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Biomedical subjects

C E Lewis

Publications and source records attributed to C E Lewis.

At least 19 recordsLinked to original sources
PubMed1992

Effect of major surgery on the release of interferon gamma by peripheral blood mononuclear cells: an investigation at the single cell level using the reverse haemolytic plaque assay.

The release of interferon gamma (IFN-gamma) by peripheral blood mononuclear cells from patients undergoing abdominal aortic aneurysm repair was measured using the reverse haemolytic plaque assay. The plasma of these patients was also assayed for interferon gamma using enzyme-linked immunosorbent assay (ELISA). Peripheral blood mononuclear cells from the surgical patients released significantly more IFN-gamma by 9 hours after incision than that released prior to surgery (P less than 0.001). This change persisted up to 9 days after surgery. Plasma IFN-gamma was not detectable using either of two different ELISA techniques. The increased secretion of IFN-gamma by peripheral blood mononuclear cells following major surgery may be a beneficial component of the host's immune response to injury.

Aged↗
PubMed1992

Primary care physicians' refusal to care for patients infected with the human immunodeficiency virus.

We conducted a telephone survey of a random sample of office-based primary care physicians in Los Angeles County to determine their practice experiences with patients infected with the human immunodeficiency virus (HIV). Telephone interviews included questions related to the physicians' experiences evaluating patients for HIV infection during the past 6 months and the presence of HIV-infected patients in their practices. Those without HIV-infected patients were asked if this was because they had not encountered such patients, because those patients had died, or because the physicians had chosen to refer these patients elsewhere or the patients had gone elsewhere for care. Of physicians who participated in the survey, 78% had evaluated a patient for HIV infection in the past 6 months; 34% were currently providing primary care for infected patients; and 36% had elected to refer HIV-infected patients elsewhere, or their patients had elected to find other physicians. In all, 48% of physicians in the sample had elected not to care for, or said they would not provide care for, patients with HIV infection. Among Los Angeles County primary care physicians, 36% have refused to provide continuing care for HIV-infected patients and another 12% indicated their unwillingness to do so should such patients present themselves for care. As of 1991, the reservoir of primary care physicians in Los Angeles not yet involved with but willing to care for HIV-infected patients is relatively small (15%).

Attitude of Health Personnel↗
PubMed1991

How satisfying is the practice of internal medicine? A national survey.

OBJECTIVE: To survey members of the American College of Physicians about their level of satisfaction and sources of dissatisfaction with practice, the extent to which their satisfaction is reflected in their counseling of students about careers in internal medicine, the prevalence of their concerns about patients' access to care, and their attitudes toward changes in the health care system. DESIGN: A questionnaire survey of a random sample of members of the College. PARTICIPANTS: Members (2254) of the College were surveyed; 1446 (64%) responded and 1290 (57%) of the responses were usable. MEASUREMENTS AND MAIN RESULTS: More than 80% of respondents were satisfied with their relationships with patients, professional challenges, and opportunities to interact with colleagues. Only about half were satisfied with their potential income, and most were dissatisfied with their autonomy or loss of control over clinical decision making. Major sources of concern were administrative burdens, the threat of malpractice litigation, loss of income, and loss of clinical autonomy. Forty percent of internists say that they discourage students from careers in internal medicine, and only 39% would once again pursue such a career. "Pain in the practice" seems generalized among internists: logistic regression analysis failed to show any specific groups who were most dissatisfied or concerned. With regard to access, 18% of internists had many patients without health care insurance; 69% had some patients without coverage; and the majority (61%) had some patients who lost their insurance because of changing jobs or location. Assuring universal access to care received the highest priority rating of a set of criteria for health care reform. CONCLUSIONS: There is growing dissatisfaction with the practice of internal medicine, primarily related to concerns over loss of clinical autonomy, the increase in administrative burdens, the potential loss of income, and the threat of malpractice litigation. Although physicians are concerned about patients' access to care, proposals to improve access should be examined for their effects on the major sources of physicians' dissatisfaction with practice.

Attitude of Health Personnel↗
PubMed1991

Internists' practices in health promotion and disease prevention. A survey.

OBJECTIVE: To estimate internists' use of disease prevention and health promotion activities, and to explore demographic, professional, behavioral, psychological, cognitive, and organizational factors associated with the use of such practices. DESIGN: Mail survey. SETTING AND SUBJECTS: A sample of 2610 members and fellows of the American College of Physicians (ACP) participated in the study. They engaged in patient care activities more than 20 hours per week and were stratified by gender and region. They lived in four geographic areas of the United States (Northeast, Southeast, Central, and West), comprising 21 ACP regions. MEASUREMENTS: A questionnaire requesting background information as well as information about personal health; record keeping; use of immunizations (pneumococcal, influenza, tetanus, hepatitis B); use of screening tests and procedures for detecting cancer (breast examination, Papanicolaou smear, stool occult blood test) and other diseases (electrocardiograms, cholesterol level tests, chest radiographs); and behavioral counseling to promote health (in the areas of smoking, exercise, and alcohol and seat belt use). MAIN RESULTS: Internists used effective preventive interventions less frequently and ineffective practices more frequently than experts recommend. Internists' use of health promotion and disease prevention activities is associated with habit, attitude, and a lack of adequate knowledge. Younger physician age, general internal medicine practice, and personal health promotion and disease prevention practices were strongly associated with more appropriate use of recommended practices (P less than 0.01). CONCLUSIONS: Internists' use of disease prevention and health promotion activities falls short of expert recommendations. Programs to improve the delivery of preventive services might be aimed at improving physicians' personal health practices, might be directed toward patients, and might include the development of effective systems to remind physicians.

Counseling↗
PubMed1991

The counseling practices of internists.

OBJECTIVES: To determine the counseling practices of a group of internists in the areas of smoking, exercise, and alcohol and seat belt use, and to determine the associations among physicians' personal health habits and their counseling practices. DESIGN: A random stratified sample of members and fellows of the American College of Physicians in 21 regions selected to represent all areas of the United States. Because of the relatively small proportion of women in this group, they were oversampled. SETTING: Physicians' practices. PARTICIPANTS: One thousand three hundred and forty-nine internists (members or fellows of the College) returned questionnaires, for a response rate of 75%; 52% defined themselves as general internists. INTERVENTIONS: A questionnaire was used to obtain information on internists' use of cigarettes, alcohol, and seat belts and their level of physical activity. Data were obtained on the indications used for counseling and the aggressiveness of counseling about each of these four habits. MEASUREMENTS AND MAIN RESULTS: Bivariate and logistic regression analyses were used to compare the tendencies of internist subgroups both in using various indications for counseling and in the thoroughness of counseling. Generalists were more likely than specialists to counsel at least once all patients who were at risk and to be more aggressive in counseling. Ninety percent of respondents counseled all of their patients who smoked, but 64.5% never discussed the use of seat belts. Only 3.8% of these internists currently smoked cigarettes, 11.3% drank alcohol daily, 38.7% were extremely or quite active, and 87.3% used seat belts all or most of the time. Among men internists, for every habit except alcohol use, personal health practices were substantially associated with counseling patients; for example, nonsmoking internists were more likely to counsel smokers, and very physically active internists were more likely to counsel about exercise. Among women internists, being very physically active was associated with counseling more patients about exercise and alcohol use. CONCLUSIONS: The low level of self-reported counseling among these internists suggests that further emphasis on training in these skills is needed. The association between personal and professional practices suggests that medical schools and housestaff training programs should support health promotion activities for future internists.

Adult↗
PubMed1991

Basic fibroblast growth factor and interleukins 4 and 6 stimulate the release of IFN-gamma by individual NK cells.

Both the secretory and cytotoxic activity of natural killer (NK) cells are known to be regulated by such cytokines as interleukin-2 (IL-2) and interferon-gamma (IFN-gamma). In the present study we have used the reverse hemolytic plaque assay to investigate either the direct effects of the protein kinase activator, phorbol myristate acetate (PMA), or exposure to recombinant human interleukins 2, 4, and 6 (IL-2, IL-4, and IL-6) tumour necrosis factor alpha (TNF-alpha) and basic fibroblast growth factor (bFGF) on the release of IFN-gamma by individual, immunoidentified NK cells isolated from peripheral blood. This sensitive immunoassay was adapted and coupled with immunocytochemistry not only to immunophenotype and enumerate cells secreting IFN-gamma in a given cell population, but also to quantify the amount of this cytokine released per individual cell. These studies have confirmed mononuclear cells with the morphology of large granular lymphocytes and the immunophenotype of CD3-/CD16+ NK cells to be the predominant source of spontaneously released IFN-gamma in vitro. In contrast to this, fewer than 2% of the CD3+ T cells secreted detectable levels of this cytokine during the assay, irrespective of the stimulus applied. Whilst TNF-alpha had no significant effect on IFN-gamma release by NK cells, a 6-hr exposure to IL-2 or PMA stimulated an increase in the amount secreted per single cell. Furthermore, bFGF and interleukins 4 and 6 elicited a marked, dose-dependent stimulation of IFN-gamma secretion by this cell type. However, exposure to these cytokines did not alter the number of cells capable of releasing detectable levels of IFN-gamma during the assay. These studies demonstrate that (i) both the spontaneous and stimulated release of IFN-gamma by NK cells can be visualized and quantified at the single-cell level using this sensitive immunoassay, and (ii) bFGF and interleukins 2, 4, and 6, but not TNF-alpha, are potent stimulants of IFN-gamma secretion by CD3-/CD16+ NK cells.

Antigens, CD↗
PubMed1991

Detecting cytokine production at the single-cell level.

Cytokines are versatile mediators of intercellular communication. Their functional diversity has aroused considerable interest and prompted the rapid development of a number of techniques for their detection and measurement. However, conventional cytokine assays measure only their bulk release by large numbers of cells and give no indication of the identity or frequency of producer cells. Here, the advantages and disadvantages of a relatively new approach to detect cytokine production by single cells are reviewed.

Animals↗
PubMed1991

Human tumour-associated NK cells secrete increased amounts of interferon-gamma and interleukin-4.

Numerous interactions between malignant and stromal/inflammatory cells take place within solid human tumours, which are mediated, in part, by the release of signalling proteins called cytokines. In the present study, we have compared the secretion of two important immunomodulatory cytokines, IFN-gamma and IL-4 by individual, immunophenotyped NK cells freshly isolated from either malignant tumour biopsies, or peripheral blood samples from patients with ductal invasive breast cancer. Due to the marked heterogeneity amongst cells isolated from these clinical samples, we have employed a technique called the reverse haemolytic plaque assay to identify and enumerate cytokine-secreting cells at the single cell level. Our data indicate that NK cells isolated directly from the tumour site secrete more IFN-gamma and IL-4 than NK cells from the blood of the same patients. However, a greater proportion of CD16+ cells from both sources in breast cancer patients secreted IFN-gamma than of those from the blood of healthy donors. We also show that factors secreted by the human breast cell lines, MCF-7 and MDA-231 PN9, were able to mimic the stimulatory influence of the tumour microenvironment on secretory activity of NK cells.

Antigens, CD↗
PubMed1991

Neurochemical mechanisms of chronic antisocial behavior (psychopathy). A literature review.

This article reviews the important emotional correlates of chronic antisocial behavior from the standpoint of primary and secondary psychopathy. Primary psychopaths exhibit a conspicuous lack of empathetic emotions and secondary psychopaths exhibit a conspicuous excess of inappropriate emotions. The article points out the relationship between passive-avoidance learning deficits and primary psychopathy and between central nervous system serotonergic dysfunction and primary and secondary psychopathy.

Adult↗
PubMed1991

Telephone screening for risk of HIV infection.

This study responds to a Centers for Disease Control request to develop innovative case-finding methods and asks two questions: 1) Will men participate in an anonymous telephone interview containing detailed questions about their sexual practices to enable screening for HIV-related risk? 2) Will individuals told they are at increased risk follow up by calling a toll-free number for additional AIDS information, counseling, or medical evaluation? Random-digit-dialed interviews were completed with 1610 adult men in Los Angeles County; the completion rate among eligible men was 68.3%. Nearly 43% of men were assessed at increased risk, half of whom described behaviors that placed them only at moderate risk and half of whom reported behaviors placing them at higher risk. Although the study found men were willing to provide personal risk-assessment information, only 14 of 343 men were willing to initiate a follow-up telephone call to the project counselors as the next step in case-finding.

AIDS Serodiagnosis↗
PubMed1991

Alcoholism, antisocial behavior and family history.

Previous investigations in selected and clinical samples have demonstrated a close association between alcoholism and both antisocial behavior and a family history of problem drinking. This study uses the National Institute of Mental Health (NIMH) Epidemiological Catchment Area (ECA) data to assess this relationship in the general population in St. Louis, Missouri (U.S.A.). The results showed that serious antisocial behavior (both conduct disorder and antisocial personality disorder), gender, and a family history of problem drinking were all significantly associated with alcoholism (DSM-III alcohol abuse or dependence). Having either conduct disorder, antisocial personality, or a first-degree relative (parent, sibling, or child) with problem drinking increased the probability of alcoholism; being male also increased its probability. Antisocial behavior and gender interacted in that antisocial behavior was a more potent risk factor for women than for men. However, despite their close association with alcoholism, having either antisocial personality or a positive family history of problem drinking identified only 49% of male alcoholics and 14% of female alcoholics. Thus, these two important predictors of alcoholism would be somewhat inefficient screeners for primary prevention. More investigation is needed to understand the development of alcoholism in those without these major risk factors and the lack of alcoholism in those with them.

Adult↗
PubMed1991

Patient satisfaction on AIDS and oncology special care units and integrated units: a pilot study.

The authors assessed patients' satisfaction with their nursing care in seven hospitals. Five of the hospitals utilized the special care unit (SCU) method of delivering care to AIDS or oncology patients; three had SCUs for AIDS patients. All seven of the hospitals had integrated units (IUs) where general medical, oncology, and/or AIDS patients were received in various proportions. Satisfaction with nursing care was measured with the Risser Patient Satisfaction Instrument. Patient satisfaction with nursing care was shown to be a function of delivery method; AIDS and oncology patients on SCUs expressed greater satisfaction with their care than medical, oncology, or AIDS patients on IUs (p less than .001). Patient satisfaction with nursing care was greater among whites than nonwhites. Also, some major sociodemographic and case mix variables, such as age, employment status, and diagnosis, were not associated with patient satisfaction directly; in other instances, the associations initially seen did not hold when delivery method (SCU vs. IU) and race were controlled for in a linear regression analysis.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Quality and cost of AIDS nursing care as a function of inpatient delivery systems.

Decisions to hospitalize persons with AIDS (PWAs) and the subsequent nursing process and outcomes associated with this hospitalization are of major concern to nurse administrators. Although decisions to hospitalize may be out of their control, events occurring during hospitalization that affect the quality of nursing care received are clearly the nurse administrator's responsibility. This report addresses a major issue concerning the care of PWAs: the decision to establish a dedicated AIDS unit. The effect upon both quality care and nursing care costs is discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1991

AIDS in California family medicine. Changing experiences, knowledge, and geographic distribution.

Information regarding practice patterns specific to acquired immunodeficiency syndrome (AIDS) was obtained in 1988 from 1774 family physicians in California using a mail survey. Data were analyzed across the following county groupings: Los Angeles County, other counties in standard metropolitan statistical areas, and counties outside standard metropolitan statistical areas. Comparisons were made with the data from a telephone survey conducted in 1986. Differences over time were analyzed. By 1988, the percentage of physicians treating or referring patients for possible AIDS had more than doubled in counties outside standard metropolitan statistical areas. The percentage of physicians reporting one or more diagnosed cases of AIDS had tripled, a finding that suggests the importance of AIDS in family medicine is increasing at a rapid rate. In addition, survey results indicate that a majority of those surveyed still lack the AIDS-related knowledge and competency necessary to effectively deal with AIDS.

Acquired Immunodeficiency Syndrome↗