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Biomedical subjects

M Earle

Publications and source records attributed to M Earle.

12 recordsLinked to original sources
PubMed1999

The future of informed consent in British common law.

Within the common law world, the use of the term informed consent implies the American doctrine. Informed consent as a doctrine is not part of the law in the United Kingdom. However, it is possible to predict a way forward in disclosure cases yet to be heard in the courts of the United Kingdom. These predictions are based on current developments in the common law in the United Kingdom as well as those in Canada and Australia, on the European Convention on Human Rights and Biomedicine and on trends within the medical profession itself in the light of the Bolam test.

Australia↗
PubMed1997

Outcome of pediatric intensive care at six centers in Mexico and Ecuador.

OBJECTIVE: To improve understanding of the causes of morbidity and mortality among critically ill children in the countries studied. DESIGN: Survey of hospital records between 1992 and 1994. SETTING: Six pediatric intensive care units (ICUs) (four ICUs in Mexico City and two ICUs in Ecuador). PATIENTS: Consecutive patients (n = 1,061) admitted to the units studied. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The mortality rate for low-risk patients (pediatric Risk of Mortality [PRISM] score of < or = 10, n = 701) was more than four times the rate predicted by the PRISM score (8.1% vs. 1.8%, p < .001), with an additional 11.3% of this group incurring major morbidity. The mortality rate for moderate-risk patients (PRISM scores of 11 to 20, n = 232) was more than twice predicted (28% vs. 12%, p < .001). For low-risk patients, death was significantly associated with tracheal intubation, central venous cannulation, pneumonia, age of < 2 months, use of more than two antibiotics, and nonsurgical diagnosis (after controlling for PRISM score). Central venous cannulation and tracheal intubation in the lower-risk groups were performed more commonly in units in Mexico than in one comparison unit in the United States (p < .001). CONCLUSIONS: For six pediatric ICUs in Mexico and Ecuador, mortality was significantly higher than predicted among lower-risk patients. Tracheal intubation, central catheters, pneumonia, sepsis, and nonsurgical status were associated with poor outcome for low-risk groups. We speculate that reducing the use of invasive central catheters and endotracheal intubation for lower-risk patients, coupled with improved infection control, could lower mortality rates in the population studied.

Child, Preschool↗
PubMed1994

Enhancing communication. The physician and family in the pediatric intensive care unit.

How well does the intensivist communicate with the parents of critically ill children? The authors' experience suggests that this process can be enhanced in a number of ways. The article reviews methods to improve communication by emphasizing the importance of the first meeting, trust, and understanding parental needs and coping mechanisms.

Adaptation, Psychological↗
PubMed1990

Use of granulocyte-macrophage colony-stimulating factor in patients with malignancy and bone marrow failure.

Recombinant human granulocyte-macrophage colony-stimulating factor (GM-CSF) was administered to 10 patients with refractory malignancies, 2 patients who had myelodysplastic syndromes with severe neutropenia and to a patient who had delayed marrow recovery after 3 cycles of therapy for acute leukemia. A marked neutropenia and monocytopenia was observed within 5 min after an i.v. injection of GM-CSF. This persisted for 1-2 h and seemed related to activation of an adhesive glycoprotein (MO1) on the surface of these cells. With continued daily i.v. administration of GM-CSF, all patients with refractory malignancies developed a striking leukocytosis. Total leukocyte counts reached 75,000/microliters within 2 weeks of treatment. This was due to an increase in band and segmented neutrophils, eosinophils and monocytes. Accelerated myelopoiesis required the continuous presence of GM-CSF; with pump failure for 24 h or discontinuation after 14 days, leukocyte counts returned to normal levels in 24-48 h. GM-CSF also increased myelopoiesis in the patients with myelodysplastic syndromes or following anti-leukemic treatment. These observations suggest that this growth factor should prove a useful adjunct in the treatment of patients with malignancies and bone marrow failure.

Aged↗
PubMed1990

Controlled localized heating and isotretinoin effects in canine squamous cell carcinoma.

Controlled localized radiofrequency heating and systemic isotretinoin were used serially as therapy in a hairless dog that developed multiple cutaneous squamous cell carcinomas in chronically sun-damaged skin. During the course of therapy, four superficial tumors regressed completely, both clinically and histologically. Two larger, deeper tumors showed clinical signs of regression but histologic clearing did not occur. Both treatment modalities are known to have antitumor effects independently and may exert their effects in an additive fashion. However, it is also possible that heat-induced injury to tumor cells could lead to retinoid-mediated enhancement of an immunologic response to tumor antigens or some other process that might lead to regression.

Animals↗
PubMed1989

Effect of recombinant human granulocyte-macrophage colony-stimulating factor on myelopoiesis in patients with refractory metastatic carcinoma.

The effect of human recombinant GM-colony-stimulating factor (CSF) was evaluated in ten patients with refractory metastatic carcinoma. Initially they received an intravenous (IV) bolus injection of 5 or 25 micrograms/m2 for assessment of acute responses. Six days later, continuous IV infusions of 100 or 500 micrograms/m2 were initiated for a 14-day treatment course. All patients developed profound leukopenia within five to 30 minutes of the bolus injection. This appeared to result from increased expression of an adhesion-promoting glycoprotein (GP) on neutrophils and monocytes as judged by increased reactivity to the Mo1 monoclonal antibody (MoAb). Leukocyte counts returned to normal levels within two hours as cells were released from marrow stores. With the continuous infusion, leukocyte counts increased by 24 hours; peak values of 22,960 and 75.900/microL were achieved after ten to 14 days of treatment with the two dose levels of GM-CSF. This leukocytosis was due to an increase in virtually all cell types. At the high dose level, there was a striking increase in neutrophils (49,400/microL) and eosinophils (20,905/microL) with a sixfold increase in monocytes and two- to threefold increase in lymphocytes. Leukocyte counts declined promptly after cessation of the infusion but remained above baseline for as long as 2 weeks in some patients. These results suggest that GM-CSF may be useful as an adjuvant therapy by stimulating myelopoiesis in cancer patients.

Bone Marrow↗
PubMed1986

Phenotypic resemblance in birth weight between first cousins.

Birth weight data on 72,078 liveborn singletons representing 5981 paternal and 7036 maternal single first cousin kinships were assembled by computerized record linkage from all marriages and livebirths registered in Hawaii during a 38-year period from 1942 to 1979. These kinships represented incrosses of five selected racial groups. An additional 15,536 livebirths from 1134 paternal and 1679 maternal cousin kinships provided data on outcrossing between racial groups, and 28,952 livebirths from 2379 paternal and 3538 maternal cousin kinships provided data on both incrossing and outcrossing within kinships. Phenotypic resemblance in birth weight between single first cousins was estimated by the covariance and intraclass correlation. The covariances between maternal cousins were generally much higher than those between paternal cousins. Neither heterogeneity in maternal genotypes nor heterogeneity in newborn genotypes had any significant effect on the resemblance between first cousins. These observations have led to the conclusion that maternal influences of non-hereditary origin are of primary importance in determining birth weight in man. The observed non-zero correlation in several groups of paternal cousins was explained in part by the process of preferential selection of mates within and among racial groups by brothers, and probably by the similarity in some maternal characteristics associated with age at childbearing among their wives.

Asian People↗
PubMed1966

Nursing at Christmas.

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Nursing Service, Hospital↗