Chemically defined media for cultivation of Naegleria gruberi

Cultivation of amebae of the axenic strain of Naegleria gruberi, NEG-M, was achieved in media consisting entirely of chemically defined components. A complete medium that contains 31 components allows growth with yields up to 5 x 10(6) amebae per ml. A minimal medium gives lower yields but defines 22 components that are essential for continuous cultivation: 11 amino acids, 6 vitamins, hematin, guanosine, D-glucose, Mg(2+), and inorganic phosphate. These media allow precise studies of the metabolism and differentiation of this unusual eukaryote.

The value, qualification, and regulatory use of surrogate end points in drug development

The acceptance and use of either surrogate end points (SEPs) or efficient clinical end points are associated with greater and more rapid availability of new medicines as compared with disease situations for which clinical end points are inefficient or no surrogates exist. This review of the history of the development, qualification, and acceptance of key SEPs shows that both successes and failures had three key characteristics: (i) apparent biologic plausibility, (ii) prognostic value for the outcome of the disease, and (iii) an association between changes in the SEP and changes in outcome with therapeutic intervention--the three factors recommended for SEPs in the International Conference on Harmonisation's "Statistical Principles for Clinical Trials." We recommend that only prognostic value be an absolute prerequisite for surrogacy, because therapeutic interventions may not exist a priori, and biological plausibility can be subjective. Ideally, all three of these factors would be traded off against one another in a consistent and transparent risk-management process.

The drug diagnostic co-development concept paper

At the Washington DC Pharmacogenomics in Drug Development and Regulatory Decision-Making: Workshop III - Three Years of Promise, Proposals and Progress on Optimizing the Benefit/Risk of Medicines (11-13 April 2005), one break-out session (Track 2) focused on co-development of therapeutic drug and diagnostic products. The Food and Drug Administration (FDA) released a draft concept paper shortly before the workshop was to convene. Track 2 was a forum for initial discussion of the content of the concept paper, and industry's initial reactions. After the workshop, formal commentaries on the co-development concept paper were submitted by several trade associations (e.g., Pharmaceutical Research and Manufacturers of America (PhRMA), Advanced Medical Technology Association (AdvaMed), American Association for Clinical Chemistry) and individual companies to FDA's Docket No. 2004N-0279. This paper includes a summary of the key features of the draft concept paper, the discussion in Track 2 of the April, 2005 meeting and highlights of the industry comments submitted to the FDA docket following the meeting.

A methodology for web-enabling a computer-based patient record with contributions from cognitive science

Cognitive science is a rich source of insight for creative use of new Web technologies by medical informatics workers. I outline a project to Web-enable an existing computer-based patient record (CPR) in the context of ideas from philosophy, linguistics, artificial intelligence, and cognitive psychology. Web prototypes play an important role (a) because Web technology lends itself to rapid prototype development, and (b) because prototypes help team members bridge among disparate medical, computing, and business ontologies. Six Web-enabled CPR prototypes were created and ranked. User scenarios were generated using a user communication matrix. Resulting prototypes were compared according to the degree to which they satisfied medical, computing, and business constraints. In a different organization, or at different time, candidate prototypes and their ranking might have been different. However, prototype generation and comparison are fundamentally influenced by factors usefully understood in a cognitive science framework.

Results after colectomy for colonic inertia: a sixteen-year experience

BACKGROUND

Colonic inertia (CI) is a disturbance of colonic motility characterized by severe constipation and abdominal pain. This study was conducted to assess the results of total abdominal colectomy (TAC) in the management of CI.

METHODS

A retrospective chart review of 55 patients who underwent TAC for CI was conducted.

RESULTS

Forty-eight patients (87%) were female with an average age of 40; severe constipation existed 2 years prior to surgery. Symptoms included severe constipation (100%) and abdominal pain (84%); diagnostic workup included sitz marker study, anal manometry, and Gastrografin enema. In all cases, sitz marker studies were abnormal and anal manometry was normal. Histologically, no patient had absence of neuroenteric plexuses. Complications included prolonged ileus (24%) and small bowel obstruction (8%). Some 49 patients (89%) had "good" or "excellent" results and 6 patients (11%) had "poor" results. Postoperative stool frequency was 5, 4, and 3 per day at 1, 2, and 12 months, respectively.

CONCLUSIONS

TAC results in resolution of constipation in most patients. We conclude that TAC is effective treatment in patients with CI.

Pitfalls in preparation of (3)H-unconjugated bilirubin by biosynthetic labeling from precursor (3)H-5-aminolevulinic acid in the dog

We report problems encountered during preparation of tritium-labeled unconjugated bilirubin ((3)H-UCB) from precursor (3)H-5-aminolevulinic acid ((3)H-ALA) in 2 dogs with external biliary drainage installed into the animals under general anesthesia. Under prolonged sedation, 12.9 or 14.0 mCi of (3)H-ALA was administered intravenously in two divided doses, and bile was collected for 9 hours. In one animal, taurocholate (TC) infusion was needed to maintain bile flow. (3)H-UCB was isolated from the bile and recrystallized with the improved method of Webster et al (Webster CC, Tiribelli C, Ostrow JD. J Lab Clin Med 2001;137:370-3). Based on radioactivity and pigment content, hourly bile collections were pooled to optimize specific activities. Surprisingly, in the first dog, only 2.9% of injected radioactivity was recovered in bile and only 14.1% in urine, and the specific activities of the crystalline (3)H-UCB from the two pools were only 39.5 and 30.0 x 10(3) dpm/microg. High-performance liquid chromatography analysis revealed that only 4% of ALA degraded during 5 minutes in injection solution at pH 6.8. The low incorporation of (3)H-ALA and low specific activity of (3)H-UCB was apparently caused mainly by prior degradation and exchange of labile tritium of the (3)H-ALA and probably by enhanced endogenous ALA synthesis caused by the anesthetic/sedative agents. Revised procedures in the second dog improved the incorporation of (3)H-ALA to 11.9% excreted in bile and the specific activity of the crystalline (3)H-UCB to 122.0 and 50.8 x 10(3) dpm/microg, while urinary excretion of tritium increased to 28.5%. These experiences emphasize possible pitfalls in preparing (3)H-UCB by biosynthetic labeling from (3)H-ALA administered to dogs.

Structured data entry in a workflow-enabled electronic patient record

Touch-screen technology is used with a structured data entry system for electronic patient records. This article describes a program that coordinates pre-set screens for detailed history, physical examination, treatment and prescription modules. It also presents "pick lists" that allow further customization and individualization of data inputs.

The early NHS and the crisis of public health nursing

Establishment of the NHS in 1948 is rightly seen as a major turning point in health care in the United Kingdom. Notwithstanding conditions of severe austerity, the NHS succeeded remarkably well in its basic remit to make all essential medical care available to the entire population, free at point of delivery. The benefits of the new system extended across the entire front of its services. However, it is important to recognise that the reforms of 1948 were uniformly advantageous. It has for instance long been recognised that the NHS failed to bring about the expected transformation in standards of general medical practice. In this short paper the author argues that public health represented a further major sphere of underdevelopment. The fact that, with minor exceptions, public health is the least studied aspect of the early NHS is itself suggestive of its status as the Cinderella of the modern health services. The author also underlines the adverse implications of this inferior position for domiciliary midwifery, district nursing and health visiting. These constituted small but strategically important sectors of nursing, all of which fell under public health administration in the new health service. The author concentrates on the first phase of the NHS, the period between 1948 and 1974, now often regarded as its golden age. For the purposes of this discussion, most of the evidence relates to the formative phase of the new service, when many major policy questions relating to public health were first confronted. It is suggested that the early neglect of public health and its constituent nursing functions has left a legacy of problems that have still not entirely been resolved. For the purposes of this paper the term will be used to embrace the totality of health functions administered by departments of local government in the period from 1948 to 1974. Most of these services fell within the public health departments of local government, headed by the Medical Office of Health (MOH). However, some important functions involving the nurses were located in other departments. Especially important was the School Health Service, which was reformed in 1944, ahead of the NHS. This was a largely independent service under the administration of Local Education Authorities. Some of the problems of public health nursing related to this fragmentation of responsibility.

Efficacy and tolerability of subcutaneous sumatriptan for acute migraine: a comparison between ethnic groups

OBJECTIVE

To evaluate efficacy and tolerability of subcutaneous sumatriptan 6 mg versus placebo for acute migraine between ethnic groups.

BACKGROUND

Patients in previous sumatriptan studies have been predominantly Caucasian and the effects of sumatriptan between different ethnic groups are unknown.

METHODS

This was a multicenter, 3-phase, 12-attack study. Phases I and III (inclinic) were randomized, double-blind, placebo-controlled, crossover designs. Phase II (outpatient) was a single-blind design. Sumatriptan was compared to placebo across 2 groups (non-Caucasian and Caucasian) and individual ethnic subgroups (black, Hispanic, and others). Headache response, pain-free response, associated symptoms, and clinical disability were assessed. Tolerability assessments included the incidence of adverse events, physical examinations, vital signs, electrocardiograms, and clinical laboratory data.

RESULTS

Two hundred patients treated at least one migraine attack (150 non-Caucasians: 46 blacks, 68 Hispanics, 36 others). Two hours postdose, significantly more inclinic sumatriptan-treated patients reported headache response (non-Caucasians, 81% versus 37% placebo; Caucasians, 87% versus 19% placebo; P<.001) and mild or no clinical disability, compared with placebo (non-Caucasians, 87% versus 50% placebo; Caucasians, 90% versus 38% placebo; P<.001). Blacks (80%), Hispanics (83%), and others (74%) reported similar patterns of headache response at 2 hours. Similar results were reported during the outpatient phase. The incidence of adverse events following sumatriptan during the inclinic phase was similar between ethnic groups (non-Caucasian, 75%; Caucasian, 79%) and higher than placebo (non-Caucasian, 51%; Caucasian, 31%). Overall, adverse events in the outpatient phase of the study were lower than in the inclinic phase.

CONCLUSION

Sumatriptan injection is effective and well tolerated in non-Caucasians and Caucasians for the treatment of acute migraine attacks. Only minor differences in efficacy or tolerability were observed between blacks, Hispanics, and others.

Enhancing practice efficiency by examining patterns of care: top ten lists data mined from a private pediatric practice

The electronic medical record allows practitioners to document their patterns of care. They can enhance performance and profitability by reviewing their top diagnoses, prescriptions, types of physical examination, referral patterns and labs and procedures. The software required to support this documentation system is described.