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Biomedical subjects

J Cook

Publications and source records attributed to J Cook.

At least 307 records · Page 17Linked to original sources
PubMedDate not supplied

A cost utility analysis of treatment options for gallstone disease: methodological issues and results.

The techniques of cost utility analysis (CUA) were used to evaluate the treatment of gallstone disease by open and laparoscopic cholecystectomy and by extracorporeal shockwave lithotripsy (ESWL). The application of the techniques in this context raised three methodological questions which are not satisfactorily resolved in the literature. The first is whether an ex ante or ex post perspective is best adopted for the measurement of quality of life (QoL). The second is the method for converting a short term deterioration in QoL followed by full health into QALYs and the reliability of the methods available. The third is the issue of indirect costs which, in the context of a temporary disease state, cannot be easily avoided. The economic evaluation found laparoscopic cholecystectomy to be generally superior than the competitor technologies (entailing lower costs and better outcomes). However, the results were sensitive to assumptions about the perspective for measuring benefits and the inclusion of indirect costs.

Cholecystectomy, Laparoscopic↗
PubMedDate not supplied

A blood analog for laser-induced photochemical anemometry.

A transparent viscoelastic blood analog fluid was developed for use with Laser-Induced Photochemical Anemometry. To provide solubility of the photochemical tracer, 1', 3', 3'-trimethyl-6-nitroindoline-2-benzopyran (TNSB dye, Kodak Chemicals), the analog solvent needed to be nonpolar, thus currently available aqueous blood analogs were not suitable. An analog consisting of 0.04% ethylhydroxyethylcellulose dissolved in gamma-butyrolactone produced a pseudoplastic steady shear response with low elasticity in unsteady shear, while being compatible with the photochemical tracer.

Blood Substitutes↗
PubMedDate not supplied

Breast cancer imaging with radiolabelled peptide from complementarity-determining region of antitumour antibody.

Specific tumour imaging with radiolabelled monoclonal antibodies has been extensively investigated. Although some success has been reported, there are many limitations due to the slow kinetics, poor extravasation, catabolism by the reticuloendothelial system, and non-specific uptake of macromolecules such as antibodies. We have tried to overcome some of the problems associated with monoclonal antibodies while retaining their specificity by using an antibody-derived synthetic peptide. A synthetic pentadecapeptide (alpha M2) derived from the third heavy-chain complementarity-determining region (CDR-3H) of a tumour-associated monoclonal antibody was produced and shown to retain its specificity against the pan-carcinoma cell-surface antigen, polymorphic epithelial mucin, detected by the parent antibody. The peptide was radiolabelled with technetium-99m and injected intravenously to image malignant lesions in 26 women with primary, recurrent, or metastatic breast cancer. Visualisation of breast tumours and their metastases was obtained shortly after administration of alpha M2, and was optimum by 3 h. Overall, 57 (77%) of 74 sites were visualised. Successful imaging was achieved in 14 of 15 primary tumour sites and all of eight local recurrences. Five of six metastases in the opposite breast, eight of 15 metastatic axillary lymph nodes, and all of six metastatic supraclavicular lymph nodes were imaged. Metastatic sites in the lungs, mediastinum, chest wall, and liver were poorly visualised because of background cardiac blood pool. alpha M2 detected small lesions ( < 2 cm) as efficiently as larger ones. The peptide was rapidly (3 h) cleared from the circulation. No acute or chronic adverse reactions due to the alpha M2 were observed. Specific tumour targeting with the radiolabelled anticancer peptide alpha M2 offers new opportunities for breast cancer imaging and possibly therapy.

Adult↗
PubMedDate not supplied

Tourette disorder in North Dakota.

This paper describes the symptom profiles of a large group of patients with Gilles de la Tourette disorder (TD). In Part one we report the results of a questionnaire study of patients in North Dakota with TD. The data suggest that TD patients have high rates of academic and social problems. Obsessive-compulsive symptomatology is quite high in this population. This report is unique in that these results are reported using an available data base to allow for pooling of future research in TD patients in other settings. In Part two of this paper we discuss important findings from our clinic population of 130 TD patients.

Adolescent↗
PubMedDate not supplied

Transient and resident microflora of burn unit personnel and its influence on burn wound sepsis.

The exogenous contamination of a thermally injured patient by contact with the health are team has been a major concern of all burn units. Since the University of Chicago Burn Center routinely monitors each burn injury for sepsis by quantitative bacteriology and recently examined the microbial population present on the hands of the health care team, it was felt that these combined data would shed some pertinent information on exogenous burn wound sepsis. Twenty-nine patients with clinical burn wound sepsis and a bacterial level of greater than 10(5) bacteria/gram of tissue were studied. These patients yielded a variety of microorganisms with P. aeruginosa and Staphylococcus aureus being predominant, followed in incidence by Candida albicans. The resident and transient microflora isolated from each member of the health care team treating the specific individual concerned did not correlate with the causative agent of burn wound sepsis. The most frequent isolate from the staff personnel was Staphylococcus epidermidis followed by Micrococcus species. Though colonization of the thermally injured individual has been reported, these data strongly suggest that colonization is primarily one of an endogenous source rather than that of an exogenous one.

Burn Units↗
PubMedDate not supplied

Preschool language intervention: a follow-up study.

A follow-up study was undertaken of 38 children who had attended a preschool language unit with detailed assessments of 25 by speech therapists and an educational psychologist. The subjects were assessed in a number of areas (language, learning and social skills) using standardized tests and rating schedules completed by teachers and parents. The initial results are presented in terms of group characteristics. At a mean age of 8.3 years the children were still making progress in all areas of development. Although some 16% of the children were attending specialist schools or classes (language unit, physically handicapped unit, schools for children with severe speech and language problems), the majority (84%) were within the mainstream of education. A continuing language difficulty was apparent on standardized tests. Reading and spelling were slightly depressed, but not significantly so. However, parents and teachers saw the children as differing little from their peers. The conclusion is reached that preschool intervention can prevent later educational failure.

Adaptation, Psychological↗
PubMedDate not supplied

Preschool language intervention--a follow-up of some within-group differences.

A more detailed study was made of the children who had been followed-up by Urwin, Cook & Kelly (1988) 4-8 years after leaving a preschool language group. Children were independently allocated into groups according to their speech and language diagnosis prior to entry to the Unit. There were two major dimensions--receptive/expressive versus expressive only, and phonology versus non-phonology. Comparisons were made between the group as indicated by children's performance at follow-up for measures of ability, achievement, language and social functioning. Conclusions are drawn about the long-term effects of the early language difficulty and preschool intervention. Attention is also drawn to differences in perceiving the effects of language difficulty between the specialist professionals on the one hand and parents and teachers on the other.

Child↗
PubMedDate not supplied

Optimized sequence of drug administration and schedule leads to improved dose delivery for gemcitabine and paclitaxel in combination: a phase I trial in patients with recurrent ovarian cancer.

We examined appropriate sequence, schedule, and doses of gemcitabine (G) and paclitaxel (T) in patients with persistent or recurrent epithelial ovarian cancer. Patients received a maximum of six cycles of gemcitabine on days 1 and 8 (starting 1000 mg/m(2)), and paclitaxel (starting 135 mg/m(2)) on day 8 (groups A and B) or day 1 (group C). Drug sequences (G-->T and T-->G) were tested in group A. In group A, changing sequences of gemcitabine and paclitaxel infusion were evaluated. Sequence G-->T raised grade 3 alanine transaminase in two of three patients leading to use of T-->G sequence for remainder of study. In group B, maximum tolerable dose was reached at gemcitabine 1000 mg/m(2) and paclitaxel 175 mg/m(2). Reducing paclitaxel to 150 mg/m(2) allowed escalation of gemcitabine to 1250 mg/m(2), but neutropenia-related treatment delays occurred. Giving paclitaxel on day 1 (group C) enabled administration of paclitaxel 175 mg/m(2) and gemcitabine 1250 mg/m(2) with minimal dose adjustments. The overall response rate was 41.0%, with 2 complete responses and 14 partial responses in 39 eligible patients. The schedule of paclitaxel 175 mg/m(2) (day 1) and gemcitabine 1250 mg/m(2) (days 1 and 8), with sequence of T-->G, appears most suitable with tolerable toxicity and promising activity.

Adult↗
PubMedDate not supplied

Bullous mastocytosis in an infant associated with the use of a nonprescription cough suppressant.

Bullous mastocytosis is an unusual expression of mastocytosis typically seen in young children, and many causes of the acute mast cell degranulation with bulla formation have been identified. We report a 6-month-old boy with urticaria pigmentosa and an extensive bullous eruption associated with the ingestion of a nonprescription cough suppressant containing dextromethorphan. The pathogenesis of mastocytosis and the care of patients with this disease are discussed.

Antitussive Agents↗
PubMedDate not supplied

Selection of end points in economic evaluations of coronary-heart-disease interventions.

Economic evaluations of interventions to lower blood pressure or cholesterol have used different outcome measures, or end points, in the denominator. Some have related the costs of interventions to improvements in physiologic end points such as mm Hg reduction in blood pressure. Some have related costs to avoidance of coronary heart disease (CHD) events or gains in life expectancy. Others have measured improvements in outcome in quality-adjusted life years (QALYs) gained. The different end points imply different analytic perspectives and different data requirements. The more ambitious analyses, though potentially more relevant in certain situations, require more controversial assumptions to be made. This paper illustrates the trade-offs of relevance, accuracy, and precision by reference to an evaluation of drug therapy for hypercholesterolemia undertaken in the United Kingdom. Estimates are given of cost per percentage cholesterol reduction, cost per CHD event avoided, cost per CHD-free year gained, cost per life year gained, and cost per quality-adjusted life year gained. In each case the assumptions required and the potential relevance of the estimate are discussed. The main findings are that: 1) some end points cannot be discounted to present values in a meaningful way and hence the timing of costs and outcomes cannot be reflected in the analysis; 2) the incorporation of quality-of-life adjustments for years on drug therapy and years post-CHD events greatly changes the cost-effectiveness ratios; 3) the rate of discount changes the pretreatment level of cholesterol for which cost per life year gained is equivalent to cost per quality-adjusted life year gained.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

The impact of AIDS continuing education on psychiatric and non-psychiatric nurses' knowledge.

BACKGROUND: Because an increasing number of chronically mentally ill individuals are HIV-positive, continuing education must include AIDS content to ensure psychiatric nurses provide competent care. The Fundamentals of Mental Health and HIV/AIDS Program was tested to determine its effectiveness in augmenting the AIDS knowledge of mental health professionals. METHOD: Two hundred forty RNs attended the Fundamental of Mental Health and HIV/AIDS Program. They completed pretest and posttest measures. RESULTS: The program significantly increased AIDS knowledge. The increase in AIDS knowledge was more dramatic for psychiatric nurses than for non-psychiatric nurses. CONCLUSION: This study reinforces the need for AIDS continuing education.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Multiresidue screening of pesticides in foods using retention time locking, GC-AED, database search, and GC/MS identification.

Fruit and vegetable extracts were screened for over 400 pesticides by gas chromatography with atomic emission detection (GC-AED) and an experimental database. A technique called retention time locking was used to match GC-AED and GC with mass spectrometry (MS) retention times to those of the database. Samples were analyzed for sulfur, nitrogen, phosphorus, and chlorine by GC-AED. Possible pesticides were suggested by database search and identified by GC/MS. Forty-four pesticide standards were analyzed to determine the precision of retention time matching and the accuracy of the database search. Analytical retention times matched database retention times within 0.32 min. Using elemental criteria, the database search identified the correct compound for 41 of 44 pesticide standards. For blind spikes of fruit and vegetable extracts, the database suggested 22 of 26 spiked pesticides as matches. Nineteen were identified by GC/MS. The combination of retention time locking, GC-AED, database search, and GC/MS can be a powerful tool for identifying pesticides in a complex matrix.

Chlorine↗