PubMed Health⌕ Search

Biomedical subjects

Michael Carter

Publications and source records attributed to Michael Carter.

At least 19 recordsLinked to original sources
PubMed2006

Human telomere reverse transcriptase expression predicts progression and survival in pediatric intracranial ependymoma.

PURPOSE: Pediatric intracranial ependymomas are a heterogeneous group of neoplasms with unpredictable clinical and biologic behavior. As part of ongoing studies to identify potential biologic and therapeutic markers, we analyzed the role of human telomere reverse transcriptase (hTERT; the catalytic subunit of telomerase) expression as a prognostic marker for this disease. PATIENTS AND METHODS: Primary intracranial ependymomas that were resected at our institution between 1986 and 2004 were identified through the pathology and oncology databases. A tissue array was constructed from the patient samples and hTERT expression was evaluated by immunohistochemistry. Twenty-one samples were also analyzed for telomerase activity (telomerase repeat amplification protocol assay). RESULTS: Eighty-seven tumors from 65 patients were analyzed. Five-year progression-free survival was 57% (SEM, 12%) and 21% (SEM, 8%) for hTERT-negative and hTERT-positive tumors, respectively (P = .002). Five-year overall survival was 84% (SEM, 7%) and 41% (SEM, 7%) for hTERT-negative and hTERT-positive tumors, respectively (P = .001). There was good correlation between telomerase activity and hTERT expression (kappa = 0.637). Multivariate analysis revealed hTERT expression to be the single most important predictor of survival of all known pathologic, clinical, and treatment factors (hazard ratio, 60.4; 95% CI, 6.4 to 561). All four patients with hTERT-negative tumors at relapse are still alive, with median follow-up of 11.2 years. CONCLUSION: In this study, hTERT expression was the strongest predictor of outcome and was independent of other clinical and pathologic prognostic markers. It represents a simple and reliable biologic prognostic factor for intracranial ependymomas. These results should be confirmed in larger prospective trials.

Adolescent↗
PubMed2006

The benefits of the MOE/MAR implementation: a quantitative approach.

Once the decision was made to implement an electronic medication order entry and medication administration record system at the University Health Network, a significant question soon emerged: How would UHN be able to determine if the project had indeed accomplished its stated objectives of improving patient safety and the medication ordering and processing cycle?

Cost-Benefit Analysis↗
PubMed2006

ABC in the news.

Explore the source record for details and available documents.

Adult↗
PubMed2005

Moving forward together: the practice doctorate in nursing.

Societal drivers, as well as trends in education and health care, are advancing the practice doctorate in nursing. For nurse practitioner preparation, the current resurgence of interest in the practice doctorate could precipitate change that mimics the evolution from post-basic certificate to Master's level education. The National Organization of Nurse Practitioner Faculties (NONPF) is a resource for the study of the practice doctorate relative to quality nurse practitioner education. This article will offer some insights into the movement toward the practice doctorate by describing, from the NP perspective, the societal impetus for change, the historical perspective of NP and doctoral education, the 4 Ws (why, what, where, and when) of the movement, and some of the myths and realities about the practice doctorate.

Aged↗
PubMed2005

Management of new onset atrial fibrillation in previously well patients less than 60 years of age.

OBJECTIVE: This study reviewed the ED management of new onset atrial fibrillation (AF) in previously well patients aged less than 60 years. METHODS: We undertook a retrospective review of ED patients from 1998 to 2002 inclusive. The main outcome measures were approaches to rate or rhythm control and anticoagulation, the use of echocardiography, the value of diagnostic testing and the frequency of hospital admission. RESULTS: Fifty-two patients were identified. In general, all patients were haemodynamically stable. One patient had mild cardiac failure and one was clinically thyrotoxic. Serum potassium was measured in 51 (98%) patients, magnesium in 23 (44%) and cardiac enzymes in 30 (58%); results were generally unhelpful. Thyroid function tests were carried out in 40 (77%) patients; results were unremarkable except for the clinically thyrotoxic patient. No patient had echocardiography in the ED; however, 6 patients (12%) were later found to have major cardiac abnormalities. Forty-four (85%) patients received a variety of medications; 37 (71%) received an anti-arrhythmic and 24 (46%) an antithrombotic. Overall, 17 (33%) patients received theoretically effective therapy for conversion to sinus rhythm. Twenty-two (42%) patients were admitted to hospital. CONCLUSIONS: This study reveals variation in the management of acute AF in previously well, haemodynamically stable, young patients. Pathology testing was frequently carried out with a low yield. There were high rates of attempts to cardiovert, use of antithrombotics and of admission to hospital. Although cardioversion attempts appeared to be contrary to existing guidelines, decisions may have been based primarily on patient symptoms. Echocardiography should be considered prior to anti-arrhythmic therapy.

Adult↗
PubMed2005

Factors that impact upon the time to hospital presentation following the onset of chest pain.

INTRODUCTION: Although morbidity and mortality associated with chest pain are related to time to intervention, many patients have delayed ED presentations. We aimed to assess the extent of and reasons for prehospital delay, and identify patient subgroups more at risk of delayed presentation. METHODS: This was an analytical, cross-sectional survey of patients with undifferentiated, potentially ischaemic chest pain, at a tertiary referral ED. Data were collected on the circumstances surrounding the chest pain incident (including components of total prehospital time) and the proportion of delayed presentations (defined as >3 h). Multiple linear regression determined variables significantly associated with prehospital time. RESULTS: One hundred and fifty patients were enrolled. Mean age was 51.9+/-15.9 years and 90 (60.0%, 95% CI 51.7-67.8) were male. The mean total prehospital time was 6.38 h (median 3.17). Seventy-nine (52.7%, 95% CI 44.4-60.8) patients had a delayed presentation (>3 h) and those most at risk of this were those at home at pain onset and those with a history of AMI. The decision time (from onset of pain to decision to present) comprised the majority (82.8%) of total prehospital time. Factors positively associated with decision time were: waiting to see if symptoms resolved (P<0.0001), seeking GP advice (P<0.0001), fluctuating symptoms (P=0.02), embarrassment (P=0.01) and attributing symptoms to muscle problems (P=0.04). Nine patients diagnosed with AMI had a mean total prehospital time of 10.2 h. CONCLUSION: Intensified efforts are required to promote awareness of the need to present directly to the ED upon the onset of chest pain. The factors associated with decision delay may help to inform revisions in public education initiatives.

Chest Pain↗
PubMed2005

Perceptions of surfboard riders regarding the need for protective headgear.

OBJECTIVE: To examine the use of protective headgear by surfers, their perceptions of its usefulness, and barriers to its use. METHODS: A researcher-administered questionnaire was used to undertake a cross-sectional survey of 646 surfboard riders at 8 popular surfing beaches in Victoria, Australia. The main outcome measures were rate of use of headgear, perceptions of head injury risk relative to a range of other activities, perceptions regarding headgear, and the reasons for not wearing headgear. RESULTS: Most surfers were men (90.2%), young (mean age 28.2 years), and experienced (mean years of surfing 11.6). Only 245 (38.0%, 95% CI 34.2-41.9) surfers considered the risk of head injury while surfing as moderate or high, and only 12 (1.9%, 95% CI 1.0-3.3) reported routine use of headgear. The surfers were more likely to believe that there was a higher risk of head injury in other sports and physical activities (P < .001). Although 475 surfers (73.8%, 95% CI 70.2-77.1) thought that surfers who wear headgear are less likely to become injured, 400 (62.1%, 95% CI 58.2-65.9) reported that headgear restricted surfing performance and that they would rather surf without it. The main reasons for not wearing headgear were "no need," discomfort, claustrophobia, and effects upon the senses and balance. CONCLUSIONS: Although most surfers acknowledge some risk of head injury, headgear is rarely used and barriers to its use are apparent. Research is required to clarify the risk of head injury among surfers and the effectiveness of headgear in reducing injury risk. Until this evidence is available, educational initiatives, improved headgear design, and profile within the surfing culture would be required to increase rates of wearing headgear.

Adult↗
PubMed2004

Dramatic decrease in the incidence of Salmonella serotype Enteritidis infections in 5 FoodNet sites: 1996-1999.

Salmonella serotype Enteritidis (SE) emerged as the most common Salmonella serotype among infected persons in the United States during the 1980s and 1990s, with infections reaching a peak in 1995. During the past decade, farm-to-table control measures have been instituted in the United States, particularly in regions with the highest incidence of SE infection. We report trends in the incidence of SE in the 5 original surveillance areas of the Foodborne Diseases Active Surveillance Network during 1996-1999: Minnesota, Oregon, and selected counties in California, Connecticut, and Georgia. Overall, the incidence of SE decreased 46% from 1996 to 1999. The greatest decrease was in Connecticut (71%), followed by northern California (50%), Minnesota (46%), and Oregon (13%). Although SE infection remains an important public health concern, there has been a remarkable decrease in its incidence. This decrease may be a result of targeted interventions, including on-farm control measures, refrigeration, and education efforts.

Female↗
PubMed2004

Risk factors for sporadic Campylobacter infection in the United States: A case-control study in FoodNet sites.

Campylobacter is a common cause of gastroenteritis in the United States. We conducted a population-based case-control study to determine risk factors for sporadic Campylobacter infection. During a 12-month study, we enrolled 1316 patients with culture-confirmed Campylobacter infections from 7 states, collecting demographic, clinical, and exposure data using a standardized questionnaire. We interviewed 1 matched control subject for each case patient. Thirteen percent of patients had traveled abroad. In multivariate analysis of persons who had not traveled, the largest population attributable fraction (PAF) of 24% was related to consumption of chicken prepared at a restaurant. The PAF for consumption of nonpoultry meat that was prepared at a restaurant was also large (21%); smaller proportions of illness were associated with other food and nonfood exposures. Efforts to reduce contamination of poultry with Campylobacter should benefit public health. Restaurants should improve food-handling practices, ensure adequate cooking of meat and poultry, and consider purchasing poultry that has been treated to reduce Campylobacter contamination.

Adolescent↗