PubMed Health⌕ Search

Biomedical subjects

S Lamb

Publications and source records attributed to S Lamb.

At least 19 recordsLinked to original sources
PubMed2005

An open label study of the effects of rituximab in neuromyelitis optica.

Eight patients with worsening neuromyelitis optica were treated with rituximab to achieve B cell depletion. Treatment was well tolerated. Six of eight patients were relapse free and median attack rate declined from 2.6 attacks/patient/year to 0 attacks/patient/year (p = 0.0078). Seven of eight patients experienced substantial recovery of neurologic function over 1 year of average follow-up. The pretreatment median Expanded Disability Status Scale score was 7.5, and at follow-up examination was 5.5 (p = 0.013).

Adult↗
PubMed2004

Does the type of flooring affect the risk of hip fracture?

BACKGROUND: The number of hip fractures occurring worldwide in 1990 was estimated at 1.7 million and is predicted to rise to 6.3 million by 2050. The vast majority occur as a result of simple falls and the impact of the femoral trochanter with the floor. Previous studies have addressed the problem from the patient's side of the impact. Little research has been carried out on the other surface involved in the impact, the floor. STUDY LOCATION: 34 residential care homes. METHODS: (1) The mechanical properties of the floor were measured with force transducers. (2) The number and location of falls and fractures on the various floors were recorded prospectively for 2 years. The threshold for reporting falls in different care homes was assessed using a standardised set of scenarios. RESULTS: A total of 6,641 falls and 222 fractures were recorded. Wooden carpeted floors were associated with the lowest number of fractures per 100 falls. The risk of fracture resulting from a fall was significantly lower compared to all other floor types (odds ratio 1.78, 95% CI 1.33-2.35). The mean impact force was significantly lower on wooden carpeted floors: 11.9 kN compared to the other floor types. DISCUSSION: The possible implications of our findings are considerable. Residents of homes are typically frail and many have a propensity to falls. In designing safer environments for older people, the type of floor should be chosen to minimise the risk of fracture. This may result in a major reduction in fractures in the elderly.

Accidental Falls↗
PubMed2002

Plasma adrenocorticotropin (ACTH) concentrations and clinical response in horses treated for equine Cushing's disease with cyproheptadine or pergolide.

Plasma ACTH levels have been variable in horses with a positive clinical response for therapy for equine Cushing's Disease (ECD). Therefore, our purpose was to determine the value of monitoring plasma adrenocorticotropin (ACTH) levels during treatment of equine Cushing's disease (ECD) with either cyproheptadine (n = 32) or pergolide (n = 10). First, we validated the chemiluminescent ACTH assay (specificity, precision, accuracy, intra-assay and interassay variations) and tested methods of handling the whole blood from the time of collection to when the ACTH was assayed. The sensitivity and specificity of high plasma ACTH levels for detecting ECD was determined in a retrospective study on hospitalised horses (n = 68). Surveys were sent to veterinarians who submitted equine ACTH levels that were high initially and had at least 2 ACTH samples to determine the value of monitoring ACTH levels during therapy of ECD. The ACTH chemiluminescent assay was valid. The ACTH was stable when whole blood was collected and held in plastic tubes for 8 h before separating the plasma. The sensitivity and specificity of plasma ACTH levels for detecting ECD were 84% (n = 19,95% CI 60,97) and 78% (n = 49,95% CI 63,88), respectively. Treated horses generally showed a decrease in plasma ACTH. Plasma ACTH levels may be helpful when monitoring therapy of ECD, although improvement in clinical signs should be considered most important. There were no differences between cyproheptadine and pergolide in terms of improvements in any of the clinical signs.

Adrenocorticotropic Hormone↗
PubMed2001

Mild-to-moderate uncomplicated hypertension: further analysis of a cost-effectiveness study of five drugs.

A cost-effectiveness model was designed to explore the effect of adding a new angiotensin-II inhibitor, telmisartan, to the therapeutic options for treating mild-to-moderate uncomplicated hypertension. Incorporating the cost of drugs, physician visits, and adverse-event treatments, the model concluded that availability of telmisartan on formulary may shorten the mean time and costs to control. The stability of the initial findings over a range of sensitivity analyses lends credence to the model conclusions that availability of telmisartan on formulary improves the therapeutic options of care for hypertension.

Adrenergic beta-Antagonists↗
PubMed1999

The small heat shock-related protein-20 is an actin-associated protein.

PURPOSE: The activation of cyclic nucleotide-dependent signaling pathways in vascular smooth muscle is important for the prevention of vein graft spasm and neointimal hyperplasia. Cyclic nucleotide-dependent relaxation is associated with an increase in the phosphorylation of a small heat shock-related protein (HSP20). In this investigation, we examined the mechanisms by which HSP20 may modulate relaxation. METHODS: The relaxation responses of the bovine carotid artery smooth muscles were determined in a muscle bath. HSP20 phosphorylation was quantitated with isoelectric-focusing immunoblots. The association with actin was determined with coimmunoprecipitation and cosedimentation. Molecular sieving columns were used to examine the macromolecular associations of HSP20. RESULTS: The activation of cyclic nucleotide signaling pathways leads to the complete relaxation of carotid smooth muscle. This relaxation response is associated with an increase in the phosphorylation of HSP20. Actin coimmunoprecipitated with HSP20, and the association of actin with recombinant HSP20 in vitro was phosphorylation-state dependent. Finally, HSP20 exists in large (>100 kDa) aggregates, which dissociate with the activation of cyclic nucleotide signaling pathways. CONCLUSION: These data support a role of HSP20 phosphorylation in mediating smooth muscle relaxation, possibly via a direct interaction of large aggregates of HSP20 with the contractile elements.

Actins↗
PubMed1998

Heat shock protein expression in umbilical artery smooth muscle.

Postpartum vasospasm in the umbilical arteries may be due to impaired vasorelaxation secondary to alterations in the expression of heat shock proteins. The contractile responses of pre- and full-term bovine umbilical artery smooth muscles were determined in a muscle bath. Heat shock protein expression was determined in bovine and human arterial tissues using western blotting with specific antisera. Full-term bovine and human umbilical artery smooth muscle was refractory to relaxation induced by the nitric oxide donor, sodium nitroprusside. This impaired vasorelaxation was associated with the expression of the inducible form of the heat shock protein, HSP70i, and increases in the expression of the small heat shock protein, HSP27. Small heat shock proteins have been implicated in modulating contraction and relaxation responses in vascular smooth muscles. Thus, alterations in heat shock protein expression may play a role in umbilical artery vasospasm.

Analysis of Variance↗
PubMed1997

Cellular mechanisms of cyclic nucleotide-induced vasorelaxation.

PURPOSE: Endothelial-derived vasorelaxants such as prostacyclin and nitric oxide (NO) induce vascular smooth muscle relaxation through activation of cyclic nucleotide-dependent cellular signalling pathways. However, the specific events that lead to dissociation of actin and myosin and relaxation are not known. The purpose of this investigation was to determine the late phase signaling events that modulate vascular smooth muscle relaxation. METHODS: Fresh bovine carotid artery smooth muscle (BCASM) contractile responses were determined in a muscle bath under Ca(2+)-containing and Ca(2+)-free conditions. Physiologic responses were correlated with phosphorylation events using whole cell phosphorylation and two-dimensional gel electrophoresis. RESULTS: Cyclic nucleotide-dependent vasorelaxation can occur without detectable changes in intracellular Ca2+ concentrations. However, vascular smooth muscles that had been precontracted with the phosphatase inhibitor calyculin were refractory to relaxation. Vascular smooth muscle relaxation was associated with an increase in the phosphorylation of two 20 kDa proteins under Ca(2+)-containing and Ca(2+)-free conditions. CONCLUSIONS: These results suggest that Ca(2+)-independent mechanisms may also modulate vascular smooth muscle relaxation. Two possible late phase signaling mechanisms include phosphatase activation and an increase in the phosphorylation of two 20 kDa phosphoproteins.

Animals↗
PubMed1997

Small heat shock proteins and vasospasm in human umbilical artery smooth muscle.

Human umbilical artery smooth muscle is uniquely refractory to cyclic nucleotide-dependent vasorelaxation. Small heat shock proteins (HSPs) have been implicated as contractile regulatory proteins. Thus, we hypothesized that alterations in the phosphorylation of small HSPs may contribute to human umbilical artery smooth muscle vasospasm. Physiologic contractile responses were determined in a muscle bath and compared with phosphorylation events determined with whole-cell phosphorylation and 2-dimensional gel electrophoresis. Precontraction of bovine carotid artery smooth muscle with serotonin followed by relaxation with forskolin was associated with increases in the phosphorylation of HSP27 and HSP20. Precontraction of umbilical artery with serotonin followed by forskolin treatment led to increases in the phosphorylation of HSP27. However, the umbilical artery smooth muscle did not relax, nor was there an increase in the phosphorylation of HSP20 with forskolin treatment. These data suggest that impaired cyclic nucleotide-dependent relaxation of umbilical artery smooth muscle is associated with a lack of phosphorylation of HSP20.

Colforsin↗
PubMed1996

Nitric oxide is an autocrine feedback inhibitor of vascular smooth muscle contraction.

BACKGROUND: Substances that increase intracellular calcium ([Ca2+]i), such as potassium chloride and serotonin, are known to induce vascular smooth muscle (VSM) contraction. One form of nitric oxide synthase, which converts L-arginine to nitric oxide, exists as a Ca(2+)-calmodulin dependent enzyme. The objective of this study was to determine whether agonists that induce VSM contraction by increasing [Ca2+]i might also activate Ca(2+)-calmodulin dependent nitric oxide synthase in VSM. METHODS: Strips of bovine carotid arterial smooth muscle denuded of endothelium were equilibrated in a physiologic muscle bath. A maximal contractile response to high extracellular potassium chloride and serotonin was established. The strips were then preincubated with NG-monomethyl-L-arginine (L-NMMA), a structural analog of L-arginine and specific inhibitor of nitric oxide synthase, and again treated with either KCl or 5-hydroxytryptamine. RESULTS: The contractile responses of muscle strips to KCl or 5-hydroxytryptamine were significantly greater in muscle strips pretreated with L-NMMA than responses in the absence of L-NMMA (p < 0.02, Student's t test). To determine whether this response was Ca2+ dependent, phorbolester-induced contractions in Ca(2+)-free conditions were examined. No difference was noted in the magnitude of Ca(2+)-free, phorbol ester-induced contractions in the presence and absence of L-NMMA. CONCLUSIONS: These data thus suggest that Ca(2+)-calmodulin dependent nitric oxide synthase is functionally present in VSM and may function as an autocrine regulatory mechanism of VSM contraction.

Animals↗
PubMed1996

Data initiatives: HEDIS and the New England Business Coalition.

The New England Business Coalition is a group of 15 health maintenance organizations, large employers, and health care purchasers operating in the New England area. Formally launched in 1994, the coalition's mission is to standardize health care reporting, improve quality, and allow for comparison of managed health care plans for the participating organizations. The National Committee for Quality Assurance (NCQA) and its measurement instrument, the Health Plan Employer Data Information Set (HEDIS) became involved in the coalition's reporting project in 1992 to help the participating plans fulfill their mission of standardization, quality improvement, and comparative evaluation. In the past 5 years, HEDIS has undergone change and development to meet the needs of both health care plans and purchasers who use the HEDIS information to make decisions about health care for employers. Changes enacted within HEDIS have been brought about with the input of HEDIS users such as the New England Business Coalition, a pilot report card project, and a nationally based HEDIS users group. Future enhancements to HEDIS will result in added value for HEDIS users as development and change continue to meet the evolving needs of plans and purchasers.

Databases, Factual↗
PubMed1995

A simple tool for designing a database: bridging the communication gaps among health care providers, researchers, and programmers.

As databases are used by a greater variety of people, highly technical methods of designing them are giving way to more human, user-centered approaches. The article describes a human approach to designing a complex, multiuse database with limited resources. The article introduces a simple data modeling tool, the entity-relationship (E-R) diagram, that crosses professional boundaries and enables providers, researchers, and programmers to communicate more easily. Constructing an E-R diagram provides a human description of the social health maintenance organization (S/HMO) multisite demonstration project. This project, now in its tenth year, provides integrated acute and community-based in-home services to allow frail elderly HMO members to stay in their homes. After briefly reviewing the three types of databases and three rules of thumb for designing a relational database, the article shows how a simple E-R diagram can clarify the management and research issues of the S/HMO health care model. The article concludes with a brief discussion of the benefits and limits of housing research-related health data in a relational database.

Communication↗
PubMed1993

Competency assessment of primary care physicians as part of a peer review program.

OBJECTIVE: To design and test a program that assesses clinical competence as a second stage in a peer review process and to determine the program's reliability. DESIGN AND SETTING: A three-cohort study of Ontario primary care physicians. PARTICIPANTS: Reference physicians (n = 26) randomly drawn from the Hamilton, Ontario, area; volunteer, self-referred physicians (n = 20); and physicians referred by the licensing body (n = 37) as a result of a disciplinary hearing or peer review. MAIN OUTCOME MEASURES: Standardized patients, structured oral examinations, chart-stimulated recall, objective structured clinical examination, and multiple-choice examination. RESULTS: Test reliability was high, ranging from 0.73 to 0.91, and all tests discriminated among subgroups. Demographic variables relating to the final category were age, Canadian or foreign graduates, and whether or not participants were certified in family medicine. CONCLUSIONS: The study demonstrated the feasibility, reliability, and validity of a multicomponent examination in the peer review process.

Adult↗
PubMed1991

Acts without agents: an analysis of linguistic avoidance in journal articles on men who batter women.

Articles on abuse of women by men were surveyed in eleven journals across four disciplines. Introductory sections from 46 articles were coded for linguistic choices--such as use of the passive voice, nominalization, and diffuse terminology--that obscure the attribution of responsibility. In half or more of the references to abuse, sentence structure and language were deemed problematic, with diffusion of responsibility the most frequent strategy of avoidance. Professional and gender biases were found, with articles by social workers less likely, and articles with male authors more likely, to contain problematic writing.

Family Therapy↗
PubMed1991

Radiosurgery: a nursing perspective.

The term radiosurgery, originally applied to three-dimensional stereotactic irradiation of small intracranial targets with low-energy x-rays, has more recently been applied to widely differing techniques and radiation sources. These include gamma units using cobalt-60; beams of protons, helium ions and neutrons; and modified cobalt-60 or linear accelerator units. These techniques allow delivery of a high dose of radiation in a single fraction to a small and well-defined intracranial volume, without delivering significant radiation to adjacent normal tissue. The most usual targets for radiosurgery are arteriovenous malformations. It is occasionally used for acoustic neuromas and primary or metastatic brain malignancies as well. Although radiosurgery is not a new procedure, its use is becoming more widespread. Nurses, as critical members of radiosurgery teams, must be informed about all aspects of the procedures and associated nursing care skills.

Brain Neoplasms↗
PubMed1988

Pediatric Symptom Checklist: screening school-age children for psychosocial dysfunction.

The Pediatric Symptom Checklist (PSC) is a 35-item screening questionnaire that is completed by parents and designed to help pediatricians in outpatient practice identify school-age children with difficulties in psychosocial functioning. The current study assessed the validity of the PSC by screening 300 children in two pediatric practices, a middle-class group practice and an urban health maintenance organization. Validity was established by comparing the results of PSC screening of 48 children with in-depth interview assessments and pediatricians' ratings. Results indicate that the PSC has a specificity of 0.68 and a sensitivity of 0.95. The screening process was well accepted by parents and pediatricians. Several children whose pediatricians' ratings had indicated adequate functioning were identified by the PSC as having substantial psychosocial dysfunction and requiring further evaluation.

Child↗
PubMed1988

Developing reliable assessment in case-managed geriatric long term care programs.

Analyses of frail elderly populations and their service needs are increasingly important in shaping future policies for long term care (LTC) financing and service delivery. Because assessment information on elderly LTC clients generates essential data bases on programs and the population, it is important that the data be reliable. This article describes a method for obtaining reliable assessment data in multisite programs involving many clinical assessors. Regular reliability checks showed marked improvement over time and generally high levels of interrater reliability.

Activities of Daily Living↗