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Biomedical subjects

D Giles

Publications and source records attributed to D Giles.

At least 19 recordsLinked to original sources
PubMed2001

Comparison of high-frequency chest wall oscillation and oscillating positive expiratory pressure in the home management of cystic fibrosis: a pilot study.

Enhanced airway clearance is thought to result in better-maintained pulmonary function in cystic fibrosis (CF). Postural drainage, percussion, and vibration (PDPV) have been the primary airway clearance technique (ACT) employed in CF for over 40 years. Two new airway clearance modalities are high-frequency chest wall oscillation (HFCWO) and oscillating positive expiratory pressure (OPEP). This pilot study was undertaken to evaluate the efficacy of these techniques during home use, assess patient satisfaction with them as compared to PDPV, and assess the feasibility of performing a definitive comparative trial. The prospective, randomized, multicenter crossover trial was conducted at three urban academic CF Care Centers. Twenty-nine CF patients, 9-39 years of age, participated. Subjects performed 4 weeks each of HFCWO and OPEP following 2-week lead-in/washout periods. Spirometry, lung volumes, National Institutes of Health and Petty Scores, and a satisfaction survey were performed at baseline and after each treatment period. An ACT preference survey was completed at the conclusion of the study. Twenty-four subjects completed both therapies. There were no statistically significant differences between therapies for spirometry, lung volumes, or clinical scores. No significant safety issues arose during the study period. Compliance between therapies was similar. Significant differences among therapies existed in patient satisfaction. Given a choice of therapy, 50% of subjects chose HFCWO, 37% OPEP, and 13% PDPV. This study suggests that HFCWO and OPEP are safe and as effective as patients' routine therapies when used for airway clearance in a home setting. Patient satisfaction and preference differ among ACTs and should be considered when prescribing home therapy. A definitive, multi-center, comparative study evaluating long-term efficacy of these techniques is feasible.

Adolescent↗
PubMed2001

Behavioral treatment of insomnia: treatment outcome and the relevance of medical and psychiatric morbidity.

Recently, we undertook a case series study and found that behavior therapy for insomnia was effective as plied in the clinic setting and that the findings were similar to those in the "clinical trial" literature. In the present study, we evaluate a second set of case series data to assess (1) the replicability of our original findings, (2) if our treatment outcomes are statistically comparable to those in the literature, and (3) if medical and psychiatric morbidity influence treatment outcome. It was found that patients who completed four or more sessions of cognitive behavioral therapy for insomnia (CBT) were, on average, 33% improved. This average corresponded to a 56% reduction in wake time after sleep onset, a 34% reduction in sleep latency, a 29% increase in total sleep time, and a 13% decrease in number of awakenings per night. These findings are not significantly different from those reported in literature for both CBT and pharmacotherapy interventions. Medical and psychiatric comorbidity did not influence treatment outcome.

Behavior Therapy↗
PubMed2000

Behavioral treatment of insomnia: a clinical case series study.

There is substantial experimental evidence that behavioral treatment of insomnia produces significant clinical improvement and that treatment gains tend to be maintained over time. Less clear is whether behavioral treatment is effective as it is plied in clinical settings. In this clinical case series study, we evaluated 47 patients with primary insomnia. It was found that patients were, on average, 43% improved. This average corresponded to a 65% reduction in sleep latency, a 46% decrease in number of awakenings per night, a 48% reduction in wake time after sleep onset, and a 13% increase in total sleep time. These results suggest that behavioral treatment for insomnia is as effective in clinical settings as it is as under clinical trial conditions.

Adult↗
PubMed1997

Non-invasive Salmonella typhimurium mutants are avirulent because of an inability to enter and destroy M cells of ileal Peyer's patches.

Salmonella typhimurium initiates infection of a host by invading M cells of Peyer's patches within the small intestine. The ability of the bacteria to invade mammalian cells has been shown to be regulated by environmental conditions, including oxygen concentrations, osmolarity, and growth phase. We have previously created oxygen-regulated Tn5lacZY S. typhimurium mutants that are defective in invasion. We have now identified the invasion genes disrupted by eight of the transposon insertions. These genes encode transcriptional regulators (hilA and invF), type III secretory components (orgA, invG and spaR) and secreted proteins (invC and invD). Examination of the protein-secretion profiles of the non-invasive mutants indicated that each of the mutants was defective in secretion of between one and six proteins. We have also demonstrated that the loss of tissue culture cell invasiveness corresponds to an inability to invade and destroy M cells of Peyer's patches in a murine ligated loop model. Virulence studies, performed in mice, demonstrated that these defects significantly reduced the ability of the mutants to cause murine typhoid fever by an oral route of infection. Virulence by an intraperitoneal route of infection was unaffected. The data indicate that in vitro invasiveness, invasion-protein secretion, and M-cell invasion are critical indicators of S. typhimurium virulence.

Amino Acid Sequence↗
PubMed1997

Effect of structurally related flavones/isoflavones on hydrogen peroxide production and oxidative DNA damage in phorbol ester-stimulated HL-60 cells.

We have examined the antioxidant properties of structurally related flavones/isoflavones in 12-O-tetradecanoylphorbol-13-acetate (TPA)-stimulated HL-60 cells. In the presence of 1.3% dimethyl sulfoxide in the medium for seven days, promyelocytic HL-60 cells were differentiated into neutrophil-like cells possessing phagocytic properties and the capacity to generate H2O2 on TPA stimulation. The effects of five selected flavones/isoflavones on the formation of H2O2 and 8-hydroxy-2'-deoxyguanosine (8-OHdG) were examined in TPA-stimulated HL-60 cells. The results indicated that genistein was the most potent inhibitor of H2O2 production by TPA-stimulated HL-60 cells, followed by apigenin and daidzein, whereas prunectin and biochanin A exhibited no effect. This inhibitory effect correlates well with the scavenging capacity of H2O2 by these flavones/isoflavones in an in vitro system. The formation of 8-OHdG in cellular DNA of HL-60 cells was induced by TPA and further enhanced by the addition of FeCl2 to the medium. Most flavones/isoflavones significantly inhibited TPA + FeCl2-induced 8-OHdG formation in HL-60 cells, with genistein being the most potent quencher. The inhibition of H2O2 production and 8-OHdG formation by these structurally related flavones/isoflavones may contribute to their chemopreventive potentials against human cancers.

8-Hydroxy-2'-Deoxyguanosine↗
PubMed1993

Physician-ordered respiratory care vs physician-ordered use of a respiratory therapy consult service: early experience at The Cleveland Clinic Foundation.

BACKGROUND: Accumulative evidence suggests that respiratory care is frequently misallocated. We report the results of a pilot study of a delivery system aimed at correcting such misallocation. METHODS: The delivery system (Respiratory Therapy Consult Service, or RTCS) allows respiratory therapists (when requested by the case-managing physician) to determine respiratory care, with decisions guided by algorithm (ie, Consult patients). In the pilot study, Therapist Evaluators responded to requests for Consults on two study wards. All staff therapists participated in implementing Evaluator-determined treatment. STUDY DESIGN: We evaluated 38 patients (20 of whom were Consult patients) randomly selected from a total of 82 patients undergoing abdominal surgery during the study period. RESULTS: Consult patients were significantly older than non-Consult patients, more likely to be heavy smokers (67 vs 43%), and sicker as suggested by a higher Triage Score. Consult patients received more types and more total respiratory care services, demonstrated a trend toward longer stay, and had significantly higher respiratory therapy charges. CONCLUSION: Our experience shows that a consult program can be successfully implemented in a large, tertiary care institution with widespread physician and nursing support. Whether the RTCS fulfills its goal of ameliorating misallocation of respiratory care has yet to be proven and awaits the completion of other studies currently under way.

Abdomen↗
PubMed1993

Project Swaziland (Part 1): development of oral health services--study methodology and summary of results.

A collaboration in oral health services research between the Kingdom of Swaziland and the Republic of South Africa is reported. The aim and methodology of the project is described and a summary of the results of the descriptive study is given. The latter included the status of dental caries, periodontal disease and malocclusion of 12 year old school children, an evaluation of a community preventive programme, an assessment of the knowledge, attitudes and behaviour of school teachers towards oral health and an analysis of the output of public oral health services. Five major strategies were recommended for the further development of oral health services in Swaziland and it is recommended that these be undertaken within the contextual realities of Southern Africa.

Adolescent↗
PubMed1985

Free triiodothyronine (T3) and thyroxine (T4) in a group of unipolar depressed patients and normal subjects.

We examined levels of free triiodothyronine (fT3) and free thyroxine (fT4) in serum from a group of 32 patients with unipolar major depression and 46 normal control subjects using the Amerlex (Amersham, Arlington Heights, IL) RIA procedures for these hormones. Free T3 levels were significantly lower (p less than 0.004) in the depressed patients as a group (5.02 +/- 1.01 pmol/L, mean +/- SD) than in the normal control subjects (5.74 +/- 1.23 pmol/L). Free T3 levels were lower (p less than 0.01) in depressed men (5.25 +/- 1.43 pmol/L) when compared with male control subjects (6.46 +/- 1.01 pmol/L). Depressed women (4.78 +/- 0.60 pmol/L) also had lower T3 levels than did the female control subjects (5.09 +/- 1.06 pmol/L), but the difference was not statistically significant. Lower fT3 levels were also observed in melancholic depressed patients when compared with nonmelancholic depressed patients or when compared with normal control subjects. No differences in fT4 were observed between groups in this study.

Adolescent↗
PubMed1985

The effects of putative amino acid neurotransmitters on somata isolated from neurons of the locust central nervous system.

Changes in spike frequency, membrane potential and input resistance of somata freshly isolated from neurons in the metathoracic ganglia of adult locusts (Schistocerca gregaria) during bath and ionophoretic application of putative amino acid transmitters and analogues were studied using intracellular techniques. gamma-Aminobutyrate, glycine, taurine, cysteine and DL-ibotenate hyperpolarized the isolated soma, the response to kainic acid was depolarizing whereas L-glutamate and L-aspartate evoked a variety of potential changes. All of these compounds reduced the input resistance of the isolated soma. Ionophoretic studies showed that the receptors for L-glutamate and gamma-aminobutyrate are diffusely distributed over the somal surface.

Action Potentials↗