Non-heart-beating organ donation.
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Biomedical subjects
Publications and source records attributed to N Pace.
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The purpose of this study was to evaluate the efficacy of the Physician in Residence (PIR) program at the Hazelden Residential Program of New York City as a substance abuse training approach using standardized patients (SP) and self-report ratings. Using an objective rating scale, two experienced drug counselors evaluated four videotaped interviews carried out by housestaff pre- and post-enrollment in the PIR program. In addition, housestaff completed self-report ratings regarding their knowledge, attitudes, and skills of substance abuse. Of the 23 housestaff who completed both pre- and post-PIR program videotape sessions, significant improvements were noted in both observer and self-reported ratings. Overall, self-report ratings showed a greater percent improvement than the counselor ratings. The PIR program may be an efficacious approach to teach substance abuse clinical skills to housestaff.
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Patients in a state of persistent vegetation or 'cognitive death' are an emotional drain on their family, and a financial drain on a society with limited resources. In this article, society's responsibility towards these patients and the moral and ethical issues involved in the withdrawal of fluid and nutrition are discussed.
This paper concerns 22 cases of compression of the posterior tibial nerve and its branches in the tarsal and calcaneal tunnels, all of which were treated by surgical decompression. The evaluation of both the operative findings and the results after a follow-up period ranging from 4 months to 2 years confirms the validity of neurolysis and emphasizes the role of the abductor hallucis muscle in the compression of the terminal branches of the posterior tibial nerve in the calcaneal tunnel.
Decisions regarding withdrawal of life support are more frequently required as our technological capabilities increase. Doctors have to recognize that in certain cases maximal use of these capabilities may be incompatible with the patient's best interests. An ethical framework may help guide doctors through these dilemmas.
The authors report 31 cases of acute severe capsuloligamentous lateral lesions of the ankle joint, 12 of which were treated surgically and 18 with a below knee plaster cast. An evaluation of the results at an average 20 months follow-up showed the superiority of the conservative method.
Daily APACHE II assessments to reflect the dynamic pathophysiologic processes affecting ICU patients were carried out prospectively on 212 adult ICU admissions for the purpose of predicting hospital outcome. Trend analysis of daily APACHE II scores was used to develop the first set of criteria for predicting deaths among the ICU patients. The analysis took into account the absolute value of APACHE II score of each day and the rate of change relative to that of the previous day. One hundred consecutive adult ICU admissions were used to determine the criteria that were tested on the following 112 consecutive adult ICU admissions. Daily APACHE II scores identified correctly 16 of the 34 patients who died. A second set of criteria was next derived by raising the values of the original limits in order to build-in greater margins of safety without too great a loss of sensitivity. The predictive power of daily APACHE II scores using the second set of criteria was superior to that of a single APACHE II score by a factor of 4. Predictions were not used to influence clinical decision-making during this study.
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The size of individual skeletal muscles in mammals is well known to change with the degree of mechanical loading imposed on the muscle. Less clear has been the effect of changes in loading of the whole organism on size of the total skeletal musculature. Pitts and coworkers have provided valuable insights by dissection and weighing of the skeletal musculature of animals subjected to various chronic centrifugation, exercise and dietary regimens, and their recent findings are reported at this meeting. However, questions remain. Independently, our laboratory several years ago embarked on a systematic definition of body composition and energy metabolism changes as a function of sex and age in 5 species of small laboratory mammals, the mouse, hamster, rat, guinea pig and rabbit. Six animals of each sex were examined in 8 age cohorts ranging from 1 to 24 months for each of the 5 species.
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Twenty-five patients with joint rheumatoid pain were treated as outpatients during 15 days with 450 mg/day fo proglumetacin. Efficacy was "good" or "very good" in 64% of the patients. No case of clinically significant side-effects was observed.
The RNA moieties of ribonuclease P purified from both E. coli (M1 RNA) and B. subtilis (P-RNA) can cleave tRNA precursor molecules in buffers containing either 60 mM Mg2+ or 10 mM Mg2+ plus 1 mM spermidine. The RNA acts as a true catalyst under these conditions whereas the protein moieties of the enzymes alone show no catalytic activity. However, in buffers containing 5-10 mM Mg2+ (in the absence of spermidine) both kinds of subunits are required for enzymatic activity, as shown previously. In the presence of low concentrations of Mg2+, in vitro, the RNA and protein subunits from one species can complement subunits from the other species in reconstitution experiments. When the precursor to E. coli 4.5S RNA is used as a substrate, only the enzyme complexes formed with M1 RNA from E. coli and the protein moieties from either bacterial species are active.