What Americans say about the nation's medical schools and teaching hospitals.
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Academic Medical Centers↗
Biomedical subjects
S Neely
Publications and source records attributed to S Neely.
Using a Standard Staffing Index to allocate nursing staff.
The Standard Staffing Index (SSI) was established as a method to determine unit staffing needs and allocate staff effectively. Daily staffing is based on the SSI, the average patient acuity, and the unit census. This has resulted in time savings to determine staffing needs and accurate monitoring of staffing patterns and productivity by nurse managers. The SSI is based on specific patient needs as determined by regular evaluations and audits.
Academic Medical Centers↗
Analysis of transient-evoked otoacoustic emissions in normal-hearing and hearing-impaired ears.
Transient-evoked otoacoustic emissions (TEOAEs) were measured in 113 normal-hearing and hearing-impaired ears to examine repeatability within a test session, which TEOAE parameter (level, TEOAE level-to-noise or reproducibility) best identified hearing loss and if the TEOAE separated into frequency-specific bands identified hearing loss in a corresponding frequency region. TEOAEs and stimulus levels were found to be very repeatable. For broadband TEOAEs, TEOAE level, TEOAE-to-noise, and % reproducibility were found to identify hearing loss equally well, based on measurement of the area underlying relative operator characteristic curves. Analysis for frequency-specific bands showed that separation of normal-hearing and hearing-impaired ears depended on frequency, with best identification at 2000 and 4000 Hz, identification at 1000 Hz slightly worse, and virtually no separation between normal-hearing and hearing-impaired ears at 500 Hz. Again, all three parameters were essentially equal in identifying hearing loss. Subjective evaluations of presence or absence of TEOAEs was highly correlated between two judges, with good agreement for TEOAEs at 1000, 2000, and 4000 Hz. The findings from this study suggest that TEOAEs will be valuable for clinical use because of their repeatability and identification of hearing-impaired ears.
Acoustic Stimulation↗
Inhibition of endothelial secretion of tissue-type plasminogen activator and its rapid inhibitor by agents which increase intracellular cyclic AMP.
We investigated the effect of agents which raise intracellular levels of cyclic AMP (cAMP) on the secretion of tissue-type plasminogen activator (t-PA) and type 1 plasminogen activator inhibitor (PAI-1) by cultured human umbilical-vein endothelial cells. Significant inhibition of baseline (unstimulated) t-PA and PAI-1 secretion was observed in response to several agents which, when added exogenously, cause increased intracellular cAMP: cholera toxin, 1-methyl-3-isobutylxanthine (MIX), dibutyryl-cAMP, and prostaglandin E1. These agents also significantly reduced or abolished the previously reported stimulatory effects of thrombin and histamine on t-PA secretion, and, with the exception of MIX, significantly reduced the previously reported stimulatory effect of thrombin on PAI-1 secretion. MIX at a concentration (10 microM) below that required to inhibit t-PA and PAI-1 secretion when tested alone, significantly increased the inhibitory effects of cholera toxin, dibutyryl-cAMP, and prostaglandin E1 on both t-PA and PAI-1 secretion. The data suggest that elevated intracellular levels of cAMP inhibit both spontaneous endothelial secretion of t-PA and PAI-1, and secretion induced by agents (thrombin and histamine) which stimulate endothelial phosphoinositide metabolism, consistent with bidirectional regulation of endothelial fibrinolytic protein secretion by the adenylate cyclase and phosphoinositide signal transduction pathways. The inhibitory effects of cAMP do not appear to be specific for t-PA and PAI-1, since cholera toxin and MIX also inhibited endothelial secretion of the adhesive protein, fibronectin. Significant inhibition of baseline endothelial t-PA and PAI-1 secretion was also caused by the stable prostacyclin analogue iloprost (ZK 36 374) and by arachidonic acid, which is converted by endothelial cells to prostacyclin, suggesting that prostacyclin produced endogenously by endothelial cells may inhibit secretion of fibrinolytic proteins by increasing intracellular cAMP.
Cyclic AMP↗
Effect of the lupus anticoagulant on endothelial fibrinolytic activity in vitro.
We investigated the effect of plasma and serum from 10 subjects with the lupus anticoagulant and thrombosis and 9 normal subjects on the secretion of tissue-type plasminogen activator (t-PA) and its rapid inhibitor (type 1 plasminogen activator inhibitor, or PAI-1) by cultured human endothelial cells. Confluent monolayers of human umbilical vein endothelial cells were incubated for 48 hours with plasma or serum diluted ten-fold in serum-free endothelial cell growth medium, and the secretion of t-PA and PAI-1 measured by enzyme-linked immunosorbent assay. No consistent differences in mean t-PA and PAI-1 release were found between cells exposed to normal plasma or serum and plasma or serum from subjects with the lupus anticoagulant and thrombosis. No plasma or serum sample produced consistent inhibition of t-PA release or stimulation of PAI-1 release (defined as t-PA levels less than the mean minus two standard deviations for normal subjects, and PAI-1 levels greater than the mean plus two standard deviations for normal subjects, respectively). These findings do not support a role for altered endothelial fibrinolytic activity in the pathogenesis of thrombosis in subjects with the lupus anticoagulant, and are consistent with previous observations that these subjects have normal fibrinolytic activity in vivo.
Antibodies↗
Incidence and outcome of acute rejection in liver transplantation.
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Antibodies, Monoclonal↗
HLA antigens in narcolepsy.
Eighteen black patients with narcolepsy underwent human leukocyte antigen (HLA) typing. Eleven of the 18 had cataplexy. Twelve patients (66.6%) had HLA-DR2; 7 patients with cataplexy had DR2. All patients had DQw1. In contrast to white and Japanese patients studied to date, not all black narcoleptics have DR2.
Adult↗
Cytarabine, cisplatin, and etoposide chemotherapy for refractory non-Hodgkin's lymphoma.
A phase II trial of cytarabine, cisplatin, and etoposide was conducted in 38 patients with refractory stage III and IV non-Hodgkin's lymphoma. There were two complete and nine partial responses (32%) among 35 evaluable patients. Response rate in patients with large cell lymphoma was 45%. The dose-limiting toxic effect was myelosuppression in 66% of patients.
Antineoplastic Combined Chemotherapy Protocols↗
Defective suppressor cell function mediated by T8+ cell lines from patients with progressive multiple sclerosis.
Activated suppressor cell function, induced with either concanavalin A or OKT3 and mediated by either unfractionated mononuclear cells or "panning" enriched T8+ cells, freshly isolated from peripheral blood, is reduced in patients with progressive multiple sclerosis (MS) as compared with control donors. In this study, we generated T8+ cell lines from the peripheral blood of these same patients and controls. Suppressor activity, mediated by T8+ cells exposed to OKT3 on days 1, 7, and 14 of culture and then treated with mitomycin C on day 16, was significantly reduced in the MS group (mean percent suppression 13% +/- 5) as compared with the control group (68% +/- 6, n = 8, p less than 0.001). No differences were noted in [3H]thymidine uptake by the OKT3-stimulated T8+ cell lines of MS and control groups. Mean percent suppression mediated by T4+ cell lines did not differ between MS and control groups (15% +/- 4, n = 3, vs 22% +/- 2, n = 4). These current data suggest that the previously observed defect in T8+ cell-mediated activated suppressor cell function in MS is a persistent one, favoring the postulate that the defect reflects intrinsic alterations in this cell population rather than a transient effect of serum factors on T8+ cell function.
Antigens, Differentiation, T-Lymphocyte↗
Leukemoid reaction in a patient with bladder and prostatic cancer.
Leukemoid reactions often are seen in patients with underlying malignancies but they have been reported infrequently in patients with urological malignancies. We report reactive leukocytosis and thrombocytosis in a patient with bladder and prostatic carcinoma. Both hematological abnormalities resolved with definitive surgical therapy. We also review other reported cases of leukemoid reactions in patients with urological malignancies.
Adenocarcinoma↗
Acute leukemias with both myeloid and lymphoid surface markers. Cytoplasmic alpha-1-anti-chymotrypsin and alpha-1-anti-trypsin as possible indicators of early granulocytic differentiation.
Blast cells from ten patients (seven adults, three children) with acute lymphoblastic leukemias (ALL) contained immunoreactive cytoplasmic alpha-1-anti-trypsin (alpha-1-AT) and alpha-1-antichymotrypsin (alpha-1-ACT). Cytochemically positive reactions for block-like periodic acid-Schiff and a localized acid phosphatase suggested that the cells were of lymphoid origin rather than myeloid origin: negative for sudan black-B, nonspecific esterase, chloroacetate esterase, and myeloperoxidase. By surface phenotype, the leukemia showed positive reactions for both lymphoid (common acute lymphoblastic leukemia antigen, Ia, OKT-10) and myeloid (OKM-1, Leu M-1) antigens. Three of three patients tested portrayed the Philadelphia chromosome. Nine patients were Mexican-American and one was Japanese: all were of Asian ethnic derivation. Both myeloid and lymphoid treatment regimens were employed, with survival less than expected. Early granulocytic differentiation detectable by cytoplasmic alpha-1-AT and alpha-1-ACT in lymphoid blasts is discussed.
Adult↗
Cold-related intracerebral hemorrhage.
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Adult↗
They've done their internship.
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Governing Board↗
Standardized Trauma Admission Orders, a pilot project.
The Standardized Trauma Admission Orders (STAOs) were developed in collaboration with the trauma team. Data supporting the development of the STAOs consisted of a retrospective chart review (group 1, n = 30) and a user satisfaction survey before the implementation of STAOs. A user satisfaction survey was administered before and after the STAOs were implemented. Both surveys showed a positive response to using the STAOs. STAOs were implemented in a surgical-trauma intensive care unit to reduce in-patient admission laboratory charges, the frequency of missed admission orders, and physician ordering variability. The difference between group 1 and group 2 (n = 30, STAOs) in-patient admission laboratory charges was significant. There was a $345 per patient reduction in the mean score between group 1 and group 2. Of the selected orders reviewed, completeness of orders was significantly improved in 5 of 21 orders. Survey results show that 11 (79%) of the staff surveyed were in favor of using the STAOs. The majority agreed that in-patient admission orders needs were being met. The STAOs are still being used in the surgical-trauma intensive care unit with some minor changes. Efforts are being directed toward the development of standardized admission orders for the neurosurgical intensive care unit and the trauma floor.
Adolescent↗