THRM forum: The impact of new technologies on health information management.
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Hospital Information Systems↗
Biomedical subjects
C K Smith
Publications and source records attributed to C K Smith.
The role of the medical record professional in developing a protocol for organ donation.
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Clinical Protocols↗
More on vaccine efficacy trial.
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Animals↗
Monosaccharide transport by Eimeria tenella sporozoites.
Eimeria tenella sporozoites were incubated in the presence of 3 different [14C]-labeled sugars; D-glucose, 2-deoxy-D-glucose and 3-O-methyl-D-glucose. The initial velocity, Vi, of uptake of D-glucose and 2-deoxy-D-glucose was similar, 41 micrograms/10(10) sporozoites/min and 46 micrograms/10(10) sporozoites/min, respectively; whereas that for 3-O-methyl-D-glucose was significantly lower, 17 micrograms/10(10) sporozoites/min. Initial velocity studies also revealed that glucose uptake was a saturable event, with an apparent KT of 20 mM and an apparent Vmax of 312 micrograms/10(10) sporozoites/min. Uptake was unaffected by exogenous sodium levels or the presence of ouabain. However, 0.1 mM phloretin significantly inhibited glucose uptake. Thus, it would appear that E. tenella sporozoites possess a Na-independent, phloretin-sensitive, carrier-mediated monosaccharide-transport system.
Animals↗
Effects of adrenalectomy on energy balance of obese mice are diet dependent.
Obese (ob/ob) and lean mice were adrenalectomized at 3 or 6 wk of age and fed a high-carbohydrate stock diet or a high-fat semipurified diet for 3 wk. Adrenalectomy of obese mice fed the stock diet reduced the energy intake, energy gain, and efficiency of energy retention so that the values equaled those of lean mice. Hindlimb muscle gain of adrenalectomized obese mice fed the stock diet increased by 50-100%, and concentrations of plasma insulin were reduced so that they also approached values in lean mice. In contrast to results obtained when the stock diet was fed, adrenalectomy of obese mice fed the high-fat diet resulted in only slight reductions in energy intake, energy gain, or efficiency of energy retention. Likewise, muscle gain was not improved nor were plasma insulin concentrations decreased when adrenalectomized obese mice were fed the high-fat diet. Although adrenal secretions contribute substantially to the gross obesity that develops in ob/ob mice fed the stock diet, these secretions are unnecessary for development of obesity in ob/ob mice fed the high-fat diet. Factors other than adrenal secretions per se, which are influenced by diet composition, thus mediate development of obesity in ob/ob mice.
Adrenal Glands↗
Life change and onset of cancer in identical twins.
The relationship of life change to the onset of cancer was studied in 22 pairs of HLA-identical siblings who were discordant for hematologic malignancies. The twin pairs were hospitalized for bone marrow transplantation. Life change was measured using a well-validated instrument, the Schedule of Recent Experiences (SRE). Contrary to our expectations, we were unable to document increased life changes in the sick twins. The timing of administration of the SRE with respect to the transplant did influence reporting of life events. However, regardless of timing of administration, in the period antedating the diagnosis of malignancy the healthy donor twins had increased or equivalent life changes when compared to their sick twins.
Adolescent↗
Cold acclimation of obese (ob/ob) mice: effects of energy balance.
Obese (ob/ob) and lean mice at 4 weeks of age were housed at 23 degrees C or 14 degrees C for 4 to 8 weeks to examine effects of acclimation to mild cold on energy balance. Energy intake of young lean mice increased by about 50% when housed at 14 degrees C, but energy intake of cold-acclimated obese mice increased by only 8%. Efficiency of energy retention (ratio of energy gain to energy intake) in obese mice declined from 22% +/- 1.2% at 23 degrees C to 10% +/- 1.8% after 4 weeks at 14 degrees C. Lean mice exhibited a less pronounced response to temperature; their efficiency of energy retention declined from 7% +/- 1.3% at 23 degrees C to 4% +/- 2.2% after 4 weeks at 14 degrees C. After 8 weeks of cold exposure, body weights and efficiency of energy retention became equal in obese and lean mice. Calculated heat production of cold-acclimated obese and lean mice was 40% higher than that of respective controls. Obese mice reacclimated to 23 degrees C after being kept for 4 weeks at 14 degrees C consumed the same amount of energy and were 16% more efficient than obese maintained at 23 degrees C; reacclimated lean mice consumed 12% more energy but were 53% less efficient than lean mice maintained at 23 degrees C. The results indicate that obese mice are able to increase heat production and markedly reduce their efficiency of energy retention when acclimated to mild cold but that they, unlike lean mice, rapidly revert to a high efficiency of energy retention after 4 weeks of reacclimation to 23 degrees C.
Acclimatization↗
Cold acclimation of obese (ob/ob) mice: effects on skeletal muscle and bone.
Obese (ob/ob) and lean mice at 4 weeks of age were housed at 23 degrees C or 14 degrees C for 4 or 8 weeks to determine effects of acclimation to mild cold on the growth of skeletal muscle, bone, and fat. Body weights at 12 weeks of age averaged 48 +/- 0.6 g and 27 +/- 1.9 g for obese mice housed at 23 degrees C and 14 degrees C and 29 +/- 0.5 g and 26 +/- 0.6 g and 26 +/- 0.6 g for lean mice housed at 23 degrees C and 14 degrees C, respectively. At 23 degrees C, muscle weights of obese mice were approximately 60% of those in lean mice. Muscles of obese mice did not grow during the first 4 weeks at 14 degrees C (4 to 8 weeks of age) but did show a small gain during the second 4 weeks (9 to 12 weeks of age) at 14 degrees C. As a result, by the end of 8 weeks at 14 degrees C, muscles of obese mice weighed only 35% to 45% as much as muscles of lean mice. Growth of the tibia and femur followed the same pattern as the muscles. Obese mice housed at 23 degrees C from 4 to 12 weeks of age contained about six times as much fat as lean mice at this age. Although exposure to 14 degrees C for 8 weeks depressed the accumulation of fat in obese mice, they still contained approximately three times the percentage body fat as lean counterparts.(ABSTRACT TRUNCATED AT 250 WORDS)
Acclimatization↗
The management of children with vesicoureteral reflux and ureteropelvic junction obstruction.
We reviewed our management of children with vesicoureteral reflux and ureteropelvic junction obstruction in the same renal unit. Of the children who underwent pyeloplasty for ureteropelvic junction obstruction 9 per cent also had vesicoureteral reflux. These children were almost exclusively boys. Ureteropelvic junction obstruction was caused mostly by a stricture or fixed kinks of the upper ureter. Vesicoureteral reflux was primarily grade IV and was associated with abnormal morphology of the ureteral orifice. Pyeloplasty was the initial surgical correction and ureteral reimplantation was performed expectantly.
Child↗
Sequential nonverbal behavior in the patient-physician interview.
This study demonstrates that there is a definite constancy to nonverbal behavioral interaction between patient and physician in a defined office interview setting. This work also introduces the technique of lag sequential analysis into family medicine research. Further refinements of study design and technique are needed in future studies to elucidate information that would be helpful to physicians in the management and care of patients and in patient education.
Family Practice↗
Benefits of early predoctoral experiences in longitudinal patient care.
A ten-year experience with a continuity clerkship taught to second-year medical students is described. Students enrolled in this course spend one half-day per week for nine months with a practicing family physician, attend a weekly seminar or workshop, and write a longitudinal patient care report. This comprehensive report summarizes their experience with a patient or a family and addresses pertinent medical and psychosocial issues. Forty-four of these reports were analyzed for the 1981-82 academic year. The analysis revealed that the main benefits to the students from the longitudinal experience were (1) recognizing the importance of continuity of care, (2) observing the interplay between the social environment, family, and the patient's health, (3) gaining insight into the role of the family physician, and (4) experiencing the difficulties of chronic disease management.
Adult↗
Current concepts in diabetes mellitus.
Family physicians play a significant role in the management of patients with diabetes. The classification of diabetes has been revised, requiring higher plasma glucose levels for diagnosis. Insulins have been purified, with contamination by proinsulin-like substances now routinely being less than 50 parts per million. As a result of increasing evidence that improved metabolic control is associated with a lower incidence of complications, especially for microvascular complications in patients with insulin-dependent diabetes, a variety of strategies have been developed to improve control. Early experience with frequent injections of insulins and constant infusion systems (pumps) has been favorable, though achievement of lower blood glucose levels is not without risk. Good control in pregnancy is especially critical. Glycosylated hemoglobin has proven to be a useful addition to assessing control. To achieve optimal therapeutic results, diabetes should be viewed as a chronic biomedical disease with major behavioral components.
Adolescent↗
Influence of monensin on cation influx and glycolysis of Eimeria tenella sporozoites in vitro.
Extracellular Eimeria tenella sporozoites exposed to 1.0 microgram/ml monensin at 40 C had an accelerated rate of sodium influx as well as an increased rubidium uptake that was inhibited by the cardiac glycoside, ouabain. These results suggested the presence of a functional (Na+-K+)-ATPase and its stimulation by monensin. Under the same conditions, sporozoite ATP concentrations declined, lactate production increased and the rate of amylopectin utilization was enhanced. Exposure to monensin also appeared to stimulate the rate of sporozoite glycolysis. The results of this study demonstrated that the cidal effect of monensin on extracellular sporozoites was caused by the capability of the ionophore to act as a transmembrane sodium carrier.
Animals↗
Responses of skeletal muscle protein synthesis and breakdown to levels of dietary protein and fat during growth in weaning rats.
Skeletal muscle growth, muscle nucleic acids, and muscle protein synthesis and breakdown were measured to evaluate the protein requirement of weanling rats. Male Sprague-Dawley rats were fed purified diets that differed in protein and energy contents. Diets ranged from 5 to 30% casein, 5 to 15% corn oil, and all were methionine fortified. All diets were provided for 14 days beginning at 24 days of age. At 38 days of age, animals were killed and the soleus, plantaris, gastrocnemius, extensor digitorum longus (EDL), and biceps brachii muscles and the inguinal, epididymal, and perirenal fat pads were removed and weighed. The soleus and EDL were used to determine protein synthesis and breakdown and nucleic acid contents. Body weight, muscle weight, protein synthesis, DNA and RNA/DNA increased as the casein content of the diet increased to 15%. Casein levels up to 30% failed to cause any additional increases in any of these parameters. These findings indicate that for growing rats maximum protein synthesis defines the minimum about of dietary protein necessary to achieve maximum growth.
Adipose Tissue↗
Effect of monitoring corpus luteum function on days open.
The concentration of progesterone in milk fat was measured to ascertain whether knowledge of corpus luteum function could be used to increase reproductive efficiency. As they calved, 47 cows were assigned to either a milk-sampled group (24) or an unsampled control group (23). Progesterone concentrations indicative of a functional corpus luteum were first present at an average of 29.4 days postpartum. The average postpartum interval to first estrus was 49 days for cows sampled and 7.19 days for control cows. The postpartum interval to conception was 84.8 days for sampled cows and 113.7 days for control cows. Twenty of 63 (31.7%) ovulations were not associated with behavioral estrus. Cystic ovarian disease with periods of anestrus were observed in five cows. We conclude that failure to detect estrus was a more limiting factor in reproductive efficiency than was anestrus. To determine the reproductive status after breeding, we measured progesterone concentrations on days 19 through 23 postinsemination. Progesterone was higher for pregnant than for nonpregnant cows on all days. However, only on days 20 and 21 was there complete separation of the progesterone ranges in pregnant and nonpregnant cows.
Animals↗
Community based studies of diabetes control: program development and preliminary analysis.
In this report are examined the patterns of control of diabetes mellitus achieved by practicing family physicians in small communities in the Pacific Northwest and Alaska. The diabetic patients under study appear to be broadly similar to patients in tertiary care settings, where most studies of diabetes care have been carried out. Motivated, competent family physicians, knowledgeable about tight control of diabetes, appear to have considerable difficulty in maintaining even modest levels of biochemical control. Goals in this study for fasting plasma glucose levels for patients with insulin-dependent diabetes mellitus (IDDM) averaged between 120 and 160 mg/100 ml. Glucose levels actually achieved ranged up to 360 mg/100 ml. A similar though lesser discrepancy was noted for patients with non-insulin-dependent diabetes mellitus (NIDDM), with achieved levels ranging up to 270 mg/100 ml fasting plasma glucose. There were wide individual differences among physicians in management styles and treatment policy, including wide discrepancies in emphasis on diet, use of oral hypoglycemic agents, and insulin use. This diversity is felt to merit further investigation. Collaborative studies of this type with community based physicians are feasible and academically rewarding. Significant research questions can be addressed and answered.U
Administration, Oral↗
Effect of ionophores on survival, penetration, and development of Eimeria tenella sporozoites in vitro.
Free Eimeria tenella sporozoites were exposed to the anticoccidial ionophores monensin, lasalocid, narasin, or salinomycin for 4 hr at 40 C, whereupon the drugs were removed by dilution centrifugation and the parasites inoculated into cultures of chick kidney cells. Cultures were fixed and stained at 4 and 96 hr postinoculation to determine the effect of ionophore uptake by the extracellular sporozoites on invasion and development. Pretreatment with each of these antibiotics significantly reduced the number of intracellular sporozoites and dramatically inhibited asexual development. These effects were dose-dependent. Exposure of free (extracellular) sporozoites to monensin at 40 C caused a significant decline in the number of surviving organisms over time as compared to nontreated sporozoites. This response also appeared to be dose-dependent. Scanning and transmission electron microscopy revealed that the surface of the treated sporozoites was very irregular and the organisms often exhibited a gross swelling. These results indicated that free Eimeria tenella sporozoites may incorporate a potentially lethal concentration of the polyether ionophorous antibiotics and that a coccidiocidal activity may be expressed whether or not penetration of host's cells occurs.
Animals↗
Characteristics of the initial medical interview associated with patient satisfaction and understanding.
This study examines the relationship between selected interview characteristics, particularly physicians' verbal behaviors, and levels of patient satisfaction and understanding. Twenty-nine initial patient interviews by 11 physicians at the University of Washington Hospital Family Medical Center were videotaped and rated using a modified Bales' technique. Questionnaires provided measures of patient satisfaction and understanding. Results of correlation analysis indicate that higher patient satisfaction was associated with greater interview length, increases in the proportional time spent by the physician in presenting information and discussing prevention, and shorter chart review times. Increased patient understanding was associated with increases in the proportional time spent presenting both information and opinions, close physical proximity, and reduced chart review time. Implications of the results are discussed as well as methodological issues relating to further research.
Adolescent↗