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Biomedical subjects

M L Campbell

Publications and source records attributed to M L Campbell.

At least 19 recordsLinked to original sources
PubMed1998

Small mammal survival and trapability in mark-recapture monitoring programs for hantavirus.

Following the 1993 hantavirus pulmonary syndrome (HPS) epidemic in the south-western United States, mammalogists and epidemiologists instituted long-term studies to monitor population density and prevalence of infection in rodents which constitute the reservoir for Sin Nombre virus (SNV). In this study, field techniques used in sampling small mammals for SNV infection were evaluated to determine if trapping and handling protocols were having significant effects on future trapability or mortality of animals. We compared rodent mark-recapture control plots, on which all rodents were simply measured, marked, and released on site, with experimental plots on which all animals were anesthetized with methoxyflurane, sampled for blood and saliva, measured, marked, and released. Blood samples were obtained from anesthetized animals on the experimental plots via a retro-orbital sinus puncture using a heparinized capillary tube. Dacron tipped oral swabs were used to collect buccal cells and saliva from the rodent's oral cavity. Field data were collected monthly from August 1994 to August 1996 at two sites in New Mexico (USA). Analyses were based on 3,661 captures of 1,513 individuals representing 21 species from three rodent families (Rodentia: Muridae, Heteromyidae, Sciuridae) and two species of rabbits (Lagomorpha: Leporidae). Overall, for most murid rodents (including five Peromyscus spp., Neotoma albigula, and Onychomys leucogaster) and one rabbit species (Sylvilagus floridanus), the handling/bleeding procedures had no significant effects on recapture rates or mortality. In contrast, several species of heteromyids (Dipodomys ordii and Perognathus flavus), one murid (Reithrodontomys megalotis) and one leporid (S. auduboni) suffered higher mortality rates, and heteromyid kangaroo rats (D. ordii and D. merriami) exhibited lower trapability as a result of the anesthesia and sampling procedures. In view of the overall non-significant influence of the sampling procedures on murid rodents, the anesthesia and blood/saliva sampling protocols described herein appear to be appropriate for hantavirus research, and may serve as a model for environmental monitoring of other zoonotic agents and their reservoirs.

Animal Welfare↗
PubMed1997

Depression and life satisfaction in aging polio survivors versus age-matched controls: relation to postpolio syndrome, family functioning, and attitude toward disability.

OBJECTIVE: To compare depressive symptoms and life satisfaction in aging polio survivors with age-matched controls and to relate these outcomes to scores to psychosocial and disability-related variables. DESIGN: A planned medical, functional, and psychosocial study with multivariate analyses. SETTING: A large, urban rehabilitation center. PARTICIPANTS: A volunteer sample of 121 polio survivors and an age-matched control group of 60 people with similar sociodemographic backgrounds. MAIN OUTCOMES: Depression as measured by the Geriatric Depression Scale and an 11-item life satisfaction scale. RESULTS: The prevalence of depressive disorders was not significantly different in the two groups, although the postpolio group tended to have more symptomatology and an overall depressive disorder prevalence of 28%. Some life satisfaction scale scores were significantly lower in the postpolio group, especially those concerned with health. People with postpolio syndrome scored significantly higher on depression scales and lower on some life satisfaction scales than people with a history of polio but without postpolio syndrome. Several psychosocial variables, most notably family functioning and attitude toward disability, helped to mediate this effect. Among people with significant depression, there was little, evidence of adequate treatment in the community. CONCLUSIONS: Postpolio by itself does not relate to higher depression scores or lower life satisfaction. Postpolio syndrome has some relation to depression, but family functioning and attitude toward disability are more important. There is a need for better community-based psychological services.

Activities of Daily Living↗
PubMed1997

Collection of surgical specimens in total joint arthroplasty. Is routine pathology cost effective?

A retrospective review of 715 consecutive cases of total joint arthroplasty (283 hips, 432 knees), performed for a variety of indications during 1992 and 1993, was undertaken to assess the cost effectiveness of routine pathologic examination. The charts were reviewed for preoperative, operative, and pathologic diagnosis, and any discrepancies in diagnosis were noted. Particular attention was paid to pathologic findings suggestive of neoplasia or rheumatoid arthritis that were not noted in the preoperative or operative diagnoses. Six of the 715 cases fit into this category, but all failed to have any clinical significance. No alteration in patient care resulted from routine pathologic examination. This paper questions the necessity of routinely submitting pathologic specimens in uncomplicated total hip and knee arthroplasty.

Aged↗
PubMed1997

Experience with an end-of-life practice at a university hospital.

OBJECTIVE: To describe a 10-yr experience with an end-of-life practice in a hospital. DESIGN: A nonexperimental, prospective, descriptive design was used to record variables from a convenience sample of patients transferred to the Comprehensive Supportive Care Team. SETTING: Detroit Receiving Hospital is an urban, university-affiliated, Level I trauma/emergency hospital. PATIENTS: Patients who are not expected to survive hospitalization, and for whom a decision has been made to focus care on palliative interventions, are candidates for care by this practice. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patient demographics, including the following information: age, gender; diagnoses; illness severity; mortality rate; and disposition. Measures of resource utilization included: referral sources; Therapeutic intervention Scoring System values; bed costs; and length of hospital stay. Satisfactory patient/family care with a measurable reeducation in the use of resources can be achieved in the hospital setting. CONCLUSIONS: A hands-on approach to the care of dying patients by this specialty, palliative care service has provided patients, families, and clinicians with the type of support needed for satisfactory end-of-life care. A summary of our experience may be useful to others.

Adolescent↗
PubMed1997

Functional alterations and apoptotic cell death in the retina following developmental or adult lead exposure.

Long-term visual system deficits occur in man and animals following developmental and occupational lead exposure. Recent experimental data suggests that the adult brain is not altered following lead exposure. Therefore, the aim of these studies was to use the retina as a CNS model to examine and compare the morphological, biochemical and electroretinographic (ERG) changes occurring in rats exposed to low or moderate levels of lead during development (0-21 days of age) with those occurring in adult rats with equivalent blood and retinal levels of lead for three or six weeks. Five main results were obtained. First, developmental and adult lead exposure for six weeks produced age- and dose-dependent retinal degeneration such that rods and bipolar cells were selectively lost. At the ultrastructural level, all dying cells exhibited the classical morphological features of apoptotic cell death. Second, in the lead-exposed groups, the decrease in the number of rods was correlated with the loss of rhodopsin content per eye confirming that rods were directly affected by lead. Third, single-flash rod ERGs and cone ERGs obtained from developmentally and adult lead-exposed rats demonstrated that there were age- and dose-dependent decreases in the rod a-wave and b-wave sensitivity and maximum amplitudes without any effect on cones. In adult rats exposed to lead for three weeks, qualitatively similar ERG changes occurred in the absence of cell loss or decrease in rhodopsin content. Fourth, developmental and adult lead exposure for three and six weeks produced age- and dose-dependent decreases in retinal cGMP phosphodiesterase (PDE) activity resulting in increased cGMP levels. Fifth, picomolar to micromolar concentration of free lead directly inhibited rat retinal and purified bovine rod cGMP PDE. In summary, there are three main conclusions. First, the retinas of developing and adult rats exposed to lead exhibit qualitatively similar rod-mediated ERG alterations as well as rod and bipolar apoptotic cell death. Thus, developing and mature retinas are both sensitive to the adverse effects of lead: albeit to significantly different extents. Second, a similar biochemical mechanism such as the inhibition of rod and bipolar cell cGMP PDE, varying only in degree and duration, underlies both the lead-induced ERG rod-mediated deficits and the rod and bipolar apoptotic cell death. Third, the composite results from our experiments and those of others suggest that the developing retina might be more sensitive to preweaning lead exposure than the hippocampus and thus may serve as a good model for studying the cellular and molecular mechanisms underlying developmental and adult lead neurotoxicity.

Animals↗
PubMed1996

Program assessment through outcomes analysis: efficacy of a comprehensive supportive care team for end-of-life care.

Addressing end-of-life care issues is difficult in our death-denying society, particularly in the hospital environment, which is characterized by a proliferation of life-sustaining therapy. A hospital model for end-of-life care has been in practice at an urban university hospital since late 1985. Outcomes analysis at the micro-level permitted a demonstration of the practice's effectiveness over time.

Comprehensive Health Care↗
PubMed1996

Medical futility and life-sustaining treatment decisions.

By focusing our attention on the questions of "what are we trying to achieve" and "are we able to do it", the discussion of medical futility has contributed an important dimension to the ethics of treatment decision making near the end of life. It is not simply enough to ask and answer the question of what the patient wants. Healthcare professionals have a responsibility to offer only those life-sustaining efforts that have a reasonable chance of being beneficial. Futility policies should permit treatment-limiting decisions to be made without the agreement of the patient or surrogate at times, but such policies should also provide opportunities to challenge a judgement of futility. Above all, such policies should not be used as a reason to avoid communication. Patients or surrogates need to be informed about what treatments are options and what are not. The futility criterion for limiting treatment should be recognized as a means of contributing to communication and discussion regarding benefits, harms and medical goals. It should not be permitted to bypass such discussions. The recognition of the significance of the concept of futility means that discussion needs to continue at another level as well. The questions of "what are we trying to achieve" and "are we able to do it" are not easily answered. It is especially important, we think, that those who are experienced in working with patients with neurological impairments contribute to the on-going reflection on what constitutes benefit or what is the appropriate use of life-sustaining interventions for such patients.

Adult↗
PubMed1996

Chronic steroid-responsive encephalitis without autoantibodies to glutamate receptor GluR3.

Autoantibodies to GluR3, an AMPA glutamate receptor subtype, may be a cause of chronic unilateral encephalitis (Rasmussen's syndrome). We report a woman with chronic left hemisphere encephalitis whose partial seizures, aphasia, and motor weakness are highly responsive to intermittent steroids and cyclophosphamide. Her serum and CSF were negative for antibodies to GluR3 by both immunoblot and immunocytochemical analysis of cells transfected with GluR3 cDNA, indicating that separate immune-mediated processes may be involved in some cases of chronic encephalitis.

Adult↗
PubMed1996

Impact of patient consciousness on the intensity of the do-not-resuscitate therapeutic plan.

BACKGROUND: The nature and intensity of a do-not-resuscitate therapeutic plan varies by patient. Some do-not-resuscitate therapeutic plans may include interventions directed at the withdrawal of life-sustaining therapy. OBJECTIVE: The purpose of this study was to examine the impact of patient consciousness on the nature and intensity of the do-not-resuscitate plan, and on the decision to withdraw life-sustaining therapy. METHODS: This study represents a secondary analysis of data obtained in a previous study to evaluate patient care requirements under varying intensities of do-not-resuscitate plans. Data were collected retrospectively through record review. Patients were grouped as follows, according to the intensity of the do-not-resuscitate plan: (1) all but cardiopulmonary resuscitation, (2) conservative care without cardiopulmonary resuscitation, (3) comfort only, and (4) withdrawal of life-sustaining therapy. In addition to demographic data, consciousness and illness severity were measured. Data were analyzed using descriptive statistics. RESULTS: There was a significant decrease in consciousness from admission in all groups except conservative care. The withdrawal group had the lowest average Glasgow Coma Scale scores at the time of the do-not-resuscitate designation. Multiple regression analysis was used to demonstrate a significant impact of consciousness on type of do-not-resuscitate decision, but no significant impact from age or illness severity. CONCLUSIONS: These results support previous observations that decisions to withdraw life-sustaining therapy are prompted by diminished consciousness. These results may stimulate caregivers to offer withdrawal of life-sustaining therapy as an option in patients with severely decreased consciousness and a poor prognosis for functional recovery.

APACHE↗
PubMed1995

Combination adriamycin and suramin induces apoptosis in bcl-2 expressing prostate carcinoma cells.

Bcl-2 expression has been associated with progression of prostate cancer from androgen-dependence to androgen-independence and may contribute to the relative drug-resistant phenotype typically observed in androgen-independent prostate cancer. Dunning-G rat prostate cancer cells transfected with a bcl-2 expression vector demonstrated resistance to apoptosis induced by adriamycin and, to a lesser extent, suramin. Use of adriamycin and suramin in combination, however, circumvents this bcl-2 associated drug resistance. Our findings indicate that combination drug actions may induce apoptosis in resistant malignant cell types with defective apoptotic pathways.

Animals↗
PubMed1995

An advanced practice model: inpatient collaborative practices.

Advanced practice nurses play a key role in optimal patient care. In primary care, their functions include history taking, physical examination, development of a plan of care, instruction and counseling, use of laboratory data, diagnosis of routine illness, prescription of medications or other therapies as allowed by state laws, coordination of services, and referral when necessary. These nursing services may be provided independently or in collaboration with physician providers. Nurse-physician collaborative practices generally occur in the ambulatory care setting. The purpose of this article is to illustrate inpatient collaborative practices with CNSs and staff physicians in an urban, medical-center hospital.

Humans↗
PubMed1994

Impact of the DNR therapeutic plan on patient care requirements.

BACKGROUND: The intensity and nature of a patient therapeutic plan should depend upon the specific therapeutic goals. When the therapeutic plan includes a do-not-resuscitate order, the intensity of the plan may be high or low. OBJECTIVE: To examine the differences in patient care requirements and hospital outcomes in patients with a do-not-resuscitate status to determine the most appropriate care setting, eg, intensive vs nonintensive care. METHOD: Data from a prospective sample of 100 patients were analyzed. Patients were grouped according to the intensity of the therapeutic plan: (1) all-but-CPR: all support except cardiopulmonary resuscitation, (2) conservative-care: medical management without the addition of life-sustaining measures, (3) comfort-only, and (4) withdrawal of life-sustaining therapy. RESULTS: Patient mortality was high for all groups except the conservative-care group. Patient care requirements remained high in the all-but-CPR group, necessitating continued intensive care. Patient care requirements decreased significantly in the comfort-only and withdrawal groups, illustrating the ability to manage these patients in a nonintensive care setting.

Aged↗