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Biomedical subjects

J Sayre

Publications and source records attributed to J Sayre.

14 recordsLinked to original sources
PubMed1992

Current attitudes and practice of American Society of Clinical Oncology-member clinical oncologists regarding cancer prevention and control.

PURPOSE AND METHODS: A nationwide needs assessment survey including a validated Cancer Prevention and Early Detection Attitude Inventory of 1,500 randomly selected American Society of Clinical Oncology (ASCO)-member clinical oncologists was conducted via a 67-item, mailed questionnaire to assess practice and attitudes regarding cancer prevention and control. RESULTS: Responses of 729 physicians from 48 states representing medical (57%), radiation (17%), surgical (16%), and pediatric oncology (6%), and hematology/other (4%) fields were obtained. Except for ambivalence regarding an important role for diet in cancer causation, cancer prevention and control recommendations were widely endorsed despite skepticism about their impact on reducing deaths from cancer. Surprisingly, a significantly (P less than .001) more favorable attitude for cancer prevention and control issues was found in physicians with greater than 20 years practice compared with younger oncology colleagues, as measured by a 22-item Cancer Prevention and Early Detection Attitude Inventory. Among all physicians, participation in cancer therapy trials exceeded that in cancer prevention and control trials (91% v 27%, P less than .01). Formal instruction during postgraduate training in cancer screening (34%) or prevention (23%) was received by few oncologists; nonetheless, 69% considered themselves a resource for cancer prevention and control issues in their practice communities. Of potential barriers to cancer prevention and control activity, only lack of patients without cancer (53%) and difficulty in including such activity economically into clinical practice (65%) were majority selections. Importantly, 64% agreed they could "motivate their patients to change lifestyle to reduce cancer risk." CONCLUSION: Clinical oncologists may represent a potential resource for implementation of cancer prevention and control objectives if economically feasible models for their use in practice settings can be identified.

Adult↗
PubMed1990

Psychodynamics revisited: an object-relations framework for psychiatric nursing.

Recent trends in psychiatry, such as shorter hospitalization and the renewed preeminence of biological treatments, are changing the practice of psychiatric nursing. The traditional tension-reduction model of anxiety and defense mechanisms is less suitable for clients in shortterm settings where somatic therapies are often the treatment of choice. For nurse therapists who wish to do more than alleviate symptoms, object-relations theory offers an alternative therapeutic framework that focuses on behavioral change, yet is suitable for seriously ill clients. Object-relations theory allows the nurse to assess the developmental level of clients' behavior in terms of specific ego functions. Through therapeutic interventions focused on repairing developmental deficiencies in the client's ego, nurses can facilitate significant behavioral change.

Adult↗
PubMed1988

Improved survival for frail elderly inpatients on a geriatric evaluation unit (GEU): who benefits?

Previously reported data from a randomized controlled trial showed that admission to the geriatric evaluation unit (GEU) and follow-up clinic at the Sepulveda VA Medical Center leads to significantly improved outcomes for frail elderly hospital patients--including a 50% reduction of one-year mortality (p less than 0.005). In the present paper, two-year survival curves for GEU and control groups are reported. In addition, we subdivided the population by potential baseline risk factors (both patient- and treatment-related) and examined one-year survival using 12-month survival curves and odds ratios. There is evidence for GEU-related survival effects in specific subgroups of patients (e.g. patients with heart and pulmonary disease, patients with low baseline scores in functional status and mental status, and patients with high baseline morale scores). Finally, employing stepwise logistic regression, we determined the predictors of one-year survival in the pooled study population. These factors were: assignment to the GEU (adjusted odds ratio = 2.45; p less than 0.001); not having a heart diagnosis (2.24; p less than 0.001); and having primarily "geriatric/rehabilitation" problems (1.95; p less than 0.005). A predictive model derived from the regression defines patient subgroups likely to survive only when assigned to the GEU: cardiac patients with primarily "geriatric" or "rehabilitation" problems, and non-cardiac patients whose problems are primarily "medical". The dramatic effect of the GEU on survival appears to be concentrated on certain identifiable subgroups of patients who might be targeted to maximize program cost-effectiveness.

Activities of Daily Living↗
PubMed1988

Clinical significance of a single test for anti-cardiolipin antibodies in patients with systemic lupus erythematosus.

PURPOSE: Clinicians have difficulty interpreting results of tests for anti-cardiolipin antibodies (aCL) because of conflicting reports of the clinical associations of these antibodies in patients with systemic lupus erythematosus (SLE). We therefore decided to evaluate the clinical associations of aCL in an effort to facilitate interpretation of single reports of either positive or negative test results. We also assessed the role of estrogen on the development of aCL. PATIENTS AND METHODS: The study population consisted of 85 consecutive outpatients with SLE and 40 control subjects. Serum samples and clinical and laboratory data were obtained from each patient and control. Testing for aCL was performed using a standardized enzyme-linked immunoabsorbent assay developed at an international workshop. RESULTS: The presence of aCL was documented in 42.4 percent of patients with SLE and 7.5 percent of control subjects. In patients with SLE, these antibodies were significantly associated with thrombosis, fetal loss, and thrombocytopenia, but not with other manifestations. Measurement of all isotypes optimized clinical correlations. Titers did not add clinical utility. Fluctuations of levels of aCL occurred, making it difficult to interpret a single negative result. Among control subjects, the presence of aCL was not significantly more common in women who used oral contraceptives. CONCLUSION: Our findings suggest that positive results of testing for aCL correlate with a predisposition for thrombosis, fetal loss, and thrombocytopenia in patients with SLE; however, the test is not predictive for other clinical manifestations of SLE, including activity and severity of disease. We believe that measurement of all isotypes of aCL should be performed in patients with SLE considering pregnancy, to identify those with a high risk of fetal loss, and in SLE patients with a thrombotic episode.

Adult↗
PubMed1987

Clinical, functional, and psychosocial characteristics of an incontinent nursing home population.

Although urinary incontinence is recognized as a prevalent, disruptive, and costly problem among nursing home residents, the factors associated with this condition have not been carefully studied. We compared clinical, functional, and psychosocial characteristics of 50 incontinent and 50 continent nursing home residents. In spite of a selection bias due to the informed consent process that resulted in the exclusion of many of the most functionally impaired incontinent residents, the incontinent study participants had significantly greater impairments in functional abilities related to toileting and, on average, took longer to perform a timed series of toileting-related tasks than did the continent comparison group. With the exception of bacteriuria, we did not find incontinence to be associated with most of the major clinical conditions and medications we examined, nor did we find differences in morale and most measures of social activities between the incontinent and continent residents. The data highlight the strong association between functional disability and incontinence in the nursing home setting and suggest that a standard functional assessment of toileting skills could make an important contribution to the care of incontinent residents.

Activities of Daily Living↗
PubMed1985

Treatment of first episode genital HSV with oral acyclovir: long term follow-up of recurrences. A preliminary report.

Systemic acyclovir (ACV) treatment has been shown to have significant effects on shortening the clinical course of first episode genital HSV infections, decreasing the quantity of HSV antibody in convalescent phase serum, without affecting the incidence of recurrences in 6 months of follow-up. In order to assess long term recurrence patterns, we prospectively studied subjects enrolled in a randomized double blind trial of oral ACV for first episode genital HSV. Sixty-three of sixty-eight subjects were followed monthly for recurrences for a mean of 36 months with 90% of subjects completing two years. There was no difference in the incidence of recurrence (90%) in (29) placebo vs (37) ACV treated HSV-2 infected subjects. Recurrences rates were similar between ACV and placebo treated subjects with nonprimary HSV-2 infection followed 2 years. The majority of these subjects were found to have HSV-2 antibody in their acute sera suggesting prior asymptomatic acquisition of HSV-2 infection and therefore established ganglionic latency at the time of first clinical disease. In subjects with true primary HSV-2 infection, however, mean recurrence rates were significantly lower in ACV treated subjects after 6 months, 0.87 ACV vs 3 placebo per 6 month period (p less than 0.01). The percentage of subjects experiencing recurrences after 1 year was also reduced by ACV treatment (70% placebo subjects vs 12.5% ACV subjects).(ABSTRACT TRUNCATED AT 250 WORDS)

Acyclovir↗
PubMed1985

Competitive binding kinetics in ligand-receptor-competitor systems. Rate parameters for unlabeled ligands for the formyl peptide receptor.

We describe the real-time kinetics of the competition of different ligands for the same receptor and use the computer routine SAAM to simulate this competition. Based on the simulation, we have developed two experimental approaches whereby the parameters of the interaction of nonlabeled ligands with their receptor can be detected; briefly, the analysis of the nonlabeled ligands depends on the perturbation of the kinetics of interaction of labeled ligands with the receptor with which they are in competition. The approach relies primarily upon an analysis of the kinetics of the competition between fluorescent and nonfluorescent ligands using a real-time, homogeneous binding assay in the fluorescence flow cytometer. A secondary approach depends upon an examination of the kinetic impact of antagonists on the responses of cells stimulated by agonists at the same receptor. Experimental verification of these approaches has been obtained using the N-formyl peptides (and their antagonists) which bind to receptors on human neutrophils and produce rapid cell stimulation. We find that agonistic N-formyl peptides have residence times of minutes while nonstimulatory antagonists have residence periods of, at most, a few seconds at these receptors. The limitations and general range of applicability of these procedures are discussed. The main advantage of these approaches is that they permit the evaluation of kinetic parameters of unlabeled ligands, even those which bind weakly or which have brief residence times--properties which make analyses by conventional methods difficult.

Binding, Competitive↗
PubMedDate not supplied

MR imaging in an experimental model of brain tumor immunotherapy.

A murine model of implanted CNS neoplasia was used to study a new form of brain tumor immunotherapy with intralesional Corynebacterium parvum (C. parvum). Assessment of treatment protocols has been limited by the inability to assess, noninvasively, tumor burden and/or the inflammatory reaction induced in the murine brain by treatment with C. parvum. This study demonstrates that contrast-enhanced MR imaging can monitor in vivo tumor burden and the immune response to intracerebral C. parvum. KHT murine sarcoma was stereotaxically implanted into the right frontal lobe of C3H/HeN mice at doses of 10,000 and 50,000 tumor cells. The KHT sarcoma is 100% fatal in untreated mice. Therapy consisted of an intraperitoneal injection of 350 micrograms of killed C. parvum 1 day after tumor implantation followed by 70 micrograms of C. parvum stereotaxically injected into the tumor 5 days after implantation. MR imaging was performed on mice injected with saline only, C parvum only, tumor only, and tumor treated with C. parvum. C. parvum alone elicited an intense transitory mononuclear cell inflammatory reaction in the meninges, ependyma, and to a variable degree at the injection site. The inflammatory response reached a peak 2 weeks after intracerebral injection. Contrast-enhanced MR imaging was able to detect the presence and severity of C. parvum-induced inflammation, which decreased 3 weeks after intracerebral injection. The transitory nature of this type of inflammation should allow its differentiation from tumor in subjects undergoing serial scanning following intracerebral injection of C. parvum as a form of brain tumor immunotherapy.

Animals↗