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At least 955 records · Page 53Linked to original sources
PubMed1998

Sickle cell disease: clinical management.

Sickle cell syndromes are a group of inherited disorders of haemoglobin structure that have no cure in adults at the present time. Bone marrow transplantation in children has been shown to be curative in selected patients. The phenotypic expression of these disorders and their clinical severity vary greatly among patients and longitudinally in the same patient. They are multisystem disorders and influence all aspects of the life of affected individuals including social interactions, family relations, peer interaction, intimate relationships, education, employment, spiritual attitudes and navigating the complexities of the health care system, providers and their ancillary functions. The clinical manifestations of these syndromes are protean. In this review emphasis is placed on four sets of major complications of these syndromes and their management. The first set pertains to the management of anaemia and its sequelae; the second set addresses painful syndromes both acute and chronic; the third set discusses infections; the fourth section deals with organ failure. New experimental therapies for these disorders are briefly mentioned at the end. Efforts were made to include several tables and figures to clarify the message of this review.

Adult↗
PubMed2002

Peering inside lipid rafts and caveolae.

Clustering of proteins into membrane microdomains, such as lipid rafts and caveolae, could act as a mechanism for regulating cell signaling and other cellular functions. Certain lipid modifications are hypothesized to target proteins to these domains on the cytoplasmic leaflet of the plasma membrane. This concept has now been tested in living cells using an assay sensitive to the lateral distribution of proteins in membranes over sub-micron distances.

Animals↗
PubMed2002

The identification of functional modules from the genomic association of genes.

By combining the pairwise interactions between proteins, as predicted by the conserved co-occurrence of their genes in operons, we obtain protein interaction networks. Here we study the properties of such networks to identify functional modules: sets of proteins that together are involved in a biological process. The complete network contains 3,033 orthologous groups of proteins in 38 genomes. It consists of one giant component, containing 1,611 orthologous groups, and of 516 small disjointed clusters that, on average, contain only 2.7 orthologous groups. These small clusters have a homogeneous functional composition and thus represent functional modules in themselves. Analysis of the giant component reveals that it is a scale-free, small-world network with a high degree of local clustering (C = 0.6). It consists of locally highly connected subclusters that are connected to each other by linker proteins. The linker proteins tend to have multiple functions, or are involved in multiple processes and have an above average probability of being essential. By splitting up the giant component at these linker proteins, we identify 265 subclusters that tend to have a homogeneous functional composition. The rare functional inhomogeneities in our subclusters reflect the mixing of different types of (molecular) functions in a single cellular process, exemplified by subclusters containing both metabolic enzymes as well as the transcription factors that regulate them. Comparative genome analysis, thus, allows identification of a level of functional interaction between that of pairwise interactions, and of the complete genome.

Animals↗
PubMed2003

Mice expressing only covalent dimeric heparin binding-deficient lipoprotein lipase: muscles inefficiently secrete dimeric enzyme.

Lipoprotein lipase (LpL) hydrolyzes triglycerides of circulating lipoproteins while bound as homodimers to endothelial cell surface heparan sulfate proteoglycans. This primarily occurs in the capillary beds of muscle and adipose tissue. By creating a mouse line that expresses covalent dimers of heparin-binding deficient LpL (hLpLHBM-Dimer) in muscle, we confirmed in vivo that linking two LpL monomers in a head to tail configuration creates a functional LpL. The hLpLHBM-Dimer transgene produced abundant activity and protein in muscle, and the LpL was the expected size of a dimer (approximately 110 kDa). Unlike the heparin-binding mutant monomer, hLpLHBM-Dimer had the same stability as nonmutated LpL. The hLpLHBM-Dimer transgene prevented the neonatal demise of LpL knockout mice; however, these mice were hypertriglyceridemic. Postheparin plasma LpL activity was lower than expected with the robust expression in muscle and was no longer covalently linked. Studies in transfected cells showed that Chinese hamster lung cells, but not COS cells, also degraded tandem repeated LpL into monomers. Thus, although muscle can synthesize tethered, dimeric LpL, efficient production of this enzyme leading to secretion, and physiological function appears to favor secretion of a noncovalent dimer composed of monomeric subunits.

Amino Acid Sequence↗
PubMed1992

Self-reported depressive symptoms in first-grade children: developmentally transient phenomena?

The question of whether self-reported depressive symptoms in young children represent more than transient developmental phenomena was examined in an epidemiologically defined sample of 1,313 first graders. Children's reports of depressive symptoms were relatively stable over a 4-month interval. The level of stability was particularly impressive for children initially in the highest quartile of depression, of all whom remained in the highest quartile at retest, 4 months later. In addition, depressive symptoms were significantly related to the negotiation of a number of salient developmental tasks at entrance to first grade, including academic achievement, peer relations, and attention/concentration in the classroom. Moreover, the relationships between depressive symptoms and the various indices of social and academic functioning remained stable over the 4-month test-retest interval.

Achievement↗
PubMedDate not supplied

Utilization management of workers' compensation: outpatient physical therapy.

Workers' compensation insurance carriers are becoming aware of the potentially high cost of physical therapy. Utilization management of outpatient physical therapy by means of a precertification process is a relatively new development in workers' compensation. Physical therapy treatment plans are reviewed by peers to ensure that proposed care is appropriate and cost-effective and that past care has resulted in measurable, objective, functional progress. Treatment plans are thus either certified or noncertified, or changes are negotiated. Ongoing care is monitored to facilitate the patient's progress through appropriate phases of physical therapy toward "maximum medical improvement."

Ambulatory Care↗
PubMed1998

Function of reinserted abductor muscles after femoral replacement.

We compared two methods of reconstruction of the abductor mechanism in 15 patients after prosthetic replacement of the upper femur, to assess abductor strength and function. Six patients in group I had direct fixation of the gluteus medius tendon and a segment of the original bone to the prosthesis. Nine patients in group 2 had the abductor tendon fixed to the iliotibial band. We assessed clinical function, isometric muscle strength and muscle cross-sectional area for each patient. The patients in group 1 had better clinical and functional results (p = 0.059), with average peak torques for hip abduction of 92% of that in the non-operated leg in group 1, and of 57% in group 2. Group 1 had a mean muscle cross-sectional area of 69% and a mean value of strength per cross-sectional area of 134% when compared with the control side. The respective values for group 2 were 52% and 91%. Direct fixation of the abductor muscles to the prostheses gave improved function and higher isometric abductor muscle force.

Adolescent↗
PubMed1981

Inhibition of ovarian function in subordinate female marmoset monkeys (Callithrix jacchus jacchus).

Plasma concentrations of progesterone, cortisol, LH and prolactin were measured in dominant and subordinate female marmosets in 10 well-established peer groups. Subordinate females never ovulated, had a reduced LH response to LH-RH and showed no positive feedback LH surge after oestrogen administration. There was no evidence of elevated plasma cortisol levels or hyperprolactinaemia in subordinates and all showed a similar prolactin response to TRH in comparison with dominants. However, subordinates showed a reduced prolactin response to metoclopramide. These results clearly indicate that high circulating levels of cortisol or prolactin are not responsible for the inhibition of ovulation in female marmosets.

Animals↗
PubMed1998

Anxiety and burnout in the health care work environment.

Burnout is linked to many problems of employees and to organizational effectiveness. Using the Maslach Burnout Inventory and the State-Trait Anxiety Inventory, this study considered the effects of the trait (a personality characteristic), and the state (a response to stressful stimuli) of anxiety to perceived burnout. Analysis showed that scores on both trait and state anxiety were significantly related to scores on burnout. Moderators, including characteristics of the work environment, as measured by selected subscales of the Work Environment Scale were evaluated for their influence on the anxiety-burnout linkage. Peer and supervisory support, age, and prior knowledge of work-day situations moderated anxiety about burnout. Other work environment factors functioned as independent predictors of burnout.

Adult↗
PubMed2003

Overrating pornography as a source of sex information for university students: additional consistent findings.

This study is an empirical investigation of how 175 university students obtained their knowledge of sexual matters and whether pornography functioned as an important source. Analysis indicated that pornography does not play an important role in the dissemination of sexual information; peers appear to be the primary source. There are, however, certain statistically significant differences between the sexes in reports of the extent of specific sexual information from pornography on matters such as oral and anal intercourse. The findings extend research on pornography as a source of sex information and are contrasted with previous studies.

Adolescent↗
PubMed1985

Ecology of adolescents' marijuana abuse.

Sixteen adolescent marijuana abusers reported data on the ecology of their use over a 3-month period. Abusers recorded data on the day, date, time, place, frequency, and amount of use. They also included information on their mood and functioning, and with whom they used marijuana. Peak use occurred just prior to school, at lunch, and in the early evening. Adolescents' homes, friends' houses, school, and cars represented 67% of locations in which marijuana was used. Happy, relaxed, and tired comprised 81% of moods experienced during time of use. Average core network was 5.8 individuals while casual networks averaged 15.5 adolescents. Presence of others during use was associated with abusers' increased use and decreased functioning.

Adolescent↗
PubMed1999

Emotional reactions of haemophilia health care providers.

This study investigated the prevalence and impact of job burnout and job satisfaction among health care professionals working with HIV-infected patients with haemophilia, using a survey that included the Maslach Burnout Inventory (MBI). A minority (7.4%) of the 213 respondents met the criteria for job burnout as assessed by the MBI. Nearly 90% of the respondents reported 'liking' their job, although only 46% anticipated being in the same job in 5 years. The following factors were associated with increased degrees of burnout: greater perceived colleague stress, less overall job satisfaction, greater perceived stress in the working environment, fewer team meetings and fewer years of career experience. Mental health professionals were also less likely than physicians to report burnout. A multiple logistic regression found that providers who reported stress with colleagues were 42% more likely than their peers to be classified as experiencing a high level of job burnout. This study underscores the importance of a well-functioning team in buffering the inevitable stresses of caring for haemophilia patients with HIV.

Burnout, Professional↗
PubMed1983

Graphic analysis of pharmacy workload as a management tool.

As pharmacy planners implement modern services and cost containment measures, a graphic analysis of pharmacy workload can assist the planner in better utilizing personnel time and assuring adequate time for the completion of additional functions by depicting the peak-trough relationship of workflow. Such analysis can be an effective tool to communicate to both peers and superiors.

Hospital Bed Capacity, 300 to 499↗
PubMed1999

Do we need new supraglottic devices? Clinical appraisal of the cuffed oropharyngeal airway (COPA)

BACKGROUND: The laryngeal mask airway (LMA) has been widely studied for both conventional and nonconventional uses, while the literature on the cuffed oropharyngeal airway (COPA) is still limited. The purpose of this manuscript was to review the initial appraisal of efficacy, safety, effects on hemodynamics and respiratory function, induction agents and drug requirements of this new supraglottic device. METHODS: We reviewed main results of studies recently published on peer reviewed journals concerning the clinical uses of COPA. RESULTS: When used in healthy adults undergoing general anesthesia for routine minor procedures, the COPA and LMA are substantially equivalent. The LMA is associated with a higher first-time placement rate and fewer manipulations during usage, but the incidence of airway untoward events during COPA anesthesia is equivalent to that reported when using an LMA. The quality of breathing and capnography during COPA ventilation is similar to that provided by the LMA ventilation, with clinically relevant decrease in the physiological deadspace/tidal volume ratio and arterial to end-tidal CO2 tension difference compared with facemask ventilation. In selected patients without risk factors for regurgitation of gastric content, positive-pressure ventilation is similarly successful and safe with the COPA as with the LMA. The COPA seems to be less stimulating than LMA because it has been demonstrated to cause a lower incidence of pharyngeal trauma and sore throat in the immediate postoperative period, requires shorter exposure to an inhalational anesthetic and lower concentrations of propofol to be successfully placed, and is associated with lower effects on the patient's hemodynamic homeostasis than LMA. CONCLUSIONS: More extensive clinical evaluations should be advocated to better understand the risk/benefit ratio of this new supraglottic device; however, it may be concluded that in healthy adults receiving general anesthesia for short procedures the COPA allows for an effective and safe control of the patient's airway and ventilation.

Adult↗
PubMed1992

[Quality assurance in psychiatry--is it possible?].

The assessment of quality depends on the eye of the beholder, the patient, the clinician and his colleagues or society/third party payers. There are already several structures that regulate quality: training requirements, judicial control commissions and public health authorities, and in psychiatry also individual supervision and extensive clinical meetings. Most clinical parameters in psychiatry are measurable, but there remains the elusiveness of mental processes, which often defies quantification. Levels of symptoms and functioning, however, can be scored. Computerisation of macro-data often permits useful comparisons, as may consensus conferences and consultations with peers. The essence of quality monitoring is to find indicators that predict results and also reflect the most important situations and problems.

Mental Health Services↗
PubMed2003

My life since my head injury.

Nancy Bauser describes her experiences as a brain injury survivor and her quest to recover. After surviving an automobile accident in 1971, Bauser relearned how to walk, talk, and function independently. Despite her physical limitations, she completed undergraduate studies and her graduate degree in social work. Her current work includes peer counseling and conducting acceptance groups with survivors of brain injury and other traumatic disorders at outpatient treatment facilities.

Adaptation, Psychological↗
PubMed1988

Neuropsychologic and academic functioning of children with sickle cell anemia.

This study compared neuropsychologic test results and academic functioning among 28 school-age children with sickle cell anemia (SCA), and 28 healthy, age-, sex-, and socioeconomically matched black peers followed at a tertiary care center. Children with SCA scored significantly lower on reading and spelling achievement scores than healthy matched peers. Also, older children with SCA performed significantly less well on tests of visual-motor and attention skills than younger children with SCA. These results were unrelated to most measures of physical illness severity. The data suggest that sickle cell anemia may be associated with subtle neuropsychological and learning deficits that can contribute to decreased school performance.

Adolescent↗
PubMed1995

[Ambulatory behavior therapy in obsessive-compulsive disorders].

The term Obsessive Compulsive Disorder (OCD) is a label for a variety of syndromes with changing symptom configurations and different intraindividual as well as interactional functions. They are among the most difficult to treat psychiatric disorders. Heterogeneous variables affecting personal development in family, school, and peer-group, as well as genetic or brain organic variables contribute to the development of obsessions and compulsions. In more than 50% of patients with OCD we find one or more of the following disturbances before the outbreak of the disorder: low self-esteem; social deficits; increased anxiety level with increased, latent aggressiveness; striving for 100% security. Behaviour therapy today is the "treatment of choice" for OCD--both in respect of direct symptom reduction as well as the treatment of "causes", co-morbidity and risk factors. Additionally to the use of highly standardised "symptom techniques" individualized, multimodal treatment is necessary in the more severely disturbed patients. Long-term follow-up results show 50-80% success--probably depending on variations in the study samples regarding the type of obsessions and compulsions, the degree of developmental deficits before the occurrence of OCD, actual co-morbidity, and professional as well as private life conditions. Whether and to what degree additional psychotropic medication can enhance the efficacy of behaviour therapy, and whether the high relapse rates of 70% after discontinuation of previously successful drug treatment can be reduced by concomitant or subsequent behaviour therapy, cannot be safely concluded from the currently available studies. Are the non-responders in each of these treatments the responders of the non-responders in the alternative treatment mode?

Ambulatory Care↗