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Biomedical subjects

E Nelson

Publications and source records attributed to E Nelson.

At least 19 recordsLinked to original sources
PubMed1992

The short-term effect of patient health status assessment in a health maintenance organization.

This study was designed to test the short-term effects of health assessment on the process of care and patient satisfaction. The 29 Chart physicians used the Dartmouth COOP Charts to measure their adult patients' health status during a single clinical encounter; the 27 control clinicians used no measure of health status. We compared the change between baseline and post-intervention information for a sample of all study clinicians' patients. Most of the patients were female (67%), well educated (70% had at least a college education) and young (approximately 90% were aged 59 years or younger). We found that the ordering of tests and procedures for women was increased by exposure to the COOP Charts (52% vs. 35%; p < 0.01); the effect in men was not as significant (37% vs. 23%: p = 0.06). Although women reported no change in satisfaction with care, men claimed that the clinician helped in the management of pain (p = 0.02). We conclude that the use of health status measures during a single clinical encounter in an HMO changes clinician test ordering behaviour and may improve the help male patients receive for pain conditions. The long-term impact of these management changes is not known.

Episode of Care↗
PubMed1992

Paired comparison of platelet concentrates prepared from platelet-rich plasma and buffy coats using a new technique with 111In and 51Cr.

Two techniques for the preparation of platelet concentrate (PC), the standard platelet-rich plasma (PRP) and buffy coat (BC) methods, were compared in nine paired studies with regard to platelet harvest, white cell (WBC) contamination, and PC quality after 5 days of 22 degrees C storage. Platelet harvest using the BC method averaged approximately 56 percent of the whole blood level (6.2 x 10(10)/concentrate), which was less than the 76 percent achieved with the PRP-PC method (8.7 x 10(10)/concentrate). An additional 5 units collected into an experimental siphon bag for BC-PC processing showed improved platelet harvest (6.7 x 10(10)/concentrate, or approx. 70% of whole blood). WBCs remaining in the BC-PC averaged 0.19 x 10(8) per unit compared to 3.6 x 10(8) per unit for PRP-PC. Buffy coat processing produced red cell (RBC) units with 50 percent of the WBC contamination of conventionally prepared units (9.8 +/- 6.2 x 10(8)/unit vs. 18.9 +/- 7.1 x 10(8)/unit). The siphon bag further reduced WBC levels in the AS-3 RBC units (6.4 +/- 3.7 x 10(8)/unit). In vitro studies performed on Days 1 and 5 after collection showed no significant differences in platelet metabolic and biologic function or cell integrity. Beta-thromboglobulin and surface glycoprotein levels, indicators of platelet activation and membrane alteration, respectively, did not differ significantly in the PRP-PC and BC-PC; nor was lactate production higher in PRP-PC, despite the substantially higher WBC counts. Autologous in vivo platelet viability determinations were performed by using concurrent transfusion of 111In-labeled freshly drawn platelets and 51Cr-labeled stored platelets.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Platelets↗
PubMed1992

Benefits and obstacles of health status assessment in ambulatory settings. The clinician's point of view. The Dartmouth Primary Care COOP Project.

In the past decade physicians have identified the need to expand patient assessment to include global function and quality of life. During the same period, the busy clinic has evolved into the location where this assessment seems most appropriate. Integrating functional health assessment into a busy clinical practice is difficult because the necessary steps require time, thought, recording, and follow-up. Attention to the office ecosystem is very important before any patient care management method is introduced. The clinician must transform the results of health status screening into a specific functional diagnosis. The clinician has to understand the sensitivity, specificity, and predictive value of the measure for a preliminary diagnosis to be made. Often, additional measurements must be taken to establish a specific diagnosis. These steps encompass assessment linkage. Once the specific cause for the dysfunction is recognized, the clinician then has to determine the need for special resources. This is called the resource linkage. By following the steps outlined in this paper, the clinician should be able to overcome many obstacles for functional health status assessment in busy ambulatory settings.

Activities of Daily Living↗
PubMed1992

Characterization of swine infertility and respiratory syndrome (SIRS) virus (isolate ATCC VR-2332).

The characterization of an isolate of swine infertility and respiratory syndrome (SIRS) virus (ATCC VR-2332) is reported. A commercial cell line (CL2621) was used for the propagation of the virus for all assays. Laboratory studies indicate that this isolate is a fastidious, nonhemagglutinating, enveloped RNA virus. Cesium chloride-purified virions visualized by electron microscopy were spherical particles with an average diameter of 62 nm (range: 48-83 nm) and a 25-30 nm core surrounded by an envelope. Virus replication was restricted to the cytoplasm, as demonstrated by immunofluorescence. The virus did not react serologically with antisera to several common porcine viruses or with antisera to known viruses in the alphavirus, rubivirus, pestivirus, and ungrouped lactic dehydrogenase virus genera of the Togaviridae. However, convalescent sow sera and rabbit hyperimmune sera neutralized the SIRS virus at titers of 1:256 and 1:512, respectively. The virus was stable at 4 and -70 C, but was labile at 37 and 56 C. The properties of this isolate of SIRS virus resemble those of the family Togaviridae but do not match the described genera.

Animals↗
PubMed1992

Determination of mercapturic acid excretions in exposure control to toxicants.

Toxicants can be converted in vivo by a variety of biotransformation reactions into substances that are more, equally, or less noxious than the parent compound. Although conjugation with glutathione is a process that usually results in less harmful products, these products might subsequently form new metabolites that exert more toxicity than the parent compound. These conjugation reactions are catalyzed by several classes of glutathione-S-transferase isoenzymes and thus result in the urinary or biliary excretion of N-acetyl-L-cysteine-S-conjugates (mercapturic acids). Inasmuch as GSH-S-transferase activity varies among different tissues, urinary excretion of mercapturic acids might reflect tissue-specific toxicity. Urinary mercapturic acids are biomarkers of internal and, in some cases, effective dose. The utility of these markers is, however, limited to times shortly after exposure. Studies on possible human deficiencies in some GSH-S-transferases might help us better understand interindividual variations in susceptibility to different toxicants and thus the differences in the pathway of mercapturic acid excretion pattern.

Acetylcysteine↗
PubMed1992

The use of baseline investigations in patients admitted from an accident and emergency department.

We studied the use of four investigations on patients admitted from our Accident and Emergency Department: full blood count, urea and electrolytes, chest x-ray and electrocardiogram. We found 1) that these investigations were performed on a high proportion of patients admitted 2) that a high percentage of these investigations yielded normal results. We suggest that a greater emphasis should be placed on clinical assessment, rather than the 'routine' use of investigations.

Diagnostic Tests, Routine↗
PubMed1991

Social isolation effects on the "behavioral despair" forced swimming test: effect of age and duration of testing.

Social loss is considered to be one of the major precipitants of depression. Prior work with the Porsolt forced swimming test (FST) has failed to demonstrate increases in despair-like immobility as a result of prior social isolation in adult animals. In the present work, increased immobility was observed in young Swiss Webster mice that had been socially isolated for 24 h prior to a 15-minute FST. The effect was not apparent until after the first five minutes of testing. The increase in immobility as a result of social isolation was apparent in 17-21-day-old animals but not in 26-30-day-old ones. Control experiments indicated that the increase in immobility was not due to the slightly higher weight loss of the socially isolated animals. Administration of reserpine (0.25 mg/kg) induced a marginal increase in immobility in the youngest animals but decreased immobility at later ages. These data suggest that the mouse only exhibits a short period of time during early development where social isolation can promote despair-like immobility in the FST and suggest that analyses of depressive processes which result from social variables may be best studied during a limited age range in this species.

Aging↗
PubMed1991

[A new approach for transfusion of neocytes: the Neocel system].

Young red cells (neocytes) were prepared in a double transfer pack having a long, narrow separation bag that allows for a density gradient column to be established during centrifugation. The lighter fraction of red cells (neocyte fraction) was then expressed into a second delivery bag. Phthalate ester density distribution curves showed that 87.1% of the neocyte units had greater than 85% enrichment, i.e. more than 85% of the cells had densities lower than the midpoint density of the original red cell unit, thalassemic patients receiving neocytes had an average decrease of 21.1% in red cells per kg/yr as compared to their frozen red cell requirement, and an average of 6.9% fewer transfusions.

Blood Transfusion↗
PubMed1991

Morphological sequelae of intracameral hydrogen peroxide after inhibition of glutathione synthesis.

The morphological sequelae of intracameral injections of hydrogen peroxide on the corneal endothelium were examined under different conditions. In animals pretreated with either intravenous 3-aminotriazole (3AT) alone, to suppress catalase activity, or intravitreal buthionine sulfoximine alone (BSO), to inhibit gamma-glutamyl synthetase activity, the endothelium was normal. The intracameral administration of 10 microliters of 10 mM hydrogen peroxide caused no response after 3AT and some small morphological but not physiological changes after BSO pretreatment. The intracameral injection of 10 microliters of 25 mM hydrogen peroxide caused no additional change in 3AT pretreated rabbits, but caused substantial morphological and physiological changes in BSO pretreated rabbits. The correlation between the present morphological changes and those seen earlier in physiological studies is excellent. The data confirm that the glutathione redox system may be more important than catalase in maintaining the integrity of the corneal endothelium at low aqueous humor concentrations of hydrogen peroxide while catalase assumes greater importance at higher peroxide concentrations.

Amitrole↗
PubMed1991

Metastatic vaginal carcinoma to the temporal bone.

Metastatic carcinoma of the temporal bone is being reported with increasing frequency. A literature review reveals 16 new cases reported in the past 2 years. In this article we present the first case of vaginal squamous cell carcinoma metastatic to the temporal bone reported in the literature. The pathophysiology, clinical presentation, and diagnostic difficulties of metastatic carcinoma to the temporal bone are discussed.

Aged↗
PubMed1990

Tourette's syndrome: a neurochemical analysis of postmortem cortical brain tissue.

Postmortem frontal, temporal, and occipital regions of the brain from adult patients who had a diagnosis of Tourette's syndrome were analyzed for neurochemical alterations. In 3 of 4 TS-affected brains, the concentration of adenosine 3',5'-monophosphate (cyclic AMP) was reduced in all brain regions evaluated. This diminution in cyclic AMP was not associated with a significant change in the activity of the synthesizing enzyme, adenylate cyclase. No significant differences were identified for the neurotransmitter-synthesizing enzymes choline acetyltransferase and glutamate decarboxylase. Concentrations of dopamine, norepinephrine, and the serotonin metabolite 5-hydroxyindoleacetic acid were not altered. Postsynaptic receptor-binding activity for muscarinic cholinergic ([3H]quinuclidinyl benzilate) and beta receptors ([125I]iodocyanopindolol) showed no generalized impairment. It is suggested that symptoms of Tourette's syndrome might be related to an abnormality within a second messenger system.

Adult↗
PubMed1990

Severe reversible thrombocytopenia resulting from butoconazole cream.

A 54-year-old woman with a 19-year history of rheumatoid arthritis developed life-threatening thrombocytopenia one week after beginning butoconazole therapy for a vaginal yeast infection. This was complicated by upper gastrointestinal hemorrhage that probably resulted from ibuprofen and methotrexate therapy. Sepsis, myelophthisic anemias, and other potential etiologies were ruled out. Once stabilized, the patient was rechallenged with other medications without incident. These findings indicate that a potentially serious thrombocytopenia may result from the administration of butoconazole vaginal cream or in combination with methotrexate and/or ibuprofen.

Administration, Intravaginal↗
PubMed1990

Role of eicosanoids in the ocular response to intracameral hydrogen peroxide.

The intracameral injection of hydrogen peroxide induces a sequence of responses in the tissues bounding the anterior chamber. These changes include intraocular pressure, corneal thickness, iris hyperemia, increased leakiness of the iris vasculature, and edema of the ciliary processes as judged from microscopic examination. Some of these responses appear to include inflammatory effects that may be the result of the local release of eicosanoids. Several antagonists of the arachidonic acid cascade, indomethacin, aspirin, dexamethasone, and nordihydroguaiaretic acid (NDGA) were used to examine their influence on the sequelae of hydrogen peroxide injection. Indomethacin, and high dose (7.5 mg/kg) NDGA were most effective in reducing the number of parameters that were altered after intracameral hydrogen peroxide. Microscopic observations supported the physiological changes and the responses to antagonists. The data indicate that a portion of the ocular tissue responses to intracameral hydrogen peroxide in the rabbit eye may be the result of eicosanoid production in these tissues.

Animals↗
PubMed1990

Chief complaint of fatigue: a prospective study.

The Dartmouth COOP Project, a primary care research network, conducted a prospective study of patients presenting to 28 primary care practices with a chief complaint of fatigue. Data were gathered on fatigue status, associated systems, health status, and origin of fatigue. Fatigue patients were demographically similar to nonfatigue patients but had significantly worse physical and mental health at study intake. Sixty-three percent of physicians and 52% of patients rated fatigue origin as primarily physical (gamma = 0.48, P less than .05), but in 41% of cases, physicians indicated there was substantial interaction between physical and psychological factors. Only two factors--depression and anxiety--separated fatigue of physical origin from fatigue of psychological origin. Clinicians must thoughtfully evaluate fatigue's often multiple causes and communicate their understanding of those causes to the patient to gain support for a reasonable treatment regimen.

Adult↗