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Biomedical subjects

M Hanson

Publications and source records attributed to M Hanson.

At least 37 records · Page 2Linked to original sources
PubMed2000

27. PET Image Interpretation. Attenuation-Corrected (ATN) Vs Non-Attenuation Corrected (NATN) Images.

Purpose: The purpose of this study was to evaluate the difference, if any, in lesion detection in ATN and NATN images.Methods: Sixty-one consecutive patients having clinical whole body FDG PET scans for oncologic indications were included. The patients were administered 10-20 mCi FDG intravenously, and imaging on the Advance (GE Medical Systems) was started 45 min-1 h after injection. The emission images were acquired for 4 min and the transmission images for 3 min per bed position. The images were reviewed on the vendor-provided workstation. Four of the interpreting physicians read the ATN images first, and the other read the NATN images first. The interpreting physicians were asked to determine if any lesions were seen on only the ATN or NATN images (discordant findings) and to describe differences in the images not affecting overall interpretation.Results: In the 61 patients, 3 discordant findings with abnormalities on the ATN images but not on the NATN images included the following: lung nodule, AP window node, and small para-aortic node. Observations that did not affect overall interpretation include the following: transmission scan helped localize lesion to be below instead of above the diaphragm; AT-N image better demonstrated liver metastasis; benign lung lesion seen only on ATN image (3 cases); pretracheal node seen better on NATN images; and low grade hilar activity on NATN not seen on ATN images.Conclusion: These results demonstrate that the ATN images detect more lesions than the NATN images, and that reviewing NATN images may not be necessary. A different method for performing this evaluation is now being undertaken.

Journal Article↗
PubMed2000

Comparing patients' experience of mental health services in England: a five-Trust survey.

The implementation of the Care Programme Approach (CPA) in English mental health services has been slow to proceed despite general support, both in England and in other countries, of its principles of good practice. This study set out to evaluate the implementation of the CPA directly from patients' experience using the "Your Treatment and Care" assessment tool. The results of a survey of 503 patients across five NHS Trusts in England showed that many patients did not have a copy of their care plan and had not been involved in the care planning procedure. Many reported shortcomings in their experience of their key worker and their psychiatrist. However, there was substantial variation in experience across services. "Your Treatment and Care" showed good internal reliability, was acceptable to users, and appeared to be able to access actual experiences better than a traditional "satisfaction" item. It appears to be very useful as a benchmarking tool and is now being used in services across the UK, the USA and Australia.

Adolescent↗
PubMed2000

Voiding pattern in healthy children 0 to 3 years old: a longitudinal study.

PURPOSE: We describe the development of voiding patterns and bladder control in healthy children during the first 3 years of life. MATERIALS AND METHODS: We determined voiding patterns, bladder capacity and post-void residual urine volume per 4 hours individually and noninvasively every 3 months in 36 female and 23 male healthy infants using the 4-hour voiding observation. RESULTS: Voiding frequency decreased slowly from 5 to 2 voiding episodes per 4 hours from ages 3 months to 3 years. We noted interrupted voiding in 33% of subjects at age 3 months but this condition was rare after age 2 years. Voiding during sleep occurred mainly during the first 7 months of life and did not continue after age 18 months. Bladder capacity increased from a median of 52 to 67, 68 and 123 ml. during years 1 to 3, respectively. As measured by post-void residual urine volume, bladder emptying was unchanged during years 1 and 2 but it decreased during year 3 (median 6 versus 0 and mean 4 versus 3 ml. per 4 hours). CONCLUSIONS: During the first 3 years of life the number of voiding episodes, including interrupted voiding, post-void residual urine and voiding during sleep, decreased while bladder capacity increased.

Child, Preschool↗
PubMed2000

FDG PET imaging in patients with pathologically verified dementia.

UNLABELLED: The purpose of this study was to confirm with pathologic verification 2 beliefs related to Alzheimer's disease (AD): (a) the long-standing impression that bilateral temporo-parietal hypometabolism, as noted on FDG PET imaging, is the metabolic abnormality associated with Alzheimer's disease (AD) and (b) that the sensitivity, specificity, and diagnostic accuracy of the metabolic pattern of bilateral temporo-parietal hypometabolism allows differentiation between other degenerative causes of dementia. METHODS: Twenty two individuals (8 women, 14 men) with difficult-to-characterize memory loss or dementia (using standard clinical criteria), and who eventually received pathologic confirmation of diagnosis, were evaluated. FDG PET brain scans were obtained and visually graded by an experienced nuclear medicine physician as to the presence of classic bilateral temporo-parietal hypometabolism as seen in Alzheimer's type dementia. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of the metabolic pattern of bilateral temporo-parietal hypometabolism were determined using pathologic diagnosis as the gold standard. RESULTS: The clinical diagnosis of possible or probable AD was determined as the primary cause of dementia in 12 patients. The sensitivity and specificity of the clinical diagnosis for probable AD were 63% and 100%, respectively. The sensitivity and specificity of the clinical diagnosis for possible and probable AD were 75% and 100%, respectively. The sensitivity, specificity, and diagnostic accuracy of bilateral temporo-parietal hypometabolism being associated with AD were 93%, 63%, and 82%, respectively. CONCLUSION: This study confirms that bilateral temporo-parietal hypometabolism is indeed the classic metabolic abnormality associated with AD. Furthermore, in individuals with dementia whose FDG PET scans indicated a metabolic pattern other than bilateral temporo-parietal hypometabolism, a cause of dementia other than AD should be suspected. These observations may be of clinical importance in differentiating dementia syndromes. The sensitivity, specificity, and diagnostic accuracy of FDG PET are acceptable as tests to be used in the evaluation of dementia and particularly to confirm the clinical suspicion of AD.

Aged↗
PubMed1999

Successful expression of beta-galactosidase and factor IX transgenes in fetal and neonatal sheep after ultrasound-guided percutaneous adenovirus vector administration into the umbilical vein.

In utero somatic gene therapy in the later stages of pregnancy may allow targeting of organ systems which are difficult to reach later in life and to prevent the development of tissue damage otherwise caused by the early onset of inherited diseases. We report here on the percutaneous delivery of two adenoviral vectors, containing the beta-galactosidase reporter gene and the human Factor IX gene respectively, to the fetal liver and circulation by ultrasound-guided umbilical vein puncture similar to procedures used in human pregnancy. Vector spread, as detected by PCR analysis for the beta-galactosidase encoding vector, was found in almost all fetal and neonatal organs and in the maternal liver. Expression of the beta-galactosidase transgene was detected in many fetal tissues by RT-PCR. High beta-galactosidase production was shown by immuno-histochemistry predominantly in the liver, where about 30percent of the hepatocytes stained positive, and in the adrenal cortex. Production of factor IX was determined by ELISA in the plasma of treated fetuses and newborn lambs and reached at birth up to 80percent of the normal human plasma concentration. This demonstrates a very hopeful proof of principle for the development of prenatal treatment of many genetic diseases but also requires more detailed investigations with respect to the observed systemic spread of the vector.

Adenoviridae↗
PubMed1999

OSCE checklists do not capture increasing levels of expertise.

PURPOSE: To evaluate the effectiveness of binary content checklists in measuring increasing levels of clinical competence. METHOD: Fourteen clinical clerks, 14 family practice residents, and 14 family physicians participated in two 15-minute standardized patient interviews. An examiner rated each participant's performance using a binary content checklist and a global process rating. The participants provided a diagnosis two minutes into and at the end of the interview. RESULTS: On global scales, the experienced clinicians scored significantly better than did the residents and clerks, but on checklists, the experienced clinicians scored significantly worse than did the residents and clerks. Diagnostic accuracy increased for all groups between the two-minute and 15-minute marks without significant differences between the groups. CONCLUSION: These findings are consistent with the hypothesis that binary checklists may not be valid measures of increasing clinical competence.

Analysis of Variance↗
PubMed1999

Curriculum renewal in child psychiatry.

OBJECTIVE: To ensure uniform design and evaluation of a clerkship curriculum for child and adolescent psychiatry teaching common disorders and problems in an efficient manner across 5 teaching sites and to include structures for continuous improvement. METHOD: The curriculum committee selected for course inclusion disorders and problems of child psychiatry that were commonly encountered by primary care physicians. Instruction methods that encouraged active student learning were selected. Course coordination across sites was encouraged by several methods: involving faculty, adopting a centralized examination format, and aligning teaching methods with examination format. Quantitative and qualitative methods were used to measure students' perceptions of the course's value. These evaluative results were reviewed, and course modifications were implemented and reevaluated. RESULTS: The average adjusted student return rate for course evaluation questionnaires for the 3-year study period was 63%. Clerks' ratings of course learning value demonstrated that the course improved significantly and continually across all sites, according to a Scheffé post-hoc analysis. Analysis of student statements from focus-group transcripts contributed to course modifications, such as the Brief Focused Interview (BFI). CONCLUSIONS: Our curriculum in child psychiatry, which focused on common problems and used active learning methods, was viewed as a valuable learning experience by clinical clerks. Curriculum coordination across multiple teaching sites was accomplished by including faculty in the process and by using specific teaching and examination strategies. Structures for continuous course improvement were effective.

Canada↗
PubMed1999

The "P's and Q's" of quality systems.

Quality improvement in blood collection centers has been a priority of regulatory and accrediting agencies for the past several years. The Food and Drug Administration and the American Association of Blood Banks have developed guidelines for quality assurance activities. Inspection programs have focused on evaluation of processes and how they are controlled to assure the safety and efficacy of blood components. A review of Food and Drug Administration enforcement actions shows that all such actions cite similar deficiencies related to management control, personnel training, error, and record management policies. A quality program that includes management commitment to compliance and continuous improvement, defined personnel training, internal audit, and error management policies provides documented evidence to management and regulatory agencies that operations are in control.

Blood Specimen Collection↗
PubMed1998

Mechanical properties of the fetal ductus venosus and umbilical vein.

During fetal circulatory compromise, velocity pulsations in the precordial veins increase and are commonly transmitted through the ductus venosus into the umbilical vein, indicating a serious prognosis. The nature of the pulsations and their transmission into the periphery, specifically the umbilical vein, is poorly understood. We present information on the mechanical properties of fetal veins as a basis for describing the pulse wave propagation. Five fetal sheep livers with connecting veins (gestational age 0.8-0.9) were studied in vitro. The transmural pressure, obtained with a fluid-filled catheter, was reduced stepwise from 10.3 to 0 mmHg, and the diameter determined by ultrasonography. Each data set was fitted to an exponential function to determine the stiffness parameter and the area at a standard pressure, which we proposed to be 5 mmHg for the fetal venous circulation. The stiffness parameter was 6.2+/-1.8 at the ductus venosus outlet, 3.4+/-1.3 at the ductus venosus inlet, and 4.0+/-1.0 in the umbilical vein. Correspondingly, values for compliance and pulse wave velocity for the three venous sections were established for a physiological pressure range. The estimated pulse wave velocity of 1-3m/s is comparable with values estimated for veins in adults. The mechanical properties of fetal veins are comparable with those described for veins later in life. The stiffness parameter represents the elastic properties at all pressure levels and conveniently permits inference of compliance and pulse wave velocity.

Animals↗
PubMed1998

In vitro detection of occult bone marrow metastases in patients with colorectal cancer hepatic metastases.

PURPOSE: The purpose of this study was to assess the immunocytochemical status of bone marrow aspirates from patients with clinically isolated hepatic metastases to test the hypothesis that such findings would allow improved patient selection for liver-directed treatment. METHODS: All patients had biopsy-proven or presumed colorectal cancer metastatic to the liver and were scheduled for an operative procedure for hepatic resection or for hepatic artery catheter and chemotherapy pump implant. Immunocytochemical analysis of bone marrow aspirate smears was performed with a panel of monoclonal antibodies directed toward cytokeratins, Lewis Y antigen and A-33 colorectal epitopes. RESULTS: Data from 80 patients indicated that bone marrow reactivity was present in 9.5 percent of those with resectable hepatic metastases and in 34 percent of those not resected (P = 0.03). No single monoclonal antibody or combination produced better discrimination. CONCLUSIONS: Presence or absence of presumed occult colorectal cancer cells in the bone marrow of patients with isolated hepatic metastases is biologically interesting, but not useful in selecting or altering patient management.

Antibodies, Monoclonal↗
PubMed1998

The innervation pattern of the radial nerve at the elbow and in the forearm.

Sixty paired cadaver forearms were dissected to examine the distribution of the radial nerve branches to the muscles at the elbow and forearm. Emphasis was placed on the innervation of the extensor carpi radialis brevis and the supinator muscles because of discrepancies in the literature concerning these muscles. The most common branching pattern (from proximal to distal) was to brachioradialis, extensor carpi radialis longus, superficial sensory, extensor carpi radialis brevis, supinator, extensor digitorum/extensor carpi ulnaris, extensor digiti minimi, abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus and extensor indicis. The branch to extensor digitorum and extensor carpi ulnaris came off as a common stem often with the branch to extensor digiti minimi. The branch to the ECRB muscle was noted to arise from the posterior interosseous nerve in 45%, superficial sensory nerve in 25% and at the bifurcation of the posterior interosseous and superficial sensory nerves in 30% of specimens. The supinator had an average of 2.3 branches from the posterior interosseous nerve (range 1-6). The branches to the supinator showed a wide variability proximal to and within the supinator.

Elbow↗
PubMed1998

The flexor pollicis longus and its relation to the anterior and posterior interosseous nerves.

Sixty paired cadaver upper extremities were dissected to study the anatomy of the flexor pollicis longus in the forearm and its relation to the median and anterior interosseous nerves. An accessory head was noted in 33 (55%) of 60 specimens. The accessory head was noted to pass anterior to the anterior interosseous nerve in all specimens. The accessory head was noted to pass posterior to the median nerve in 57 specimens, and anterior to the nerve in three. Tendon or muscle anomalies were noted in eight specimens (13%), seven of which involved an anomalous attachment between the FPL and the flexor digitorum profundus of the index.

Forearm↗
PubMed1998

Ductus venosus agenesis prevents transmission of central venous pulsations to the umbilical vein in fetal sheep.

Velocity pulsations in the umbilical vein are widely used as a marker for congestive heart failure in the fetus. It has been suggested that the atrial pressure waves are transmitted to the umbilical vein mainly through the ductus venosus. In a case of ductus venosus agenesis in a fetal sheep of 110 days' gestation, we recorded pressures in the inferior vena cava and umbilical vein simultaneously with Doppler velocimetry in the medial hepatic vein and umbilical vein, under general anesthesia. During fetal respiratory acidosis (pH 7.01) and varying degrees of umbilical clamping, we did not observe the typical pulsations in the umbilical vein (deflections of the maximum velocity during atrial contraction) in spite of varying degrees of reversed flow in the hepatic vein (5-16%). The systolic-diastolic pressure amplitude in the inferior vena cava was 5.5-6.4 mmHg, sometimes reaching 9.19-11.03 mmHg. Varying degrees of reversed portocaval pressure gradient during atrial contraction (1.40-9.51 mmHg), periods of reversed portocaval pressure gradient throughout the entire cardiac cycle, tachycardia (240 beats/min) or bradycardia (99 beats/min) also did not produce the type of pulsation in the umbilical vein that reflects augmented atrial contractions. The results support the hypothesis that the ductus venosus is essential for the transmission of atrial pressure waves to the umbilical vein.

Animals↗
PubMed1998

Dating the origin of the CCR5-Delta32 AIDS-resistance allele by the coalescence of haplotypes.

The CCR5-Delta32 deletion obliterates the CCR5 chemokine and the human immunodeficiency virus (HIV)-1 coreceptor on lymphoid cells, leading to strong resistance against HIV-1 infection and AIDS. A genotype survey of 4,166 individuals revealed a cline of CCR5-Delta32 allele frequencies of 0%-14% across Eurasia, whereas the variant is absent among native African, American Indian, and East Asian ethnic groups. Haplotype analysis of 192 Caucasian chromosomes revealed strong linkage disequilibrium between CCR5 and two microsatellite loci. By use of coalescence theory to interpret modern haplotype genealogy, we estimate the origin of the CCR5-Delta32-containing ancestral haplotype to be approximately 700 years ago, with an estimated range of 275-1,875 years. The geographic cline of CCR5-Delta32 frequencies and its recent emergence are consistent with a historic strong selective event (e.g. , an epidemic of a pathogen that, like HIV-1, utilizes CCR5), driving its frequency upward in ancestral Caucasian populations.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Validation of an objective structured clinical examination in psychiatry.

PURPOSE: To examine the validity of a psychiatry clerkship's objective structured clinical examination (OSCE). METHOD: In 1996, 33 clinical clerks and 17 psychiatry residents at the University of Toronto participated in an eight-station OSCE evaluated by psychiatrist-examiners using binary checklists and global ratings. Prior to the OSCE, communication course instructors were asked to rank the clerks on interviewing ability, and faculty supervisors were asked to identify the OSCE stations on which the clerks were likely to do well or poorly. RESULTS: Mean OSCE scores were significantly higher for the residents than for the clerks on global ratings but not on checklists. The communication instructors accurately predicted the clerks' rankings on the global scores but not their scores on the checklists. The faculty supervisors predicted with moderate accuracy the clerks' success on the OSCE stations as measured by the checklists but not by the global ratings. The residents rated the OSCE scenarios as highly realistic. CONCLUSIONS: The evidence of construct and concurrent validity together with high ratings of realism suggest that a psychiatry OSCE can be a valid assessment of clerks' clinical competence.

Clinical Clerkship↗