be 100 micrograms/m2 when infused intravenously, and 75-125 micrograms subcutaneously. Subcutaneously administered rG-CSF at a dose of 100 micrograms/m2 did not contribute to spare the nadir count of neutrophils, but contributed toward reducing the period of neutropenia induced by the 3-drug combination which was much more myelosuppressive than conventional regimens. Thus, the optimal dose of the agent should be determined according to the dose-intensity of chemotherapy. Peripheral neutrophils obtained after recovery from VIP-induced neutropenia showed a normal activity in superoxide anion production and mobility when combined with rG-CSF, although the activity showed a trend to remain subnormal in the recovered neutrophils without rG-CSF. In conclusion, rG-CSF considerably reduces the neutropenia and possibly reduces infections caused by intensive chemotherapy. Hereafter, clinical trials must determine whether rG-CSF improve the therapeutic outcomes of patients receiving chemotherapy in terms of response rate and patient survival.

Adenocarcinoma↗
PubMed1994

Exact permutational tests for group sequential clinical trials.

An efficient numerical algorithm is developed for computing stopping boundaries for group sequential clinical trials. Patients arrive in sequence, and are randomized to one of two treatments. The data are monitored at interim time points, with a fresh block of patients entering the study from one monitoring point to the next. The stopping boundaries are derived from the exact joint permutational distribution of the linear rank statistics observed across all the monitoring times. Specifically, the algorithm yields the exact boundary generating function, Pr(W1 < b1, W2 < b2, ..., Wi-1 < bi-1, Wi = wi), where Wj is the linear rank statistic at the jth interim time point. The distribution theory is based on assigning ranks after pooling all the patients who have entered the study, and then permuting the patients to the two treatments independently within each block of newly arrived patients. The methods are applicable for an arbitrary number of monitoring times, which need not be specified at the start of the study. The data may be continuous or categorical, and censored or uncensored. The randomization rule for treatment allocation can be adaptive. The algorithm is especially useful during the early stages of a clinical trial, when very little data have been gathered, and stopping boundaries are based on the extreme tails of the relevant boundary generating function. In that case the corresponding large-sample theory is not very reliable. To illustrate the techniques we present a group sequential analysis of a recently completed study by the Eastern Cooperative Oncology Group.

Algorithms↗
PubMed1996

Banking cryopreserved heart valves in Europe: assessment of a 5-year operation in an international tissue bank in Brussels.

OBJECTIVE: The heart valve bank of the European Homograft Bank has been set up in 1988 to meet the growing demand of cardiac surgeons for various sized and quality controlled cryopreserved homografts. METHODS: Heart valve donors less than 60 years of age were classified in 3 categories: multiorgan donors with non transplantable hearts, recipients of cardiac transplantation and non beating heart cadavers with a warm ischemic time of less than 6 hours. Past history and biology were checked for transmissible diseases. Preparation, progressive freezing and storage in liquid nitrogen vapors, and quality control were according to the standards of the Belgian Ministry of Health. RESULTS: From end January 1989 to end May 1994, 989 homograft valves were cryopreserved (514 pulmonary, 475 aortic and 3 mitral) whereas 962 valves were discarded. The first cause of rejection being a major macroscopic lesion (41.48%). 138 hearts accepted at inspection were contaminated and 43 cases remained so after antibiotics. 38 cases were positive for hepatitis B or C. Complication at distribution and thawing included 10 instances of bag rupture and 15 of transversal fracture through the wall of the conduit. 477 aortic, 474 pulmonary valves as well as one mitral were implanted between May 1989 and May 1994, either for left or right ventricular outflow tract reconstruction. In the left ventricular outflow tract series 111 aortic and 23 pulmonary homograft valves were used in cases of native endocarditis, prosthetic endocarditis or recurrent endocarditis after homograft implantation. 9.6% of the requests could no be satisfied. Regular follow up information was available from 382 implants-40.1% only. CONCLUSIONS: The assessment of 5 years operation of the heart valve bank indicates: 1) the efficiency of selecting, cryopreserving and allocating quality controlled homograft valves from a large pool of donor hearts provided by a network of hospitals; 2) the difficulty of obtaining regular follow up information on the implants.

Belgium↗
PubMed2004

Rural Integrated Primary Care Psychiatry Programme: a systems approach to education, training and service integration.

OBJECTIVE: To describe the development of a rural primary care psychiatry programme, within a stepped collaborative care model. CONCLUSION: Development of a system-wide approach to the provision of mental health services offers the opportunity to increase the proportion of people with mental health problems who receive effective treatment. In addition, it enables allocation of resources and matching of interventions to patient preference and clinical need. This is particularly important in rural areas where there is a shortage of specialist mental health services and practitioners.

Community Health Workers↗
PubMed2004

'To each according to his needs': public libraries and socially excluded people.

To deliver a comprehensive and efficient service to all the community, public libraries must first identify needs and allocate an appropriate level of resources. This article focuses on public libraries in England. It outlines: the Government's policy on social inclusion; the needs of the various socially excluded groups; partnerships and funding; staff training and motivation; and examples of good practice.

Community Networks↗
PubMed1993

The dual epidemics of tuberculosis and AIDS: ethical and policy issues in screening and treatment.

As the recent increase in cases of tuberculosis is addressed, there is a danger that the need for increased protection of the public health will create a climate in which the rights of individuals with tuberculosis and human immunodeficiency virus (HIV) infection may be disregarded. This paper considers ethical and policy issues in the control of tuberculosis. The authors conclude that mandatory HIV testing is not critical to effective tuberculosis control, and that although individuals infected with HIV are at increased risk for developing tuberculosis, exclusionary employment practices are not justified. Because failure to complete the course of tuberculosis treatment increases the prospect that drug-resistant strains will develop, it is crucial to require all those who commence treatment to complete their therapy. To ensure the completion of treatment, special attention must be paid to the needs of the homeless, drug users, and those with psychiatric impairments. In addition, all tuberculosis patients should begin their posthospital care under direct observation. Patients who fail to complete treatment despite efforts to encourage and facilitate their cooperation should be subject to confinement after a hearing with full due process protections.

AIDS Serodiagnosis↗