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Biomedical subjects

W M Robinson

Publications and source records attributed to W M Robinson.

16 recordsLinked to original sources
PubMed2002

Assessment of the risk/benefit ratio of phase II cancer clinical trials by Institutional Review Board (IRB) members.

BACKGROUND: This study examined the assessment of risk/benefit ratios for phase II cancer clinical trials by Institutional Review Board (IRB) members. PATIENTS AND METHODS: Semi-structured interviews were conducted with 53 IRB members from six research hospitals and specialized cancer centers in The Netherlands. RESULTS: While the toxicity and side-effects of treatment were most often identified as risks associated with participating in a phase II trial, approximately two-thirds of IRB members also cited psychosocial and/or quality-of-life risks. Conversely, 68% of the respondents identified psychosocial benefits of trial participation, while 25% cited treatment effectiveness as a possible benefit. Between one-quarter and two-thirds of respondents indicated that trial protocols provide insufficient information regarding the likelihood, magnitude and duration of both risks and benefits. Between 15% and 34% of IRB members reported feeling less than fully competent at evaluating various aspects of phase II protocols (e.g. originality and feasibility of the study, adequacy of the methods and analysis procedures, etc.). This was particularly the case for non-physician IRB members. Few IRB members reported weighing risks and benefits in a systematic manner, but rather relied on global impressions or preferred to leave such matters to the IRB as a whole or to their patients. CONCLUSIONS: A substantial minority of IRB members believes that trial protocols provide too little information relevant to evaluating various cost/benefit and scientific issues, and feels less than fully competent in carrying out such evaluations. IRB members are more likely to identify psychosocial benefits than physical health benefits that may accrue to patients participating in phase II trials.

Adult↗
PubMed1997

End-of-life care in cystic fibrosis.

OBJECTIVE: End-of-life clinical care in cystic fibrosis (CF) differs substantially from terminal care in childhood cancer. To examine this difference, we reviewed the medical care of a cohort of CF patients treated at Children's Hospital, Boston, to document the use of preventive, therapeutic, and palliative care in the month preceding death. PATIENTS: We reviewed the medical records of 44 patients older than 5 years who died of CF-related respiratory failure for the years 1984 to 1993. RESULTS: Thirty-eight patients (86%) received opiates for the treatment of severe dyspnea and pain; the duration of opiate use varied from less than 1 hour to greater than 1 month. The dose of opiates varied from less than 5 mg per hour to greater than 30 mg per hour. Thirty-three patients (75%) continued to receive intravenous antibiotics in the last 12 hours of life; 32 (72%) continued to receive preventive or therapeutic oral medications in the last 12 hours of life. All patients were designated as do not resuscitate at the time of death; 43 of the patients died in the hospital with 1 patient dying at home under hospice care. CONCLUSIONS: The model of comfort care developed in childhood cancer does not adequately describe the combination of preventive, therapeutic, and palliative care given at the end of life for CF at our institution. The majority of CF patients continued to receive intravenous antibiotics and/or oral vitamin preparations while being treated with opiates for terminal pain and dyspnea. Small doses of opiates seem to be effective in the treatment of the pain and dyspnea at the end of life in CF.

Adolescent↗
PubMed1991

Genetic and nongenetic determinants of blood pressure in a southern Brazilian sample.

A probabilistic sample representative of the adult population of Rio Grande do Sul, Brazil, was studied to estimate the genetic and nongenetic determinants of blood pressure. Four thousand five hundred and sixty-five individuals, 20 to 74 years old, from 2050 households, were examined. The genetic determination of the SBP (systolic blood pressure) and DBP (diastolic blood pressure) was evaluated in 557 families extracted from this sample. The analysis was performed first with no adjustments for other influencing factors, and then adjusting for the effects of the two significant covariates, age and Quetelet's index, identified through a multiple stepwise regression analysis with nine independent variables. Higher heritability estimates were obtained for DBP (raw data: 0.40; residuals: 0.45) than for SBP (raw data: 0.22; residuals: 0.26). The significant correlation coefficients varied from 0.13 (for father-offspring raw data, total sample), to 0.36 (for siblings, adjusted data, untreated sample). Slight differences were observed between the total and pharmacologically untreated samples in relation to correlation and heritability estimates.

Adult↗
PubMed1989

Cytodiagnostic urinalysis. Three years experience with a new laboratory test.

Cytodiagnostic urinalysis is performed by examining Papanicolaou-stained cytocentrifuge preparations of urine sediment. Nonrenal transplant patient results (N = 1,602) were reviewed. Renal hematuria was found in 37.7% of specimens, white blood cell casts in 11%, and renal tubule cell injury in 53%. The technique demonstrates significantly improved sensitivity to detect urine sediment abnormalities indicative of renal parenchymal disease. The technical requirements are readily available and easy to implement in the laboratory. Skills required for identification and quantitation can be acquired in a few weeks.

Cytodiagnosis↗
PubMed1984

Blood groups, salivary secretion and other immunologic variables in rheumatic fever and rheumatic heart disease.

A total of 100 patients and carefully matched controls were studied in relation to six genetic systems (ABO, MN, Rh, haptoglobin, ABH secretion and amylase types), as well as for serum and saliva antibody and ABH antigen levels. The differences observed between patients and controls were generally small and statistically non-significant, the previously reported association between haptoglobin types and reactions to streptococcus infections being not confirmed here. The A/O, B/O and secretor/non-secretor relative incidences, however, occurred in the expected direction considering previous investigations.

Amylases↗
PubMed1982

The clinical picture of mania in manic-depressive black patients.

Recent studies have shown that misdiagnosis of manic-depressive illness among blacks is a frequent occurrence. There are a number of historical and institutional dynamics involved in this process that have the roots of racism as their foundation. In light of this the authors decided to look at the clinical symptoms and behaviors of manic-depressive illness among black patients to see if their interpretation might be another contributing factor in misdiagnosis.The authors found the clinical symptoms of manic-depressive illness in black patients to be essentially what one would expect as determined by criteria in the Diagnostic and Statistical Manual (DSM III). However, there were cultural and socioeconomic determinants of behavior that affected the clinical manifestations.

Adult↗
PubMed1980

Venous thromboembolism and ABO blood groups in a Brazilian population.

The ABO blood groups were determined in 125 patients suffering from venous thrombosis in a Brazilian population. There is a clear effect of the sex on the disease incidence, women being more frequently affected, but the mean age was not different regarding the sex. No differences were found in the disease incidence when Caucasians and Negroids were compared. An excess of blood group A and a decrease of blood group O was observed among the patients. The analysis of the combined data from ten different published series shows a A/O relative incidence significantly higher than unity, but the heterogeneity was also significant in the series.

ABO Blood-Group System↗
PubMed1975

Central nervous system effects of bupivacaine.

The central nervous system and concurrent cardiovascular effects of bupivacaine infusion were studied in cats. It was possible to block cortical E.E.G. desynchronization resulting from a sensory stimulus with bupivacaine. The earliest subcortical change that occurred was rhythmic activity in the amygdala and later in the hippocampus. Occasionally, this activity appeared simultaneously in both these sites. Diazepam pretreatment raised the seizure threshold of bupivacaine. Diazepam was also effective in terminating established seizure activity resulting from bupivacaine. All animals pretreated with diazepam (Valium) or diazepam solvent developed cardiac dysrhythmias durind bupivacaine infusion. The possible clinical significance of the interaction of bupivacaine and diazepam solvent is considered.

Amygdala↗