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Biomedical subjects

L Burke

Publications and source records attributed to L Burke.

At least 37 records · Page 2Linked to original sources
PubMed1998

Research utilization and improvement in outcomes after diagnostic cardiac catheterization.

This research utilization project helped summarize the research basis of current practice related to duration of bed rest after cardiac catheterization via the femoral artery. Several physicians have changed their practice as a result of this project, and the safety of patients is being maintained. Interestingly, De Jong and Morton recently published a research analysis of interventions used to control vascular complications after cardiac catheterization. These authors concluded from the review of the literature on duration of bed rest that evidence was sufficient to support a change in practice. Because we thought that the published evidence was insufficient to be used as the sole basis for a change in practice, we continued to follow the Iowa model. Specifically, we integrated scientific principles and expert recommendations with the published research base; recommended a change in practice; and monitored patients' outcomes, which ultimately did confirm the recommendations of De Jong and Morton. We are convinced that the combination of data from our own patients and the review of the literature was helpful to assure our medical and nursing staff that this change in practice was safe. This project illustrates the benefit of using the Iowa Model for Research Based Practice to Promote Quality Care as a guide to improve patients' outcomes.

Algorithms↗
PubMed1997

Sinusitis in the intensive care unit patient.

A retrospective study was undertaken to determine the incidence of sinusitis as a source of fever in the intensive care unit (ICU) patient, evaluate the effectiveness of radiologic studies in diagnosing sinusitis, and develop guidelines that may help predict the result of antral lavage. Sixteen of 52 (30.7%) lavages in patients studied with plain films and 27 of 67 (40.3%) lavages in patients studied with computed tomography of the sinuses revealed purulence in the maxillary sinuses. Conversely, 23 of 30 (76.7%) of the cases with purulence in the middle meatus had purulence in the maxillary sinus (chi-squared = 27.1). If no purulence was seen, the results of the antral lavage were negative in 68 of 89 cases (76.4%). When physical examination was used in conjunction with computed tomography, 92.3% of lavages confirmed purulence in the maxillary sinus (chi-squared = 16.6). In conclusion, the most important factor in predicting a positive result with antral lavage is the presence of purulence in the middle meatus on physical examination in conjunction with the presence of sinus disease on computed tomography of the sinuses.

Adult↗
PubMed1996

Transcriptional repression by the orphan steroid receptor RVR/Rev-erb beta is dependent on the signature motif and helix 5 in the E region: functional evidence for a biological role of RVR in myogenesis.

RVR/Rev-erb beta/BD73 is an orphan steroid receptor that has no known ligand in the "classical' sense. RVR binds as a monomer to an element which consists of an A/T-rich sequence upstream of the consensus hexameric half-site. However, RVR does not activate transcription and blocks transactivation of this element by ROR/RZR. The mechanism of RVR action remains obscure, hence we used the GAL4 hybrid system to identify and characterize an active transcriptional silencer in the ligand binding domain (LBD) of RVR. Rigorous deletion and mutational analysis demonstrated that this repressor domain is encoded by amino acids 416-449 of RVR. Furthermore, we demonstrated that efficient repression is dependent on the so-called LBD-specific signature motif, (F/W)AKxxxxFxxLxxxDQxxLL (which spans loop3-4 and helix 4) and helix 5 (H5; identified in the crystal structures of the steroid receptor LBDs). Although RVR is expressed in many adult tissues, including skeletal muscle, and during embryogenesis, its physiological function in differentiation and mammalian development remains unknown. Since other 'orphans', e.g. COUP-TF II and Rev-erbA alpha, have been demonstrated to regulate muscle and adipocyte differentiation, we investigated the expression and functional role of RVR during mouse myogenesis. In C2C12 myogenic cells, RVR mRNA was detected in proliferating myoblasts and was suppressed when the cells were induced to differentiate into post-mitotic, multinucleated myotubes by serum withdrawal. This decrease in RVR mRNA correlated with the appearance of muscle-specific markers (e.g. myogenin mRNA). RVR 'loss of function' studies by constitutive over-expression of a dominant negative RVR delta E resulted in increased levels of p21Cip1/Waf1 and myogenin mRNAs after serum withdrawal. Time course studies indicated that expression of RVR delta E mRNA results in the precocious induction and accumulation of myogenin and p21 mRNAs after serum withdrawal. In addition, we demonstrated that over-expression of the COUP-TF II and Rev-erbA alpha receptors in C2C12 cells completely blocked induction of p21 mRNA after serum withdrawal. In conclusion, our studies identified a potent transcriptional repression domain in RVR, characterized critical amino acids within the silencing region and provide evidence for the physiological role of RVR during myogenesis.

Amino Acid Sequence↗
PubMed1996

Nurses' views of the decision not to resuscitate a patient.

The decision not to resuscitate a patient is a complex issue and there is little guidance for nurses on how such a decision is made. The aim of this study was, therefore, to explore the views and working practices of staff in relation to current guidelines and theories, using a situational analysis. Overall, the staff seemed to meet the criteria outlined in the guidelines, although there was little awareness of the guidelines. Nurses in the clinical area should be both educated in the recommendations for practice and should be consulted and involved in developing such recommendations.

Attitude of Health Personnel↗
PubMed1996

Steroidal contraceptive use update, United States, 1989-1994.

OBJECTIVE: To update United States steroidal contraceptive use data for the period 1989 to 1994. STUDY DESIGN: Pharmaceutical marketing data were used to examine trends in the utilization and distribution of oral contraceptives, Norplant, and Depo-Provera. RESULTS: There were 56.8 million prescriptions for oral contraceptives dispensed through retail pharmacies in 1994. Estrogen and progestin doses remained fairly stable over time. The average ethinyl estradiol dose of formulations was approximately 34 microg per pill. Mentions for oral contraceptives among 35- to 44-year-old women increased. Approximately 169,000 Norplant systems were distributed from 1991 through 1994. More than 1.5 million milliliters of Depo-Provera were distributed from 1993 to 1994. CONCLUSIONS: Oral contraceptives remain a popular form of contraception. Parenteral formulations have been rapidly accepted.

Journal Article↗
PubMed1996

Antinuclear antibodies and thyroid function in sexually abused girls.

Sexually abused girls manifest dysregulation of physiological stress response systems. In this exploratory investigation, 14 sexually abused and 13 control girls, ages 8-15 years, recruited from a prospective, longitudinal study, underwent plasma antinuclear antibody and thyroid function tests. Thyroid function tests and plasma antinuclear antibody titers did not differ between sexually abused and control girls. However, a significantly higher incidence of plasma antinuclear antibody titers was seen in abused subjects when compared with the frequency of positive antinuclear antibody titers in a sample of 22 adult healthy female volunteers, ages 20-58 years. These findings suggest that sexually abused girls may show evidence of an alteration in normal immune homeostatic function.

Adult↗
PubMed1996

Criteria of good dental practice generated by general dental practitioners and patients.

A survey was carried out asking patients to evaluate the criteria of good dental practice proposed by patients and dentists. A total of 344 patients from 4 different general dental practices in South East England evaluated 16 criteria of good dental practice. Eight criteria were generated by 30 general dental practitioners and the other eight by 30 patients. Questionnaires containing the 8 pairs of criteria randomly assigned by a computer were drawn up, with each pair containing one patient and one general dental practitioner criterion. Patients were asked to indicate their preference. The number of times each criterion was preferred was scored and ranked. The three highest ranked criteria were explanation of procedures, sterilisation/hygiene and dentist's skills (all criteria proposed from patients), whilst the three lowest ranked criteria were up-to-date equipment, pleasant decor and surroundings and good practice image (all criteria proposed from dentists). Overall the criteria proposed by patients as a group scored significantly more highly than those proposed by dentists as a group. There was variation in rankings relating to the sex, age, pattern of attendance and social class of the respondents.

Adolescent↗
PubMed1995

Ultrasound evaluation of cervical shortening after loop excision of the transformation zone (LETZ).

OBJECTIVES: To assess cervical shortening after loop excision of the transformation zone (LETZ), and confirm the validity of ultrasound measurement of cervical length. METHODS: Subjects (n = 29) were patients at the colposcopy clinic of Beth Israel Hospital who underwent vaginal ultrasound measurement of cervical length before and after LETZ. The pathologic specimen was measured by ruler. Mean cervical length (+/- S.D.), mean percentage (+/- S.D.) of cervical length removed, and correlation (r) between ultrasound and pathology specimen measurement were determined. RESULTS: Mean (+/- S.D.) cervical length measurements prior to LETZ were 3.2 +/- 0.9 cm and after LETZ were 2.6 +/- 0.9 cm, with a difference of 0.7 +/- 0.4 cm. The pathologic specimen (mean +/- S.D.) was 0.6 +/- 0.3 cm. The correlation between ultrasound and pathology measurement was r = 0.9 (p = 0.0001). Mean (+/- S.D.) cervical length was shortened by 22 +/- 12%. CONCLUSIONS: There is excellent correlation between ultrasound and ruler measurement of the cervix. There is significant cervical length shortening after LETZ, but further study is needed to see whether this persists or leads to pregnancy complications.

Cervix Uteri↗
PubMed1995

Use of menopausal estrogens and medroxyprogesterone in the United States, 1982-1992.

OBJECTIVE: To describe trends in the prescription of menopausal estrogens and medroxyprogesterone in the United States. METHODS: Annual estimates of the number of prescriptions for menopausal estrogens and medroxyprogesterone and descriptive information on patients and providers were obtained from two pharmaceutical marketing research data bases, the National Prescription Audit and the National Disease and Therapeutic Index of IMS America. RESULTS: An estimated 13.6 million prescriptions were dispensed for oral menopausal estrogens in 1982, and 31.7 million in 1992, a 2.3-fold increase (P = .0001). In 1992, Premarin, the only oral conjugated estrogen currently approved for use, was the most frequently dispensed brand-name pharmaceutical in the United States. Dispensed prescriptions for Estraderm, a transdermal estradiol first marketed in 1986, increased from 1.5 million in 1987 to 4.7 million in 1992. Dispensed prescriptions for oral medroxyprogesterone also increased from 2.3 million prescriptions in 1982 to 11.3 million in 1992, a 4.9-fold increase (P = .0001). An estimated one in six to one in four postmenopausal women were taking menopausal hormones in 1992. These drugs were prescribed mainly by obstetrician-gynecologists. CONCLUSION: The use of menopausal estrogens and medroxyprogesterone has increased substantially over the past decade. These trends indicate that American women are widely exposed to menopausal hormone replacement.

Administration, Cutaneous↗
PubMed1995

Practical issues in nutrition for athletes.

Many athletes do not achieve sound nutritional practices to optimize their sports performance. Factors include poor nutrition knowledge, dietary extremism, poor practical skills in choosing or preparing meals, and reduced access to food due to a busy lifestyle and frequent travel. Education in nutrition for the athlete needs to be practical, so as to address eating strategies and key food and fluid choices that will help to achieve the goals of sound nutrition. Strategies that can achieve a number of nutritional goals simultaneously are most useful, since athletes often find it difficult to integrate separate issues. Athletes with extreme nutrient requirements, or with nutritional problems, should seek individual assessment and counselling from a sports nutrition expert.

Adipose Tissue↗
PubMed1994

Paget's disease of the breast in a man without underlying breast carcinoma.

A case of histologically confirmed Paget's disease of the breast in a 72 year old man, without underlying breast carcinoma, is reported. This report raises questions about the pathogenesis of this condition and suggests that Paget's disease is an independent, intraepidermal carcinoma rather than a direct extension of intraductal carcinoma of the breast to the nipple and areola.

Aged↗
PubMed1994

Hypothalamic-pituitary-adrenal axis dysregulation in sexually abused girls.

Childhood sexual abuse is associated with an increased incidence of age-concurrent and adult psychopathology. Little is known, however, about the biological manifestations and sequelae of childhood sexual abuse. In this study, we characterized the hypothalamic-pituitary-adrenal axis of a self-selected sample of sexually abused and control girls recruited from a prospective longitudinal study. Plasma ACTH and total and free cortisol responses to ovine CRH (oCRH) stimulation were measured in 13 sexually abused and 13 control girls, aged 7-15 yr. Psychiatric profiles and 24-h urinary free cortisol (UFC) measures were also obtained. Sexually abused girls had a greater incidence of suicidal ideation (chi 2 = 4.51; df = 1; P < 0.05), suicide attempts (chi 2 = 4.51; df = 1; P < 0.05), and dysthymia (chi 2 = 8.85; df = 1; P < 0.01) than control girls. Sexually abused girls showed significantly lower basal (t = 2.1; df = 24; P < 0.05), and net oCRH stimulated (t = 2.2; df = 24; P < 0.05) ACTH levels and significantly reduced total ACTH responses (t = 2.5; df = 24; P < 0.05) compared with control subjects. Their total and free basal and oCRH-stimulated plasma cortisol levels and 24-h UFC measures, however, were similar to those in controls. The attenuated plasma ACTH with corresponding robust plasma cortisol responses to oCRH stimulation and normal 24-h UFC measures in sexually abused girls suggest a dysregulatory disorder of the HPA axis in these individuals. This may reflect pituitary hyporesponsiveness to oCRH. The ability of sexually abused subjects to correct for the proposed pituitary hyporesponsiveness to CRH may be related to their young age and the presence of intact glucocorticoid feedback regulatory mechanisms.

Adolescent↗
PubMed1994

Influence of sodium on glucose bioavailability during exercise.

To examine the influence of beverage sodium content on glucose bioavailability during exercise, six trained men were studied during 30 min of cycle ergometer exercise at 65% VO2max. Immediately prior to exercise, subjects ingested 400 ml of a 10% glucose solution containing 100 microCi of D-(3-3H]-glucose, with a sodium concentration of either 0, 25, or 50 mmol.l-1. Trials were conducted in the morning after an overnight fast and in randomized order at least 1 wk apart. Blood samples were obtained from a forearm vein before and during exercise and subsequently analyzed for plasma glucose and 3H-glucose activity and blood lactate. No differences in oxygen uptake, heart rate, or blood lactate were observed between trials. Resting plasma glucose levels were not different between trials. The increases in plasma glucose and the plasma accumulation of 3H-glucose were similar in the three trials. These results indicate that alterations in beverage sodium content, from 0-50 mmol.l-1, have no effect on glucose bioavailability, as measured by increases in plasma glucose and 3H-glucose activity during moderate intensity exercise.

Adult↗
PubMed1993

Epstein-Barr virus in normal, pre-malignant, and malignant lesions of the uterine cervix.

AIM--To detect the presence or absence of Epstein-Barr virus (EBV) in cervical lesions ranging from normality to invasive malignancy. METHODS--Eighteen randomly selected cases of invasive squamous cell carcinomas of the uterine cervix were examined as well as 25 cases each of normal cervices and those showing cervical intra-epithelial neoplasia (CIN) I, II, and III. DNA-DNA in situ hybridisation, using a biotinylated probe to the Bam H1 "W" fragment of EBV, was carried out in addition to the polymerase chain reaction using specific primer sequences that flank a 153 base pair segment of the Bam H1 "W" region of the EBV genome and which do not cross-amplify other DNA herpes viruses. Positive control material included paraffin wax embedded P3 HR1 lymphoblastoid cells (containing high copy numbers of EBV) and two nasopharyngeal carcinomas positive for EBV. RESULTS--Neither normal nor CIN I tissue was positive. Eight per cent of CIN II tissue was positive; 8% of CIN III, and 43% of carcinomas were positive for EBV. CONCLUSION--The study shows that the virus is present in some cases of cervical carcinoma and to a lesser degree in some premalignant lesions of the cervix, but the exact association between it and cervical oncogenesis, be it causative or incidental, remains to be determined.

Base Sequence↗