Biomedical subjects

Stephen Looney

Publications and source records attributed to Stephen Looney.

7 recordsLinked to original sources

PubMed2004

Dialysis of saliva improves accuracy of saliva lithium determinations.

BACKGROUND: Saliva lithium (Li) determinations have been explored as a potential alternative to plasma levels. Unfortunately, this method has been shown to be unreliable. Saliva has two major components: the aqueous and the mucopolysaccharide portions. METHODS: Since Li is likely to distribute only in the aqueous fraction, we dialyzed the saliva through a 3000 Da filter to isolate the aqueous component and determine the Li level in it. RESULTS: Lithium levels in the dialyzed saliva agreed more closely with plasma levels (Spearman's rho = 0.901, p < 0.001) than did whole saliva (Spearman's rho = 0.775, p = 0.012). CONCLUSION: Dialysis of saliva may contribute to more accurate saliva Li levels.

Adult↗

PubMed2003

Introducing practice-based learning and improvement ACGME core competencies into a family medicine residency curriculum.

BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) recommends integrating improvement activities into residency training. A curricular change was designed at the Department of Family and Community Medicine, University of Louisville, to address selected ACGME competencies by incorporating practice-based improvement activities into the routine clinical work of family medicine residents. METHODS: Teams of residents, faculty, and office staff completed clinical improvement projects at three ambulatory care training sites. Residents were given academic credit for participation in team meetings. After 6 months, residents presented results to faculty, medical students, other residents, and staff from all three training sites. Residents, staff, and faculty were recognized for their participation. PROGRAM EVALUATION: Resident teams demonstrated ACGME competencies in practice-based improvement: Chart audits indicated improvement in clinical projects; quality improvement tools demonstrated analysis of root causes and understanding of the process; plan-do-study-act cycle worksheets demonstrated the change process. CONCLUSIONS: Improvement activities that affect patient care and demonstrate selected ACGME competencies can be successfully incorporated into the daily work of family medicine residents.

Academic Medical Centers↗

PubMed2002

Warfarin dose adjustments based on CYP2C9 genetic polymorphisms.

BACKGROUND: The dose response relationship of warfarin is unpredictable. Polymorphism of the Cytochrome P4502C9 enzyme leads to warfarin hypersensitivity presumably due to decreased metabolism of the S-enantiomer. The purpose of this study was to further characterize the relationship between CYP2C9 genotype and phenotype and to develop a basis for guidelines to interpret CYP2C9 genotype for warfarin dosing. METHODS AND RESULTS: Patients stabilized on warfarin therapy were recruited from an anticoagulation clinic. Patients were genotyped for CYP2C9*2, CYP2C9*3 and CYP2C9*5 alleles by standard methods of polymerase chain reaction amplification and restriction endonuclease digestion. Phenotype was determined by; dose (mg/kg/d) required to maintain anticoagulation, (INR 2.0-3.0), oral plasma S-warfarin clearance, and the plasma S:R-warfarin ratio. In this cohort, no subjects were found to have the CYP2C9*5 allele. The plasma S-warfarin concentration did not differ with age, dose or CYP2C9 genotype. Both CYP2C9*2 and *3 alleles were associated with lower maintenance dosages, lower total and R-warfarin plasma concentrations, decreased oral clearance of S-warfarin, increased plasma S:R-warfarin ratio and extended S-warfarin elimination half-life. Advancing age was found to decrease Warfarin maintenance dose in subjects with the common active CYP2C9*1/*1 genotype but did not influence dose requirement of subjects with one or more variant CYP2C9 alleles. CONCLUSIONS: Subjects who have been titrated to a consistent target INR demonstrate comparable plasma S-warfarin concentrations independent of CYP2C9 genotype. The warfarin dose required to maintain a consistent target INR between subjects differs as a function of S-warfarin clearance which is decreased by both CYP2C9*2 and or CYP2C9*3 variant alleles. The variables of CYP2C9 genotype and age can be applied to restrict the dosage range considered for individual patients.

Adult↗

PubMed2002

The Eden Alternative: findings after 1 year of implementation.

BACKGROUND: This study examines the effects of the Eden Alternative (EA), a systematic introduction of pets, plants, and children into a nursing home, on the quality of life of nursing home residents. METHODS: Two nursing homes run by the same organization participated. The study site began implementing the EA in November 1998. The control site continued traditional care. Patient-level data from the Minimum Data Set (MDS), Version 2.0, and aggregate data based on staff reports were used to compare the residents at the two sites in terms of cognition, survival, immune function, functional status, and cost of care after 1 year. RESULTS: After adjusting for baseline differences, follow-up MDS data indicated that the Eden site had significantly greater proportions of residents who had fallen within the past 30 days (p =.011) and residents who were experiencing nutritional problems (p <.001). Staff report data indicated that, during the study period, the Eden site had significantly higher rates of residents requiring skilled nursing and hypnotic prescriptions, and more staff terminations and new hires. The control site had significantly higher rates of residents requiring anxiolytic prescriptions. CONCLUSIONS: The findings from this study indicate no beneficial effects of the EA in terms of cognition, functional status, survival, infection rate, or cost of care after 1 year. However, qualitative observations at the Eden site indicated that the change was positive for many staff as well as residents, suggesting that it may take longer than a year to demonstrate improvements attributable to the EA.

Aged↗

PubMed2002

Decreased morning serum cortisol levels in children with asthma treated with inhaled fluticasone propionate.

OBJECTIVE: In an observational long-term study, we followed 62 children (37 males, 25 females; mean age: 11.6 +/- 2.9 years) with moderate-to-severe asthma for 2 years and studied the effects of fluticasone propionate (176-1320 microg/day) on the function of the hypothalamic-pituitary-adrenal axis. STUDY DESIGN: Morning cortisol levels were monitored after patients had been on fluticasone for a mean of 8.0 +/- 5.2 months. Patients who had abnormal low morning cortisol levels (<5.5 microg/dL) were then switched either to lower fluticasone dosage or to other inhaled steroid formulation. Exact methods based on the binomial distribution were used to construct a 95% confidence interval for the true proportion of abnormal readings among those treated, and the Wilcoxon signed rank test was used to test for a significant difference between cortisol levels taken before and after the switch. RESULTS: Twenty-two patients (36%) had abnormal morning cortisol levels while on fluticasone. Of the patients on a low dose (176 microg/day), 17% had abnormal values, whereas 43% of patients on a high dose (> or =880 microg/day) were abnormal. Patients with abnormal results (17/22) had their morning cortisol levels repeated 3 months after the switch. Thirteen of these patients (77%) had normal levels. A stratified analysis of the difference in morning cortisol levels before and after the switch showed significant increase in morning cortisol levels in the group receiving 440 microg/day or less of fluticasone (median difference: 5.25; confidence interval: 3.60-8.15), as well as in the group receiving 440 microg/day or more (median difference: 3.85; confidence interval: 1.00-7.60). CONCLUSION: Inhaled fluticasone, even at conventional doses, may have greater effects on the adrenal function than previously recognized, but the clinical significance of this suppression still remains to be established.

Administration, Inhalation↗

PubMedDate not supplied

Relationships between reverse transcriptase-polymerase chain reaction for prostate specific antigen, survival, and various prognostic laboratory factors in patients with hormone refractory prostate cancer.

The detection of prostate-specific antigen (PSA) mRNA by reverse transcriptase-polymerase chain reaction (RT-PCR) in the bloodstream of prostate cancer patients has been hypothesized as a prognostic marker, however little data are available concerning the association between this molecular marker and other laboratory values of potential importance. In this study, in patients with hormone-refractory prostate cancer (HRPC), relationships were determined between PSA RT-PCR positivity, survival, and various relevant markers including serum PSA, LDH, albumin, alkaline phosphatase and hemoglobin. A total of 19/30 HRPC patients were positive for PSA by RT-PCR. Positivity was significantly linked to serum PSA (P=0.004) and serum alkaline phosphatase (P=0.026) but not to the other laboratory variables. Median survival time for RT-PCR-positive patients was 9 months, compared to 19 months for RT-PCR-negative patients (P=0.035). Median survival time for patients with a hemoglobin>or=11 g/dL was 12 months, compared to 9 months for patients with <11 g/dL (P=0.005). Dichotomized (>or=or or=11 g/dL) remained statistically significant (P=0.019), indicating that RT-PCR had no independent association with survival after controlling for hemoglobin status in this study.

Aged↗

PubMedDate not supplied

Postpartum depression and social support in adolescents.

OBJECTIVE: The purpose of the study was to determine the effectiveness of a social support intervention delivered to pregnant adolescent girls between 32 and 36 weeks of gestation in preventing symptoms of depression at 6 weeks postpartum. DESIGN: The study used a repeated measures design. SETTING: Data were collected at a teenage parenting program, an educational option of the public school system. PARTICIPANTS: Participants (n = 128) were pregnant and postpartum adolescents. MAIN OUTCOME MEASURE: Symptoms of depression at 6 weeks postpartum. INTERVENTION: Participants completed the Postpartum Support Questionnaire, Rosenberg's Self-Esteem instrument, and the Center for Epidemiological Studies of Depression instrument at baseline, then were randomly assigned to one of three intervention groups (pamphlet, video, or pamphlet plus video) or the control group. The content of the intervention was based on a synthesis of the literature describing social support needed and desired by postpartum adolescents. RESULTS: No significant differences were found in Center for Epidemiological Studies of Depression instrument scores among the groups at 6 weeks postpartum. Using path analysis, the authors found that predictors of symptoms of depression at 6 weeks postpartum were (a) receiving more support from friends, family, and others and (b) having low self-esteem. CONCLUSION: These findings differ from earlier studies, and both research and clinical implications are discussed.

Adolescent↗