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Biomedical subjects

K Kress

Publications and source records attributed to K Kress.

11 recordsLinked to original sources
PubMed2001

Integrating evidence-based practices and the recovery model.

Consumer advocacy has emerged as an important factor in mental health policy during the past few decades. Winning consumer support for evidence-based practices requires recognition that consumers' desires and needs for various types of treatments and services differ significantly. The authors suggest that the degree of support for evidence-based practices by consumer advocates depends largely on the degree of disability of the persons for whom they are advocating. Advocates such as members of the National Alliance for the Mentally Ill, who focus on the needs of the most seriously disabled consumers, are most likely to be highly supportive of research that is grounded in evidence-based practices. On the other hand, advocates who focus more on the needs of consumers who are further along their road to recovery are more likely to be attracted to the recovery model. Garnering the support of this latter group entails ensuring that consumers, as they recover, are given increasing autonomy and greater input about the types of treatments and services they receive. The authors suggest ways to integrate evidence-based practices with the recovery model and then suggest a hybrid theory that maximizes the virtues and minimizes the weaknesses of each model.

Evidence-Based Medicine↗
PubMed1999

Therapeutic jurisprudence and the resolution of value conflicts: what we can realistically expect, in practice, from theory.

This article assesses the criticisms of therapeutic jurisprudence that it cannot resolve value conflicts, especially between autonomy rights and therapeutic values, or, less radically, that it has not provided a general method for resolving conflicts. Grounded in general jurisprudential principles about conflict resolution, including novel developments respecting the meaning of weighing and balancing, the article rejects the criticisms as unfounded. The article also develops and critiques arguments maintaining that therapeutic jurisprudence cannot resolve certain value conflicts because the values are incommensurable. The argument is illustrated by examples concerning the right to refuse treatment, and jurisprudential analyses of that right.

Conflict, Psychological↗
PubMed1997

Comparison of technetium-99m-sestamibi scintimammography with contrast-enhanced MRI for diagnosis of breast lesions.

UNLABELLED: Scintimammography using 99mTc-sestamibi and contrast-enhanced MRI were performed to determine the diagnostic accuracy of either method in the diagnostic workup of patients suspicious for breast tumors. METHODS: Fifty-six patients (42 with indeterminate mammograms) underwent preoperative prone planar scintimammography and pre- and postcontrast-enhanced MRI. Visually determined signal increase after application of Gd-DTPA was compared with visually scored sestamibi uptake, and the diagnoses of both methods were correlated with the final histopathologic results. RESULTS: Overall, sensitivity and specificity of scintimammography for diagnosing breast cancer were 88% and 83%, respectively. In the subgroup of patients with indeterminate mammograms, sensitivity was 79% and specificity was 83%. MRI readings provided a higher sensitivity (91% with respect to all patients and 89% with respect to patients with indeterminate mammograms), but a considerably lower specificity (52% in both groups) due to contrast-enhancement in different benign lesions. CONCLUSION: Due to its considerably higher specificity, scintimammography rather than MRI may be suitable to reduce the number of breast biopsies which yield benign results. Thus, this method may be suggested as the preferable tool in the diagnostic workup of patients with indeterminate mammographic findings.

Adult↗
PubMed1997

Evaluation of mammographic breast lesions with Tc-99m sestamibi scintimammography and contrast enhanced MRI.

Scintimammography using Tc-99m sestamibi and contrast enhanced MRI were performed in order to determine the accuracy of both methods in the diagnostic work up of patients with suspicious or indeterminate preliminary diagnosis. 25 controls and 56 patients (14 with suspicious and 42 with indeterminate preliminary diagnoses), in whom physical examination and/or mammography warranted breast biopsy, underwent prone planar scintimammography. Sestamibi uptake was scored visually and measured using the ROI technique to enable semiquantitative evaluation. The patient group additionally underwent plain and contrast enhanced MRI. Visually determined signal increase following application of Gd-DTPA was compared with scintigraphic findings and final histopathologic results. Sensitivity and specificity of semiquantitative scintimammography for diagnosing breast cancer was 88% and 87%, respectively. Based on ROC analysis a target/non target ratio R > 1.3 was shown to be the optimal threshold for separating benign from suspicious scintigraphic diagnoses. MRI reading provided a slightly higher sensitivity (91%), but a considerable lower specificity (52%) due to contrast enhancement of different benign lesions. In the clinically important patient subpopulation with indeterminate results from previous diagnostic procedures, sensitivity of scintimammography fell to 79%, while specificity remained at 87%. MRI revealed a higher sensitivity of 89% and a lower specificity of 52%. Our data indicate that semiquantitative scintimammography using Tc-99m sestamibi provides a comparable sensitivity to contrast enhanced MRI in the assessment of breast cancer. The latter does not reduce the number of biopsies yielding benign results due to the high number of false positive diagnoses. Therefore, scintimammography seems to be the preferable tool in the diagnostic work-up of patients with indeterminate mammographic diagnoses.

Aged↗
PubMed1993

Diagnosis of pathogenic Entamoeba histolytica infection using a stool ELISA based on monoclonal antibodies to the galactose-specific adhesin.

Monoclonal antibodies (MAbs) directed against pathogen-specific epitopes of the galactose adhesin of Entamoeba histolytica were used in an ELISA to detect antigen from pathogenic E. histolytica. Single stool specimens from 74 patients in Bangladesh were used. The ELISA for pathogenic E. histolytica was positive in all 12 stool specimens with pathogenic amebae subsequently cultured, in no stool specimens with nonpathogenic E. histolytica and in 2 of 40 stools with other or no intestinal parasites detected. Specificity and sensitivity of the assay for pathogenic E. histolytica were 97% and 100%, respectively. These preliminary data offer promise for an ELISA using MAbs to the galactose adhesin as a rapid and sensitive means to detect the presence of pathogenic E. histolytica infection in stool specimens.

Animals↗
PubMed1991

[Adjuvant postoperative radiotherapy of rectal cancer with special reference to the problem of local recurrence].

For a longer period of time the question of indication for adjuvant postoperative radiotherapy of the rectal cancer has been discussed and handled in practice with a lot of controversy. The lymphnode status plays a very important role as an prognostic indicator for the development of the disease. This already has been shown in large collections of patient data. According to our opinion, this evidence should lead to an increase of indication of the adjuvant postoperative radiotherapy. After the introduction of the computer-aided planned, small volume four-field-technique, the former problem of an additional significant damage through adjuvant postoperative radiotherapy are no longer of importance. The life quality of living of the patient with progressive disease often shows much earlier and decisive decrease by local failure comparing a metastatic disease to the liver and lung with few symptoms over a long period of time. Our radiation therapy on 135 patients in Dukes stage B2 to C2 has shown a rate of only 7.6% local failure and in Dukes stage B an even minimaly better outcome with 5.6% compared to stage Dukes C, which expectedly shows the worst result (12.7%). The median followup of 20.4 months corresponds about to the critical 2-years period. Comparing these excellent results with the literature, one has to notice that the 5-year survival rate according to the actuarial method of Kaplan-Meier in our group is as low as 27.6% (compared to the rate of about 60% in the literature). We explain this difference with the specific age structure and the relatively high rate of distant metastasis in our patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1990

Pathogenic and nonpathogenic strains of Entamoeba histolytica can be differentiated by monoclonal antibodies to the galactose-specific adherence lectin.

Entamoeba histolytica infection results in either asymptomatic colonization or invasive colitis and liver abscess. E. histolytica isolates from patients with invasive disease have characteristic isoenzyme profiles (pathogenic zymodemes), suggesting a role for parasite factors in determining the severity of infection. A galactose-specific cell surface lectin from a pathogenic zymodeme was shown to mediate in vitro adherence to human colonic mucins and contact-dependent killing of target cells. Six nonoverlapping antigenic determinants were identified on the 170-kilodalton heavy subunit of the pathogenic lectin. Anti-lectin monoclonal antibodies (MAb) directed against epitopes 1 and 2 enhanced adherence whereas MAb to epitopes 3 through 6 either inhibited or had no effect on adherence. We tested 50 pathogenic and nonpathogenic strains for reactivity to these anti-lectin MAb by radioimmunoassay. MAb to epitopes 1 through 6 reacted in the radioimmunoassay with all 16 pathogenic zymodeme strains tested. In contrast, only MAb to epitopes 1 and 2 bound to the lectin from nonpathogenic strains. Western immunoblots with anti-lectin antibodies showed that the 170-kilodalton heavy subunit was present in the nonpathogenic amebae. Adherence of the nonpathogenic SAW 760 strain to human erythrocytes was enhanced by MAb to epitope 1 and blocked by galactose, confirming the presence of a functionally active lectin. A lectin radioimmunoassay based on MAb to epitopes 1 and 3 proved to be a simple and rapid method to distinguish pathogenic from nonpathogenic amebae in culture. Further exploration of the functional consequences of the antigenic differences demonstrated for the lectin may lead to a better understanding of its role in pathogenesis.

Animals↗