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Biomedical subjects

Kelly M Smith

Publications and source records attributed to Kelly M Smith.

At least 19 recordsLinked to original sources
PubMed2006

Medication and nutrient administration considerations after bariatric surgery.

PURPOSE: Medication and nutrient administration considerations after bariatric surgery are discussed. SUMMARY: Bariatric surgery is categorized by surgical technique (i.e., restrictive procedure or a combination of restrictive and malabsorptive procedures). Roux-en-Y gastric bypass is the most frequently performed bariatric surgery in the United States. Patients who have undergone this surgery are at risk for nutrient deficiencies. Several factors, such as pH and absorption sites, should be considered when providing these patients with appropriate supplementation. Drug solubility and surface area for absorption are also affected by gastric bypass procedures. By bypassing major portions of the small intestine, Roux-en-Y procedures drastically reduce the surface area for absorption. These changes may warrant manipulation in drug route or dose to ensure adequate delivery. Drugs with long absorptive phases that remain in the intestine for extended periods are likely to exhibit decreased bioavailability in these patients. The reduced size of the stomach after surgery can place patients at risk for adverse events associated with some medications. Medications implicated in such adverse events include nonsteroidal antiinflammatory drugs, salicylates, and oral bisphosphonates. Drugs that are rapidly and primarily absorbed in the stomach or duodenum are likely to exhibit decreased absorption in patients who have had combination restrictive-malabsorptive procedures. Because reduced drug absorption may result in decreased efficacy rather than toxicity, increased patient monitoring for therapeutic effects can help detect potential absorption problems. CONCLUSION: Selection of appropriate nutrient salts can improve nutrient replacement in patients who have undergone bariatric surgery. Changes in dosage forms based on drug characteristics can improve bioavailability.

Bariatric Surgery↗
PubMed2006

Emotional intelligence as a predictor of academic and/or professional success.

The concept of "emotional intelligence" has been extensively popularized in the lay press and corporate world as individuals purport the potential ability of emotional intelligence to predict various markers of success. Emotional intelligence (EI) most commonly incorporates concepts of emotional expression and regulation, self-awareness, and empathy. The concept has been criticized by some for its loose definition and parallels to personality traits. Additionally, several limitations to the instruments used to measure emotional intelligence have been identified. This review examines the foundations of the definitions of emotional intelligence as well as existing educational research involving emotional intelligence, both within the health professions and externally. Recommendations for future research and research potential are discussed.

Aptitude Tests↗
PubMed2006

Human mammary epithelial cells express CYP27B1 and are growth inhibited by 25-hydroxyvitamin D-3, the major circulating form of vitamin D-3.

1alpha,25-dihydroxycholecalciferol [1alpha,25(OH)2D3], the active form of cholecalciferol, is a negative growth regulator of breast cancer cells. CYP27B1 is a cytochrome P450-containing hydroxylase expressed in kidney and other tissues that generates 1alpha,25(OH)2D3 from an inactive vitamin D precursor 25-hydroxycholecalciferol [25(OH)D3]. In these studies, we tested the hypothesis that mammary cells express CYP27B1 and locally produce 1alpha,25(OH)2D3, which acts in an autocrine manner to regulate cell turnover. Using Western blot and quantitative real-time PCR, CYP27B1 mRNA and protein were detected in immortalized, nontumorigenic human mammary epithelial cell (HMEC) cultures. Furthermore, HMEC cultures were dose dependently growth inhibited by physiological concentrations of 25(OH)D3, suggesting that CYP27B1 converts this precursor cholecalciferol metabolite to 1alpha,25(OH)2D3, the ligand for the vitamin D receptor (VDR). In support of this suggestion, both 1alpha,25(OH)2D3 and 25(OH)D3 transactivated VDR in HMEC cultures, as measured by induction of a vitamin D responsive reporter gene and upregulation of CYP24, an endogenous VDR target gene. No induction of CYP24 by 25(OH)D3 was observed in mammary cells derived from CYP27B1 null mice. Similar results were observed in 2 independently derived immortalized HMEC lines as well as in primary cultures derived from human breast epithelium. These are the first studies to demonstrate that nontransformed human mammary cells express CYP27B1, that they are growth inhibited by physiologically relevant concentrations of 25(OH)D3, and that they provide a biological mechanism linking vitamin D status to breast cancer risk.

25-Hydroxyvitamin D3 1-alpha-Hydroxylase↗
PubMed2006

Predicting cardiac rehabilitation enrollment: the role of automatic physician referral.

BACKGROUND: Despite the established benefits of cardiac rehabilitation, evidence suggests referral to, and subsequent enrollment in, cardiac rehabilitation following a coronary event remains low (10-25%). The aim of this study was to identify predictors of attendance to cardiac rehabilitation intake and subsequent enrollment in rehabilitation after coronary artery bypass graft surgery within the framework of an automatic referral system. DESIGN AND METHODS: We conducted a historic prospective study of patients who underwent coronary artery bypass graft surgery between 1 April 1996 and 31 March 2000 and lived within the geographic referral area of a multi-disciplinary cardiac rehabilitation center in central-south Ontario, Canada. Coronary artery bypass graft surgery patients are automatically referred to cardiac rehabilitation at the time of hospital discharge. Consecutive health records of eligible patients were reviewed for medical history, cardiac risk factor profiles, and evidence of cardiac rehabilitation intake attendance and enrolment. RESULTS: A total of 3536 patients met eligibility criteria. Patients were predominantly male (79.1%), approximately 64 years of age, living with a spouse or a partner, English-speaking, retired and had multiple cardiac risk factors. Of eligible patients, 2121 (60.0%) attended the cardiac rehabilitation intake appointment. Of patients who attended cardiac rehabilitation intake 1463 (69%) enrolled in at least one cardiac rehabilitation service, based on their risk factor profile. Selected cardiac rehabilitation services were exercise training (n=1287; 88%), nutrition counseling (n=571; 39.0%), nursing care (n=546; 37.3%), and psychological intervention (n=223; 15.2%). CONCLUSIONS: An institutionalized, physician-endorsed system of automatic referral to cardiac rehabilitation resulted in higher rates of cardiac rehabilitation intake and enrollment following coronary artery bypass graft surgery than previously reported and should be adopted for all cardiac populations.

Aged↗
PubMed2006

Exercise and the heart failure patient: aerobic vs strength training--is there a need for both?

Heart failure (HF) is characterized by general muscular weakness, muscle atrophy, and exercise intolerance that lead to reductions in functional capacity, ability to perform activities of daily living, and health-related quality of life. Until recently, exercise programs for patients with HF were centered on aerobic exercise training alone. Although many activities of daily living require significant muscle strength, the role of strength training for HF patients, either alone or in combination with aerobic exercise, has not been well studied. There is suggestive evidence that combined strength-aerobic exercise training may offer additional benefits in terms of health-related quality of life and functional capacity. Strength training can be targeted to reduce muscle atrophy to a greater extent than aerobic training. Further research is required to isolate the specific role of strength training regarding improvements in prognosis, HF-related morbidity and hospitalization, and health-related quality of life for patients with HF.

Evidence-Based Medicine↗
PubMed2006

Analysis of morbidity in liver transplant recipients following human albumin supplementation: a retrospective pilot study.

OBJECTIVES: To assess incidence of morbidity (i.e., documented infection, acute renal failure, acute graft rejection, acute cardiovascular events, and hospital readmission rates) 6 months following liver transplantation using linear regression as a function of cumulative albumin dose. DESIGN: Retrospective chart review. SETTING: A 473-bed tertiary care teaching facility with a solid-organ transplantation center. PATIENTS: Forty liver transplant recipients examined from January 1 to December 31, 2003. MEASUREMENTS AND RESULTS: Data from 40 liver transplant recipients were collected. Mean albumin dose administered was 190.9 +/- 162.3 g. No statistical differences were identified in patients receiving less than 140 g (n=20) or more than 140 g (n=20) with respect to demographic data other than gender and ethnicity. The mean APACHE III (Acute Physiology and Chronic Health) score was 69.7 +/- 24.3. Approximately 70 episodes of morbidity and 23 readmissions were observed. Regardless of the APACHE III score, albumin was associated with increased overall morbidity and cardiovascular complications. Liver transplant recipients receiving more than 140 g had a longer hospital stay (14 vs. 8 days, P = .025) and intensive care unit stay (6 vs. 3 days, P = .051) than patients receiving 140 g or less. No correlation with risk of acute rejection was seen with albumin or tacrolimus. Conclusion-Albumin supplementation among liver transplant recipients was associated with a significant risk for cardiovascular complications and overall number of complications regardless of APACHE III score. Future prospective studies are needed to further define the potential risk for complications in this patient population.

APACHE↗
PubMed2006

Prevalence and characteristics of adverse drug reactions in neurosurgical intensive care patients.

OBJECTIVE: To evaluate the prevalence and characteristics of adverse drug reactions (ADRs) in neurosurgical intensive care patients. METHODS: Retrospective analysis of ADR data obtained from a spontaneous reporting system in a tertiary care university hospital. Reports of suspected ADRs in adult patients admitted emergently or electively to the neurosurgical service were included. RESULTS: Over the 3 year period, 3496 neurosurgical intensive care unit (ICU) patient admissions accounted for 5% of all hospital admissions. A total of 10% of all neurosurgical patients developed a suspected ADR, with three patients experiencing multiple reactions. Other adult ICU patients developed ADRs at a comparable rate (9%, P > 0.05). Overall, neurosurgery patients accounted for 12% of all spontaneously reported ADRs. Preventable reactions were observed in 43 (13%) cases, and treatment was required for 76%. The majority (96%) of ADRs resolved or improved at the time of the ADR report. Nausea, pruritus, thrombocytopenia, and vomiting were most frequently noted. Therapies most often associated with reported events were analgesics, antipyretics, antibiotics, anticonvulsants, and histamine H2 antagonists. The relationship between central nervous system disease and adverse event occurrence is not clear. CONCLUSION: Despite the narrow scope of drug regimens in neurosurgical ICU patients, ADRs can complicate therapy in this critically ill population. Neurosurgical ICU patients seem to experience ADRs no more frequently than their adult ICU counterparts.

Adult↗
PubMed2006

Clinical effects and management of methamphetamine abuse.

Methamphetamine is a highly potent and addictive drug that is abused in the United States and around the world. The drug is inexpensive and easily manufactured from simple chemicals such as pseudoephedrine. These features, coupled with its long half-life and highly addictive nature, contribute to the increasing problem of illicit methamphetamine use. Abuse of this agent has both acute and chronic serious health consequences. Policy makers and public health officials must continue to develop programs that educate the public and limit the abuse associated with methamphetamine.

Amphetamine-Related Disorders↗