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Biomedical subjects

M Price

Publications and source records attributed to M Price.

At least 37 records · Page 2Linked to original sources
PubMed1997

Merkel cell carcinoma arising after therapeutic immunosuppression.

Azathioprine and cyclosporin have been used as immunosuppressants for many years, but long-term use has also been associated with neoplasia. We report three cases of rapidly fatal Merkel cell carcinoma in patients who had been treated with azathioprine for many years either for rheumatoid arthritis or following organ transplantation. Two of these patients had also received cyclosporin. We suggest that Merkel cell carcinoma may be seen more commonly in immunosuppressed patients than in the normal population and that the oncogenic potential of azathioprine and cyclosporin should be borne in mind when prescribing these drugs.

Aged↗
PubMed1997

Clients entering drug abuse day treatment: 18-month outcomes.

Clients who entered and remained in day treatment for at least 2 weeks (N = 66) were interviewed at 6, 12, and 18 months after baseline. Follow-up rates for each time point ranged from 58% to 68%, and 30 clients (45%) were interviewed at every time point. Those who were consistently followed (N = 30) did not differ from those who were not consistently followed (N = 36) on demographics or on outcome variables measured at baseline. Comparison of mean outcome scores across time using MANOVA indicated significant changes from baseline to 6 months in the areas of alcohol, drug, legal, and social problem severity, and these changes were maintained up to 18 months postadmission. Outcomes reflecting psychiatric symptoms and employment also changed over time, but exhibited different patterns of change. Results are confounded by treatment received, since many respondents also participated in residential treatment during follow-up. Day treatment can serve clients having a range of substance abuse problems, and can act as a bridge to traditional residential treatment. Randomized clinical trials, where clients receive only one or the other type of treatment, are needed to assess the effectiveness of day treatment alone.

Adult↗
PubMed1997

Nurse managed occupational health services without on-site clinical care delivery: a case example.

1. In this program management/community network model of occupational health services, the occupational health nurse is responsible for managing program development and implementation, with vendors providing the clinical services. 2. Occupational health nurses' primary areas of responsibility are occupational health, disability case management, ergonomics, and health promotion. 3. Successful management of program outcomes requires the occupational health nurse to continually assess employee/business needs, maintain communication with employees and management, and partner with the environmental, health, and safety team, other functional work groups, and vendors. 4. Effective management of contracts becomes critical to the process beginning with clear service requirements through the delivery of quality services.

Ambulatory Care Facilities↗
PubMed1995

Assessment of five serum marker assays in patients with advanced breast cancer treated with medroxyprogesterone acetate.

This study concerns five different tumour marker assays examined in the context of 94 patients with advanced breast cancer treated in a prospectively randomised trial of different doses of medroxyprogesterone acetate (MPA). MPA was administered at doses of 500 or 1000 mg daily and clinical evaluation of patients was carried out according to UICC criteria. Carcinoembryonic antigen (CEA) was selected as a standard marker, with three assays for MUC1 mucins (epithelial mucin core antigens (EMCA), EMCA2 and BR-MA immunoradiometric assay) differing in antibody specificities for different mucin epitopes. An additional novel assay for soluble cytokeratin was also evaluated as an example of an independent marker with a different nature and biology. Sensitivity of individual assays ranged between 44 (EMCA2) and 69% (cytokeratin) and the use of two assays in combination led to sensitivities as high as 84% (cytokeratin+BR-MA). The proportion of patients found to be assessable by each assay ranged between 51 (EMCA2) and 76% (cytokeratin). Of those patients whose marker changes were assessable, those receiving the higher dose of MPA displayed significant falls in marker levels after 12 weeks of treatment. This effect was not observed in patients receiving 500 mg. The change in cytokeratin levels in patients undergoing high dose MPA therapy proved to be most marked. Using the cytokeratin assay, 91% (of 23 patients) of patients with progressive disease showed at least a 25% rise in serum marker levels. Of these, 66% showed increases before disease progression was detected clinically with a mean lead time of 14 weeks. There was very little difference between the responses of the five tumour marker assays in patients with stable or responding disease, the proportion of these patients with stable or falling tumour marker levels ranging between 58% (CEA) and 77% (EMCA). We conclude that the cytokeratin assay has an application in monitoring response to therapy and predicting tumour progression in advanced breast cancer patients with assessable tumour marker profiles, especially if used in combination with a MUC1 mucin assay.

Adult↗
PubMed1995

Indicators and research methods for rapid assessment of a tuberculosis control programme: case study of a rural area in South Africa.

SETTING: An evaluation of the Tuberculosis Control Programme (TBCP) of KaNgwane, a rural, previously designated 'homeland' of South Africa, was performed in 1990. OBJECTIVE: The evaluation is presented as a case study to illustrate a proposed methodology for rapid, comprehensive, management oriented TBCP research. DESIGN: The components of the TBCP were categorised into direct TBCP activities, management processes and integration of the TBCP into Primary Health Care (PHC). The methods used to evaluate indicators for each of these components included: policy analysis, interviews with staff and patients, observation of in-patient and ambulatory patient care, record reviews and a household survey. RESULTS: The regional scope of the study yielded a wealth of useful information at a managerial level. Detailed, quantitative information was obtained, allowing for the identification of weaknesses in the TBCP and the targeting of appropriate action. Particularly problematic aspects were: the health information collection, case-finding and case-holding, health education and coordination and supervision. Comparative analyses between different health wards helped identify particular areas of weakness. Both illustrative results and methodological limitations are presented. The methodology used is related to previous South African TB health service research and to the emerging field of rapid assessment methods. CONCLUSIONS: A rapid but comprehensive review of a TBCP can be done if indicators and research methods are carefully selected and record systems are functional. If record systems are not functional, the non-record review methods still offer substantial information on many indicators and one or two quantitative indicators (e.g. case holding) could be selectively measured through reviewing a sample of records.

Adult↗
PubMed1995

Isoniazid prophylactic therapy for tuberculosis in HIV-seropositive patients--a least-cost analysis.

The expected upsurge in the number of new cases of tuberculosis resulting from the HIV/AIDS epidemic prompted an examination of the feasibility of prevention strategies to limit the increase in clinical tuberculosis. A computer spreadsheet model was developed to estimate the costs and benefits that would result from isoniazid chemoprophylaxis for tuberculosis in a hypothetical cohort of 100,000 HIV-seropositive people in South Africa over a period of 8 years. At a 50% prevalence of tuberculosis infection among those at high background risk, and 5-10% among those at low risk, there would have been 34,000 cases of active tuberculosis in the cohort and their contacts if no prophylactic therapy had been used. On the other hand, a chemoprophylaxis policy would have meant only 12,200 cases of tuberculosis, if a patient compliance rate of 68.5% had been assumed. Such a policy would have prevented 21,800 cases of active tuberculosis. The estimated total discounted cost of a chemoprophylaxis programme would have been R51.3 million. In the absence of preventive therapy the discounted cost of treating patients with active tuberculosis would have been R91.9 million over the 8-year period. Therefore, if the benefits of chemoprophylaxis were defined in terms of averted health care costs, such a policy would have resulted in net savings of R40.6 million. This study did not estimate losses in production associated with tuberculosis treatment or the value of preventing tuberculosis per se, though such indirect costs would have increased the benefit of the prevention programme.(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulatory Care↗
PubMed1995

Myositis and fasciitis associated with group A beta hemolytic streptococcal infections: development of a rabbit model.

Group A streptococci produce a variety of clinical symptoms ranging from minor pharyngeal infections to life-threatening soft-tissue disease. A rabbit model is described for induction of myonecrosis and fasciitis with group A beta-hemolytic streptococci. Group A streptococcal infections have shown remarkable virulence in recent years, resulting in severe local tissue destruction and life-threatening toxicity. After subcutaneous injection into the thigh of 20 ml broth containing 10(5) to 10(9) cfu/ml, initial soft tissue infection rapidly progressed to rhabdomyolysis. The response of the rabbits to the infection was consistent with the human response.

Adult↗
PubMed1995

Utilisation of primary curative services in Diepkloof, Soweto.

A study was undertaken to compare characteristics of attenders at primary curative services in Diepkloof, Soweto, and their reasons for the utilisation thereof. A structured questionnaire was administered to a sample of patients attending a provincial clinic and two general practitioners (GPs) in the Diepkloof area. The demographic characteristics, utilisation characteristics and reasons for choosing the service are compared. The most important characteristic determining choice of primary care was an individual's access to medical aid: 14% of clinic attenders compared with 67% of GP attenders. Other significant differences between the service users were employment and income. Perceived quality of care, attitude of health workers, distance to the service, availability of credit, waiting time, and the type of illness were also important determinants of choice of service. Methodological issues with regard to the heterogeneity of GP practices and ways of dealing with attitudinal data from a facility-based survey are illustrated.

Adolescent↗
PubMed1995

Asking questions: a management tool.

The occupational health nurse manager does not have all the answers. In using a democratic style of leadership with well qualified professionals, the technique of questioning can be invaluable in clarifying the issue, brainstorming solutions, developing a course of action, and monitoring success. The personal rewards to the occupational health nurse manager will include a reputation for being an effective listener, a problem solver, and a valued member of the company's management team.

Communication↗
PubMed1994

Incest: transference and countertransference implications.

It has not been the attempt of this paper to discuss the overall treatment of adults with a history of incest, but rather to elucidate and identify the various transference and countertransference implications that are emergent in psychoanalytic therapy. Despite this, some statements can be made regarding the analysis of these themes and the overall effectiveness of treatment with these patients. Analytically oriented treatment with adults with a history of incest concerns itself with three intertwined aspects. They are the reconstruction, integration, and validation of a past history of trauma (Alpert, 1991; van der Kolk, 1987), the analysis of its impact on self-identity and its effect on the person's object relations. This last component is deeply connected with the analytic relationship. This relationship is initially consciously and/or unconsciously consciously constructed by the patient as one that can typify his or her past and will be characterized by fears of abuse, neglect, and exploitation, as well as wishes and fantasies of merger, idealization, and reparation. "In the patient's psychic reality, the experience of the analytic situation then becomes the trauma, be it seduction or failure to protect" (Levine, 1990). The concept of projective identification explains how the patient may attempt to reenact his or her history and how this may be used as a vehicle for empathy and change. Throughout treatment, the analyst attempts to contain, understand, and make timely interpretations regarding herself, reactions to the patient, and their mutual interactive processes. Even when acting out inevitably occurs, it is hoped that it will be reflected on and eventually understood. At times, this process is shared with the patient and becomes a mutual endeavor. Individuals with a history of incest have been abused and exploited by those on whom they were dependent. The development of a realistic intimacy with the analyst that takes into account and respects each other's boundaries is a therapeutic goal in the treatment of adults who have been sexually abused. This can occur through the successful identification and analysis of transference/countertransference themes and the various projective identifications. Through this, the patient who has been a victim of incest is able to develop a new object relationship that is not characterized by deliberate abuse. As Horner (1987) states, the analyst and patient create a new history together, a new object relationship.(ABSTRACT TRUNCATED AT 400 WORDS)

Acting Out↗