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Biomedical subjects

L H McCarthy

Publications and source records attributed to L H McCarthy.

9 recordsLinked to original sources
PubMed2001

Screening for microalbuminuria to prevent nephropathy in patients with diabetes: a systematic review of the evidence.

OBJECTIVE: Our goal was to evaluate whether screening patients with diabetes for microalbuminuria (MA) is effective according to the criteria developed by Frame and Carlson and those of the US Preventive Services Task Force. STUDY DESIGN: We searched the MEDLINE database (1966-present) and bibliographies of relevant articles. OUTCOMES MEASURED: We evaluated the impact of MA screening using published criteria for periodic health screening tests. The effect of the correlation between repeated tests on the accuracy of a currently recommended testing strategy was analyzed. RESULTS: Quantitative tests have reported sensitivities from 56% to 100% and specificities from 81% to 98%. Semiquantitative tests for MA have reported sensitivities from 51% to 100% and specificities from 21% to 100%. First morning, morning, or random urine sampling appear feasible. Assuming an individual test sensitivity of 90%, a specificity of 90%, and a 10% prevalence of MA, the correlation between tests would have to be lower than 0.1 to achieve a positive predictive value for repeated testing of 75%. CONCLUSIONS: Screening for MA meets only 4 of 6 Frame and Carlson criteria for evaluating screening tests. The recommended strategies to overcome diagnostic uncertainty by using repeated testing are based on expert opinion, are difficult to follow in primary care settings, do not improve diagnostic accuracy sufficiently, and have not been tested in a controlled trial. Although not advocated by the American Diabetes Association, semiquantitative MA screening tests using random urine sampling have acceptable accuracy but may not be reliable in all settings.

Albuminuria↗
PubMed2000

How to write a case report.

BACKGROUND: Since before Hippocrates, case reports have provided a rich resource for teaching and research in medicine. Case reports are published by many prominent journals--more than 140,000 case reports are indexed in MEDLINE from 1996 to present--and a number of narrative guidelines for the preparation of case reports have appeared in the medical literature. To facilitate the preparation of case reports, we reviewed the existing guidelines and a random sampling of published case reports and created a fill-in-the-blanks worksheet for physicians to use to capture unique scientific observations. Although originally developed to assist family practice residents to write case reports, the case report worksheet can be used by physicians in any practice setting and any discipline to collect and report interesting, unusual, or newsworthy cases.

Guidelines as Topic↗
PubMed1997

Baseline studies in the Slave River, NWT, 1990-1994: Part II. Body burden contaminants in whole fish tissue and livers.

The Northwest Territories section of the Slave River is the recipient of chemical compounds from a variety of sources, including upstream industry and agriculture. In 1990, concerned government agencies formulated a practical, focussed, and comprehensive environmental monitoring program to assess contamination in the river and the Slave River Environmental Quality Monitoring Program was established. The program was designed to respond to the distinct requirements of two major monitoring goals. The first priority was to ascertain whether the fish in the Slave River were safe to eat. The second goal was to establish a baseline data set with which to compare future effects from upstream activities and long-range transport of contaminants. From the data gathered in the present study, it appears that whole tissue of fish (muscle) is fit for human consumption. Throughout the monitoring period, consistently low concentrations of organochlorine pesticides, PCBs, dioxin and furan isomers, PAHs, chlorinated phenolics, and heavy metals have been observed and median concentrations have all been below federal fish consumption advisories. Also, the numerous data values below analytical detection limits attest to the relatively uncontaminated nature of the fish. These results were comparable with other studies conducted on arctic animals. The heavy metals observed in fish tissue are probably of natural origins, since inorganic analyses of suspended sediment in the Slave River indicated relatively elevated levels, with no known anthropogenic source. While the present study concluded that contaminant levels in whole fish are low, toxaphene levels in burbot livers should continue to be monitored since concentrations were consistently above fish consumption advisories during the monitoring and are eaten extensively by the native peoples. The second goal of the monitoring program was to develop a baseline data set and the values tabled in the current paper are useful in establishing a foundation for future comparison.

Animals↗
PubMedDate not supplied

An overview of recent studies on the potential of pulp-mill effluents to alter reproductive parameters in fish.

In the early 1990s, many Canadian pulp and paper mills implemented process changes to comply with new regulations that came into effect in 1993. These regulations placed stricter guidelines on a number of parameters in effluent discharges, including limits on acute toxicity, on the discharges of suspended solids, and on biochemical oxygen demand. To meet these new regulations, many of the older Canadian pulp and paper mills had to install secondary treatment systems. The investment by the Canadian pulp and paper industry was in excess of $5 billion, and the implementation of the new regulations and the process changes took several years. The new regulations were an extension of regulations designed in the early 1970s and were not designed specifically to address the reproductive responses recently reported in fish collected downstream of mills in Scandinavia and North America. This report describes a series of projects conducted between 1991 and 1996 to evaluate the effectiveness of the new regulations to address the issue of reproductive responses in fish associated with exposure to pulp-mill effluents. These studies have shown that the existing short-term bioassays do not adequately predict the potential of effluents to affect reproduction in wild fish. Laboratory testing using fathead minnows exposed over a full life cycle confirmed depression in sex steroid production, delay in sexual maturity, reduced egg production, and changes in secondary sex characteristics documented at some sites. Our studies demonstrated that both steroid hormone changes and induction of liver detoxification enzymes take place quickly. While short-term exposures can predict the potential of some effluents to impact steroid hormone production, there is no readily available assay that can be widely applied. In the absence of a usable and transferable laboratory bioassay, field collections were conducted at a number of sites. Generalizations are not possible at this time, but impacts have been seen at a variety of sites, and partial recovery has been documented at five sites in North America following various process and waste treatment changes. Data gaps and critical research areas are identified.

Animals↗