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Biomedical subjects

L Garner

Publications and source records attributed to L Garner.

18 recordsLinked to original sources
PubMed2001

The Connecticut Cardiovascular Consortium: a unique, state-wide research collaboration to advance clinical outcomes in patients with heart disease.

The establishment of "best clinical practices" founded upon evidence-based medicine has become an increasingly important priority. Frequently, management guidelines are derived from published research data and disseminated among practitioners to help optimize patient care. The ultimate clinical impact of these guidelines in the "real world," however, is often clouded by an incomplete assessment of patient outcomes throughout the continuum of health-care delivery models. In order to address this gap in clinical outcome assessment, we propose to establish the Connecticut Cardiovascular Consortium. The Consortium will consist of a collaborative partnership among all 31 Connecticut hospitals working in concert with Connecticut Office of Health Care Access (OHCA). The primary objective of the Consortium will be to assess, compare, and optimize clinical outcomes among Connecticut residents with cardiovascular disease. As an initial goal for the Consortium, we further propose to undertake a prospective, observational study of Connecticut residents who present with ST Segment Elevation Acute Myocardial Infarction (STEMI). Recent advances in pharmacologic and mechanical reperfusion for STEMI have resulted in a need to define the optimal use of these therapies in the community at large. The primary purpose of this study will be to determine the relative merits of different treatment patterns for STEMI with regard to the use of fibrinolytic therapy and percutaneous coronary intervention (PCI). Particular emphasis will be placed on assessing the relative benefits of urgent mechanical revascularization performed at the state's seven tertiary facilities with PCI capability compared to all other treatment modalities. Successful completion of this unique collaborative endeavor is expected to have significant impact on improved patient care and on current health-care policy for medical resource allocation. Moreover, continued collaboration of health-care providers within the Connecticut Cardiovascular Consortium infrastructure should serve as a useful mechanism for ongoing improvements in evidence-based cardiovascular medicine and clinical research in the state of Connecticut.

Connecticut↗
PubMed2000

How are we doing? A statewide survey of community adjustment among people with serious mental illness receiving intensive outpatient services.

Although mental health consumers often prefer community living, the factors influencing community outcomes are not well understood. In order to address this issue in Connecticut, the Department of Mental Health and Addiction Services (DMHAS) commissioned a statewide study of 6,800 clients receiving the most intensive community-based mental health services funded by the state. DMHAS clinicians provided the ratings for their clients on a variety of variables including demographics, diagnosis, clinical stability, current psychotic symptomology, adherence to prescribed medications, substance abuse, history of violent crime, community trouble-making or victimization, likelihood of threatening behavior, frequency of social contacts, and difficulty in adjusting to life in the community. Also, the total length of stay and total number of admissions during a two year period were taken from the statewide management information system for each client in the study. Descriptive data analysis included frequencies and means to describe the demographic, the diagnostic, and the clinical profile of the DMHAS clients. A stepwise hierarchical multiple regression analysis (MRA) was performed to determine what factors predict a composite score of overall functioning, community adjustment, and psychiatric impairment. Clients with better composite scores were those who had a prescription for medications, adhered more to their medication regimen, perceived to be less threatening, and had more frequent social interactions. Implications of these findings for outpatient treatment are discussed.

Adolescent↗
PubMed2000

Driving-induced stress in urban college students.

Urban college student commuters (N = 407) were surveyed about their experiences with stress induced by driving. Of the participants 23.6% reported becoming angry at another driver more than once per day. They rated stress from other drivers as equal to the stress experienced during a college examination but gave slightly lower ratings to traffic congestion, road construction, and finding a parking place as sources of stress. Slow drivers, a child not restrained, and a vehicle following too closely were the highest rated annoying situations. Of participants, 21.6% had reported another driver to the police; nearly 22% said they carried a weapon for protection from other drivers (5.4% said a gun). Men were more than twice as likely as women to carry a weapon and three times as likely to carry a gun. Of the total sample, 19.1% feared being shot by another driver. Most participants (75.8%) said drivers were more aggressive and dangerous than they were five years ago.

Automobile Driving↗
PubMed1998

Evaluating a state agency's case management services.

Lessons learned in developing and implementing a program evaluation model for a state case management program are described. Uniformity of standards, data collection, and uniform data formats are critical components to measuring system outcomes.

Case Management↗
PubMed1994

Ear lobe keloids, surgical excision followed by radiation therapy: a 10-year experience.

This retrospective study was conducted to analyze the recurrence of ear lobe keloids in 36 patients after surgical excision followed by radiation therapy. In all the cases keloids were excised and the surgical wound closed primarily. Following surgery, patients underwent 1800 cGy of radiation therapy in three equally divided doses over five to seven days. Most of our patients were young black females who developed keloids secondary to ear lobe piercing. Of the 36 patients followed for a mean period of 5.6 years, we noted only one (2.8%) recurrence. All the patients were followed for a minimum of two years. No serious complications were observed in our series. However, one patient developed radiation dermatitis followed by patchy hypopigmentation. We conclude that surgical excision followed by radiation therapy is a safe and effective method to control keloid recurrence in the ear lobe region.

Adult↗
PubMed1985

Heart block after intravenous lidocaine in an infant.

A 14-day-old infant received intravenous lidocaine (2 mg X kg-1) at the conclusion of cataract surgery to prevent coughing from tracheal tube stimulation. Within 30 seconds the infant developed high-grade AV heart block and a ventricular rate of 40. Following brief resuscitation efforts, the patient had a normal cardiac rhythm, blood pressure and respiratory pattern. Intravenous lidocaine may be followed by major disturbances in cardiac rhythm and rate. Cautious titration of small doses should decrease the potential for adverse effects.

Cataract Extraction↗
PubMed1984

Captopril reduces the dose requirement for sodium nitroprusside induced hypotension.

The authors studied 12 patients who required deliberate hypotension for spinal fusion operations in order to investigate the efficacy of captopril for reducing dose requirement for sodium nitroprusside (SNP). Six patients, selected at random, were pretreated with captopril, 3 mg/kg po, and the remaining six patients served as controls. All patients received a similar anesthetic technique, consisting of thiopental 3 mg/kg, pancuronium 0.1 mg/kg, morphine 0.5 mg/kg, plus nitrous oxide 70% in oxygen. SNP was used to maintain mean arterial pressure (MAP) at 50-55 mmHg during deliberate hypotension lasting 140 +/- 13 minutes (mean +/- SE). Patients who received captopril required less SNP than untreated patients both early during hypotension (1.4 +/- 0.5 micrograms X kg-1 X min-1 vs. 4.8 +/- 0.8 micrograms X kg-1 X min-1, P less than 0.05), as well as late during hypotension (2.2 +/- 0.2 micrograms X kg-1 X min-1 vs. 5.6 +/- 0.6 micrograms X kg-1 X min-1, P less than 0.05). Whole blood cyanide was significantly lower in the patients pretreated with captopril than the untreated controls both early in the hypotensive period (2.7 +/- 0.6 mumol/l vs. 13 +/- 4 mumol/l, P less than 0.05) and also late in the hypotensive period (3.7 +/- 0.8 mumol/l vs. 30 +/- 10 mumol/l, P less than 0.05). MAP was reduced by captopril pretreatment both following induction of anesthesia (64 +/- 4 mmHg captopril vs. 80 +/- 4 mmHg control, P less than 0.05) and during surgery before deliberate hypotension (86 +/- 5 mmHg captopril vs. 100 +/- 4 control, P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

Ascending myeloencephalopathy due to intrathecal vincristine sulfate. A fatal chemotherapeutic error.

A case of fatal myeloencephalopathy secondary to accidental intrathecal administration of vincristine is reported in a 16-year-old boy. He underwent a progressive ascending chemical meningoencephalitis leading to coma, and died 36 days after the injection. Multiple samples of cerebrospinal fluid (CSF) and serum were assayed for vincristine sulfate. CSF levels of vincristine were consistently much higher than serum levels. At autopsy, all regions of the brain that had been in direct contact with the CSF were necrotic. The spinal cord was likewise necrotic throughout its length. Microscopically there was total neuronal loss with tissue destruction in the affected regions. The presence of numerous gemistocytic astrocytes, some in arrested mitosis, was a conspicuous feature in these areas. Three previous reports of intrathecal vincristine instillation are reviewed. No treatment for this devastating iatrogenic error exists, underscoring the importance of preventive measures in chemotherapy administration.

Adolescent↗
PubMed1983

Time course and variability of dark focus.

When the eye is deprived suddenly of visual stimulation, the accommodative system drifts from the previous state of accommodation to a state known as the dark focus. This condition also is known as night myopia. We measured the time course of this drift using a continuously recording infra-red optometer. The time course resembles an exponential decay function with a time constant of 1-3 seconds. The recovery of accommodation to the prior level after visual stimulation is restored suddenly has a time constant of 0.2-0.4 seconds. The state of accommodation in the dark depends on the state of accommodation prior to the onset of darkness. Our subjects showed a zone of accommodative inactivity rather than a single resting point of accommodation.

Accommodation, Ocular↗
PubMed1982

Subchronic toxicity of chlorine dioxide and related compounds in drinking water in the nonhuman primate.

Subchronic toxicities of ClO2, NaClO2, NaClO3 and NH2Cl were studied in the African Green monkeys (Cercopithecus aethiops). The chemicals were administered in drinking water during 30-60 days subchronic rising dose protocols. The only unexpected and significant toxic effect was elicited by ClO2; this chemical inhibited thyroid metabolism in the animals at a dose of ca. 9.0 mg/kg/day. A statistically significant decrease of serum thyroxine occurred after the fourth week of exposure to 100 mg/l.concentration. The extent of thyroid suppression was dose dependent in each individual monkey, and was reversible after cessation of exposure. NaClO2 and NaClO3 failed to elicit similar effects in doses up to ca. 60 mg/kg/day. Also, NaClO4 or NH2Cl did not cause T-4 suppression in doses of 10 mg/kg/day. The selective thyroid effect of ClO2 was unexplained and it appeared to be paradoxical since ClO2 was rapidly reduced by the oral and gastric secretions to nonoxidizing species (presumably Cl-). No evidence of thyroid effects were detected in the serum of human volunteers who ingested approximately 1 mg/l. of ClO2 in drinking water as a result of routine use in the community water treatment process. Sodium chlorite induced dose-dependent oxidative stress on hematopoesis, causing decreased hemoglobin and red cell count and increased methemoglobin content. At the same time, serum transaminase (SGPT) levels showed significant subclinical elevation. The hematologic effects of NaClO2 rebounded during exposure indicating compensatory hemopoietic activity taking effect during oxidative stress. Sodium chlorate and chloramine did not induce detectable hematologic changes in the animals.

Animals↗
PubMed1977

Computer-based audit to detect and correct overutilization of laboratory tests.

We developed a computer-bases system to detect inappropriate use of the clinical laboratory and tested a program of physician education to reduce overutilization. We modified the hospital laboratory's computerized reporting system to identify medical patients with three or more determinations of lactic dehydrogenase (LDH) or calcium during the preceding seven days. We audited the charts of these patients, using explicit criteria, to determine whether multiple studies were justified. During the control period 51 per cent of the charts audited for multiple determinations of LDH revealed overutilization. During the study period, when physicians were notified if overutilization was found, 65 per cent of the charts showed overutilization. This difference was not significant. A simultaneous, undisclosed audit of calcium determinations also showed no change between the two periods. Therefore, this method is effective in detecting and measuring overutilization of the laboratory. It is a method which is easily adaptable to a hospital's computerized laboratory reporting system, and it can be applied without a computer. However, our program of notification and education of physicians is not effective in reducing overutilization. More effective methods of modifying physicians' use of laboratory tests need to be developed.

Calcium↗