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Biomedical subjects

D A Goldman

Publications and source records attributed to D A Goldman.

At least 19 recordsLinked to original sources
PubMed2001

Lack of association between the T-->C 267 serotonin 5-HT6 receptor gene (HTR6) polymorphism and prediction of response to clozapine in schizophrenia.

The affinity of clozapine for 5-HT2A, 5-HT2C, 5-HT6, 5-HT7, and 5-HT1A receptors has been suggested to contribute to various aspects of its complex clinical actions. This study examined the hypothesis that genetic variation in 5-HT1A, 5-HT6, and 5-HT7 receptor genes is involved in the variability observed in response to clozapine. We employed a pharmacogenetic approach in a group (n=185) of schizophrenia patients that have been clinically well characterized for clozapine response. Polymorphisms in the 5-HT6 (HTR6), 5-HT1A (HTR1A) and 5-HT7 (HTR7) receptor genes were genotyped. No evidence for either an allelic or genotypic association of the T-->C 267 HTR6 polymorphism with response to clozapine was found in our sample (allele: chi(2)=0.06, 1 df, P=0.80; genotype: chi(2)=1.21, 2 df, P=0.55). The pro16leu HTR1A polymorphism was not observed in our sample; all individuals genotyped were pro/pro 16 homozygotes. With respect to the pro279leu HTR7 polymorphism, one Caucasian male responder to clozapine was observed to be heterozygous (pro/leu 279 genotype). This individual was clinically similar to the other clozapine responders. Overall, our findings do not support a role for the T-->C 267 polymorphism of the 5-HT6 receptor gene in response to clozapine, although replication is required to confirm this finding.

Adult↗
PubMed2001

Thalidomide use: past history and current implications for practice.

PURPOSE/OBJECTIVES: To review the history of thalidomide, examine fears emanating from its renewed usage, and discuss the nurse's critical role in patient education. DATA SOURCES: Published articles, abstracts, books, and clinical experience. DATA SYNTHESIS: In the early 1960s, the teratogenic effects of thalidomide became widely known. The words thalidomide and birth defects became permanently linked as a result of pregnant women who used thalidomide as a sedative, thus giving birth to children with horrific birth defects. As researchers look at novel properties of drugs and new indications in the oncologic setting, thalidomide has made a comeback, particularly in the treatment of multiple myeloma. Patient education is important to combat fear in using and prescribing thalidomide and is essential in preventing birth defects and other side effects associated with thalidomide use. CONCLUSIONS: Nurses are vital in the patient-education process, yet on extensive nursing literature search revealed limited publications regarding thalidomide. Nurses can prevent thalidomide-associated birth defects through comprehensive patient education and can assist patients in decreasing any anxiety related to potential and actual side effects. IMPLICATIONS FOR NURSING PRACTICE: With careful patient monitoring and comprehensive education of physicians, nurses, and patients, it is possible to reap the benefits of thalidomide and avoid the tragedy of misues. Nurses are in the forefront of education, and their expertise will empower patients to use thalidomide responsibly.

Angiogenesis Inhibitors↗
PubMed2000

Are standardized mortality ratios valid for public health data analysis?

Standardized mortality ratios (SMRs) have been criticized as lacking validity, and it has been recommended to use standardized rate ratios (SRRs) instead. A review of the epidemiology literature and standard epidemiology textbooks showed disagreement concerning the validity of SMRs and a lack of data to support claims concerning their validity. Therefore, we sought to determine the validity of SMRs in public health data analysis. Simulations were carried out using widely disparate study population age distributions and disease rates encountered in public health data analysis. We compared SMRs and SRRs as absolute measures of increased mortality in a population, and for ranking mortality in different populations. The simulations showed that SMRs changed by 6 per cent to 8 per cent when the age distribution was changed from that of a 'young' age distribution to that of an 'old' age distribution. In comparison, SRRs changed by 4 per cent to 5 per cent when the age-adjustment standard was changed from the 1940 U.S. Census population to the 1990 U.S. Census population. County rankings by SRR were somewhat more similar among themselves than when compared with rankings by SMR, but the differences were not large. Based on our findings, SMRs are of similar usefulness to SRRs in public health data analysis, will lead to similar conclusions, and may be used to compare different geographic areas.

Adolescent↗
PubMed1998

Language differences in interpretation of breast cancer health messages.

BACKGROUND: Little is known about how women interpret terminology used in breast cancer messages. The authors assessed the understanding of common cancer terms and whether understanding differed by language of interview. METHODS: In interviews, low-income women 50 years old or older were asked open-ended questions about the meanings of specific terms and phrases in commonly used health messages. RESULTS: Of 232 completed interviews, 167 were conducted in English and 65 in Spanish. Both English- and Spanish-speaking women poorly understood the terms "risk factors," "at risk," and "cancer." Spanish speakers were less likely to provide technical definitions of "diagnosed" and "mammogram" and had different interpretations of several cancer terms compared with English speakers. CONCLUSIONS: Cancer terms mean different things to English and Spanish speakers. Client education could be vastly improved if these cultural differences in interpretation were addressed.

Aged↗
PubMed1998

Improving the quality of care for children in health systems.

OBJECTIVE: To summarize the state of the art in quality improvement, review its application to care for children, and define the information that will be needed so that care for children can be further improved. PRINCIPAL FINDINGS: Health services for children exhibit numerous deficiencies in quality of care. The deficiencies cross all major domains of pediatric care--preventive services, acute care, and chronic care--and provide the opportunity for creative application of improvement strategies with a potential to benefit the health and well-being of children. Approaches to quality improvement have changed over the past two decades from those emphasizing the inspection of structural aspects of care and the imposition of sanctions to more dynamic strategies that emphasize measurement and comparison to motivate change; the use of evidence to specify aims for improvement; and the adoption of a variety of management strategies adapted from business and the social sciences to achieve these aims. These modern approaches to quality improvement have rarely been subjected to rigorous testing of their effectiveness. Moreover, their application in pediatrics has been less widespread than in adult healthcare. For children, several aspects about health services, such as the relative rarity of chronic illness, the important effects of social factors on health, and the limited cost, make some of these approaches even more challenging and may require new approaches or meaningful modifications. RECOMMENDATIONS: Research to understand better the general process of improvement will benefit improvement efforts for children. Research that builds the base of knowledge about best practices for children--effectiveness research--will also result in an enhanced capacity for improvement of those systems that care for children's health. Quality of care for children would be enhanced by targeted research examining ways both to foster improvement across segments of society, and to make recommendations for care more sensitive to children's development and environmental context. Research that supports incorporating the child's perspective into care is both uniquely challenging to perform and central to improving pediatric care.

Adult↗
PubMed1997

Sustaining CQI.

Explore the source record for details and available documents.

Attitude of Health Personnel↗
PubMed1994

Survey of El Paso physicians' breast and cervical cancer screening attitudes and practices.

One hundred and ninety-eight primary care physicians in El Paso, Texas, were surveyed for their practices and attitudes concerning breast and cervical cancer screening. The response rate was 83%. For women 40-49 years old, 77% of respondents stated that they ordered a screening mammogram at least every two years. For women 50-74 years old, 73% said they ordered an annual screening mammogram. For women 75 years and older, 61% stated they ordered an annual screening mammogram. For women 40 years or older, 89% of respondents said they performed annual or more frequent clinical breast examinations. Eighty-four percent of respondents stated they ordered a Pap smear every 1-3 years, both for pre- and post-menopausal women. The most common reasons given for not ordering or doing a breast or cervical screening exam were patient refusal, knowledge that other doctor performs exam, high price, inadequate insurance, patient not under regular care, do not see patient for gynecologic care, and patient being seen for different reason. Seventy percent of respondents do vaginal smears on women who have had a total hysterectomy for a benign condition, and 38% use a cytobrush for endocervical sampling. Respondents were generally more comfortable with their ability to do Pap smears (72% comfortable, 1% uncomfortable) than they were in performing clinical breast examinations (52% comfortable, 4% uncomfortable). Obstetricians and gynecologists were more likely than other physicians to do vaginal smears, use a cytobrush, and feel comfortable with their Pap smear technique.

Adult↗
PubMed1992

Multiple realities. Teaching rounds in an inpatient pediatric service.

Teaching rounds are a mainstay of most educational programs for interns and residents, but little is known about how they are conducted and the role they play in house staff members' learning. We performed a qualitative study of teaching rounds in an inpatient adolescent service using five data sources: observations, interviews, house staff ratings, results of a house staff retreat, and documents outlining faculty responsibilities. Interns, senior residents, and faculty members expressed differing views regarding the purpose, process, and content of rounds; mutual roles and expectations; and time management. An interactive teaching format focused around the visit of a patient to the conference room stimulated house staff interest and learning to a greater extent than did more traditional case presentations and lectures. These results suggest a need to develop a consensus among faculty and house staff regarding the purpose, content, and process of rounds.

Adolescent↗
PubMed1990

Coordinate expression of lactase-phlorizin hydrolase mRNA and enzyme levels in rat intestine during development.

The development of rat intestinal lactase-specific activity displays a well-known post-weaning decline. In contrast, total lactase activity increases to reach maximal levels around weaning, and remains high subsequently. In order to elucidate the molecular basis for these patterns, a rat lactase cDNA was isolated and characterized, and used in the quantification of lactase mRNA during development. This lactase cDNA uniquely hybridized to a 6.8-kilobase mRNA in the small intestine. To assess the amount of lactase mRNA encoding for lactase enzyme activity in the small intestine, total intestinal RNA was isolated and analyzed by Northern and dot-blot hybridization. The pattern of total lactase mRNA during development followed that of total lactase activity, suggesting that over this time span the level of lactase activity is primarily controlled at the transcriptional level. However, the magnitude of increase of total lactase activity during lactation compared to that of total lactase mRNA suggests that additional mechanisms are involved in regulating lactase levels. Analysis of the regional distribution of lactase mRNA along the small intestine at 14 days revealed that mRNA was high in the proximal three regions, but was dramatically lower in the distal regions. Total lactase activity, in contrast, displayed maximum activity in the mid-intestine with decreased levels both proximally and distally. Thus, lactase activity in the intestine appears to be regulated during development predominantly by transcriptional mechanisms, while alterations during lactation, and along the proximal to distal gradient, are the result of other control mechanisms.

Aging↗
PubMed1988

Definition and identification of homology domains.

A method is described for identifying and evaluating regions of significant similarity between two sequences. The notion of a 'homology domain' is employed which defines the boundaries of a region of sequence homology containing no insertions or deletions. The relative significance of different potential homology domains is evaluated using a non-linear similarity score related to the probability of finding the observed level of similarity in the region by chance. The sensitivity of the method is demonstrated by simulating the evolution of homology domains and applying the method to their detection. Several examples of the use of homology domain identification are given.

Algorithms↗
PubMed1978

Group C streptococcal surgical wound infections transmitted by an anorectal and nasal carrier.

Streptococcus equisimilis (Lancefield group C), an unusual cause of nosocomial surgical infection, was isolated from two orthopedic postoperative wound infections. Both operations had been performed by the same surgeon within a three-day period. Examination of the surgeon revealed perianal dermatitis from which S. equisimilis was isolated. The organism was also recovered from the surgeon's nose and rectum. The wound infections responded to treatment with penicillin derivatives. The surgeon was successfully treated with topical bacitracin and oral penicillin and vancomycin. This report documents the pathogenicity of the C Streptococcus in postoperative infection and suggests a possible nosocomial source of the organism.

Adolescent↗
PubMed1977

Scarlet fever and group A streptococcal surgical wound infection traced to an anal carrier.

Four patients developed group A streptococcal wound infections shortly following orthopedic surgery. Two of these patients developed scarlet fever which provided an early indication of the presence of a streptococcal epidemic. A single antigenically characteristic strain of group A streptococci was recovered from the wounds of all four patients and from the anus of one surgeon who had participated in the surgery on three of the patients.

Adolescent↗