PubMed Health⌕ Search

Biomedical subjects

E J Stanek

Publications and source records attributed to E J Stanek.

At least 55 records · Page 3Linked to original sources
PubMed1991

Medical versus pharmaceutical continuing education: are both appropriate for the pharmacist?

Continuing education (CE) courses in pharmacy and medicine often overlap with regard to their informational content. At the present time, however, it is feasible that two pharmacists could attend the same national meeting that has continuing medical education (CME) approval status and only one of them would receive CE credit from his state board of pharmacy. Therefore, a survey of 51 state board of pharmacy policies regarding acceptance of CME was conducted. Forty-five of the 51 boards of pharmacy require CE for relicensure. Twenty percent of state boards requiring CE accept CME credit without review, 24 percent do not accept CME credit, and the remaining 56 percent review submitted requests for CME credit. A general lack of uniformity exists among state boards regarding policies pertaining to CE credit. If CME credit was universally accepted, pharmacists would benefit from the increased availability of CE, the building of collegial relationships with other healthcare professionals, and the cost savings of combining courses that mutually benefit both pharmacists and physicians.

Accreditation↗
PubMed1990

A two-step method for understanding and fitting growth curve models.

With data from a repeated measures design, analysts often overlook growth curve analysis based on the Potthoff-Roy model. The reluctance to perform a growth analysis may result partially from unfamiliarity with the technique, and partially from the lack of readily available computational programs to fit the models. Although growth curve analysis has traditionally appeared as a special technique in multivariate analysis, one can fit the models with the use of two simple ideas: transformation of variables, and weighted least squares (WLS). When presented in this manner, growth models are a natural extension of univariate repeated measures models. Growth curve analyses share with univariate analyses the common objective to limit estimation to a parsimonious set of parameters that characterize the response profiles. One can readily fit models with commonly available software. The two-step methodology also allows the fit of more general growth models that are appropriate when groups have different shape profiles. Two examples illustrate this approach to growth curve analysis.

Animals↗
PubMed1990

Preliminary adult soil ingestion estimates: results of a pilot study.

Six adults were evaluated for the extent to which they ingest soil. This study was originally part of a large childhood soil ingestion study and was used to validate part of the analytical methodology used in that larger study. The adult study followed the soil tracer methodology of the children's study. The principal findings of the adult study revealed that the four most reliable tracer elements based on recovery studies in a mass balance assessment [aluminum (Al), silicon (Si), yttrium (Y), and zirconium (Zr)] yielded the following mean daily adult soil ingestion estimations: Al (77 mg), Si (5 mg), Y (53 mg), and Zr (22 mg). The median daily soil ingestion estimations based on these same tracer elements were: Al (57 mg), Si (1 mg), Y (65 mg), and Zr (-4 mg). These findings represent the first published quantitative estimates of soil ingestion by adults.

Adult↗
PubMed1990

City directories as sources for survey work in low- and middle-income black communities.

Commercial directories and governmental lists of dwelling units in low income urban Black communities in four eastern cities were evaluated for completeness. With rare exceptions, less than 90 percent of dwelling units were included in any one list and no list adequately identified multiple dwelling unit structures. Since household income is likely to be lower among households in such structures, all lists tend to miss the very poor, i.e., those who may be at highest health risk.

Black or African American↗
PubMed1989

A cautionary note on the use of autoregressive models in analysis of longitudinal data.

Rosner et al. presented a simple, easily implemented modelling method for retaining time order relationships in analyses of longitudinal data when successive measures are correlated. Evaluation of time order is particularly useful in epidemiologic studies concerned with exposure to potentially toxic substances and subsequent outcome, but may also have use in more traditional growth studies that relate intake to subsequent development. The analysis allows for unequally spaced measures and missing data. The estimation method permits varying numbers of observations per subject and, with measures equally spaced, one can fit the model with use of ordinary least squares regression software. We report on a potential false association that can result when both exposure and outcome are related to time. We illustrate this problem with a small scale simulation and example. We also note a more serious problem with Rosner's approach in interpreting parameters. Although the model may be useful for prediction, parameters depend on the autocorrelation and are not readily interpretable. We recommend alternative modelling strategies be used when autocorrelation of errors is suspected.

Age Factors↗
PubMed1989

How much soil do young children ingest: an epidemiologic study.

Sixty-four children aged 1-4 years were evaluated for the extent to which they ingest soil. The study followed the soil tracer methodology of S. Binder, D. Sokal, and D. Maughan (1986, Arch. Environ. Health, 41, 341-345). However, the present study included a number of modifications from the Binder et al. study. The principal new features were (1) increasing the tracer elements from three to eight; (2) using a mass-balance approach so that the contribution of food and medicine ingestion would be considered; (3) extending the period of observation from 3 days to 8 days; and (4) validating the methodology by having adult volunteers ingest known amounts of soil in a mass-balance validation study. The principal findings reveal the following. (1) The adult study confirmed the validity of the tracer methodology to estimate soil ingestion. (2) Of the eight tracers employed in the adult study, only Al, Si, and Y provided sufficient recovery data that was directly acceptably stable and reliable. (3) If food ingestion determinations were taken into consideration, the median estimates of soil ingestion from the eight tracers ranged from a low of 9 mg/day (Y) to a high of 96 mg/day (V); the median values of Al, Si, and Y, the three most reliable tracers, ranged from 9 mg/day to 40 mg/day. (4) One child had soil ingestion values ranging from 5 to 8 g/day, depending on the tracer. (5) If food ingestion had not been considered, the estimates of soil ingestion would have increased about two- to sixfold, depending on the tracer with Ti and Y being most affected by food intake. (6) Since soil and dust samples did not significantly differ in their levels of tracer elements, no reliable differentiation between the contribution of ingestion of dust and soil could be made. (7) These findings are generally consistent with the previously reported findings of Binder et al. (1986) and P. Clausing, B. Brunekreff, and J.H. van Wijnen (1987, Int. Arch. Occup. Med., 59, 73) if these latter studies are corrected for ingestion of tracers in food and medicine. The findings also account for the apparent discrepancy between the estimates from Al and Si and estimates based on Ti in previous studies. Thus the elevated estimates of soil ingestion by Ti were substantially reduced when food ingestion is considered.

Adult↗
PubMed1988

Growth curve models of repeated binary response.

Experimental designs that include repeated measures of binary response variables over time and under different conditions are common in biology. In such settings, it is often desirable to characterize the response pattern over time. When response variables are continuous, this characterization can be made in terms of a growth model such as the Potthoff-Roy growth curve model. We illustrate how a similar growth curve modeling strategy can be implemented using weighted least squares (WLS) methods for binary response data. The growth models are constructed in terms of polynomial functions across marginal response. However, when growth models are fit to repeated binary response, the nonsignificant higher-order polynomial functions are dropped from the model, rather than used as covariates. Dropping the nonsignificant polynomials from the model will reduce the number of response functions, and help avoid small-sample problems that can occur when the number of correlated response functions is large and sample sizes are small. The reduced set of response functions are then modeled using WLS methods. We illustrate such models with an example of binary fly oviposition response (accept or reject) exhibited by two populations of flies at four ages to two types of fruit.

Animals↗
PubMed1987

Degree of public support for household hazardous waste control alternatives.

This paper reports information from Massachusetts on attitudes of householders toward alternative approaches and economic solutions to household hazardous waste (HHW) generation and disposal. Residents appear to be aware of the nature of the HHW problem and clearly support action to address the problem. The majority support a law fining householders for the improper disposal of HHW, endorse paying a sales tax on domestic hazardous products to finance safe disposal, and appear willing to drive up to five miles to dispose of HHW twice yearly.

Adult↗
PubMed1986

The relationship between the dentist's year of graduation and ordering of bitewing radiographs.

This article reports the results of a survey of general practice dentists on the relationship of the dentist's year of graduation to the ordering of bitewing radiographs for patients. More recent graduates were more likely to indicate ordering the radiographs at 6-month intervals. There were no differences in ordering associated with the dentist's experience. Shorter intervals between ordering were indicated by all dentists for patient groups at high risk of caries.

Adolescent↗
PubMed1983

Evidence that healthy human gingiva contains functionally heterogeneous fibroblast subpopulations.

Six mass cultures of human fibroblasts derived from a single biopsy of a normal gingival papilla tip were studied with regard to their protein, collagen and glycosaminoglycan synthesis in vitro, using incorporation of radiolabelled substances. The proliferation rates, replicative life-spans and cell-size distributions of these mass cultures were determined. There were significant differences among the 6 cultures and these differences persisted throughout numerous cell replications in vitro. It is suggested that functional heterogeneity exists among phenotypically stable fibroblast subpopulations or subpopulation mixtures from normal tissue. The concept of participation of fibroblast subpopulations in disease pathogenesis is supported by these preliminary findings.

Adult↗
PubMed1983

A survey of radiographs obtained at the initial dental examination and patient selection criteria for bitewings at recall.

This paper reports the results of a 1980 survey of a 27% simple random sample of all practicing dentists in North Carolina. The objective of the survey was to establish current practice standards regarding panoramic, full-mouth series, and bitewing radiographs. A total of 414 dentists (76.2% of those surveyed) responded. A questionnaire recorded demographic data on the dentists, age-specific prevalence data on the type of radiograph most often done at a patient's initial visit, and prevalence of radiographs based on need as perceived by the dentist and assessed separately for a variety of patient characteristics (age, oral hygiene, caries activity, fluoride treatment, and systemic medical problems). Results of the survey of a subset of 338 dentists in general practice showed the median age to be 40 with a median length of experience of 13 years. At an initial visit, for patients younger than 12, bitewing radiographs only were most commonly taken; for patients older than 12, bitewings plus a panoramic radiograph were taken. Full-mouth series plus bitewings were rarely performed among patients younger than 6 years (2.1% of the time), but were more commonly performed as patients aged (29.0% for patients aged 40 and older). A variety of patient characteristics were considered for their impact on the need for bitewing radiographs on recall. Caries activity was ranked most important by the general dentist, followed by oral hygiene and periodontal activity.

Adolescent↗
PubMed1982

Suicide rates among cancer patients in Connecticut.

This study derives age-sex specific standardized mortality ratios (SMR's) among cancer (ca) patients with respect to population suicide rates. Suicide rates were derived for all 144,530 ca patients in the Connecticut Tumor Registry from 1940-1973. We also derived rates by number of years since diagnosis (y-s-dx) and by decade of dx. We hypothesized beforehand that suicide rates will (1) be higher in ca patients than the population; (2) be higher soon after dx than in later y-s-dx; (3) vary directly with spread of disease at dx, highest for metastatic, lowest for local. We address hypotheses (1) and (2) here. After collapsing age groups and y-s-dx in the observed 192 ca patient suicides, SMR's derived for age, sex and y-s-dx were tested with an exact Poisson distribution. Overall, SMR for males was significantly elevated (230, P less than 0.005), but not for females. In males, a test for trend in SMR's with y-s-dx showed a significant decline, supporting hypothesis (2) for males (chi2 = 4.0, df = 1, P less than 0.05). No trend was found for decade of dx. On combining decades, male SMR's were significantly elevated in 10 of the 25 cells of age by y-s-dx, while none of the female cells was significant. We conclude that both hypotheses were supported for males, and neither for females.

Adolescent↗
PubMed1981

Inhibition of urinary bladder cancer by N-(ethyl)-all-trans-retinamide and N-(2-hydroxyethyl)-all-trans-retinamide in rats and mice.

The chemopreventive activity of two synthetic retinamides of relatively low toxicity against N-butyl-N-(4-hydroxybutyl)nitrosamine (OH-BBN)-induced urinary bladder cancer was studied in F344 rats and C57BL/6 X DBA/2 F1 mice. Female and male rats were given a total dose of either 1800 or 3200 mg OH-BBN over a period of 6 or 8 weeks, respectively. Male mice were given a total dose of either 90 or 180 mg OH-BBN over a period of 9 weeks. Seven days after the final intubation of a period of 9 weeks. Seven days after the final intubation of OH-BBN, animals were fed either a placebo diet or a diet supplemented with the following retinoids: for rats, 0.8 mmol 13-cis-retinoic acid, 2 mmol N-(ethyl)-all-trans-retinamide, or 2 mmol N-(2-hydroxyethyl)-all-trans-retinamide per kg diet; and for mice, either 0.5 or 1.0 mmol of N-(ethyl)-all-trans-retinamide or N-(2-hydroxyethyl)-all-trans-retinamide per kg diet. Animals were killed 6 months after the initial gastric intubation. In comparison to male and female rats fed placebo diets, all three retinoids reduced the incidence, number, and severity of the low-grade papillary transitional cell carcinomas of the urinary bladder. Similarly, treatment of mice with either of the two retinamides reduced the incidence of highly invasive urinary bladder carcinomas. The chemopreventive effect of the less toxic retinamides was equal to or greater than that of 13-cis-retinoic acid.

Animals↗
PubMedDate not supplied

Household hazardous waste in Massachusetts.

Household wastes, when disposed of improperly, are hazardous to health. This paper reports a random digit dial telephone survey of Massachusetts households concerning household hazardous waste (HHW) disposal with a 54% response. Of the automotive oil disposed of by 33% of survey households, 57% was deposited in the ground, sewer, or landfill. Annually by household oil disposal in Massachusetts is estimated to be 8.8 million quarts. Four percent of hazardous waste generated in Massachusetts is from households. Improper disposal makes it a major environmental contaminant. More households (41.5%) in smaller communities disposed of oil compared with 26% of households in larger communities. Paint and pesticides were disposed of by 10% of the households, but were dumped on the ground sewer or landfills more than 90% of the time.

Household Products↗
PubMedDate not supplied

Patient preferences for thrombolytic therapy in acute myocardial infarction.

BACKGROUND: Despite extensive professional debate regarding the optimal thrombolytic therapy strategy in acute myocardial infarction (AMI), patient preferences have not been explored. METHODS: Preferences among patients with known or suspected coronary artery disease for treatment with tissue plasminogen activator (tPA) or streptokinase (SK) for AMI were determined using a questionnaire presenting GUSTO-1 trial and drug cost data. Preferences were based on consideration of 30-day mortality (M) alone, hemorrhagic stroke rate (SR) alone, overall preference (M + SR), drug acquisition costs, and the estimated annual costs of using a single agent to treat all AMIs. Cost-related responses were provided under payer designations of self, third-party insurance, and federal government. RESULTS: The response rate was 81% (101/125 patients). tPA was preferred by 84%, and SK by 66%, for M alone and SR alone, respectively (chi 2, p < 0.01). Overall preference (M + SR) favored tPA (78%, p < 0.01). tPA preference decreased to 43% considering drug acquisition costs under the self-pay option (p < 0.01 vs M + SR). Similar trends of lesser magnitude were also observed for the third-party and government-payer options. CONCLUSIONS: Under conditions of zero cost and consideration of mortality plus stroke-risk data, tPA were preferred overall due to its lower mortality. Introduction of drug-cost data significantly shifted the preference toward SK, particularly under the self-payer designation. Patient preferences for thrombolytic therapy in AMI indicate tradeoffs between clinical attributes and costs, and should assist in framing medical debate and decision making.

Acute Disease↗
PubMedDate not supplied

Amlodipine overdose.

OBJECTIVE: To report a nonfatal intentional overdose of amlodipine. CASE SUMMARY: A 42-year-old woman with a history of hypertension reported ingesting 50-100 mg amlodipine besylate and at least 40 ounces of beer in a suicide attempt. The patient's symptoms were mild; BP ranged from 79/50 to 113/76 mm Hg and HR from 92 to 129 beats/min (sinus tachycardia). Laboratory studies revealed normoglycemia, mild metabolic acidosis, mild hypocalcemia, blood ethanol concentration of 263 mmol/L, and a serum amlodipine concentration of 88 ng/mL (normal 3-11) 2.5 hours after ingestion. Therapy included activated charcoal, whole bowel irrigation, and intravenous NaCl 0.9%. After receiving 1.5 L of NaCl 0.9%, the patient developed signs of mild pulmonary edema that resolved over several hours without intervention. A serum amlodipine concentration obtained 35 hours later was 79 mg/mL. The patient was discharged on day 2 in good condition. DISCUSSION: In this case, an amlodipine overdose was associated with sustained hypotension and sinus tachycardia, as well as transient pulmonary edema following relatively low-volume fluid replacement. A previously published report described an amlodipine overdose that was fatal due to refractory hypotension and was complicated by concomitant oxazepam overdose. CONCLUSIONS: Amlodipine overdose produces prolonged hemodynamic effects and may lead to pulmonary edema. Due to a long elimination half-life and delayed onset of effects, patients with amlodipine overdose should receive aggressive decontamination therapy and may require extended clinical monitoring and supportive care if they are hemodynamically unstable.

Adult↗
PubMedDate not supplied

Effect of long-term angiotensin-converting enzyme inhibitor therapy on arterial oxygen saturation in patients with mild to moderate heart failure.

STUDY OBJECTIVE: To evaluate the effects of angiotensin-converting enzyme (ACE) inhibition on continuous pulse oximetry recordings of arterial oxygen saturation (SpO2). DESIGN: Open-label study. SETTING: Cardiology clinics at two large teaching hospitals. PATIENTS: Eight patients with New York Heart Association Functional Class (NYHA FC) II-III heart failure. INTERVENTIONS: Patients were studied after an ACE inhibitor washout (baseline, B), and after 3 months following resumption of therapy (ACE). MEASUREMENTS AND MAIN RESULTS: Monitoring times for B and ACEI were approximately 22 hours. Reduction trends were observed for number (190 +/- 170 vs 125 +/- 67 B vs ACEI), magnitude (8.2 +/- 1.4% vs 7.5 +/- 1.8%), and duration (2.45 +/- 2.8 vs 1.35 +/- 0.8 min) of desaturations/monitoring period, and for nadir SpO2/desaturation (88.1 +/- 1.5% vs 89.9 +/- 3.3%). The B desaturation index [(cumulative desaturation time/monitoring period time) x 100, a measure of hypoxic stress or burden] decreased from 19.4 +/- 8.1% to 11.9 +/- 8.1% at ACEI (p = 0.024). CONCLUSION: Long-term ACE inhibitor therapy improves the profile of SpO2 values over time in patients with NYHA FC II-III heart failure.

Adolescent↗