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Biomedical subjects

B Winston

Publications and source records attributed to B Winston.

7 recordsLinked to original sources
PubMed2001

Costs of managing Helicobacter pylori-infected ulcer patients after initial therapy.

BACKGROUND: The objective of this research was to evaluate the outcomes and costs of alternative approaches to managing patients previously treated for peptic ulcer disease and Helicobacter pylori infection. MATERIALS AND METHODS: A decision-analytic model was used to compare (1a) urease breath testing (UBT) for assessment of H. pylori status versus (1b) observation without further testing or treatment, among patients who were symptom-free following initial antimicrobial and antisecretory therapy for endoscopically demonstrated ulcer and H. pylori infection; and (2a) UBT versus (2b) repeat endoscopy with H. pylori testing, and versus (2c) repeat antimicrobial and antisecretory therapy without further testing, among patients who remained symptomatic following initial therapy. RESULTS: Among patients who were symptom free after initial therapy, 6.1% receiving UBT had symptomatic ulcer at one year, compared to 18.2% of those simply observed. The expected first-year cost per symptom-free patient following initial therapy was $591 for UBT compared to $480 for observation. Among patients with persistent symptoms after initial therapy, 21% receiving repeat therapy had symptomatic ulcer at one year, compared to 23.8% receiving repeat endoscopy, and 23.3% receiving UBT. Corresponding medical costs per patient were, respectively, $766, $1787 and $1122. CONCLUSIONS: The optimal approach to managing patients following initial treatment for ulcer and H. pylori infection depends on symptom status following initial therapy. For symptomatic patients, the preferred approach is to prescribe a repeat course of antimicrobial and antisecretory therapy. For patients without symptoms following initial therapy, UBT is the preferred approach because it is associated with a threefold lower risk of symptomatic ulcer at one year, although it costs an additional $110 per patient, compared with observation.

Breath Tests↗
PubMed2001

Toward an integrated brief psychotherapy.

The authors argue for an integrated model of brief psychotherapy that includes psychoanalytic and cognitive-behavioral approaches, as well as pharmacotherapy when necessary. The use of such a model gives the clinician the opportunity to tailor the treatment to the individual patient using differential therapeutics. In implementing a differential therapeutic approach, dynamic psychotherapy can be conceptualized using a health-sickness or psychopathology continuum, which is then superimposed upon a psychotherapy continuum ranging from expressive to supportive interventions. The use of such a psychotherapy continuum helps clinicians tailor the treatment approach to the specific patient. The authors first review psychotherapy outcome studies from the last two decades that suggest that an integrated approach may be advantageous. They then present findings from process studies that highlight the importance of the patient/therapist relationship. In the final sections of the article, the authors discuss how to use an integrated approach to brief psychotherapy, including the use of medication when appropriate. The authors also discuss the use of trial therapy during the initial session to help the therapist determine whether a supportive or expressive approach will be most appropriate for the individual patient and present two case vignettes illustrating the expressive and supportive approaches to trial therapy.

Journal Article↗
PubMed1990

Non-conventional techniques of ventilatory support.

The non-conventional techniques for ventilatory support represent a new approach to the management of patients with respiratory failure. A large number of studies indicate that these techniques can maintain adequate gas exchange under conditions in which the traditional concepts of gas transport no longer hold. We have reviewed the group of techniques, collectively called high frequency ventilation (HFV), in which the tidal volumes are much less (1 to 5 ml per kg) than those observed during conventional mechanical ventilation. Although HFV has theoretical advantages in some clinical settings, it has been shown to be superior to conventional mechanical ventilation in but a few. HFV appears to provide adequate ventilation while still allowing access to tracheal and laryngeal surgical fields. It has been successful during pneumonectomy, and in the treatment of bronchopleural fistulae. The relevance of tracheal insufflation (TRIO) of oxygen and constant flow ventilation (CFV) to the human clinical setting is uncertain. TRIO may be useful to oxygenate patients who are difficult to intubate, or TRIO could be applied for ventilation of patients involved in mass casualties. Although CFV does not maintain normal levels of PaCO2 in humans, it can provide adequate oxygenation. It might be clinically applicable during thoracic surgery, in which movement of the abdominal and thoracic contents associated with conventional mechanical ventilation is undesirable. During CFV, the lung is kept motionless with sufficient airway pressures to maintain patency of airways and alveoli. CFV is useful as a tool for studying phenomena affected by breathing. The rationale for the use of an artificial lung during extracorporeal membrane oxygenation (ECMO) or extracorporeal carbon dioxide removal with low positive pressure ventilation (ECCO2R-LFPPV) in the treatment of acute respiratory failure is to provide temporary respiratory function while the pulmonary lesion is being treated or is resolving. The factors that most limit the usefulness of ECMO are not technical but relate to the ability of the lung to recover structurally and functionally after a severe insult. Poor survival figures in the published series of ECMO in adults reflect the gravity of illness prior to treatment. However, results in neonates have been quite encouraging. ECCO2R allows less exposure of blood to the extracorporeal circuit and avoids the reduction in pulmonary blood flow associated with ECMO. Although the reported survival of adults with severe acute respiratory failure treated with ECCO2R is extremely promising, it is important to point out that none of the published reports are controlled, randomized studies.(ABSTRACT TRUNCATED AT 400 WORDS)

Extracorporeal Membrane Oxygenation↗
PubMed1979

Whole body potassium and total exchangeable potassium in elderly patients with cardiac-failure.

Body potassium status of patients with cardiac failure may be estimated by a number of methods, but increasing reliance is being placed upon radioisotope dilution with 42K which measures the total exchangeable potassium. Total exchangeable potassium comprises between 86 per cent and 97 per cent of whole body potassium in healthy subjects. We have measured total exchangeable potassium in 22 oedema-free elderly patients with stable cardiac failure and compared the results with simultaneously determined measurements of whole body potassium obtained by whole body counting. The mean whole body potassium was 2360 +/- 640 mmol. The mean value of total exchangeable potassium measured at 24 hours was 1820 +/- 610 mmol (77% of whole body potassium) and increased further to 2000 +/- 600 mmol (84%) when measured after 48 hours. In patients with cardiac failure and, perhaps, also other patients with a history of fluid retention, the mixing of a tracer dose may be significantly delayed, which if not appreciated may lead to an overestimate of potassium depletion.

Aged↗
PubMed1976

Destruction of sympathetic nerve terminals by 6-hydroxydopamine: protection by 1-phenyl-3-(2-thiazolyl)-2-thiourea, diethyldithiocarbamate, methimazole, cysteamine, ethanol and n-butanol.

1-Phenyl-3-(2-thiazolyl)-2-thiourea (PTTU) administered i.p. to mice prevented the neurodegenerative actions of subsequently injected (1 hour later) 6-hydroxydopamine (6-OHDA) or 6-aminodopamine on peripheral adrenergic nerve terminals. Destruction of nerve terminals was studied in vitro in the left atrium by measuring the accumulation of 3H-norepinephrine (3H-HE), and in the iris by both 3H-NE accumulation and fluorescence microscopy methods. Strong protection was observed at 4, 24 and 72 hours after 6-OHDA. The degree of protection was dose-dependent and showed step-wise decrements for concentrations of PTTU below 200 mg/kg (viz., 100, 50 and 20 mg/kg) or concentrations of 6-OHDA-HBr above 7.5 mg/kg (viz., 10, 20 and 50 mg/kg). Protection also fell off at time intervals greater than 1 hour after administration of PTTU (viz., 3 and 5 hours). The appearance (fluorescence microscopy) of the nerve plexus of fully protected mice and the remaining plexus in partially protected mice was essentially normal at 24 hours, except for infrequent large swellings. PTTU proved to be a very effective scavenger of hydroxyl radicals; the formation and scavenging of these radicals was studied by gas chromatography in a system in which the hydroxyl radicals (which were generated during the autoxidation of 6-aminodopamine) gave rise to ethylene, a hydrocarbon gas. Other hydroxyl radical scavengers, namely diethyldithiocarbamate and methimazole, exhibited a protective action on sympathetic nerves in the left atrium; PTTU, diethyldithiocarbamate and methimazole are also recognized as copper chelating compounds. Ethanol, n-butanol and cysteamine, which are well known hydroxyl radical scavengers, also exhibited some degree of protection against 6-OHDA. Blockade of transport of 6-OHDA into sympathetic nerves was ruled out as a protective mechanism by the observation that none of the protective compounds inhibited the accumulation of tritium by the left atrium when 3H-NE was injected in place of 6-OHDA. The mechanism of action for these protective agents has not been definitively established, but scavenging of cytotoxic hydroxyl radicals within neurons may play a significant role.

Animals↗
PubMed1975

Prevention of 6-hydroxydopamine neurotoxicity.

1-Phenyl-3-(2-thiazolyl)-2-thiourea (PTTU) prevented the neurotoxic actions of 6-hydroxydopamine on adrenergic nerves in the mouse atrium and iris. This is the first reported 6-hydroxydopamine antagonist that does not act by blocking uptake of catecholamines into nerve terminals. PTTU also prevented the diabetogenic action of alloxan.

Animals↗