PubMed Health⌕ Search

Biomedical subjects

M Eddy

Publications and source records attributed to M Eddy.

12 recordsLinked to original sources
PubMed2000

Can peak expiratory flow predict airflow obstruction in children with asthma?

STUDY OBJECTIVES: A recent trend in the treatment of asthma has been the widespread, independent use of peak expiratory flow (PEF). We examined whether PEF monitoring creates inaccuracies in assessment of children with moderate to severe asthma. METHODS: We compared the negative predictive value of PEF in relation to the forced expiratory volume in 1 second (FEV(1)), and to the forced expiratory flow between 25% and 75% of the vital capacity (FEF(25-75%)) at different levels of air trapping as determined by the residual volume over total lung capacity ratio (RV/TLC). RESULTS: The study included 244 patients, ages 4 to 18 years with all classes of asthma severity, with FEV(1) ranging from 28% to 134% of predicted value. We analyzed 367 sets of pulmonary function tests performed throughout a 3-year period. Thirty percent of patients with a normal PEF value had an abnormal FEV(1) or FEF(25-75%). As air trapping increased, the ability of a normal PEF to predict normal FEV(1) and FEF(25-75%) readings fell from 83% to 53%. The negative predictive value was significantly lower for patients with RV/TLC ratio >30 compared with patients with RV/TLC <30. CONCLUSIONS: The results of this study suggest that it might be possible to identify children for whom the PEF is likely to give false-negative results. As air trapping increases, it causes the PEF to give misleading reassurance of normal pulmonary function. Furthermore, poor predictiveness of PEF is obtained when values 80% of predicted for age are considered normal.

Adolescent↗
PubMed1999

Insomnia.

Insomnia is a common complaint with potentially significant medical and psychologic complications. In some cases insomnia presents as a symptom of another underlying medical, psychiatric or environmental condition. In these cases, management of insomnia depends on accurate diagnosis and successful treatment of the underlying condition. In other cases, insomnia is a primary disorder requiring direct treatment. Pharmacologic treatments include nonprescription medications, sedating tricyclic antidepressants, benzodiazepines and related drugs. Behavior management methods that may be administered in the office setting include stimulus control therapy, sleep restriction therapy and sleep hygiene education. Although prescription medications and behavior therapy have similar short-term efficacy, behavior interventions are recommended as the first line of treatment for primary insomnia because of their greater safety and long-term efficacy.

Behavior Therapy↗
PubMed1999

Above reproach: developing a comprehensive ethics and compliance program.

How can a healthcare organization improve the public's confidence in the conduct of its business operations? What can it do to ensure that it can thrive despite being the subject of public and governmental scrutiny and doubt? Healthcare providers must establish standards of conduct that are above reproach and ensure that those standards are clearly articulated and strictly adhered to. This article describes the merits of a comprehensive ethics and compliance program, suggests five basic elements of such a program--organizational support/structure, setting standards, creating awareness, establishing a mechanism for reporting exceptions, and monitoring and auditing--and then demonstrates how those elements should be applied in several high-risk areas. Fundamentally, an ethics and compliance program has two purposes: to ensure that all individuals in an organization observe pertinent laws and regulations in their work; and to articulate a broader set of aspirational ethical standards that are well-understood within the organization and become a practical guideline for organization members making decisions that raise ethical concerns. Every ethics and compliance program should contain certain fundamental aspects. First, the effort must have the active support of the most senior management in the organization. To instill a commitment to ethics and compliance absent a clear and outspoken commitment to such purposes by organization leaders is simply impossible. Second, an ethics and compliance program is fundamentally about organizational culture--about instilling a commitment to observe the law and, more generally, to do the right thing. Third, ethics and compliance are responsibilities of operating management (sometimes called line management). Although staff such as compliance officers are obligated to provide the necessary resources for a successful program and to design the program, such staff officers cannot achieve implementation and execution. Only operating managers can do that. Fourth, an ethics and compliance effort should be about the conduct of individuals, not about "checking the boxes" in a model plan or generating attractive written or educational materials. Such an effort is about individuals on a day-to-day basis knowing what is expected of them and doing it and about never compromising integrity, regardless of pressures faced. A great deal of progress has been made in healthcare organizations in the development of increasingly sophisticated ethics and compliance programs. A particularly energetic focus has been placed on these programs since formal government guidance regarding compliance programs was first issued in the laboratory area about two years ago and as more sophisticated automated monitoring tools have been developed. As ethics and compliance programs have become more sophisticated, certain best practices have been established. This discussion will set forth approaches to ethics and compliance in the context of what are believed to be illustrative best practices. Much of what is described here is descriptive of the efforts of Columbia/HCA Healthcare Corporation from October 1997 to the present; however, this article has been presented not as a mere descriptive piece but rather as a set of normative guidelines. We hope that other healthcare providers will find this to be of practical use. Provider settings pose certain unique challenges that are specifically addressed in this discussion; however, many of the issues raised can be adapted to other healthcare organizations. For simplicity's sake, because the authors of this article all work on a daily basis primarily with hospitals, the article is written from a hospital perspective.

Ethics, Institutional↗
PubMed1993

Glycemic control and development of retinopathy in youth-onset insulin-dependent diabetes mellitus. Results of a 12-year longitudinal study.

BACKGROUND: In 1979, the authors began a prospective study of the natural history of retinopathy in youth-onset insulin-dependent diabetes mellitus (IDDM). Their major goal was to determine if there was an association between glycemic control and the development and progression of retinopathy. METHODS: The study consisted of 420 individuals with IDDM (onset younger than 20 years of age) and no retinopathy at baseline. Study subjects were enrolled between 1979 and 1988. Stereo color fundus photographs were obtained annually. Two eye endpoints were recorded: duration when retinopathy was first detected, and when proliferative retinopathy was detected. Glycemic control was assessed by quarterly determinations of glycohemoglobin (GHb). Life-table analyses were performed relating duration of diabetes, sex, GHb, and age of diabetes onset to development of retinopathy. RESULTS: Retinopathy did not develop before 2 years' duration or before puberty. The prevalence of retinopathy was 50% by 9 years' duration and 100% by 20 years' duration. Retinopathy developed in females approximately 2 years sooner than in males, but plotting duration as postpubertal years resulted in nearly identical rates. Retinopathy developed significantly earlier in subjects with prepubertal onset of diabetes than in subjects with postpubertal onset if duration was plotted as postpubertal years. When separated into three groups based on GHb levels (< 7.5%, 7.5%-9%, > 9%), retinopathy developed approximately 2 years later in subjects in the less than 7.5% GHb group than those in the higher GHb groups. Proliferative retinopathy developed in 11 subjects. Their mean GHb level was higher than the mean GHb for those without proliferative retinopathy (10.9 versus 8.6%; P < 0.01). The higher the level of GHb, the sooner proliferative changes were detected. CONCLUSION: Long-term glycemic control is significantly related to both development and progression of retinopathy. Prepubertal duration of diabetes is a significant risk factor for the development of retinopathy.

Adolescent↗
PubMed1992

Alternate cardiovascular baseline assessment techniques: vanilla or resting baseline.

The accurate evaluation of cardiovascular reactions to psychological challenge requires stable baselines against which change can be evaluated. When more than one challenge is employed, the recovery of this baseline becomes important in order to avoid carryover effects. Resting periods, even those of 20 min or more, do not guarantee baseline stability. We compared a 20-min resting condition and a new form of baseline condition in 48 college men using video tasks as the psychological challenges. The new form was a minimally demanding color detection task, termed the "vanilla" baseline condition. A 10-min version and a 20-min version of this condition were tested. Comparisons to 10-min resting baselines were made using our prior work and values from the literature. Vanilla baseline conditions were shown to be equal to or better than resting baseline conditions using criteria of between- and within-baseline stability, amplitude and significance of responsivity, and generalizability between sessions on separate days. Ten-minute resting baselines also showed acceptable stability, questioning the value of lengthy baselines. The good performance of the 10-min vanilla baseline in initial and replication samples supported its utility for estimating baselines for many purposes.

Adolescent↗
PubMed1991

Malignant glioma: current treatment perspectives.

Cytoreduction through multimodality therapy is the primary goal in management of malignant gliomas. Clinical trials such as those offered by the Brain Tumor Cooperative Group help to define current standards of care and investigate new therapies. Available therapies are in the medical, surgical, radiation and chemotherapeutic realms.

Brachytherapy↗
PubMed1985

A comparative assessment of lactate dehydrogenase isozymes, LDHk and LDH5.

An apparently unique isozyme of lactate dehydrogenase has been reported associated with transformation by Kirsten sarcoma virus, which was also expressed in human cancer. This isozyme was designated LDHk (Anderson, G.R., and Kovacik, W.P., Jr., (1981) Proc. Natl. Acad. Sci. U.S.A. 78, 3209-3213; Anderson, G. R., Kovacik, W. P., Jr., and Marotti, K. R. (1981) J. Biol. Chem. 256, 10583-10591). However, preparations of LDH5 from human placenta and from HeLa cells were later shown to exhibit some of the properties ascribed to LDHk9 and the identify of LDHk as a unique isozyme was questioned (Morin, M. E., and Hance, A. J., (1983) J. Biol. Chem. 258, 2864-2869). Saavadra and Anderson (Saavedra, R. A., and Anderson, G. R. (1983) Science (Wash. D.C.) 221, 291-292) refuted the arguments of Morin and Hance (Morin, M. E., and Hance, A. J. (1983) J. Biol. Chem. 258, 2864-2869) by claiming that commercial preparations of human placental LDH5 were contaminated with LDHk. Re-evaluation of the unique properties which distinguish LDHk from conventional LDH5 indicates that the two isozymes may not be different. Highly purified preparations of LDHk exhibit a single Mr = 34,000 polypeptide subunit on sodium dodecyl sulfate-acrylamide gels, yet retain activity detectable as both LDHk and LDH5. Attempts to separate LDHk and LDH5 by column chromatography or by continuous electrophoresis on a variety of solid support matrices were unsuccessful. Enzyme activity identified as LDHk in imidazole-borate-buffered gels migrating toward the cathode was detected as LDH5 activity on re-electrophoresis. LDH5 activity identified by electrophoretic migration toward the anode in Tris-glycine-buffered gels also recorded as LDHk when re-electrophoresed toward the cathode in imidazole-borate-buffered gels. Quantitative assays of enzyme activity recovered from the two-gel assay systems, as well as re-electrophoresis of isozyme-enriched preparations, indicated that cross-contamination of isozymes was not responsible for the results obtained.

Animals↗
PubMed1978

Acquisition of sign language by autistic children. I: Expressive labelling.

There has been growing interest in teaching sign language to autistic children who have failed to develop speech. However, controlled experimentation in this area is nonexistent. In the present study, four nonverbal autistic children were taught expressive sign labels for common objects, using a training procedure that consisted of prompting, fading, and stimulus rotation. The efficacy of the procedure was demonstrated in a multiple-baseline design across objects. The results were reliable, replicable across children, and generalizable across therapists. A stimulus control analysis demonstrated that, for three of the children, correct signing was controlled solely by the visual cues associated with the presentation of a given object and was independent of respect to the known perceptual and linguistic deficits of autistic children.

Adolescent↗