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Biomedical subjects

L Quinn

Publications and source records attributed to L Quinn.

At least 19 recordsLinked to original sources
PubMed2001

Objective assessment of progression in Huntington's disease: a 3-year follow-up study.

Objective measures to assess progression of Huntington's disease (HD) are desirable. The authors have previously found that patients with HD with higher Unified Huntington's Disease Rating Scale (UHDRS) motor scores exhibited higher variability of isometric grip forces while grasping an object. Therefore, the authors assessed grip force variability during this task in 10 HD patients with a 3-year follow-up. Grip force variability increased in all patients at the follow-up. Thus, grip force variability during grasping might be an objective and quantitative measure to assess motor deficits associated with the progression of HD.

Analysis of Variance↗
PubMed2001

Altered movement trajectories and force control during object transport in Huntington's disease.

Individuals with Huntington's Disease (HD) have difficulty grasping and transporting objects, however, the extent to which specific impairments affect their performance is unknown. The present study examined the kinematics and force coordination during transport of an object in 12 subjects with HD and 12 age-matched controls. Subjects grasped an object between their thumb and index finger, transported it 25 cm forward, replaced and released it while their fingertip forces and the object's position were recorded. Five trials were performed with each of three weights (200 g, 400 g, and 800 g). While bradykinesia was evident in subjects with HD, this slowness was not consistently observed in all phases of the movement. The slowness of movement seen during the task appears to be due to impairments in sequencing and the movement strategies selected by the subjects. Compared to control subjects, subjects with HD produced highly curvilinear hand paths and more variable grip forces that were dependent on the weight of the object. Isometric force development and movement speed during transport were unaffected by the disease. The results suggest that prolonged task durations in subjects with HD are not necessarily due to slowness of movement, per se. These findings have clinical implications for understanding the task-specific nature of movement impairments in HD and developing effective intervention strategies.

Adult↗
PubMed2001

STRICA, a novel Drosophila melanogaster caspase with an unusual serine/threonine-rich prodomain, interacts with DIAP1 and DIAP2.

The recently published genome sequence of Drosophila melanogaster predicts seven caspases in the fly. Five of these caspases have been previously characterised. Here, we describe the Drosophila caspase, STRICA. STRICA is a caspase with a long amino-terminal prodomain that lacks any caspase recruitment domain or death effector domain. Instead, the prodomain of STRICA consists of unique serine/threonine stretches. Low levels of strica expression were detected in embryos, larvae, pupae and adult animals. STRICA is a cytoplasmic protein that, upon overexpression, caused apoptosis in cultured Drosophila SL2 cells that was partially suppressed by DIAP1. Interestingly, unlike other fly caspases, STRICA showed physical association with DIAP2, in cotransfection experiments. These results suggest that STRICA may have a unique cellular function.

Amino Acid Sequence↗
PubMed2001

Type and incidence of cracks in posterior teeth.

STATEMENT OF PROBLEM: The use of magnified vision in the operatory has enhanced the early diagnosis of structural defects in the dentition and in existing restorations. There is little in the literature to guide the clinician on the significance of cracks and other interruptions in the integrity of teeth. PURPOSE: This study characterized the type and incidence of cracks in posterior teeth and identified possible etiologic factors. MATERIAL AND METHODS: An observational cross-sectional survey of 51 patients from a private practice examined during an 18-month period was used to identify 4 types of cracks in posterior teeth. The study identified both patient- and tooth-level variables present in each patient examined. The data were subjected to statistical analysis to determine whether correlations existed between the variables and cracks. RESULTS: Cracks in teeth were shown to have chronicity and can be classified according to appearance. Variables such as the presence of a Class I or II restoration and the presence of excursive interferences were shown to significantly increase (P< .0001) the chances of a crack being present. Combinations of variables, such as interferences and a restoration, also increased the chance of a crack being present. CONCLUSION: Within the limitations of this study, the presence of cracks in teeth was associated with the placement of a Class I or II restoration and with the presence of excursive interferences. Age played a role in the presence of stained or symptomatic cracks, which suggests that cracks have chronicity. Although many questions remain regarding prevention, it is evident that protecting teeth from excursive interferences and parafunction may thwart premature breakdown.

Adult↗
PubMed2001

Type 2 diabetes: epidemiology, pathophysiology, and diagnosis.

Type 2 diabetes is a major global health problem that affects over 124 million individuals worldwide. In the United States, type 2 diabetes affects 90% of the 15.6 persons with diabetes, of which approximately one half remain undiagnosed. Type 2 diabetes is increasing exponentially especially among minority populations. In addition, type 2 diabetes, which is normally associated with older adults, is becoming more common in children and adolescents. There are a variety of environmental and genetic factors that seem to mediate the development of type 2 diabetes. This article explores the epidemiology, pathophysiology, and diagnosis of type 2 diabetes and identifies risk factors associated with the development of this disorder.

Adolescent↗
PubMed2001

Pharmacologic management of the patient with type 2 diabetes.

The United Kingdom Prospective Diabetes Study (UKPDS) demonstrated that the benefit of optimal glucose control in type 2 diabetes is a significant reduction in diabetes-related complications. In addition, the UKPDS also demonstrated that type 2 diabetes is a progressive disorder. Whereas many patients may initially receive good glucose control from a single medication, they are likely to require multiple medications to maintain this same level of glucose control as the disease progresses. The recent introduction of several new classes of glucose-lowering medications has allowed health care providers to explore the use of these medications alone and in combination to help patients with type 2 diabetes maintain optimal glucose control. Therefore, it is important to understand the physiologic actions, benefits, and risks of these medications in the treatment of type 2 diabetes.

Blood Glucose↗
PubMed2001

Exercise and physical activity in the treatment of type 2 diabetes.

Exercise has been recommended as a treatment for type 2 diabetes for centuries. It is only in the last 2 decades, however, that the powerful role exercise and physical activity play in treating and preventing type 2 diabetes has been fully appreciated. The molecular understanding of exercise in relation to type 2 diabetes is evolving, as is knowledge about the best mode, frequency, and duration of exercise to treat and prevent this disorder. In addition, there is a growing appreciation for the role of diverse types of exercise, such as strength training, in type 2 diabetes. Although people with diabetes-related complications have been discouraged from exercising in the past, there are a variety of activities that allow for safe exercise in a supervised setting. As such, individualized exercise training can become an integral part of the treatment plan for the management of type 2 diabetes.

Blood Glucose↗
PubMed2001

Glycemic control and heart disease.

The leading cause of death among patients with diabetes is cardiovascular disease with approximately 80% of all deaths being attributed to coronary heart disease. Acute myocardial infarctions (AMIs) in patients with diabetes are associated with an increased rate of reinfarction than those without diabetes. Following AMI, patients with diabetes are more likely to develop severe heart failure. The Diabetes and Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) clinical trial examined the relationship between intensive insulin and conventional therapy following AMI. Results of the DIGAMI study clearly identify the need for tight glucose control following AMI in improving clinical outcomes and mortality.

Blood Glucose↗
PubMed2001

Diabetes emergencies in the patient with type 2 diabetes.

Type 2 diabetes has traditionally been associated with the development of hyperglycemic hyperosmolar nonketotic syndrome (HHNKS), yet evidence suggests that diabetic ketoacidosis (DKA) is increasing among this population. Patients with type 2 diabetes may develop DKA or HHNKS and require hospitalization. In addition, patients with type 2 diabetes, hospitalized for other medical or surgical conditions, are clearly at risk for the development of metabolic decompensation during hospitalization. This article explores the acute complications of type 2 diabetes and some of the issues associated with managing these patients in the hospital setting.

Blood Gas Analysis↗
PubMed2000

A multicomponent intervention to prevent major bleeding complications in older patients receiving warfarin. A randomized, controlled trial.

BACKGROUND: Warfarin is effective in the treatment and prevention of many venous thromboembolic disorders, but it often leads to bleeding. OBJECTIVE: To develop a multicomponent program of management of warfarin therapy and to determine its effect on the frequency of warfarin-related major bleeding in older patients. DESIGN: Randomized, controlled trial. SETTING: University hospital in Cleveland, Ohio. PATIENTS: 325 patients 65 years of age or older who started warfarin therapy during hospitalization. INTERVENTIONS: Patients were stratified according to baseline risk for major bleeding and were randomly assigned to receive the intervention (n = 163) or usual care (n = 162) by their primary physicians for 6 months. The intervention consisted of patient education about warfarin, training to increase patient participation, self-monitoring of prothrombin time, and guideline-based management of warfarin dosing. MEASUREMENTS: Major bleeding, death, recurrent venous thromboembolism, and therapeutic control of anticoagulant therapy at 6 months. RESULTS: In an intention-to-treat analysis, major bleeding was more common at 6 months in the usual care group than in the intervention group (cumulative incidence, 12% vs. 5.6%; P = 0.0498, log-rank test). The most frequent site of major bleeding in both groups was the gastrointestinal tract. Death and recurrent venous thromboembolism occurred with similar frequency in both groups at 6 months. Throughout 6 months, the proportion of total treatment time during which the international normalized ratio was within the therapeutic range was higher in the intervention group than in the usual care group (56% vs. 32%; P < 0.001). After 6 months, major bleeding occurred with similar frequencies in the intervention and usual care groups. CONCLUSIONS: A multicomponent comprehensive program of warfarin management reduced the frequency of major bleeding in older patients. Although the generalizability and cost-effectiveness of this program remain to be demonstrated, these findings support the premise that efforts to reduce the likelihood of major bleeding will lead to safe and effective use of warfarin therapy in older patients.

Aged↗
PubMed2000

Coordination of prehensile forces during precision grip in Huntington's disease.

The present study examined the coordination of prehensile forces during precision grip in subjects with Huntington's disease (HD). Fingertip forces were measured in 12 subjects with HD and 12 age-matched controls during the lifting of an instrumented object whose weight and surface texture were varied. The results indicate that subjects with HD have impaired initiation and delayed transitions between movement sequences and produce excessive and variable forces. However, subjects with HD demonstrated anticipatory scaling of force development based on the object's expected physical properties (planning) and adjustment of the force to the object's actual physical properties (sensorimotor integration). The observed findings generally were unrelated to the overall disease severity. However, the variability in forces was correlated with functional capacity and motor performance suggesting that variability is a key feature of the motor deficit. These results provide insights into the impaired hand function observed in individuals with HD.

Adult↗
PubMed1999

Dystonia in Huntington's disease: prevalence and clinical characteristics.

BACKGROUND: The prevalence and clinical characteristics of dystonia in Huntington's disease (HD) have not been formally assessed. OBJECTIVES: To study (1) the prevalence of dystonia in HD in a clinic population, (2) the clinical features of dystonia, and (3) clinical correlates of dystonia (for example, age, disease duration). METHODS: Patients with HD attending the HD Center at the New York State Psychiatric Center were administered the Unified HD Rating Scale and underwent a standardized 5.5-minute videotaped examination. Two neurologists reviewed the videotaped examination and rated the severity and constancy of dystonia, calculating a total dystonia score for each patient. RESULTS: Prevalence of dystonia of any severity was 95.2%. Twenty-four of 42 (57.1%) had dystonia in at least one body region that was moderate and present more than half of the time, and seven of 42 (16.7%) had dystonia that was severe and constant. The most prevalent types of dystonia were internal shoulder rotation (64.3%), sustained fist clenching (47.1%), excessive knee flexion (42.9%), and foot inversion (42.9%). In 37 of 42 (88.1%) patients, there were more than two types of dystonia, and in the average patient, three to four types of dystonia. The mean severity was between 1 (mild) and 2 (moderate), and the mean constancy was between 2 (present less than half of the time) and 3 (present more than half of the time). Multivariate linear regression revealed that disease duration (p = 0.0005) and taking an antidopaminergic agent (p = 0.03) were positively associated with the total dystonia score. CONCLUSIONS: The majority of patients in this HD clinic exhibited some dystonia. The dystonia was present in several body regions and manifested by a variety of movements and postures not typical of idiopathic torsion dystonia. The dystonia was not bothersome to most patients, and its severity was a function of disease duration and use of an antidopaminergic agent.

Adult↗
PubMed1998

Doctor talk and diabetes: towards an analysis of the clinical construction of chronic illness.

During the last two decades the illness narrative has emerged as a popular North American literary form. Through poignant stories, well-educated patients have recounted their struggle with disabling diseases as well as with the hospitals and health care bureaucracies from whom they seek service. However, much less has been written about the doctor's narrative construction of chronic diseases either in the process of learning medicine or through diagnosing, treating and counseling chronically ill patients. Indeed, following Kleinman's lead, the physician's narrative has been narrowly viewed as a discourse on the verifiable manifestations of pathophysiology. Drawing on contemporary theories of storytelling--including the conception of narrative as conversational interaction--the present paper argues that doctor narratives are equally complex if quite different than patient stories. Indeed, through an analysis of doctor talk centering on diabetes mellitus collected in several distinct venues--case presentations, narrative interviews and medical consultations--it is argued that physician stories not only employ very evocative tropes, but that these stories combine didactic, rhetorical and soterological elements in the telling. The research was conducted at two, urban family practice training sites in Chicago.

Attitude of Health Personnel↗
PubMed1998

Glucose monitoring in the acutely ill patient with diabetes mellitus.

The Diabetes Control and Complications Trial (DCCT) clearly demonstrated that improved blood-glucose control results in the decreased occurrence and progression of microvascular complications. The progression of acute medical conditions, commonly found in hospitalized diabetic patients, are also related to glycemic control. Glycemic control in the hospitalized setting is measured by point-of-care blood-glucose monitors. These monitors provide immediate feedback so that subcutaneous or infused insulin can be adjusted in a more timely and physiologic manner. The practitioner must become familiar with some of the limitations of these systems to ensure the accuracy of blood-glucose results.

Acute Disease↗
PubMed1998

"What is going on here?": Baldwin's Another country.

This paper uses two teaching experiences with Baldwin's 1962 novel Another Country to frame a discussion of the complicated critical history of this literary work and its relation to Baldwin's literary reputation. The contested relationship between the categories of race and sexuality in the novel is tracked and its political implications explored.

Bisexuality↗
PubMed1998

A pain management relief plan.

This article addresses a hospital's initiative to offer responsive pain management through the development of a Pain Management Task Force. It provides a sequential model and guide for nursing managers to use in their own health care environments.

Humans↗
PubMed1997

Declines in hospital mortality associated with a regional initiative to measure hospital performance.

To determine changes in hospital mortality that occurred in association with the dissemination of data by a regional initiative to profile hospital performance, we conducted a retrospective cohort study of patients admitted before and subsequent to dissemination of comparative data in 1992. The analysis included 101,060 consecutive eligible discharges from 30 hospitals in Northeast Ohio with eight diagnoses: acute myocardial infarction, congestive heart failure (CHF), obstructive airway disease, gastrointestinal hemorrhage, pneumonia, stroke, coronary artery bypass surgery, and lower bowel resection. Baseline (1991, N = 35,629) mortality rates were compared to rates during three subsequent periods (July-December 1992, N = 20,392; January-June 1993, N = 23,070; and July-December 1993, N = 21,969). Mortality rates were risk-adjusted using validated multivariable models based on data abstracted from patient's medical records. For all conditions, risk-adjusted mortality declined from a baseline rate of 7.5% to rates of 6.8%, 6.8%, and 6.5%, respectively, during the three subsequent periods. Using weighted linear regression analysis to estimate trends across periods, declines in mortality rates were significant for CHF (0.50% per period; P = 0.002) and pneumonia (0.38% per period; P = 0.03). We conclude that hospital mortality declined in association with the dissemination of comparative data. Although changes in hospital care were not directly examined, the results suggest that initiatives to examine provider performance may have a beneficial impact on quality of care.

Aged↗