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Biomedical subjects

Donald N Reed

Publications and source records attributed to Donald N Reed.

8 recordsLinked to original sources
PubMed2005

The stages of change questionnaire as a predictor of trauma patients most likely to decrease alcohol use.

BACKGROUND: Research has shown that negative trauma-related consequences of drinking can predict readiness to change drinking behavior. These findings are confined to patients with positive blood alcohol levels at admission. The current study extends such findings by examining whether stage of readiness to change among all adult trauma activations admitted to the emergency department for 24 hours or more can be used to predict a change in behavior at followup. STUDY DESIGN: Patients 18 years of age or older admitted to a Level II trauma center between December 1, 2001, and January 31, 2003, with a trauma activation were eligible to participate. Enrolled patients were screened for alcohol use and readiness to change with the Alcohol Use Disorders Identification Test (AUDIT) and Short Form Stages of Change (SFSC), respectively, within 2 days of discharge. Blood alcohol level (BAL) was obtained for all study patients. Six to 18 months after discharge, patients were followed up with the AUDIT. The ability of the SFSC to predict change in alcohol behavior at followup was analyzed by multiple regression. RESULTS: Of 253 eligible patients, 146 patients were enrolled and had BAL taken. Most were men (64%) and 36% were women. Mean positive BAL (n = 57) was 186 mg/dL (range 10 to 537 mg/dL). Of these, 23% (13 of 57) met AUDIT criteria for harmful drinking and 47% (27 of 57) met criteria for dependent drinking. Even among those with undetectable BAL (n = 89), harmful or dependent drinking was identified by the AUDIT for 11% (10 of 89). A readiness to change was common among those reporting harmful or dependent drinking (26%) at baseline. The SFSC independently and significantly predicted change in drinking behavior among the 72 patients with followup (p = 0.05). Patients indicating greater readiness to change at baseline were those more likely to decrease their consumption pattern at followup. CONCLUSIONS: Findings suggest that administering the brief SFSC questionnaire to all trauma patients and providing assistance to those demonstrating a willingness to change may prove to be an effective strategy for reducing problem alcohol use.

Adult↗
PubMed2005

Use of a single question to screen trauma patients for alcohol dependence.

BACKGROUND: Alcohol-dependent trauma patients are known to be at future risk for both recidivism and mortality. Psychological tools exist to screen for alcohol-dependent disorders, and among patients with alcohol-dependent disorders, a brief intervention has been shown to modify behavior. However, the training involved and time required to administer these tools may decrease their utility. We explored the possibility that yet simpler screening tools could be used. METHODS: A prospective consecutive study was designed whereby all adult patients admitted to the trauma service were asked to participate in the study. If consent was obtained, one trained member of the research team would apply a standard alcohol-misuse screening tool (i.e., the Alcohol Use Disorders Identification Test [AUDIT]). One hundred forty-nine patients met criteria and agreed to participate. Fully completed questionnaires were then subjected to statistical analysis. RESULTS: Among the 149 participating patients, 36% were women and 64% were men, and 146 had blood alcohol levels (BALs) drawn. Those 146 patients form the basis of this report. Fifty-seven of the 146 (39%) patients had positive BALs and, among them, 74% of men and 54% of women recorded screening results consistent with harmful or dependent drinking. Among those with negative blood alcohol levels, 8% of women and 13% of men had scores consistent with harmful or dependent drinking by the AUDIT score. In both groups of patients, a cutoff of three or more drinks per day as a response to question 2 on the AUDIT (i.e., "On a typical day when you are drinking, how many drinks do you have?") correlated strongly with scores on the entire screening tool (AUDIT) in identifying those at risk for alcohol misuse. CONCLUSION: It may be reasonable to substitute a single question for the entire AUDIT screening instrument to screen for those at risk for alcohol misuse. If so, this single question could easily be incorporated into the history taken among patients admitted to a trauma service. Confirmation with a larger study is recommended.

Alcoholic Intoxication↗
PubMed2004

Redox-mediated enrichment of self-renewing adult human pancreatic cells that possess endocrine differentiation potential.

OBJECTIVES: The limited availability of transplantable human islets has stimulated the development of methods needed to isolate adult pancreatic stem/progenitor cells capable of self-renewal and endocrine differentiation. The objective of this study was to determine whether modulation of intracellular redox state with N-acetyl-L-cysteine (NAC) would allow for the propagation of pancreatic stem/progenitor cells from adult human pancreatic tissue. METHODS: Cells were propagated from human pancreatic tissue using a serum-free, low-calcium medium supplemented with NAC and tested for their ability to differentiate when cultured under different growth conditions. RESULTS: Human pancreatic cell (HPC) cultures coexpressed alpha-amylase, albumin, vimentin, and nestin. The HPC cultures, however, did not express other genes associated with differentiated pancreatic exocrine, duct, or endocrine cells. A number of transcription factors involved in endocrine cell development including Beta 2, Islet-1, Nkx6.1, Pax4, and Pax6 were expressed at variable levels in HPC cultures. In contrast, pancreatic duodenal homeobox factor 1 (Pdx-1) expression was extremely low and at times undetectable. Overexpression of Pdx-1 in HPC cultures stimulated somatostatin, glucagon, and carbonic anhydrase expression but had no effect on insulin gene expression. HPC cultures could form 3-dimensional islet-like cell aggregates, and this was associated with expression of somatostatin and glucagon but not insulin. Cultivation of HPCs in a differentiation medium supplemented with nicotinamide, exendin-4, and/or LY294002, an inhibitor of phosphatidylinositol-3 kinase, stimulated expression of insulin mRNA and protein. CONCLUSION: These data support the use of intracellular redox modulation for the enrichment of pancreatic stem/progenitor cells capable of self-renewal and endocrine differentiation.

Acetylcysteine↗
PubMed2003

Decreasing mortality of bile leaks after elective hepatic surgery.

BACKGROUND: Bile leak is a serious complication following major hepatic surgery. It is associated with significant mortality rates if reoperative management is attempted. We evaluated our experience with aggressive, nonoperative management of postoperative biliary complications. METHODS: All medical records of patients undergoing major liver resection, cryosurgery or radiofrequency ablation from September 1996 through March 1999 were reviewed. RESULTS: Seventy-four patients were identified, and 9 (12%) developed bile leaks. Biliary leaks were investigated with endoscopic retrograde cholangiopancreatography (ERCP) and treated with endoscopic stenting when possible. The bile leak was found to originate from the resected duct stump or ablated surface of the liver in all cases. Patients were treated with ERCP stent placement (5), computed tomography-guided percutaneous drainage (3), and hepaticojejunostomy "chimney" (1). Six of 9 patients had resolution of their bile leak with the mean time of removal of the drain of 4.7 months. There was only 1 death, and that patient died nearly 3 months after surgery from complications not directly related to the bile leak. CONCLUSIONS: Bile leak after liver resection can be managed nonoperatively in most cases with a combination of percutaneous drain placement and biliary stenting. Most bile leaks will close with time, although a drain may be required for many months.

Adult↗
PubMed2003

Upper gastrointestinal cancer risk in familial adenomatous polyposis.

Familial adenomatous polyposis has a known risk of colorectal carcinoma. Less well recognized, however, is the association with duodenal polyps and their subsequent malignant degeneration. While frequent endoscopic surveillance is acceptable, a case of early malignant transformation is presented, and the argument for prophylactic preemptive pancreaticoduodenectomy is made.

Adenomatous Polyposis Coli↗
PubMed2002

Risk factors for delirium tremens in trauma patients.

BACKGROUND: The development of delirium tremens (DT) is associated with significant morbidity and mortality. This study identifies characteristics in trauma patients that are predictive of DT. METHODS: Data from 1,856 trauma patients who either developed DT (n = 105) or had a positive blood alcohol concentration but did not develop DT (n = 1,751) were collected from the trauma registry of a Level I trauma center. Odds ratios were used to measure the association between predictors and DT as an outcome and between DT and length of stay as an outcome. RESULTS: Of seven significant (p < 0.05) predictors of DT, four were retained after stepwise logistic regression: age >40, white race, burn as a mechanism of injury and, as a negative predictor, motor vehicle collision as a mechanism of injury. The DT group stayed an average of 6.5 and 5.2 days longer in the hospital and the intensive care unit, respectively, than those in the control group. CONCLUSION: It is possible to determine which intoxicated trauma patients are at increased risk for DT using the above predictors. Patients who develop DT have worse outcomes than those who do not. Whether routine DT prophylaxis would improve outcomes among those at increased risk for DT is unknown, but deserves further study.

Adult↗
PubMedDate not supplied

Acute lung injury: an indicator of serious systemic illness.

The history of the acute respiratory distress syndrome (ARDS) parallels that of critical care. Descriptive and colorful names for the condition such as "shock lung," "post perfusion lung," and "traumatic wet lung" clearly communicate the reality that the pulmonary tissue is involved in a pathologic process. It is not difficult to speculate that the focus on the lung originated from the dramatic chest radiographs and gas exchange abnormalities frequently observed in association with the syndrome. However, a named condition does not necessarily dictate the therapeutic approach to it, and a review of some pertinent studies suggests the condition is in fact systemic in nature. Concurrent with this recognition, the need for markers of severity of illness has become more important. Rather than a process needing primarily pulmonary approaches to management, it now seems that ARDS is the result of systemic events with noticeable pulmonary manifestations, which may suffice as a clinical marker for severity of systemic inflammation. Because the pathophysiology has been described elsewhere, this article will focus on the clinical trials that are shaping our perception and management of the syndrome.

Enteral Nutrition↗