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Biomedical subjects

B Rush

Publications and source records attributed to B Rush.

At least 19 recordsLinked to original sources
PubMed2006

The efficacy of intratumoural 5-fluorouracil for the treatment of equine sarcoids.

OBJECTIVE: To document the efficacy of intratumoural injections of 5-fluorouracil for the treatment of equine sarcoids. DESIGN: A prospective study that included 13 horses and one donkey. PROCEDURE: Sarcoids were confirmed by histological examination and treated with intratumoural 5-fluorouracil every 2 weeks. If the sarcoids did not resolve after seven treatments, treatment was considered a failure. All cases were re-examined 6 months after treatment commenced and owners were telephoned 3 years after commencement of treatment to report on tumour recurrence. Outcome comparisons were performed to determine the effect of previous treatment, tumour size and tumour location on sarcoid resolution. The efficacy of intratumoural 5-fluorouracil was compared with other previously documented treatments of equine sarcoids. RESULTS: Sarcoids smaller than 13.5 cm3 were significantly (P = 0.032) more likely to resolve with treatment than larger sarcoids. Sarcoids that were not responsive to previous therapies were significantly (P = 0.007) more likely to recur after 3 years than sarcoids that had not been treated prior to this study. In this study, there were similar rates of resolution in cases with mutiple tumours (66.6%) when compared to cases with single tumours (60%). The numbers in this study were too small to properly evaluate the effect of tumour location on the success of treatment. Intratumoural 5-fluorouracil appeared to have resolved sarcoids in 9 of 13 cases (61.5%) as determined by follow up conversation with the owners 3 years after the initial treatment. CONCLUSION: The use of intratumoural 5-fluorouracil compares favourably with other treatment modalities for sarcoids, with a long term successful resolution rate of 61.5%. Owners should be warned that resistant sarcoids and sarcoids larger than 13.5 cm3 have a poorer prognosis for resolution and more aggressive therapeutic options should be considered.

Animals↗
PubMed2004

Mental health service user involvement in England: lessons from history.

This historical analysis draws attention to differing assumptions, which promote or limit user involvement in nursing practice. The meaning of the term 'user involvement' is analyzed with reference to varying models. A continuum is offered to illustrate the relationship between assumptions about people with mental health problems and their involvement in care. It is argued that the range of views concerning recipients of mental health services, from being dangerous and irrational to being considered equal partners with health professionals, creates an unresolved tension that has existed through the ages. The key to resolving this tension is for all parties openly to acknowledge conflicts between their views and those of others and engage in meaningful dialogue about them. In this way the lessons from history may be learned.

England↗
PubMed2001

Influenza vaccine effectiveness in preventing hospitalizations and deaths in persons 65 years or older in Minnesota, New York, and Oregon: data from 3 health plans.

This study developed methods and determined the impact of influenza vaccination on elderly persons in 3 large health plans: Kaiser Permanente Northwest, HealthPartners, and Oxford Health Plans. Data for the 1996-1997 and 1997-1998 seasons were extracted from administrative databases. Subjects were health plan members > or = 65 years old. Comorbid conditions collected from the preceding year were used for risk adjustment with logistic regression. The virus-vaccine match was excellent for year 1 and fair for year 2. Both years, during peak and total periods, vaccination reduced all causes of death and hospitalization for pneumonia and influenza: hospitalizations were reduced by 19%-20% and 18%-24% for years 1 and 2, respectively, and deaths were reduced by 60%-61% and 35%-39% for the same periods. These results show that all elderly persons should be immunized annually for influenza. The methods used in this study are an efficient cost-effective way to study vaccine impact and similar questions.

Age Factors↗
PubMed2000

Effect of a preoperative intervention on preoperative and postoperative outcomes in low-risk patients awaiting elective coronary artery bypass graft surgery. A randomized, controlled trial.

BACKGROUND: In publicly funded health care systems, a waiting period for such services as coronary artery bypass graft surgery (CABG) is common. The possibility of using the waiting period to improve patient outcomes should be investigated. OBJECTIVE: To examine the effect of a multidimensional preoperative intervention on presurgery and postsurgery outcomes in low-risk patients awaiting elective CABG. DESIGN: Randomized, controlled trial. SETTING: A regional cardiovascular surgery center in a tertiary care hospital, southwestern Ontario, Canada. PATIENTS: 249 patients on a waiting list for elective CABG whose surgeries were scheduled for a minimum of 10 weeks from the time of study recruitment. INTERVENTION: During the waiting period, the treatment group received exercise training twice per week, education and reinforcement, and monthly nurse-initiated telephone calls. After surgery, participation in a cardiac rehabilitation program was offered to all patients. MEASUREMENTS: Postoperative length of stay was the primary outcome. Secondary outcomes were exercise performance, general health-related quality of life, social support, anxiety, and utilization of health care services. RESULTS: Length of stay differed significantly between groups. Patients who received the preoperative intervention spent 1 less day [95% CI, 0.0 to 1.0 day] in the hospital overall (P = 0.002) and less time in the intensive care unit (median, 2.1 hours [CI, -1.2 to 16 hours]; P = 0.001). During the waiting period, patients in the intervention group had a better quality of life than controls. Improved quality of life continued up to 6 months after surgery. Mortality rates did not differ. CONCLUSION: The waiting period for elective procedures, such as CABG, may be used to enhance in-hospital and early-phase recovery, improving patients' functional abilities and quality of life while reducing their hospital stay.

Anxiety↗
PubMed1999

Health-related quality of life in survivors of tumours of the central nervous system in childhood--a preference-based approach to measurement in a cross-sectional study.

There is an evident need to measure the comprehensive burden of morbidity experienced by survivors of brain tumours in childhood. To this end, a questionnaire based on the Health Utilities Index mark 2 (HUI2) and mark 3 (HUI3) systems was completed independently for a cohort of such children by their parents, by a nurse, by physicians and by a selected group of the children themselves. Each of the HUI2 and HUI3 systems consists of a multi-attribute health status classification scheme linked to a preference function which provides utility scores for levels within single attributes (domains of health) and for global health states. All eligible families (n = 44) participated. Even cognitively impaired children of at least 9.5 years of age could complete the questionnaire. The greatest burden of morbidity, occurring in two-thirds of children, was in the attribute of cognition. Surprisingly, almost one-third of children experienced pain. Global health status was lowest in children who underwent radiotherapy before the age of 5 years and the corresponding utility scores were related inversely to the volume irradiated. Children with demonstrable disease had lower scores than those in whom disease was not evident. There was a high level of agreement (intraclass correlation coefficients > 0.5) on formal assessment of inter-rater reliability for global health-related quality of life utility scores. The usefulness of measures of health status and health-related quality of life, in children surviving brain tumours, has been demonstrated by this study.

Adolescent↗
PubMed1996

Thalidomide inhibits TNF response and increases survival following endotoxin injection in rats.

Sepsis is a leading cause of death following major trauma and complicated abdominal surgery. Tumor necrosis factor-alpha (TNF) is believed to be a central mediator in the inflammatory response syndrome. Numerous methods of blunting the TNF response in sepsis have been attempted with suggestion of increased survival and decreased organ injury. Thalidomide, shown in vitro to selectively inhibit TNF production, has been used clinically in states of chronic TNF elevation with encouraging results. In this study, we examined the effect of thalidomide administration in a rat model of acute septic shock. Femoral artery cannulation was performed and baseline TNF measured. Dose response was determined by giving varying doses of thalidomide by gavage. Rats were injected intraarterially with endotoxin and serial samples drawn. TNF was measured by ELISA. For survival, thalidomide was given by gavage and endotoxin injected intraperitoneally. Serum TNF elevation occurred after endotoxin injection with peak levels at 90 min. Thalidomide treated rats had lower TNF levels at all time points (P = <0.01 at 90 and 120 min), with the inhibition being dose dependent. Survival in treated rats exceeded that of untreated rats (53% vs 19%, P = <0.05) at 48 and 72 hr. In conclusion, we found that thalidomide administration leads to increased survival following acute endotoxemia, which may be due to the observed TNF inhibition.

Analysis of Variance↗
PubMed1996

Measuring capacity to complete an advance directive.

OBJECTIVE: To validate reference standards for the assessment of capacity to complete an advance directive and to develop and test three simple screening instruments. METHODS: We administered five measures of capacity to 96 older subjects from nursing homes, retirement homes, and homes for the aged. The measures included two reference standard evaluations: an assessment by a specially trained nurse in collaboration with a multidisciplinary team (Competency Clinic assessment) and geriatrician assessment using a decisional aid. Three screening instruments were also included: a Generic Instrument designed for any advance directive, a Specific Instrument designed for the "Let Me Decide" advance directive, and the Standardized Mini-Mental Status Examination (SMMSE). The screening instruments and the geriatrician's assessment were administered twice to half of the respondents to determine interrater agreement. RESULTS: The chance-corrected agreement for the assessment by two geriatricians was 0.78, and for agreement between the geriatricians and Competency Clinic assessments it was 0.82. Agreement for the Generic and Specific screening instrument assessments by two observers was 0.77 and 0.90, respectively. The areas under the Receiver Operating Characteristic curve relating the results of the three screening instruments to the Competency Clinic assessment were 0.82 for the Generic Instrument, 0.90 for the Specific Instrument, and 0.94 for the SMMSE; chance is an unlikely explanation for the difference between these three values (P < or = .01). CONCLUSIONS: Using rigorous methods, health workers can make reproducible and valid assessments of capacity to complete an advance directive. The SMMSE accurately differentiates people who can learn about and ultimately complete advance directives from those who cannot.

Advance Directives↗
PubMed1996

Substance abuse treatment for Ontario residents in the United States.

In Canada, individuals experiencing problems related to their alcohol and drug use receive treatment and rehabilitative care through services provided primarily through the publicly funded health and social service system. During the past decade, however, an increasing number of Canadians have received treatment for substance abuse at facilities located in the United States, with most of the cost for this treatment borne by the various provincial health insurance plans. This paper provides a comprehensive analysis of the Ontario experience of treatment for substance abuse in the United States. First, the policy and planning context for the use of American treatment programs by Ontario residents and the rationale for recent changes to the reimbursement guidelines for such out-of-country treatment is reviewed. Secondly, the major trends in utilization of American programs over the past decade will be described and comparisons drawn to trends in the development of Ontario's own treatment system. This information has been used to help guide the development of treatment services in Ontario. In addition, the data serve as a baseline to measure the impact of various policy and program initiatives recently introduced in Ontario to reduce the utilization of treatment resources based in the United States.

Adolescent↗
PubMed1995

Repair of a massive ventral hernia in a morbidly obese patient.

Aggressive perioperative management, with progressive preoperative pneumoperitoneum, is a worthy method of repairing massive ventral hernias with associated loss of domain in morbidly obese patients. The authors present a case and its successful outcome.

Adult↗
PubMed1994

Detecting, preventing, and managing patients' alcohol problems.

OBJECTIVE: To examine Canadian family physicians' attitudes, beliefs, and practices regarding alcohol use and alcohol-related problems among their patients. DESIGN: A self-administered questionnaire mailed to a random sample of 2883 family physicians. The survey was conducted using a modified Dillman method. PARTICIPANTS: Canadian physicians in active office-based practice during 1989. Sample included certificated and noncertificated members of the College of Family Physicians of Canada, as well as non-members of the College. MAIN OUTCOME MEASURES: Perceived importance of various health-promotion behaviours; attitudes and beliefs about working with problem drinkers; current knowledge and practices regarding identifying and managing problem drinkers; and demographic characteristics. RESULTS: Respondents had a strong sense of role legitimacy in working with problem drinkers, but predominantly negative and pessimistic attitudes. Half the respondents felt they had failed in their work with problem drinkers. More physicians agreed on a psychosocial etiology for alcoholism than on a biological origin. Three quarters of respondents said they "almost always" ask patients about quantity and frequency of alcohol use, and just over one third "almost always" ask about problems related to drinking. Data also suggest doctors have relatively few patients with alcohol problems, and they need help in responding to such patients. CONCLUSION: Physicians need more training for their role in identifying and managing patients with alcohol problems.

Alcohol Drinking↗
PubMed1994

How general practitioners view alcohol use. Clearing up the confusion.

This paper reviews the findings of qualitative and quantitative research into family physicians' attitudes, beliefs, and experience with patients with alcohol problems. The implications of the findings are discussed in the context of the need for educational programs to improve physicians' work with these patients.

Alcohol Drinking↗
PubMed1993

Mature T cells of autoimmune lpr/lpr mice have a defect in antigen-stimulated suicide.

Antigen receptor-stimulated cell death of developing, immature T cells plays an important role in shaping the repertoire of antigens to which mature T cells will respond, but a role for receptor-stimulated death in controlling responses of mature T cells is controversial. Mutant lpr/lpr mice exhibit an autoimmune syndrome similar to systemic lupus erythematosus. Here we demonstrate that these mice have a defect in antigen-stimulated suicide of activated T cells in mature CD4+ and CD8+ T cell compartments. The defective suicide pathway is evident when the T cells are stimulated with antigen on antigen-presenting cells or with immobilized anti-CD3 in the absence of antigen-presenting cells. These studies, in concert with the work of others, suggest that antigen-stimulated death of mature cells may be important both in establishing peripheral tolerance and in limiting inflammation during normal immune responses.

Animals↗
PubMed1993

Trends in the development of alcohol and drug treatment services in Ontario: a replication and extension of a previous study.

This paper summarizes the major trends in the development of alcohol and drug treatment services in Ontario from 1979 to 1989. Data were obtained from all treatment services in the province by surveys undertaken in 1980, 1983, 1986 and 1989. Supplementary archival data are included on the use of American treatment programs by Ontario residents over a similar time period. Across the period of analysis, there has been a rapid increase in the number of alcohol and drug programs (130 to 217), their total cost ($44.4 million to $77.1 million) and the total treatment caseload (30,356 to 61,622). With respect to different types of services, the largest growth in capacity has occurred for specialized assessment/referral centres. Use of short-term residential resources within the province has risen slightly but this has been augmented by a rapid increase in the use of similar programs in the United States. Contrary to expectations from research evidence and provincial policy initiatives, only modest gains have been experienced with non-residential treatment alternatives compared to the increases in availability and utilization of residential treatment programs.

Alcoholism↗
PubMed1993

The treatment of disabled persons with alcohol and drug problems: results of a survey of addiction services.

This report provides information on disabled clients that was collected as a supplement to the 1989 Addiction Research Foundation survey of alcohol/drug services in Ontario. The estimated prevalence of disabled clients in the treatment population was highest for those with psychiatric disorders (10.3%), followed by physical disabilities (mobility, 3.7%; vision, 1.5%; hearing, 1.4%; other impairments, 0.1%) and developmental handicaps (2.3%). There were, however, relatively few agencies reporting services tailored specifically for the disabled. Respondents generally felt that clients with psychiatric disorders or developmental handicaps would be better served by specialized programs with additional staff training, while the physically disabled could be adequately served in "mainstream" services. Resources for physically disabled clients were not available in many addiction programs. Not all agencies desired these resources, however, even if funding were to be made available. Other factors were also important, such as the architectural feasibility of wheelchair accessibility, or the perception among the agencies that outreach capacity was beyond the role of their program. Implications of various methods of service delivery for the disabled are discussed.

Activities of Daily Living↗
PubMed1990

A systems approach to estimating the required capacity of alcohol treatment services.

This paper describes a model for estimating the required capacity of alcohol treatment systems at the local or regional level. Previous attempts at developing comprehensive forecasting models for addiction services are briefly described. The four steps followed in the development of the present model are then outlined. In many respects, the resulting model is specific to Ontario, Canada. However, the general approach, and many of the underlying concepts and assumptions, may have wider application in assessing the need for alcohol treatment services.

Alcoholism↗