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Biomedical subjects

D G Smith

Publications and source records attributed to D G Smith.

At least 181 records · Page 10Linked to original sources
PubMed1993

Asian affinities and continental radiation of the four founding Native American mtDNAs.

The mtDNA variation of 321 individuals from 17 Native American populations was examined by high-resolution restriction endonuclease analysis. All mtDNAs were amplified from a variety of sources by using PCR. The mtDNA of a subset of 38 of these individuals was also analyzed by D-loop sequencing. The resulting data were combined with previous mtDNA data from five other Native American tribes, as well as with data from a variety of Asian populations, and were used to deduce the phylogenetic relationships between mtDNAs and to estimate sequence divergences. This analysis revealed the presence of four haplotype groups (haplogroups A, B, C, and D) in the Amerind, but only one haplogroup (A) in the Na-Dene, and confirmed the independent origins of the Amerinds and the Na-Dene. Further, each haplogroup appeared to have been founded by a single mtDNA haplotype, a result which is consistent with a hypothesized founder effect. Most of the variation within haplogroups was tribal specific, that is, it occurred as tribal private polymorphisms. These observations suggest that the process of tribalization began early in the history of the Amerinds, with relatively little intertribal genetic exchange occurring subsequently. The sequencing of 341 nucleotides in the mtDNA D-loop revealed that the D-loop sequence variation correlated strongly with the four haplogroups defined by restriction analysis, and it indicated that the D-loop variation, like the haplotype variation, arose predominantly after the migration of the ancestral Amerinds across the Bering land bridge.

Americas↗
PubMed1993

The effects of copayments and generic substitution on the use and costs of prescription drugs.

Rising costs of prescription drugs are a concern to both private and public purchasers. Common methods of controlling or sharing costs include copayments and incentives to use generic substitutes. A study of prescription drug use and costs for a set of employer groups reveals that a common change in the rate of copayment from $3 to $5 per prescription is estimated to be associated with a 5% decrease in the number of prescriptions, an offsetting increase in ingredient costs per prescription, a 10% decrease in employer costs per person, and an increase in employee costs of approximately the $2 copayment per prescription.

Cost Sharing↗
PubMed1993

Closed interlocking nailing of femoral shaft fractures: assessment of technical complications and functional outcomes by comparison of a prospective database with retrospective review.

Although closed interlocking femoral nailing is generally considered to be a difficult but effective procedure, the true incidence of technical complications has not been well documented. Similarly, long-term and functional patient-oriented data are limited. We reviewed our experience with an interlocking nail system that was introduced in our institution in October 1987. One hundred and twenty-three patients were retrospectively reviewed with particular attention to technical complications (Group I). A second group of 144 patients with femoral shaft fractures were reviewed prospectively as a part of our Orthopaedic Trauma Outcome Database (Group IIA). In the earlier retrospective group, the technical complications in 123 cases included one distal screw fracture, one broken drill bit left (in situ), one "missed" locking distal screw, and three cases where comminution at the fracture site was increased. In the prospective group of 144 fractures, the technical complications included two "missed" distal locking screws, two broken screws, and one bent nail due to additional secondary trauma. In a third group of 56 patients (Group IIB) selected from Group IIA, an abbreviated functional assessment was performed at a minimum of 12 months postinjury. Of this group, 37% of the patients had pain that was described as related to barometric changes and was either constant or activity related; 39% had some limitation in ability to ambulate or stand. Nine percent had to obtain new employment or seek job modifications. Based on our data we conclude that closed intramedullary nailing can be done at a Level I Trauma Center with relatively few technical complications, but the functional outcomes are not as good as had been previously believed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Scarred muscle excision for the treatment of established ischemic contracture of the lower extremity.

Nine patients with rigid equinocavovarus contractures of the foot and ankle after ischemic episodes of the leg were treated from 1986 to 1989. The ischemic contractures occurred after tibial and fibular fractures in six cases, and after a trimalleolar ankle fracture, an electrical burn, and cardiac bypass surgery in one case each. Previous tendon and nerve releases had failed. The scarred portion of the various involved muscles of the deep posterior compartment were widely excised along with the respective tendons. A variety of additional foot procedures were generally necessary to obtain a plantigrade foot. Night splinting to maintain a plantigrade foot was prescribed for all patients.

Adolescent↗
PubMed1992

Urea-hydrolysis-dependent citrulline synthesis by Ureaplasma urealyticum.

Some of the ammonia produced by hydrolysis of urea by Ureaplasma urealyticum is channelled into an anabolic pathway with resultant 'de novo' synthesis of citrulline. The organism appears to possess ornithine carbamoyltransferase and carbamoyl phosphate synthetase or some modified form of these enzymes.

Ammonia↗
PubMed1992

Impact of consumer fees on drug utilisation.

A review of research on consumer fees for drugs and drug utilisation suggests that the demand for drugs tends to be quite insensitive to consumer fees. Although higher consumer fees are associated with slightly reduced rates of drug utilisation, use of most other medical services is not meaningfully affected and health status has not been shown to be adversely affected. The larger impact of consumer fees demonstrated in the published literature is to shift drug costs from third parties to consumers. Since much of the literature is limited to insurance programmes with quite small consumer fees, the generalisability of results may be limited. Ability-to-pay and health needs may also be important considerations in the relationship between use and fees for particular drugs.

Aged↗
PubMed1992

Verbal memory elicited by ambient odor.

This study examined whether an ambient odor can act as a contextual cue for retrieval of verbal stimuli. Subjects (N = 47) learned a list of 24 words while exposed to one of two odors (either jasmine incense or Lauren perfume) and subsequently relearned the list with either the same or the alternative odor present. Superior memory for the word list was found when the odor present during the relearning session was the same one that had been present at the time of initial learning, thereby demonstrating context-dependent memory. There were no differences in initial learning between the two odor conditions. No differences in pleasantness or intensity were found between the odors.

Adolescent↗
PubMed1992

Hospital-reviewer relations and effective utilization review.

A survey of utilization review nurses revealed substantial variation in the relationships between these nurses and the hospitals at which they review cases. Hospitals providing reviewers with complete responses to questions were associated with high levels of utilization review compliance, which was a significant factor in explaining the savings associated with utilization review. Improving relations between hospitals and utilization reviewers may yield higher levels of utilization review compliance and significant cost savings.

Communication Barriers↗
PubMed1992

Toward effective hospital utilization management. Ten lessons from case studies.

The challenges presented by managed care arrangements and third-party utilization controls have led hospitals to strengthen internal utilization management programs. This article reports findings from a set of case studies on how hospitals have adapted their utilization management programs to their environments. While knowledge acquired from case studies should not be overgeneralized, the findings of these studies suggest some lessons that merit consideration by hospitals advancing their own programs in utilization management.

Hospital Administrators↗
PubMed1992

Partial calcanectomy for the treatment of large ulcerations of the heel and calcaneal osteomyelitis. An amputation of the back of the foot.

Twelve patients who had a large ulceration over the heel were managed with a partial calcanectomy, in lieu of a below-the-knee amputation, after unsuccessful non-operative treatment of the ulcer. Only patients who had an ankle-arm index (the ratio of blood pressure at the ankle to the brachial blood pressure) of more than 0.45, a transcutaneous PO2 of more than twenty-eight millimeters of mercury (3.7 kilopascals), a level of albumin of more than 3.0 grams per deciliter (thirty grams per liter), and a total lymphocyte count of more than 1500 were managed with a partial calcanectomy. The primary diagnosis was diabetes in seven patients, peripheral vascular disease in three, quadriplegia in one, and myelodysplasia in one. The duration of follow-up averaged thirty-three months and ranged from seven to sixty-four months. The wound healed after the partial calcanectomy in ten of the twelve patients. Nine of these ten patients maintained the level of mobility that they had had preoperatively. (One patient was unable to walk because he was quadriplegic before the operation). The wound did not heal in two patients, and those patients ultimately had a below-the-knee amputation and a decrease of one grade on the scale that was used to evaluate walking ability.

Adult↗
PubMed1991

Efficacy of danofloxacin in the therapy of acute bacterial pneumonia in housed beef cattle.

Danofloxacin, a novel fluoroquinolone antimicrobial drug was evaluated in the treatment of acute bacterial pneumonia in recently housed beef cattle of approximately 300 kg liveweight. The clinical responses of 67 pneumonic cattle treated with danofloxacin were compared with those of 65 cattle treated with oxytetracycline, both treatments being given by intramuscular injection for either three or five days, depending on clinical response. Both treatments resulted in a rapid fall in group mean rectal temperature and improved the clinical condition of the majority of cases. However, in comparison with oxytetracycline, danofloxacin therapy was characterised by significantly fewer treatment days, a higher response rate, significantly better reduction of pyrexia and fewer cattle requiring re-treatment.

4-Quinolones↗