PubMed Health⌕ Search

Biomedical subjects

D R Black

Publications and source records attributed to D R Black.

At least 19 recordsLinked to original sources
PubMed2004

Vancomycin-induced linear IgA bullous disease presenting as toxic epidermal necrolysis.

Linear IgA bullous dermatosis (LABD) is a rare autoimmune vesiculobullous disorder characterized by variable clinical presentations that may mimic bullous pemphigoid, dermatitis herpetiformis, cicatricial pemphigoid and erythema multiforme. A few cases of drug-induced LABD that clinically resembled toxic epidermal necrolysis (TEN) have been reported. A subset of patients with LABD have been found to be drug-induced; the most common drug being vancomycin. The diagnosis of LABD is confirmed by the presence of a linear band of IgA along the basement membrane zone on direct immunofluorescence microscopy. We report a case of a 77-year-old man who presented to us with vancomycin-induced LABD that presented clinically as TEN. He had a complete recovery over a 3-week period following discontinuation of the vancomycin and the addition of oral dapsone therapy. It is important to be aware that drug-induced LABD can mimic TEN.

Aged↗
PubMed2000

Echocardiographic assessment of coronary blood flow velocity during controlled hypotensive anesthesia with nitroglycerin.

OBJECTIVE: To determine the effect of nitroglycerin on coronary blood flow velocity during controlled hypotensive anesthesia in humans. DESIGN: Internally controlled prospective study. SETTING: Single university hospital. PARTICIPANTS: Twenty American Society of Anesthesiologists class I and II patients undergoing general anesthesia for surgical resection of a malignancy. INTERVENTIONS: General anesthesia was induced with thiopental, fentanyl, and succinylcholine and maintained with isoflurane and vecuronium. Transesophageal echocardiography was used to evaluate left ventricular wall motion and blood flow velocity in the left anterior descending coronary artery. Intravenous nitroglycerin was used to reduce systolic arterial pressure to 60 to 70 mmHg. Intravenous albumin 5% was administered to maintain pulmonary capillary wedge pressure >5 mmHg. MEASUREMENTS AND MAIN RESULTS: The left anterior descending coronary artery was visualized clearly in 16 of 20 patients. At a mean nitroglycerin dose of 16+/-14 microg/kg/min, peak diastolic left anterior descending flow velocity increased significantly from 32.5+/-10.3 cm/sec to 44.7+/-14.6 cm/sec (p = 0.0103). None of the patients developed any ST-segment changes. CONCLUSIONS: During nitroglycerin-induced hypotensive anesthesia, coronary blood flow as assessed by peak diastolic left anterior descending flow velocity is preserved or increased in most patients. Increases in left anterior descending flow velocity are predictably achieved only at nitroglycerin doses >5 microg/kg/min. Intraoperative transesophageal echocardiography is useful in monitoring coronary flow velocity responses to controlled hypotensive anesthesia.

Adult↗
PubMed2000

Evaluation of a screening test for female college athletes with eating disorders and disordered eating.

OBJECTIVE: To develop a screening test to detect female college athletes with eating disorders/disordered eating (ED/ DE). No validated eating disorder screening tests specifically for athletes have been available. DESIGN AND SETTING: In this cross-sectional study, subjects from a large midwestern university completed 3 objective tests and a structured diagnostic interview. MEASUREMENTS: A new test, developed and pilot tested by the researchers (Athletic Milieu Direct Questionnaire, AMDQ), and 2 tests normed for the general population (Eating Disorder Inventory-2, Bulimia Test-Revised) were used to identify ED/DE athletes. A structured, validated, diagnostic interview (Eating Disorder Examination, version 12.OD) was used to determine which test was most effective in screening female college athletes. SUBJECTS: Subjects included 149 female athletes, ages 18 to 25 years, from 11 Division I and select club sports. RESULTS: ED/DE subjects (35%) were found in almost every sport. Of the ED/DE subjects, 65% exhibited disordered eating, 25% were bulimic, 8% were classified as eating disordered not otherwise specified (NOS), and 2% were anorexic. The AMDQ more accurately identified ED/DE than any test or combination of items. The AMDQ produced superior results on 7 of 9 epidemiologic analyses; sensitivity was 80% and specificity was 77%, meaning that it correctly classified approximately 4 of every 5 persons who were truly exhibiting an eating disorder or disordered eating. CONCLUSIONS: We recommend that the AMDQ subsets, which met statistical criteria, be used to screen for ED/DE to enable early identification of athletes at the disordered eating or NOS stage and to initiate interventions before the disorder progresses.

Journal Article↗
PubMed1999

Health communication and professional preparation: health educator credibility, message learning, and behavior change.

Health education graduate students were surveyed to assess perceptions of their professional responsibility to be role models of healthy behaviors, characteristics of a professional role model, and related socializing experiences during professional preparation. A total of 233 randomly selected health education graduate students participated in this study nationwide. Significant inverse associations were found between students' year in graduate school and sense of excellence as a role model, graduate program satisfaction, and professional commitment (all ps < 0.05). Students' sense of professional marketability and competence to role model were statistically significant in predicting their perception that role modeling healthy behaviors is a professional responsibility, F(2, 215) = 110.25, p = 0.00001. Positive associations also were found between students' desire to improve fitness behavior, nutrition, and weight and/or body fat ratio with self-ratings as role models (all ps < 0.05). Implications for the profession and preparation are provided.

Adult↗
PubMed1999

Role modeling: an opportunity for the health education specialist.

It is the responsibility of the profession to determine what is right, reasonable, and ethical health education practice. Opportunities within the profession abound to deliberate about the responsibility of health education specialists to role model positive health behaviors. Davis summarized the espoused perspectives nicely: We owe it to our profession and to our students to personally travel as far on the wellness continuum as behavioral choices will permit.... Health educators do have a special responsibility to be positive health role models by fulfilling their health potential and modeling the healthiest behaviors of which they are capable. All health educators need to accept for themselves the responsibilities that we assign to others.

Education, Professional↗
PubMed1998

Accuracy of self-reported body weight: Stepped Approach Model component assessment.

This study was conducted to investigate innovative solutions to a measurement problem pertaining to self-reported body weight data as a key component of the Stepped Approach Model (SAM) of service delivery. Subjects (n = 223) were randomly assigned to one of two conditions: Informed Group (of self-report and weight measurement) + six body weighing habit items (IG, n = 113) and Uninformed Group (of self-report and weight measurement) + one body weight item (UG, n = 110). A t-test indicated that IG subjects reported significantly more accurately, t(194) = 2.99, P = 0.002, and with significantly less variability than UG subjects, F(109,112) = 1.95, P < 0.0005. A multiple regression of absolute difference weight (observed--self-reported weight) on observed weight revealed consistent accuracy across the weight range for IG subjects, whereas UG subjects' accuracy decreased as body weight increased. The slope of the IG did not significantly differ from 0, t(218) = 1.44, P = 0.150, but did significantly differ from the slope of the UG, t(218) = 2.78, P = 0.006. The following conclusions are noted when IG conditions are used: (1) a three-component strategy designed for maximum effect size results in accurate reporting across the entire weight range, (2) self-reported body weights under prescribed conditions can be used as valid 'proxies' for observed measurements, and (3) SAM proponents can rely on the validity of self-report body weight as a credible basis for decisions about changing intervention steps and evaluating intervention efficacy.

Adolescent↗
PubMed1998

Peer helping/involvement: an efficacious way to meet the challenge of reducing alcohol, tobacco, and other drug use among youth?

Peer-led drug prevention programs for middle school youth are reviewed as to whether or not they are a vital resource in an overall effort to minimize the use of alcohol, tobacco, and other drugs (ATOD). The paper focuses on the following: a) results of a 120-study meta-analysis of school-based drug prevention programs and positive program features; b) considerations for falsely concluding that peer programs are ineffective; c) features of two model or stellar programs that compared interactive (peer leadership) to teacher/researcher-led (non-interactive) programs that followed National Peer Helpers Association (NPHA) Programmatic Standards; and d) suggestions for designing and implementing high-quality, peer-led programs. The authors conclude that interactive peer interventions for middle school students are statistically superior to non-interactive didactic, lecture programs led by teachers/researchers. Programs implemented according to NPHA Programmatic Standards may eliminate Type II (false negative) and III ("implementation failure" or ineffectively designed and implemented program) errors. Opportunities for prudent application of well-designed peer programs appropriately implemented and evaluated must remain a salient priority.

Adolescent↗
PubMed1997

Self-administered interventions: a health education strategy for improving population health.

A case is presented for using self-administered interventions (SAIs) as a viable public health education/promotion option. SAIs are promulgated as a means to more fully participate in projected health care changes. One readily available opportunity is to incorporate SAIs into managed care organizations concerned about balancing costs and care, and responsible for the health care of the populations they serve. SAIs are both clinical and 'population-based' strategies that are viable alternatives to 'usual' care because SAIs offer a means to enhance reach, efficiency and efficacy when used independently or as part of a sequential, systematic series of interventions. SAIs also have other advantages such as being easily shared, disseminated, reusable and capable of including a valuable, inexpensive human resource, trained peer helpers or volunteers. The SAIs of minimal intervention and self-instruction have been widely used with a variety of lifestyle behaviors associated with cardiovascular disease. Research from the weight management literature is used as a heuristic illustration of the application of SAIs, and to describe the nature and potential of SAIs as public health strategies to meet health care challenges of the future related to service delivery.

Health Education↗
PubMed1996

Healthy body weights: an alternative perspective.

The primary purpose of this roundtable discussion of the American Health Foundation is to establish healthy weight standards for adults. In most large, long-term, well-designed studies, the lowest morbidity and mortality rates occurred in adults at weights that yielded BMIs (in kg/m2) between 19 and 25. Best body fat percentages averaged between 12% and 20% for men and 20% and 30% for women. However, statistical values are not applicable to everyone and their strict application may be counterproductive. We believe that most weight-associated health problems result from a cascade of events associated with abnormal blood concentrations of insulin, glucose, or lipids that occur when fat cells become full and insulin-insensitive, and lose their protective functions. Indexes associated with high risk in obese persons often return to normal with appropriate physical activities, dietary habits, and a small weight loss even when body weight and percentage body fat remain above recommended amounts. We believe that statistically derived standards for body weight and percentage body fat are appropriate for use as a screening test but should be downplayed as strict guidelines for all.

Adipose Tissue↗
PubMed1996

Nitric oxide improves transpulmonary vascular mechanics but does not change intrinsic right ventricular contractility in an acute respiratory distress syndrome model with permissive hypercapnia.

OBJECTIVE: To test the hypothesis that in a swine model of acute respiratory distress syndrome (ARDS) with permissive hypercapnia, inhaled nitric oxide would improve transpulmonary vascular mechanics and right ventricular workload while not changing intrinsic right ventricular contractility. DESIGN: Prospective, randomized, controlled laboratory trial. SETTING: University research laboratory. SUBJECTS: Eleven swine (30 to 46 kg). INTERVENTIONS: The swine were anesthetized, intubated, and paralyzed. After median sternotomy, pressure transducers were placed in the right ventricle, pulmonary artery, and left atrium. An ultrasonic flow probe was placed around the pulmonary artery. Ultrasonic dimension transducers were sutured onto the heart at the base, apex, left ventricle (anterior, posterior, free wall), and right ventricle (free wall). An additional transducer was placed in the interventricular septum. A surfactant depletion model of ARDS was created by saline lung lavage. Nitric oxide was administered at 2, 4, and 6 parts per million (ppm), in a random order, under the condition of permissive hypercapnia (Paco2 55 to 75 torr [7.3 to 10.0 kPa]). MEASUREMENTS AND MAIN RESULTS: We evaluated the pulmonary vascular and right ventricular effects of permissive hypercapnia, with and without inhaled nitric oxide, by measuring variables of transpulmonary vascular mechanics and right ventricular function. These variables included mean pulmonary arterial pressure, right ventricular total power, right ventricular stroke work, transpulmonary vascular efficiency, and right ventricular intrinsic contractility. Data were obtained after lung injury under the following conditions: a) normocapnia (Paco2 35 to 45 torr [4.7 to 6.0 kPa]) and nitric oxide at 0 ppm; b) hypercapnia and nitric oxide at 0 ppm; c) hypercapnia and nitric oxide at 2, 4, and 6 ppm; and d) repeat measurements with hypercapnia and nitric oxide at 0 ppm. In ARDS with permissive hypercapnia, inhaled nitric oxide therapy (2 to 6 ppm) improved transpulmonary vascular mechanics and right ventricular workload by lowering pulmonary arterial pressure (29.6 +/- 1.3 vs. 24.6 +/- 1.0 mm Hg, p = .0001), increasing transpulmonary vascular efficiency (13.9 +/- 0.5 vs. 16.1 +/- 0.7 L/W-min, p = .0001), decreasing right ventricular total power (142 +/- 9 vs. 115 +/- 9 mW, p = .001), and decreasing right ventricular stroke work (653 +/- 37 vs. 525 +/- 32 ergs x 10(3), p = .001). Inhaled nitric oxide did not change right ventricular contractility, as measured by preload-recruitable stroke work. CONCLUSIONS: Inhaled nitric oxide ameliorated any negative effects of hypoxic and hypercapnic pulmonary vasoconstriction. The beneficial effects of inhaled nitric oxide are related to alterations in right ventricular afterload and not intrinsic right ventricular contractility. The improved cardiopulmonary effects of inhaled nitric oxide with permissive hypercapnia potentially expand the use of nitric oxide in ARDS and other conditions in which this strategy is employed.

Animals↗