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At least 883 records · Page 49Linked to original sources

PubMed2005

Integrated versus non-integrated management and care for clients with co-occurring mental health and substance use disorders: a qualitative systematic review of randomised controlled trials.

The purpose of this paper is to conduct a qualitative review of randomised controlled trials in relation to the treatment of adults with co-occurring mental health and substance use disorder (MH/SUD). In particular, integrated approaches are compared with non-integrated approaches to treatment. Ten articles were identified for inclusion in the review. The findings are equivocal with regard to the superior efficacy of integrated approaches to treatment, although the many limitations of the studies need to be considered in our understanding of this finding. Clearly, this is an extremely challenging client group to engage and maintain in intervention research, and the complexity and variability of the problems render control particularly difficult. The lack of available evidence to support the superiority of integration is discussed in relation to these challenges. Much remains to be investigated with regard to integrated management and care for people with co-occurring and MH/SUD, particularly for specific combinations of dual diagnosis and giving consideration to the level of inter-relatedness between the disorders.

Adult↗

PubMed2005

Aldosterone: good guy or bad guy in cerebrovascular disease?

Stroke is a leading cause of disability in the Western world, yet the choices for therapeutic intervention are few. The complex role played by aldosterone in the pathogenesis of stroke is beginning to emerge. Chronic mineralocorticoid receptor (MR) blockade reduces the incidence of hemorrhagic strokes and the severity of damage caused by ischemic strokes. This appears to be a vascular phenomenon because MR blockade increases vessel lumen diameter, which presumably increases blood flow and perfusion of the tissue to reduce ischemic damage. However, the vascular protection afforded by MR antagonism is at odds with the results seen within the brain, where MR activation is required for neuronal survival. Both of these divergent effects have possible therapeutic implications for stroke.

Aldosterone↗

PubMedDate not supplied

Borderline personality and psychotropic medication prescription in an outpatient psychiatry clinic.

Borderline personality is a complex disorder and pharmacological intervention is typically focused on target symptoms. Previous studies indicate that patients with borderline personality disorder (BPD) are prescribed a greater number of psychotropic medications than those without BPD. However, these studies were self-report in design and/or preceded the use of newer psychotropic medications such as selective serotonin reuptake inhibitors (SSRIs). In this study, we explored among 280 psychiatric outpatients the relationships between an axis II diagnosis of BPD and the number of axis I diagnoses, psychotropic medications, and psychotherapy sessions. Compared to those with other types of personality disorders (n=128) or no personality disorder at all (n=91), those with BPD (n=61) were diagnosed with significantly more axis I disorders, prescribed significantly more psychotropic medications, and attended significantly more psychotherapy sessions. These findings suggest that: (1) BPD patients will probably be prescribed more psychotropic medications than other psychiatric outpatients, and (2) in addition to psychotropic medication prescription, there may be additional variables (e.g., psychotherapy sessions) that make a meaningful contribution to the overall healthcare utilization among those with BPD.

Adolescent↗

PubMed2001

Glycoprotein Ia C807T polymorphism and risk of restenosis following coronary stenting.

Platelets are thought to contribute to development of restenosis following percutaneous coronary interventions. The glycoprotein Ia/IIa complex is a major platelet collagen receptor, its surface expression being influenced by two, linked single nucleotide polymorphisms (C807T and G873A) in the glycoprotein Ia gene. T807 is associated with increased expression of this integrin receptor. We assessed whether T807 is associated with an increased risk of restenosis in 1769 consecutive patients treated with coronary stenting. 6-month follow-up angiograms were available in 82.4% of the patients. C807T genotype distribution was CC in 35.8%, CT in 47.6% and TT in 16.6% of the patients. Restenosis (diameter stenosis > or =50% at follow-up angiography) occurred in 32.9% of CC, 31.5% of CT and 32.1% of TT patients (P=0.87). The rate of major adverse cardiac events (death, myocardial infarction or need of reintervention) within 1 yr was 21.6% for CC, 21.7% for CT and 21.2% for TT patients (P=0.98). Thus, carriage of the GP Ia T807 allele is not associated with an increased risk of restenosis or unfavorable late outcome following coronary artery stenting.

Aged↗

PubMedDate not supplied

The molecular bases of restenosis.

Studies on the fundamental mechanisms of restenosis after arterial intervention have undergone upheaval. The rat carotid artery has provided perhaps the most widely used experimental preparation for the study of the response to acute arterial injury and gave rise to the multiwave model of restenosis. However, simple arterial injury differs substantially from angioplasty to diseased human vessels. The human intimal lesion already contains abundant smooth muscle cells and leukocytes. Therefore, although the rat carotid injury preparation has provided keen insight into the biology of the response to injury, it mimics human restenosis poorly, if at all. The first wave and second wave of the response to arterial injury so well delineated in rats (medial smooth muscle cell proliferation and migration from media into intima) may not apply to clinical angioplasty injury at all. Smooth muscle proliferation, a constant in injury to animal arteries, may be indolent in human restenosis. Accumulation of extracellular matrix probably explains in part the dissociation between intimal thickening and smooth muscle replication. Also, failure to "remodel" outwards to maintain the increased caliber produced by interventional arterial dilatation, may prove more important than intimal thickening in determining ultimate intimal caliber. Despite a rather disappointing decade of translation of laboratory findings to the clinic, some grounds for optimism in approaching the complications of arterial intervention have emerged. Our appreciation for the biological complexities underlying the restenosis problem have increased. In interventional cardiology we can now proceed, more experienced and wiser, to longer range solutions to help our patients based on mechanistic insights.

Angioplasty, Balloon↗

PubMedDate not supplied

Nursing management of elderly patients with asymptomatic bacteriuria.

Nursing management of elderly patients with asymptomatic bacteriuria encompasses an array of basic and complex nursing observations and interventions to eliminate or reduce those risk factors that contribute to persistent bacteriuria and to identify warning signs of an impending inflammatory response. Selected risk factors, the prevalence of bacteriuria in the elderly population, and nursing management of clients with asymptomatic bacteriuria are discussed.

Aged↗

PubMed1998

Lethal abdominal gunshot wounds at a level I trauma center: analysis of TRISS (Revised Trauma Score and Injury Severity Score) fallouts.

BACKGROUND: The TRISS methodology (composite index of the Revised Trauma Score and the Injury Severity Score) has become widely used by trauma centers to assess quality of care. The American College of Surgeons recommends including negative TRISS fallouts (fatally injured patients predicted to survive by the TRISS methodology) as a filter to select patients for peer review. The purpose of this study was to analyze the TRISS fallouts among patients with lethal abdominal gunshot wounds admitted to a level I trauma center. STUDY DESIGN: All patients categorized as TRISS fallouts admitted from January 1995 through December 1996 were analyzed. RESULTS: During the study period, 848 patients with abdominal gunshot wounds were admitted. Of the 108 patients with any sign of life on admission who subsequently died, 39 (36%) were TRISS fallouts. The patients were largely young (mean age, 29 years) and male (87%), received rapid transport (mean scene time, 11 minutes), and had an attending-led trauma-team response (<5 minutes, 87%). Major vascular (80%) and multiple intraabdominal injuries (90%) predominated. The mean Penetrating Abdominal Trauma Index was 40.3. The mean TRISS probability of survival was 89%. The peer-review process deemed the deaths to be nonpreventable in 38 patients (97%) and potentially preventable in one patient (3%). CONCLUSIONS: "TRISS fallouts" were predominantly patients who died despite receiving rapid prehospital transport, rapid senior-level trauma-team response, and surgical intervention for a serious complex of injuries. We conclude that without regional adjustment of coefficients used to predict the probability of survival, the TRISS methodology is of limited use in patients with abdominal gunshot wounds.

Abdominal Injuries↗

PubMedDate not supplied

Pocket v.2: further developments on receptor-based pharmacophore modeling.

A deriving pharmacophore model from the three-dimensional structure of a target protein provides helpful information for analyzing protein-ligand interactions and further improvement of ligand binding affinity. A standalone program, Pocket v.2, has been developed based on the original Pocket module in the de novo drug design program LigBuilder. Pocket v.2 is able to derive a pharmacophore model directly from a given protein-ligand complex structure without human intervention. Key features in the pharmacophore model are automatically reduced to a reasonable number. Pocket v.2 has been applied to several case studies, including cyclin dependent kinase 2, HIV-1 protease, estrogen receptor, and 17beta-hydroxysteroid dehydrogenase. It well reproduced previously published pharmacophore models in all of these cases. One notable feature of Pocket v.2 is that it can tolerate minor conformational changes on the protein side upon binding of different ligands to give a consistent pharmacophore model. For different proteins accommodating the same ligand, Pocket v.2 gives similar pharmacophore models, which opens the possibility to classify proteins with their binding features.

17-Hydroxysteroid Dehydrogenases↗

PubMed2006

Reaction of hydroxyl radicals with azacytosines: a pulse radiolysis and theoretical study.

Pulse radiolysis and density functional theory (DFT) calculations at B3LYP/6-31+G(d,p) level have been carried out to probe the reaction of the water-derived hydroxyl radicals (*OH) with 5-azacytosine (5Ac) and 5-azacytidine (5Acyd) at near neutral and basic pH. A low percentage of nitrogen-centered oxidizing radicals, and a high percentage of non-oxidizing carbon-centered radicals were identified based on the reaction of transient intermediates with 2,2'-azinobis(3-ethylbenzothiazoline-6-sulfonate), ABTS2-. Theoretical calculations suggests that the N3 atom in 5Ac is the most reactive center as it is the main contributor of HOMO, whereas C5 atom is the prime donor for the HOMO of cytosine (Cyt) where the major addition site is C5. The order of stability of the adduct species were found to be C6-OH_5Ac*>C4-OH_5Ac*>N3-OH_5Ac*>N5-OH_5Ac* both in the gaseous and solution phase (using the PCM model) respectively due to the additions of *OH at C6, C4, N3, and N5 atoms. These additions occur in direct manner, without the intervention of any precursor complex formation. The possibility of a 1,2-hydrogen shift from the C6 to N5 in the nitrogen-centered C6-OH_5Ac* radical is considered in order to account for the experimental observation of the high yield of non-oxidizing radicals, and found that such a conversion requires activation energy of about 32 kcal/mol, and hence this possibility is ruled out. The hydrogen abstraction reactions were assumed to occur from precursor complexes (hydrogen bonded complexes represented as S1, S2, S3, and S4) resulted from the electrostatic interactions of the lone pairs on the N3, N5, and O8 atoms with the incoming *OH radical. It was found that the conversion of these precursor complexes to their respective transition states has ample barrier heights, and it persists even when the effect of solvent is considered. It was also found that the formation of precursor complexes itself is highly endergonic in solution phase. Hence, the abstraction reactions will not occur in the present case. Finally, the time dependent density functional theory (TDDFT) calculations predicted an absorption maximum of 292 nm for the N3-OH_5Ac* adduct, which is close to the experimentally observed spectral maxima at 290 nm. Hence, it is assumed that the addition to the most reactive center N3, which results the N3-OH_5Ac* radical, occurs via a kinetically driven process.

Aza Compounds↗

PubMed2000

A system for determination of 3D vessel tree centerlines from biplane images.

With the increasing number and complexity of therapeutic coronary interventions, there is an increasing need for accurate quantitative measurements. These interventions and measurements may be facilitated by accurate and reproducible magnifications and orientations of the vessel structures, specifically by accurate 3D vascular tree centerlines. A number of methods have been proposed to calculate 3D vascular tree centerlines from biplane images. In general, the calculated magnifications and orientations are accurate to within approximately 1-3% and 2-5 degrees, respectively. Here, we present a complete system for determination of the 3D vessel centerlines from biplane angiograms without the use of a calibration object. Subsequent to indication of the vessel centerlines, the imaging geometry and 3D centerlines are calculated automatically and within approximately 2 min. The system was evaluated in terms of the intra- and inter-user variations of the various calculated quantities. The reproducibilities obtained with this system are comparable to or better than the accuracies and reproducibilities quoted for other proposed methods. Based on these results and those reported in earlier studies, we believe that this system will provide accurate and reproducible vascular tree centerlines from biplane images while the patient is still on the table, and thereby will facilitate interventions and associated quantitative analyses of the vasculature.

Coronary Angiography↗

PubMed2005

[Learning curve--calculation and value in laparoscopic surgery].

The learning curve shows the progress in mastering a new method. It is completed when the monitored parameters reach a steady state and when the final results can be compared with literature. The earlier used analysis of the performance-improvement with its "on the spots" appraisals at certain time-intervals is replaced by a continuous assessment. The multimode learning curve is particularly useful for it, because not only one parameter (f.e. operation-time), but also several important factors can be put together into one single graphic. For the operation-time, the Moving Average Method is useful. For incidents, which may happen or not like a conversion from laparoscopy to laparotomy as well as complications, the Cusum-method is of practical use. The learning curves of the technique of laparoscopic cholecystectomy, colo-rectal surgery, fundoplicatio and hernia surgery have been completed. Also, the learning curve of the industry is well advanced. Reliable data for the learning curves of individual surgeons for certain operations cannot be given, as, only now, young doctors are being trained on a large scale in laparoscopic technique as used to be the case in the open abdominal surgery. This will influence greatly the learning curves and will shorten the time till their completion. Different bias concerning the individual surgeons and their clinics prohibit the production of comparable curves. Several factors like the patient respectively his abdomen are complicating all this. That's why the learning curves cannot be used as benchmarks to compare different surgeons or clinics, as long as no valid scoring system concerning the complexity of a surgical intervention exists. Learning curves which become quality curves after reaching a steady state, can be used for the individual monitoring of a surgeon's performance and serve as a quality measurement of a clinic. The learning curves of the laparoscopic cholecystectomy, fundoplicatio, colo-rectal surgery and hernia surgery are discussed in particular The mandatory number of operations needed to learn a new method cannot yet be established today, even if all the existing data are consulted. Therefore, the learning curve is a useful instrument to monitor the individual progress and the results of a clinic in the meaning of an individual quality-management. After completion of the learning curve, a quality curve using the same parameters will be given, which shows the deviations of its own standard.

Cholecystectomy, Laparoscopic↗

PubMed2001

Opioid analgesic prescribing and use - an audit of analgesic prescribing by general practitioners and The Multidisciplinary Pain Centre at Royal Brisbane Hospital.

AIMS: This study evaluated the use of and need for opioids in patients attending the Multidisciplinary Pain Centre at the Royal Brisbane Hospital (RBH). METHODS: All consecutive in-patient admissions in 1998 were reviewed. A 10-point scoring system based on the World Health Organization (WHO) analgesic ladder was devised to facilitate comparison of analgesic prescribing on admission and at the time of discharge. A conversion table was used to standardize opioid analgesic doses to an oral morphine equivalent. RESULTS: Of the 370 patients reviewed, 233 (81%) were by their general practitioners. Records of 288 (78%) were available for full review and 270 (94%) of these had noncancer pain. On admission, 239 (83%) were taking an opioid analgesic, with 135 (47%) taking strong opioids (e.g. morphine, oxycodone, methadone). There was a significant decrease in the mean total daily oral morphine equivalent prescribed on discharge 36.9 mg (95% CI: 33.4, 40.4) compared with that on admission 88.7 mg (95% CI: 77.6, 99.8) (P < 0.001). There was a significant decrease (P < 0.05) in the proportion of patients taking a primary opioid on discharge 153 (58%) compared with admission 239 (83%), although the proportion of patients taking a strong opioid on discharge 150 (52%) compared with admission 135 (47%) was not significantly different (P > 0.05). The proportion of patients taking a laxative showed a significant increase on discharge 110 (73%) compared with admission 38 (28%) (P < 0.05). CONCLUSIONS: Our analgesic prescribing scoring system and opioid conversion table have the potential to be developed further as tools for assessing opioid analgesic prescribing. The significant decrease in total daily oral morphine equivalents signifies the value of prescribing in accordance with the WHO analgesic ladder, and the necessity of general practitioner education. The management of chronic pain is complex, and it requires interventions additional to pharmacological therapy. Evaluation by a multidisciplinary team, coupled with experience in and an understanding of analgesic prescribing and rehabilitation provides an effective basis for improving the management of patients with chronic pain.

Acetaminophen↗

PubMedDate not supplied

Achieving clarity in evaluation of community/public health nurse generalist competencies through development of a clinical performance evaluation tool.

Community/public health nursing practice is complex and based on interventions targeted at individuals, families, populations, and communities. Evaluating clinical practice involves a comparison of predetermined standards, such as those developed by American Nurses Association (ANA), against competencies associated with the practice of the specialty. In this study, 301 performance evaluation records from a locally developed clinical performance evaluation tool were examined for construct validity and reliability based on the ANA Standards for Community and Public Health Nursing.

Adult↗

PubMed2005

The impact of medical issues in inpatient geriatric psychiatry.

At an advanced age, serious medical and psychiatric illnesses frequently coalesce. Often, the need for admission to inpatient geriatric psychiatric care arises from coexisting medical problems. While cognitive and behavioral interventions are important, the complexity of physical comorbidities usually becomes the focus of hospitalization and requires intensive medical treatments. This paper describes adaptations made in one metropolitan geriatric psychiatry unit in order to better treat complex patients who experience both medical and psychiatric illness. The need for all members of the interdisciplinary team to expand their practice and the importance of complementary approaches of psychiatry and medicine are emphasized.

Aged↗

PubMedDate not supplied

Cytokines in immunotherapy of experimental uveitis.

A better understanding of the basic mechanisms of uveitis and of the role of cytokines in experimental ocular inflammation autoimmune diseases should allow us to define new approaches for therapy. Modulation of the cytokine network by either blocking cytokine activity or administration of regulatory Th2 cytokines has shown its efficacy in several experimental autoimmune diseases including uveitis. However, cytokines present pleiotropic activities and thus may exert different effects depending on the autoimmune diseases, making interventions on their production complex. Anti-cytokine therapy or a combination of anti-cytokine drugs, antibodies, and cytokine gene therapy to synergize the therapeutical effects of other treatments appear to be of interest. Improvements in drug delivery and in biotechnology will also allow us to elaborate new and safe immunomodulatory strategies.

Animals↗

PubMed2003

A pilot study of the effects of a behavioural intervention on treatment adherence in HIV-infected patients.

A pilot study was carried out in a group of six HIV-infected non-adherent men testing the effects of a behavioural medication management intervention on adherence with antiretroviral drugs. The study was prospective, using a one-group repeated-measures design. Adherence was measured using two self-reports. The intervention was a behaviourally-based programme that lasted for three months and included individualized education about antiretroviral medication and their side effects; positive reinforcement and encouragement; individualized counselling weekly; follow-up calls; and lifestyle assessment and the identification of adherence barriers. Assessments were carried out at recruitment, immediately after the initiation of the intervention, one month, three months and six months later. Results suggested that the intervention enhanced adherence rates from a mean percentage of 80.27 at baseline to a mean of 97.5% at the end of follow-up (six months time point). Similar improvement was observed in the scores of the scale measuring adherence difficulties. Further, CD4+ counts also slightly improved. Interviews with four of the participants at the end of the study highlighted the problems experienced by patients in taking their medication and supported the usefulness of the intervention. Because of the complexity of the factors behind adherence, it is important that patients are supported with individualized medication management programmes.

Adult↗

PubMed2006

Flooding treatment of phobia to having her feet touched by physiotherapists, in a young woman with Down's syndrome and a traumatic brain injury.

This case study describes the treatment of a 32-year-old woman with Down's syndrome and a recent head injury, for phobia to treatment of her feet by physiotherapists. The phobia had the potential to severely limit rehabilitation progress in terms of the client regaining the ability to stand, assist with transfers (including to and from a car), and walk. A single session, in vivo, flooding intervention was used. The treatment resulted in a substantial change in tolerance of physiotherapists' touching of feet to the extent rehabilitation was able to proceed within the bounds of expectation had a phobia not been evident. Benefits were maintained at multiple follow-ups. The results of the case study extend the evidence for the utility of such behavioural interventions to people with complex disability and unusual phobias in neurological rehabilitation systems.

Adult↗

PubMed2026

Temporal mismatch in allogeneic iPSC therapies: biological risks and implications for clinical translation.

INTRODUCTION: The clinical translation of pluripotent stem cell-derived therapies has entered a new phase following conditional approval of first-in-class allogeneic induced pluripotent stem cell (iPSC)-derived products in Japan. These approvals highlight both the therapeutic promise of iPSC technologies and regulatory challenges associated with evaluating complex cell-based interventions. AREAS COVERED: This report examines the evidentiary basis supporting recent approvals and reviews key biological characteristics of allogeneic iPSC-derived therapies, including pluripotency-associated instability, immunological constraints, and manufacturing-related genomic variability. Drawing on recent clinical studies and relevant experimental literature, we analyze how these multilayered risks evolve over extended time horizons and assess their implications for the interpretation of early-phase clinical data and current regulatory frameworks. EXPERT OPINION: We argue that the central challenge extends beyond limited clinical evidence to a fundamental mismatch between the temporal dynamics of biological risk and the duration of conventional clinical evaluation. As a result, early clinical observations may systematically underestimate long-term risks. Conditional approval pathways should therefore incorporate safeguards aligned with this temporal uncertainty, including long-term follow-up, rigorous post-approval evaluation, and enhanced transparency in biological and manufacturing data. Aligning regulatory design with intrinsic properties of pluripotent stem cell-derived therapies will be essential for ensuring safe and responsible clinical translation.

Humans↗