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Biomedical subjects

A Shakespeare

Publications and source records attributed to A Shakespeare.

14 recordsLinked to original sources
PubMed2006

A method for determining the extent of thermal burns in elephants.

A practical method was developed to assess the extent of burns suffered by elephants caught in bush fires. In developing this method, the surface areas of the different body parts of juvenile, subadult and adult elephants were first determined using standard equations, and then expressed as a percentage of the total body surface area. When viewed from a distance, the burnt proportion of all body segments is estimated, converted to percentages of total body surface area, and then summed to determine the extent of burns suffered.

Age Factors↗
PubMed2006

Investigating the depth of thermal burns in elephants.

Histological examination of burn injuries in elephants revealed that the depth was not as severe as expected from clinical observation. Although the actual burn depth was deep, the thickness of elephant skin, especially the dermis, resulted in the lesions being classified as less severe than expected. Examination of skin samples from selected areas showed that most lesions were either superficial (1st degree) or superficial partial-thickness (superficial 2nd degree) burns with the occasional deep partial thickness (deep 2nd degree) wound. These lesions however, resulted in severe complications that eventually led to the death of a number of the elephants.

Animals↗
PubMed2000

The impact of metrifonate therapy on caregivers of patients with Alzheimer's disease: results from the MALT clinical trial. Metrifonate in Alzheimer's Disease Trial.

OBJECTIVE: To assess the impact on burden reported by caregivers of patients with mild to moderate Alzheimer's disease (AD) who were treated with metrifonate during a randomized double blind clinical trial. DESIGN: Randomized clinical trial, with a 2-week screening period and a 26-week double blind, placebo controlled, treatment phase. Caregivers were assessed at baseline, at 12 weeks, and at end of trial. SETTING: Caregivers were interviewed at clinics as part of the assessment of the patients. PARTICIPANTS: Six hundred and three caregivers of AD patients who were enrolled in the MALT trial; 591 (98%) provided data suitable for analysis at baseline, and 546 (91%) provided data allowing for inclusion in the analysis of change scores. MEASUREMENTS: The Caregiver Burden Assessment consisted of the Screen for Caregiver Burden, including both subjective (SCB-subj) and objective (SCB-obj) scores; the cognitive subscale of Poulshock and Deimling (PD); an abridged version of the Relatives Stress Scale (aRSS); assessments of time spent in providing care, including the Caregiver Activity Time Scale (CATS); and demographic and background variables on both the patient and caregiver. RESULTS: Treatment of mild to moderate AD patients with metrifonate for a duration of 26 weeks significantly reduced the psychological burden of care to the caregivers, as measured by the SCB-subj, the PD, and the aRSS. There were no statistically significant differences on the measures assessing the time spent in caregiving, except for the caregiver's subjective impression of the change in time spent providing care during the trial. When comparing individual dose groups, most of the measures of burden showed the largest benefits in burden for the 60/80 mg group, followed by the 40/50 mg group, and then the placebo group. However, there was no statistically significant dose effect. CONCLUSIONS: This study provides the first evidence from a randomized clinical trial of any acetylcholinesterase inhibitor used in the treatment of AD demonstrating a positive impact on the patient's caregiver as well as benefits to the patient. These results were shown consistently across several measurement scales and were observed after six months of treatment. These findings reinforce the clinical significance of research that has shown that metrifonate has beneficial impacts on the cognitive, behavioral, and functional abilities of AD patients. Because caregiver burden is a leading factor in the decision for institutional care placement, the ability to favorably impact that burden through pharmacological treatment of the patient is important.

Aged↗
PubMed1998

Economic analysis of epilepsy treatment: a cost minimization analysis comparing carbamazepine and lamotrigine in the UK.

New anti-epileptic drugs differ from existing standard therapies not in their clinical efficacy, but in their side-effects profiles. To determine the relative economic value of these agents, one must compare drug costs, costs of resources employed in the management of adverse events, and costs associated with therapeutic switching. In this economic analysis, carbamazepine (CBZ) and lamotrigine (LTG) are evaluated in monotherapy treatment of partial and/or general tonic-clonic seizures in the UK. Adverse event and tolerability data are obtained from a published randomized controlled trial of CBZ vs. LTG. A Delphi panel of clinicians advised treatment patterns for adverse events. Cost data are obtained from public sources. Results show that CBZ therapy costs about one-third of LTG therapy (pound sterling 179 for CBZ vs. pound sterling 522 for LTG) even after the costs associated with the management of adverse events and therapeutic switching are considered.

Anticonvulsants↗
PubMed1996

A new decision model for cost-utility comparisons of chemotherapy in recurrent metastatic breast cancer.

In the absence of comparative clinical and pharmacoeconomic trial data for docetaxel versus paclitaxel as second-line therapy for patients with anthracycline-resistant metastatic breast cancer, a computer-based decision-analysis model was designed to evaluate the comparative utility to patients of these two taxoids. The model used the Markov process to analyse disease states (response, stable disease, progressive disease) and toxicities (acute, cumulative) for each treatment during the period from commencement of up to six 3-weekly cycles of chemotherapy, to death. A cost-utility analysis was carried out using the model, with a probability, a cost and a utility determined for each health state. Response rates were obtained from clinical trial data supplemented by expert clinical opinion. Costs were taken from UK national databases and published sources and the published UK prices of docetaxel and paclitaxel. Utilities for the various health states were established by use of standard gamble and visual analogue methods assessed by 30 oncology nurses in the UK who were acting as proxy patients. The results of the model showed that response rate is the key parameter determining the utility and cost utility of treatments for metastatic breast cancer. Although the total per-patient cost associated with docetaxel was marginally higher than that for paclitaxel (8233 pounds vs 8013 pounds), the higher response rate associated with docetaxel produced an improvement in utility to the patient at an incremental healthcare cost that is acceptable according to available defined limits. Sensitivity analyses revealed that, although the model was sensitive to changes in response rate and drug costs, the cost-utility ratio for docetaxel versus paclitaxel varied within acceptable limits in response to all likely changes in key parameters. In summary, in the base case used in this model, docetaxel produces a substantially larger utility benefit than paclitaxel, at a small additional cost per QALY gained (equivalent to 7 pounds per additional day of perfect health).

Breast Neoplasms↗
PubMed1996

Preferences for schizophrenia-related health states: a comparison of patients, caregivers and psychiatrists.

Health state preferences are important for evaluating the outcomes of medical treatment. This study examined preferences of patients for schizophrenia-related health states and compares patient preferences with those of caregivers and psychiatrists. Health-state descriptions were developed for five different outcomes likely to be experienced by schizophrenic patients. Forty-nine schizophrenic patients and their primary caregiver assigned preferences to the hypothetical states and the patient's current state using categorical rating scales and paired comparisons; physicians rated the states using the standard gamble and categorical rating scale. Mean standard gamble utilities for the patient's current health were 0.75, and ranged from 0.56 for the inpatient state to 0.83 for excellent function, outpatient. Mean categorical rating scale preferences for the patient's current health state were 0.67 for patients, 0.66 for caregivers and 0.66 for clinicians. Patient preferences were comparable with clinician and caregiver preferences for hypothetical health states. Patient preferences were correlated with clinician and caregiver preferences for current health. It was concluded that schizophrenic patients are able to complete categorical rating scales and paired comparisons, and patient preferences are associated with clinician and caregiver preferences.

Adult↗
PubMed1994

Cost effectiveness of antiviral treatment with zalcitabine plus zidovudine for AIDS patients with CD4+ counts less than 300/microliters in 5 European countries.

A cost-effectiveness model was developed on the basis of early clinical trial results from the US reporting sustained CD4+ cell response in patients receiving zalcitabine in addition to zidovudine. This model was then adapted and applied to 5 European countries to assess the comparative cost effectiveness of adding zalcitabine to antiviral treatment for AIDS patients. The countries included in the modelling effort were Switzerland, France, Italy, Germany and the UK. The model used a Markov state-transition process to estimate the rate of acute opportunistic disease episodes, lifetime medical treatment costs, and survival for populations of AIDS patients with baseline CD4+ counts of less than 300/microliters. Physician panels in each country developed standard treatment algorithms and adjusted the epidemiological data to reflect the AIDS profile of each country. Economic consultants provided cost data. Results from this exploratory data analysis show that if CD4+ counts correlate with the incidence of opportunistic disease episodes as expected, the combined use of zalcitabine and zidovudine for a 1-year period should be cost effective.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Categorization of types of medical/psychiatry units based on level of acuity.

Medical/psychiatry units can be categorized by the level of acuity of medical and psychiatric illness. Type I units are categorized as those that primarily provide psychiatric care with a low level of medical acuity. Type II units include general medicine or medical subspecialty units that are associated with a psychiatric liaison service and provide low levels of psychiatric care to those admitted to the general medical setting. Type III and Type IV units are characterized by a true departure from the current ward settings and care for patients who have concurrent and more severe medical and psychiatric problems in a unified setting. Both of these units require special physical changes in the ward structure, additional nurse training, and coordinated physician coverage to function effectively.

Acute Disease↗
PubMed1992

Quality assurance in a setting designed to care for patients with combined medical and psychiatric disease.

In an attempt to address the needs of patients with combined medical and psychiatric illness, a variety of clinical centers are now creating medical/psychiatry units. These units differ widely in their clinical capabilities, yet no adequate delineation of safeguards regarding quality of care currently exists. This article discusses minimum quality guidelines for four types of medical/psychiatry units that are based on the level of acuity of patients' medical and psychiatric disease.

Acute Disease↗
PubMed1991

The safety of dimetridazole alone and in conjunction with oxytetracycline in Hereford crossbred steers.

Dimetridazole was given intraruminally alone, and in conjunction with oxytetracycline to healthy, 10-11 month-old Hereford cross-bred steers (n = 6). Intraruminal treatment with dimetridazole was given through a fistula at 75 mg kg-1 daily for 5 d, while the oxytetracycline was injected intramuscularly at 10 mg kg-1 on Days 1 and 3 of the dimetridazole treatment. The animals were observed at various intervals throughout the trial period for adverse reactions, including effects on ruminal activity and motility, changes in live-mass, venous acid-base balance, haematology and ruminal and serum ammonia concentrations. Dimetridazole, either when used alone or in conjunction with oxytetracycline, had a marked effect on ruminal function. Within 6 h of dosing, the ruminal pH fell to below 5, but then returned to pretreatment values over the next 24-48 h. This was followed by the eradication of the ruminal protozoal population in all animals tested and an increase in the methylene blue reduction time to more than 6 min. Ruminal motility remained unaffected throughout this period. During the week of treatment, the mean live-mass of the animals dropped by 20 +/- 9.9 kg in the dimetridazole treated group and by 13.3 +/- 2.8 kg in the animals treated with both dimetridazole and oxytetracycline. A mild to severe watery diarrhoea, which continued for 1 to 2 d, occurred in 4 animals after the first dimetridazole treatment. A compensated metabolic acidosis and an increase in haematocrit were observed. An initial transient rapid rise in rumen ammonia concentrations did not result in a concurrent rise in serum ammonia concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

Psychiatry and internal medicine resident education in an acute care medical-psychiatry unit.

A Medical-Psychiatry Program has been developed at the University of Iowa. It includes a medical-psychiatry unit, a medical-psychiatry lecture series, a medical-psychiatry residency program, and a medical-psychiatry fellowship. The program enables residents pursuing straight psychiatry or internal medicine training to participate in a rotational experience requiring that they evaluate and treat patients for illnesses in both specialties under the supervision of both a staff psychiatrist and internist. During the rotation the resident learns how psychiatric and medical disease in the same patient complicates patient care and the skills needed to diagnose and treat such patients in the climate of their own specialty. The rotation is considered a valuable training experience by the majority of residents going through the rotation.

Combined Modality Therapy↗