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Biomedical subjects

D Fitzgerald

Publications and source records attributed to D Fitzgerald.

At least 37 records · Page 2Linked to original sources
PubMed1986

How to keep up with the medical literature: I. Why try to keep up and how to get started.

Patient care is often outmoded because physicians lack awareness about important advances in medical knowledge. According to physicians, reading journals is the most popular method for staying informed, but the great volume of journal literature precludes clinicians' from reading all of it. In this first of six articles on keeping up with the medical literature, we describe three strategies to enhance the efficiency and effectiveness of journal reading. First, priority should be given to reading original articles concerning reports of planned investigations because only these articles provide sufficient details to assess the relevance, validity, and clinical application of new knowledge. Second, reading should be restricted to articles of direct pertinence to one's clinical practice. Third, the methods section of articles should be quickly screened first to select studies that have used sufficiently high standards to warrant clinical action based on study results.

Education, Medical, Continuing↗
PubMed1986

How to keep up with the medical literature: II. Deciding which journals to read regularly.

For practitioners, one of the major objectives for reading the medical literature is to maintain clinical competence. Ideally, this task is accomplished through efficiently extracting from the literature properly validated advances in medical knowledge of direct relevance to the reader's own practice. Practically, the extraction process is a difficult one because reports describing such advances are disseminated through a multitude of general and specialty journals. We describe a preemptive strategy for clinicians to determine which journals to read on a regular basis. General and specialty journals of potential relevance to the reader's practice should be selected initially on the basis of circulation or citation impact, and then consecutive issues surveyed to determine the journals' yields of articles that are both directly relevant and of high quality. Subsequent reading should concentrate on the journals that produce the highest yield on this personal survey.

Clinical Competence↗
PubMed1986

How to keep up with the medical literature: III. Expanding the number of journals you read regularly.

Clinicians can derive immense satisfaction from keeping abreast of new developments in patient care by regularly scanning the medical journal literature. Combined with good reading habits and self-discipline, this scanning generally can be accomplished within the time that most practitioners allot to attempting to keep up to date. We describe tactics for formulating a personalized journal-reading list and ensuring access to the key articles in one's field at a reasonable cost. These tactics begin with deleting low-yield journals from regular reading and adding journals more relevant to one's interests. The cost of multiple journal subscriptions can be reduced by circulating different journals among colleagues or by regular visits to the library. These tactics can be supplemented or replaced by using Current Contents or the Selective Dissemination of Information service of the National Library of Medicine and other database vendors.

Education, Medical, Continuing↗
PubMed1986

How to keep up with the medical literature: IV. Using the literature to solve clinical problems.

Ideally, searches for published articles to solve clinical problems should lead to the best evidence on a given topic quickly and at reasonable expense. This goal can be achieved with modern information skills, sources, and services. In this article, we describe and compare various means, from textbooks to computers, that provide access to information of potential value in addressing clinical problems as they arise. Using the problem of understanding and controlling the risk for the acquired immunodeficiency syndrome among personnel of a community hospital, we examined the following sources for their utility in locating journal literature: general and specialty medical texts, personal reprint collections, expert clinicians, recent journal issues, library textbook collections, the Index Medicus "Bibliography of Reviews" and subject index, and MEDLINE computer searching. For this problem, Index Medicus and MEDLINE were the best sources of up-to-date articles, but MEDLINE was three times as fast.

Information Services↗
PubMed1986

How to keep up with the medical literature: V. Access by personal computer to the medical literature.

Access to the medical literature through personal computers is now readily available and can greatly reduce logistical barriers to using recently published journal articles to support clinical decisions. In this article, we describe many of the options available to clinicians who wish to do their own computer searching of MEDLINE, the largest of the electronic services for the biomedical literature. The "bare bones" computer equipment needed includes a terminal or personal computer, a modern and telephone line, and a printer. Access to MEDLINE is then gained through subscribing to any of a burgeoning number of database vendors. A comparison of 17 permutations and combinations of software and vendors shows that the software and vendors vary substantially in efficiency, cost, and ease of use. Direct subscription to MEDLINE is least expensive, PaperChase is the simplest service to use, and Colleague and Medis provide both MEDLINE access plus full-text journals online. Basic search techniques are illustrated for three clinical problems.

Computers↗
PubMed1986

How to keep up with the medical literature: VI. How to store and retrieve articles worth keeping.

The human mind is not well suited to storing and retrieving large amounts of infrequently used information. An effective personal filing system is needed if good articles that we encounter in our efforts to keep up to date are to be kept handy for future reference. Many options exist for the creation of a personal filing system. In this article, we assist the reader in the development of a tailor-made system that is based on making key decisions that strike a balance between filing needs and the lack of enthusiasm that most of us have for filing. The complexity of the system should match the number of purposes that your file must serve. Important additional considerations include how much time and effort you are willing to spend; where and how you will house your collection; how many articles you want to keep in the file; what standards you will apply in selecting material for your file; what subject headings are most appropriate for your articles; whether you will need to cross-reference; and what access you will have to personal computers.

Abstracting and Indexing↗
PubMed1985

Uterine papillary serous carcinoma. Complete response to combination chemotherapy.

A case of metastatic uterine papillary serous carcinoma with a complete response to chemotherapy is reported. The patient presented with vaginal, pelvic, and lymph node metastases 11 months after primary surgical resection was performed. A complete response to cyclophosphamide, Adriamycin (doxorubicin), and cisplatin was achieved. In this histologic pattern of endometrial adenocarcinoma, which behaves clinically like epithelial ovarian cancer, combination chemotherapy can offer significant response and palliation.

Aged↗
PubMed1985

Computer searching of the medical literature. An evaluation of MEDLINE searching systems.

Although clinicians can now search the medical literature electronically from the clinic, bedside, or operating suite, little is known about the performance characteristics of online information services. Fourteen access routes to the MEDLINE database of journal literature were compared for retrieval quantity and quality, user and online search time, and cost for randomly ordered, standardized searches on common clinical problems. All routes produced the articles we judged to be the most definitive on the clinical problem. However, routes differed significantly (p less than 0.01) for the same searches with respect to online time (range, 5.15 to 18.72 minutes), total search time (8.37 to 20.55 minutes), cost (US $3.38 to $11.62), and proportion of articles relevant to the topic (98% to 75%). "User friendliness" aside, our results showed that the higher the cost, the worse the product. Clinicians should consider these major differences when deciding which search system to use.

Costs and Cost Analysis↗
PubMed1985

Accuracy and reliability of the Del Mar Avionics pressurometer III.

We assessed the accuracy and reliability of the Avionics pressurometer, a fully automated ambulatory blood pressure recorder. Accuracy was assessed in 96 patients against the Hawksley random-zero sphygmomanometer. Two recordings were made with each device in a random sequence. No mean difference was found between methods. However, there was a marked variation in the difference between Avionics and Hawksley recordings. This was not due to variability in blood pressure alone since the agreement between Avionics and pressurometer systolic recordings (r = 0.88) was less than the agreement between sequential systolic blood pressure measurements with the Hawksley (r = 0.976, P < 0.001). In addition, a small degree of inter-device variability was demonstrated between three Avionics recorders, one device giving higher readings. Reliability was assessed in 30 patients during normal daily activities and compared with the Remler M2000. The rate of markedly artefactual recordings was higher with the Avionics. Thus, variability in Avionics recordings makes this device unreliable.

Blood Pressure Monitors↗
PubMed1985

The role of home and ambulatory blood pressure recording in the management of hypertension.

A review of the literature shows that doctor-recorded measurement (DRM) of blood pressure is higher than patient-recorded measurement (PRM) by either home-recording or ambulatory measurement. The role of home-recording and ambulatory measurement as a means of supplementing doctor-recorded measurement is discussed. The results of two studies comparing home-recording with clinic and ambulatory blood pressure showed that home-recording of blood pressure did not lower blood pressure.

Blood Pressure Determination↗
PubMed1984

Cardiac sensitivity to isoprenaline, lymphocyte beta-adrenoceptors and age.

The heart rate response to isoprenaline in 11 subjects aged 19-46 years was compared with lymphocyte beta-adrenoceptor numbers and lymphocyte cyclic AMP responsiveness. The dose of isoprenaline required to increase heart rate by 25 beats/min ( CD25 ) increased as a function of age (r 0.79; P less than 0.01). Lymphocyte receptor numbers also correlated directly with age (r 0.61; P less than 0.05), but there was no true correlation between CD25 and lymphocyte receptor numbers. Baseline and maximum lymphocyte cyclic AMP concentrations in response to isoprenaline stimulation in vitro were unrelated to age, CD25 or receptor numbers. This study confirms previous findings of a reduced responsiveness with age and a rise in receptor numbers in young and middle-aged adults. However, the decline in the heart response to isoprenaline was unrelated to any measurable change in beta-adrenoceptor concentration or responses, at least in the isolated lymphocyte.

Adult↗
PubMed1984

Evidence that the penton base of adenovirus is involved in potentiation of toxicity of Pseudomonas exotoxin conjugated to epidermal growth factor.

When KB cells are incubated for 1 h with human adenovirus type 2 or type 5 (1 microgram/ml) and a conjugate of epidermal growth factor and Pseudomonas exotoxin (EGF-PE), protein synthesis is inhibited by 80 to 90%. Under these conditions, neither adenovirus nor EGF-PE alone has any effect on host protein synthesis. Thus, adenovirus enhances the toxicity of EGF-PE. A number of antibodies to intact virus and capsid components were tested for their ability to block the enhancing activity and virus uptake. At appropriate dilutions, antibodies prepared against intact virus and penton base blocked the enhancing activity without affecting virus uptake. Antibodies against hexon and fiber blocked virus uptake and enhancing activity in parallel. These studies suggest that the penton base is important in lysis of the vesicles which contain adenovirus and EGF-PE, and this base allows virus and toxin to enter the cytoplasm.

Adenoviruses, Human↗
PubMed1984

The efficacy of indapamide in hypertensive patients failing to respond to a beta-blocker alone.

A double-blind, placebo-controlled, cross-over study was carried out to evaluate the efficacy and safety of 2.5 mg indapamide in 24 hypertensive patients failing to respond to oxprenolol alone. An additional 6 patients were assessed by ambulatory blood pressure recordings over a 15-hour period with a Remler M2,000 semi-automatic sphygmomanometer. On average, indapamide reduced supine blood pressure by 18.5/10 mmHg and standing blood pressure by 19.6/8.9 mmHg. The ambulatory recordings carried out in 6 patients detected a fall in diastolic pressure not observed using clinic readings in these 6 patients, suggesting that this is a more sensitive method of detecting antihypertensive effect. These responses were not associated with significant changes in heart rate or body weight and there was no significant postural fall in blood pressure. No serious side-effects were reported. Changes in serum potassium, chloride and urate similar to those seen with diuretics were observed. These results suggest that indapamide is a useful and safe adjunct to beta-adrenoceptor blocking therapy for uncontrolled hypertension.

Adult↗
PubMed1982

Essential role of calcium in cellular internalization of Pseudomonas toxin.

Pseudomonas exotoxin (PE) has been shown previously to enter mouse LM cells by receptor-mediated endocytosis, to block protein synthesis, and to cause cell death. The requirement for the divalent cation calcium in the binding and internalization of PE was examined. Biochemical studies showed that depletion of extracellular calcium with ethylene glycol-bis(beta-aminoethyl ether)-N,N'-tetraacetic acid protected cells from the action of PE when the chelator was present during the internalization step. Extracellular calcium was not required for binding. We observed with immunoelectron microscopy that, in the cold, toxin bound to cell surfaces equally well in the presence or absence of chelator. In the presence of chelator, toxin was not cleared from the cell surface when cells were warmed to 37 degrees C. Replenishment of calcium (2 mM CaCl2), however, allowed normal rapid clearance of PE to occur. We suggest that internalization, but not binding, of PE by LM cells requires extracellular calcium.

ADP Ribose Transferases↗