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Abstract
BACKGROUND Isolated pulmonary cryptococcosis in an immunocompetent parturient host is a rare event. Little is known about this condition, its prognosis, and its treatment in the immunocompetent pregnant woman. CASE A 28-year-old woman, para 3, was diagnosed with isolated pulmonary cryptococcosis postpartum. She had delivered a healthy neonate at term who revealed no clinical features compatible with maternal-fetal transmission. The woman was monitored closely throughout the course of her disease and radiogic, clinical, and serologic resolution was achieved after treatment with fluconazole. CONCLUSION Patients with pulmonary cryptococcosis present with clinical pictures similar to other well-known diseases such as septic pulmonary emboli or choriocarcinoma. Treatment with triazole antifungal therapy yielded favorable results in our patient with this rare condition.
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Hertz MI, Jordan C, Savik SK, Fox JM, Park S, Bolman RM, Dosland-Mullan BM. Randomized trial of daily versus three-times-weekly prophylactic ganciclovir after lung and heart-lung transplantation. J Heart Lung Transplant 1998; 17:913-20. [PMID: 9773865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Cytomegalovirus is an important cause of morbidity and mortality risk after lung transplantation. Ganciclovir, when given for a period of up to 3 months after lung transplantation, has been shown to reduce the incidence and severity of cytomegalovirus. However, daily prophylaxis is associated with considerable expense, inconvenience, and morbidity risk. The goal of this study was to determine whether 3-times-weekly dosage is as effective as daily prophylaxis with ganciclovir in preventing cytomegalovirus disease. METHODS Seventy-two consecutive subjects who had either donor or recipient cytomegalovirus seropositivity were randomized to the daily group (n = 35) or the 3-times-weekly group (n = 37). All subjects received twice-daily ganciclovir treatment for 2 weeks. Thereafter, subjects received either daily or 3-times-weekly ganciclovir dosing until 90 days after transplantation. Subjects were then monitored for 28 +/- 13 months to identify outcomes and complications. RESULTS There were no significant differences between the daily and 3-times-weekly groups with respect to survival free from cytomegalovirus infection or survival free from cytomegalovirus disease. In both groups, cytomegalovirus infection and disease frequently emerged after the termination of prophylaxis. However, in most cases the cytomegalovirus syndromes observed were mild and in many cases could be treated on an outpatient basis. There was no significant difference between the groups in the incidence of obliterative bronchiolitis or time to onset of grade 2 bronchiolitis obliterans syndrome. Overall patient survival was better in the daily group, but the survival advantage did not appear to be related to a reduction in cytomegalovirus-related disease. Complications of ganciclovir prophylaxis included leukopenia in 2 subjects in the 3-times-weekly group and catheter-related sepsis in 6 subjects from each group. CONCLUSIONS We conclude that intravenous ganciclovir given 3 times weekly for 3 months after transplantation is as effective as daily ganciclovir given for a similar time period. The 3-times-weekly dosing regimen did not result in increased infection, disease, or sequelae of cytomegalovirus infection when compared with the daily regimen.
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Grobe SJ, Becker H, Calvin A, Biering P, Jordan C, Tabone S. Clinical data for use in assessing quality: lessons learned from the Texas Nurses' Association Report Card Project. SEMINARS FOR NURSE MANAGERS 1998; 6:126-38. [PMID: 9887863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The purpose of this report is to describe the Texas Nurses' Association Report Card Project. As part of ANA's Safety and Quality Initiative, the project was designed as a feasibility study to determine whether clinically based quality indicator data could be collected in standard ways across acute care agencies in Texas. Clinicians from 12 agencies, under leadership of the professional association (Texas Nurses' Association), participated in this initial effort to reach consensus on clinical indicator definitions and on how to collect clinical data for each indicator. Data were collected for falls and injuries, bacteremias, pressure ulcers, skill mix, nursing hours per patient day, patient satisfaction (with nursing, hospital stay, education, and pain management), and nurse satisfaction. The process used is described, as well as the findings and the lessons learned. The importance of standard definitions and precise and standard primary sources for the data are emphasized for the phase II report card efforts to follow.
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Joseph T, Fajadet J, Laurent JP, Jordan C, Cassagneau B, Laborde JC, Marco J. [Implantation of coronary stents in diabetic patients. Short- and medium-term clinical results]. ARCHIVES DES MALADIES DU COEUR ET DES VAISSEAUX 1998; 91:715-20. [PMID: 9749187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Coronary balloon angioplasty is associated with a high incidence of restenosis in diabetics and of revascularisation of the culprit lesion and increased long-term mortality. The authors report the short and medium-term results of coronary stenting in diabetics. Between May 1995 and April 1997, 2,182 patients underwent coronary stenting. This population included 272 diabetics : 58 insulin-dependent and 214 non-insulin dependent (oral antidiabetics). Stents were implanted in vessels with mean diameters of 3 mm and over. During the hospital period, the complication rate (mortality, non-fatal myocardial infarction, emergency coronary bypass surgery, subacute thrombosis of the stent) was comparable in non-diabetics, insulin-dependent and non-insulin-dependent diabetics (2.55, 0 and 2.0% respectively). One patient (0.5%) died and another (0.5%) had non-fatal myocardial infarction (thrombosis of the stent) in the non-insulin-dependent group. No complications were observed in the insulin-dependent diabetic group. The mean clinical follow-up of 13 months (3-26 months) was respected in 93 and 97% of diabetics. The non-fatal myocardial infarction rate and revascularisation of the culprit lesion were comparable in the insulin and non-insulin-dependent groups (0 versus 0.5% and 8.2 versus 10.5% respectively) but global mortality was higher in the insulin-dependent diabetics (9.3 versus 2.4%).
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Bagott M, Jordan C, Wright C, Jarvis S. How easy is it for young people to obtain cigarettes, and do test sales by trading standards have any effect? A survey of two schools in Gateshead. Child Care Health Dev 1998; 24:207-16. [PMID: 9618035 DOI: 10.1046/j.1365-2214.1998.00066.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Smoking prevalence among young people continues to rise and cigarettes are easily available from many shops. Test sales are used by trading standards departments to try to reduce under-age sales, but it is not known whether this has any real impact on cigarette purchase and consumption. This study aims to evaluate the impact of test sales on purchase and consumption of cigarettes by young people. A survey of two schools in Gateshead, one in the intervention area and one acting as a control was carried out. A series of test sales were targeted to shops within 1.5 km of the intervention school. A questionnaire was administered in both schools among year 10 pupils, age 14-15 years, prior to the intervention and again 1 year later. The outcomes measured were number of successful test sales, reported availability of cigarettes and change in smoking prevalence following the intervention. Some 224 pupils from both schools were surveyed in 1995 and 163 pupils from the new cohort of year 10 pupils in 1996. Prior to the intervention, the levels of regular smoking in the intervention school were 39% for girls and 26% for boys. In the control school these levels were 24% and 14%, respectively. The intervention by trading standards resulted in no purchases and hence no prosecutions, but children reported being able to buy cigarettes with ease from the nearby shops; only three (2.5%) reported sales refused in 1995 and five (5.8%) in 1996. Not surprisingly there was no significant change in smoking prevalence in either school in 1996. This study suggests that test sales may not be effective in modifying cigarette availability to young people and that they are not a reliable measure of access to cigarettes by children.
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Labordo J, Fajadet J, Cassagnoau B, Jordan C, Cortina R, Joseph T, Laurent J, Marco J. Is combined percutaneous carotid artery stanting and coronary or extra-coronary artery angioplasty a safe procedure? J Am Coll Cardiol 1998. [DOI: 10.1016/s0735-1097(98)80323-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Laborde J, Fajadet J, Cassagneau B, Jordan C, Joseph T, Cortina R, Laurent J, Marco J. Carotid stenting in patients at risk for surgery: immediate and long-term results. J Am Coll Cardiol 1998. [DOI: 10.1016/s0735-1097(98)80921-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Joseph T, Fajadet J, Cassagneau B, Jordan C, Laborde J, Laurent J, Cortina R, Marco J. Clinical outcome of patients undergoing coronary stenting for extended lesions ≥30 mm? J Am Coll Cardiol 1998. [DOI: 10.1016/s0735-1097(98)81832-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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84
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Joseph T, Fajadet J, Cassagneau B, Jordan C, Laborde J, Laurent J, Corlina R, Marco J. Two years experience of coronary stenting in diabetic patients: immediate and mid-term results. J Am Coll Cardiol 1998. [DOI: 10.1016/s0735-1097(98)82233-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Bagott M, Jordan C, Wright C, Jarvis S. Test sales do not have impact on prevalence of smoking by children. BMJ (CLINICAL RESEARCH ED.) 1997; 315:491. [PMID: 9284691 PMCID: PMC2127326 DOI: 10.1136/bmj.315.7106.491] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Jordan C. Androgen receptor (AR) immunoreactivity in rat pudendal motoneurons: implications for accessory proteins. Horm Behav 1997; 32:1-10. [PMID: 9344686 DOI: 10.1006/hbeh.1997.1397] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Pudendal motoneurons in male rats are located in two sexually dimorphic motoneuronal pools: the spinal nucleus of the bulbocavernosus (SNB) and the dorsolateral nucleus (DLN). SNB motoneurons innervate sexually dimorphic muscles bulbocavernosus (BC) and levator ani (LA) and the sexually monomorphic external anal sphincter (EAS) muscle. DLN motoneurons innervate either the sexually dimorphic ischiocavernosus (IC) muscle or the sexually monomorphic external urethral sphincter (EUS) muscle. Previous observations indicate that the size of BC, LA, and IC motoneurons in males is sensitive to adult androgen manipulations, whereas the size of EAS and EUS motoneurons is not, raising the question of whether this difference in androgen sensitivity among pudendal motoneurons reflects a difference in androgen receptor (AR) expression. AR immunocytochemistry using the PG-21 antiserum was carried out on spinal cord tissue from normal adult male rats in which specific pudendal motoneuronal subpopulations were identified with retrograde markers. Over 90% of BC, LA, and IC motoneurons displayed AR immunoreactivity in their nuclei. Among motoneurons in the SNB, significantly fewer EAS motoneurons had AR-positive nuclei, which may contribute to the reported failure of EAS motoneurons to morphologically respond to changes in androgen levels. However, within the DLN, despite the fact that IC but not EUS motoneurons are reported to respond to androgen with an increase in soma size, IC and EUS motoneurons had the same proportion of AR-positive nuclei. These results indicate that androgen receptors, while necessary, are not sufficient to confer androgen sensitivity to cells.
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Aurang K, Spraggs CF, Jordan C, Lloyd KC. Role of gastrin/CCK-B receptors in meal-stimulated acid secretion in rats. THE AMERICAN JOURNAL OF PHYSIOLOGY 1997; 272:G1243-8. [PMID: 9176236 DOI: 10.1152/ajpgi.1997.272.5.g1243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Gastrin is the principal hormonal mediator of gastric acid secretion. Using an in vivo, intact, anesthetized rat model, we studied the role of gastrin/cholecystokinin (CCK)-B receptors in regulating the release of histamine and somatostatin during intragastric stimulation of acid secretion during a peptone meal. In pylorusligated, adult male rats (each implanted with a gastric cannula and portal venous and splenic artery catheters), after a 30-min basal period, gastric acid secretion was stimulated for 90 min either by an intravenous infusion of gastrin-17 (15 micrograms.kg-1.h-1) or by extragastric titration of 5 ml 8% peptone meal at pH 5.5. Basal and stimulated acid outputs and portal venous plasma gastrin, histamine, and somatostatin concentrations were measured before and after close-arterial injection of a new, relatively selective, gastrin/CCK-B receptor antagonist GR143330X. GR143330X reduced basal acid output by 50% but not basal plasma gastrin, histamine, or somatostatin concentrations. GR143330X reduced gastrin-stimulated acid output by 80%, plasma histamine by 70%, and plasma somatostatin by 34%. During intragastric peptone meal stimulation GR143330X reduced the acid response by 42% during the 30- to 60-min period but not during the 60- to 90-min period. GR143330X reduced the plasma histamine response by 72 and 68%, and the plasma somatostatin response by 32 and 54% during the 30- to 60- and 60- to 90-min periods, respectively. GR143330X did not block the gastrin response to peptone at any time. These results indicate that GR143330X is an effective agent for blocking gastrin-stimulated acid secretion and histamine and somatostatin release in rats. Furthermore, we show for the first time in an intact, in vivo, anesthetized rat model that meal-stimulated activation of gastrin/CCK-B receptors stimulates acid secretion in part by regulating the release of histamine and somatostatin.
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Jordan C, Payton CJ, Bartlett RM. Perceived comfort and pressure distribution in casual footwear. Clin Biomech (Bristol, Avon) 1997; 12:S5. [PMID: 11415701 DOI: 10.1016/s0268-0033(97)88312-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION:: Footwear manufacturers view comfort as a basic customer need that is growing in importance and is increasingly competing with fashion as a reason for buying shoes. A number of researchers have suggested that pressures and forces between the foot and the insole may influence perceptions of comfort (Chen et al., 1994). To date, no study has attempted to measure the relationship between pressure variables and perceived comfort in a range of commercially available footwear and, furthermore, little attention had been given to the dorsum of the foot with respect to comfort and pressure distribution. METHODS:: Twenty male subjects without foot pathology walked the length of a 10 m walkway at a self-selected pace. A 'perception of comfort' questionnaire was designed to measure perceived plantar comfort in six regions (rearfoot medial, rearfoot lateral, midfoot medial, midfoot lateral, forefoot medial and forefoot lateral) and perceived dorsal comfort in two regions (flex-line and lacing). Ten commercially available shoes were selected to represent two distinct groups in terms of perceived comfort: comfortable and uncomfortable. Plantar and dorsal pressure data were collected using a Pedar in-shoe system and Mikro-EMED system (Novel GmbH) respectively. Analysis of variance tests were used to determine differences (p<0.01) between the two shoe groups. RESULTS:: Peak Pressure was found to be significantly greater for the uncomfortable group both for the total plantar surface and for the all regions of the foot measured. Maximum force was significantly greater for the uncomfortable group for the rearfoot and forefoot regions but significantly lower for the midfoot regions of the plantar surface. For the dorsal surface maximum force was found to be significantly greater for the uncomfortable group. Contact area was significantly greater for the comfortable group in the midfoot regions of the plantar surface but was significantly lower for the comfortable group at the dorsal surface. DISCUSSION:: This study showed that perceived comfort at the plantar and dorsal surfaces could be related to peak pressure and maximum force in all regions and contact area in the midfoot region of the plantar surface and the total dorsal surface. The relationship between perceived comfort and peak pressure was consistently negative across the entire surface of the foot, whereas the relationship between maximum force and perceived comfort varied depending on foot region. This emphasises the need for researchers to address specific regions of the shoe when measuring comfort. The findings of this study suggest that pressure measurement systems could be used by footwear manufacturers' attempting to improve the comfort of their footwear.
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Burgess S, Jordan C, Bartlett RM. The influence of a small insert, in the footbed of a shoe, upon plantar pressure distribution. Clin Biomech (Bristol, Avon) 1997; 12:S5-S6. [PMID: 11415702 DOI: 10.1016/s0268-0033(97)88313-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION:: A recent development in plantar pressure distribution research, has been the study of the effects of sensory input on pressure distribution. It has been suggested that proprioceptive and exteroceptive information received from the plantar surface of the foot plays an important role in adapting to high pressures in shoes. Robbins and Gouw (1991) suggested that surface irregularities should be added to the insoles of running shoes to gain correct sensory input. Hayda et al. (1994) found that placing a pad proximal to the metatarsal heads produced significant reductions in forefoot plantar pressures around the first and second metatarsal heads. A development by Villeneuve (1993), 'La Posteropodle', utilized a small insert to maintain postural equilibrium, by stimulating the mechanoreceptors in the plantar surface of the foot. The aim of this study was to measure changes in plantar pressure distribution using a small circular insert. METHODS:: Ten non-pathological male subjects were tested whilst walking, after one day of wearing a pair of oxfords (hard) and running shoes (soft), containing an insert of 4 mm in height placed on a 0.8 mm EVA insole. The foot was split into five sections: (1) midfoot, (2) first metatarsal head, (3) 2nd and 3rd metatarsal heads, (4) 4th and 5th metatarsal heads, (5) the phalanges. A PEDAR system (Novel GmbH) was used to collect in-shoe plantar pressure data, with data collections at the beginning and end of a working day. Subjects were tested under two conditions: (1) the insert 5 mm proximal to the metatarsal heads, between the 2nd and 3rd heads, (2) a control, with no insert. RESULTS:: Preliminary results indicate that whilst wearing a hard shoe the insert had the effect of shifting peak pressures from the first metatarsal head, to the area of the second and third metatarsal heads. Peak pressures were found to be lower with the insert present. This has not yet been tested for significance. With the running shoe there appeared to be no significant differences between conditions with and without the insert. There were also no differences between the beginning and end of the day, for both shoe types. DISCUSSION:: From the results it appears that the insert is successful in both shifting peak pressures from the medial to the lateral forefoot, whilst reducing peak pressures simultaneously. This was only evident in the hard shoe condition however, suggesting that the footbed of the running shoe was perhaps too soft to allow the insert to influence sensory input sufficiently. These findings indicate that there may be implications for the use of small orthotics. Further study is required, however, to fully substantiate this hypothesis.
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Drew WL, Lalezari J, Jordan C, Jensen P, Moe A, Reynolds L, Mohanty S, Cross A, Dunkle L. In vivo anti-cytomegalovirus (CMV) activity and safety of oral lobucavir in HIV infected patients. Antiviral Res 1997. [DOI: 10.1016/s0166-3542(97)83156-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Viney C, Poxon I, Jordan C, Winter B. Does the APACHE II scoring system equate with the Nottingham Patient Dependency System? Can these systems be used to determine nursing workload and skill mix? Nurs Crit Care 1997; 2:59, 62-3. [PMID: 9873303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The development of a holistic patient dependency system for intensive care in Nottingham has enabled nursing staff to analyse their patient's needs more comprehensively and relate them to existing staffing levels. A recent publication (Chellel et al., 1995) implied that some units were using medical scoring systems to predict workload and that practitioners were dissatisfied with current scoring systems. Patient dependency scores were correlated with APACHE II scores by regression analysis on 1,743 patients from the Adult Intensive. Care Unit at the University Hospital, Nottingham. Analysis revealed that APACHE II had little ability to predict patient dependency and, therefore, is unreliable at predicting nursing workload and skill mix.
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Abstract
The role of videofluoroscopy with the modified barium swallow in the assessment and management of motor neurone disease (MND) is discussed. Nine patients (age range 40-82) with dysphagia secondary to MND were assessed over a four-year period. The examinations were carried out by a multiprofessional team of radiologist, speech and language therapist and dietitian assessing the preoral, oral and pharyngeal phases of swallowing. Preoral feeding abnormalities were present in four out of nine patients, oral phase abnormalities in eight out of nine patients, while 33% of patients demonstrated abnormality in all three phases. Where aspiration occurred (four out of nine cases), no cough reflex was noted. On the basis of these examinations management changes were introduced in all patients. Nonoral feeding was continued or introduced in three patients. Videofluoroscopic examination with the modified barium swallow may be helpful in planning suitable feeding regimes for dysphagia in MND.
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Douglin CP, Jordan C, Rock R, Hurley A, Levett PN. Risk factors for severe leptospirosis in the parish of St. Andrew, Barbados. Emerg Infect Dis 1997; 3:78-80. [PMID: 9126452 PMCID: PMC2627591 DOI: 10.3201/eid0301.970114] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Logue FP, Rees P, Heffernan JF, Jordan C, Donegan JF, Hegarty J, Hiei F, Ishibashi A. Effect of Coulomb enhancement on optical gain in (Zn,Cd)Se/ZnSe multiple quantum wells. PHYSICAL REVIEW. B, CONDENSED MATTER 1996; 54:16417-16420. [PMID: 9985758 DOI: 10.1103/physrevb.54.16417] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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DiScenza S, Nies M, Jordan C. Effectiveness of counseling in the health promotion of HIV-positive clients in the community. Public Health Nurs 1996; 13:209-16. [PMID: 8677237 DOI: 10.1111/j.1525-1446.1996.tb00242.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The purpose of this study was to examine the effects of a nurse's counseling intervention on high-risk sexual behaviors of HIV-positive patients and to explore the relationship of gender, race, age, and education to high-risk sexual behaviors. A convenience sample of 20 adults who were newly diagnosed with HIV and were being treated at an inner-city out-patient clinic was used. Subjects were administered a questionnaire to determine their precounseling AIDS knowledge and precounseling sexual behaviors. A registered nurse then counseled them about safe-sex practices. After 2-3 months the questionnaire was readministered to determine the effects of counseling on AIDS knowledge and high-risk sexual behaviors. Although statistical analysis indicated a significant main effect for change in high-risk sexual behaviors after counseling, there were no significant relationships among change and the individual demographic variables of age, gender, race, and education. Pretest knowledge was not found to influence pretest behavior, nor was posttest knowledge found to affect posttest behavior. Paired t tests indicated a significant change in high-risk sexual behavior scores after counseling but no significant change in knowledge scores.
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Jordan C, Püschel B, Koob R, Drenckhahn D. Identification of a binding motif for ankyrin on the alpha-subunit of Na+,K(+)-ATPase. J Biol Chem 1995; 270:29971-5. [PMID: 8530398 DOI: 10.1074/jbc.270.50.29971] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Cytoskeleton membrane associations are important for a variety of cellular functions. The anion exchanger of erythrocytes (AE1) and Na+,K(+)-ATPase of polarized epithelial cells provide well studied examples of how integral membrane proteins are anchored via the linker molecule ankyrin to the spectrin-based membrane cytoskeleton. In the present study we have generated several recombinant fragments of the large (third) cytoplasmic domain (CD3) of Na+,K(+)-ATPase to define binding sites of ankyrin on CD3 at a molecular level. We provide evidence that a cluster of four amino acids, ALLK, is essential for binding of ankyrin to both recombinant CD3 and to native Na+,K(+)-ATPase. Once bound, conformational changes might uncover further binding sites for ankyrin on Na+,K(+)-ATPase. A motif related to the ALLK cluster is also present in the cytoplasmic domain of AE1 where this sequence (ALLLK) turned out to be also important for ankyrin binding. These motifs are highly conserved during evolution of both Na+,K(+)-ATPase and AE1, further underlining their potential role in cytoskeleton to membrane linkage.
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Kabcenell AI, Wakefield D, Kaiden SA, Thraen I, Holland M, Helms C, Jordan C. Lessons in cooperation: four hospital consortia relate their quality improvement experiences. THE JOINT COMMISSION JOURNAL ON QUALITY IMPROVEMENT 1995; 21:579-92. [PMID: 8608329 DOI: 10.1016/s1070-3241(16)30186-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In 1989, The Robert Wood Johnson Foundation launched a demonstration project to test a consortium approach to quality improvement. As part of this project, four hospital consortia in various parts of the United States are currently sharing quality resources (for example, training) and collaborating on various improvement efforts. The purpose of the project is to demonstrate that hospitals can take on more difficult problems and accomplish more in cooperation with each other than on their own. CASE STUDIES The Institute for Quality Healthcare (Iowa City, Iowa) has built a comparative database so that 40 member hospitals can make meaningful comparisons on various aspects of performance; The Vermont Program for Quality in Health Care has lowered the postoperative infection rate in Vermont by monitoring compliance with consensus guidelines; Interwest Quality of Care, Inc, which has member organizations in Utah, Wyoming, and Idaho, has adapted and disseminated guidelines for diabetic care; and The Public Hospital Institute, in Berkeley, California, has worked with the Joint Commission on Accreditation of Healthcare Organizations to develop a written guide to help surveyors understand the unique operational traits of public hospitals. LESSONS LEARNED Projects such as those with champions in several member organizations and comparative data analysis lend themselves more easily to cooperative work than others. They also provide some strategies for collaboration, such as continually reinforcing the principles of collaboration, obtaining a fully informed commitment, beginning with initiatives that are likely successes, and being serious and vocal about the commitment to confidentiality. CONCLUSIONS Collaborators in quality improvement gain important resources, such as better information, more relevant reference databases, colleagues and support for quality improvement specialists, and economies of scale in education programs, training materials, and interaction with vendors. However, the difficulties in collaboration are great. Hospitals must continually consider not only "What's in this for me," but also "What can we accomplish as a group that is greater than what each of us can do alone?"
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Singh KK, Lessells AM, Adam DJ, Jordan C, Miles WF, Macintyre IM, Greig JD. Presentation of endometriosis to general surgeons: a 10-year experience. Br J Surg 1995; 82:1349-51. [PMID: 7489161 DOI: 10.1002/bjs.1800821017] [Citation(s) in RCA: 120] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The presentation and management of 24 patients with endometriosis (median age 34 (range 21-68)years) presenting to general surgeons over a period of 10 years (1985-1994) was reviewed. Patients presented with an abdominal wall swelling related to a previous Pfannenstiel incision (seven patients), umbilical swelling (four), inguinal canal swelling (two), incidentally following appendicectomy (five), terminal ileal obstruction (two), rectal bleeding (two) and urinary symptoms (two). Endometriosis was not suspected in most patients but was confirmed by surgical excision or resection with minimal morbidity. No recurrence occurred during a median follow-up of 53 (range 9-113) months. Endometriosis is a disease rarely seen by general surgeons and is often diagnosed incidentally or on histological examination. Cyclical symptoms associated with menstruation are present in 50 per cent of patients and should suggest the diagnosis in those presenting with scar-related and/or subcutaneous swellings. Simple excision or resection of the presenting lesion provides adequate treatment but, since pelvic endometriosis may be present, referral to a gynaecologist is recommended in every case.
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Jordan C, Weller C, Thornton C, Newton DE. Monitoring evoked potentials during surgery to assess the level of anaesthesia. J Med Eng Technol 1995; 19:77-9. [PMID: 7494214 DOI: 10.3109/03091909509030279] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The hypnotic and analgesic components of anaesthesia can be assessed using middle latency auditory evoked potentials (MLAEPs) and somatosensory evoked potentials (SEPs). To monitor these potentials reliably during clinical anaesthesia, we have developed an evoked potential (EP) system based around a portable personal computer, a DSP board and an isolated pre-amplifier unit. Unlike many currently available systems, this amplifier is largely immune to diathermy interference due to excellent isolation via a digital fibre optical link, small size and RF screening and filtering. The pre-amplifier unit has integral auditory and somatosensory stimulators, and automatic calibration and impedance checking. Stimulus intensity and profile are under software control and SEP stimulus level is constantly monitored. The unit is powered by two AA cells and battery status continuously monitored by the PC software. Up to eight channels of EEG may be recorded and displayed in a smoothly scrolling window and as moving average MLAEPs and SEPs.
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Abstract
A lateral patellar retinacular release that transects the tendon of the vastus lateralis muscle may result in significant complications. To avoid such complications, the superior extent must be limited, and maximizing the inferior extent may be important in achieving an adequate release. The effective release of the patella from its lateral retinaculum was examined for 2 incision lengths using 10 fresh-frozen human cadaveric knees and comparing the medial displacement of the patella relative to the femur for 3 study groups (control, intact retinacula; Group A, retinacula cut from the inferior third of the vastus lateralis tendon down to the anterolateral arthroscopic portal; and Group B, retinacula cut from the inferior third of the vastus lateralis tendon down to the tibial tubercle) when a 22-N medially directed force was applied to the patella with the knee at 30 degrees and 60 degrees of flexion. The extended release (Group B) resulted in a significantly more effective release when compared with the standard release (Group A) or control group. This technique may allow an adequate release of the patella while preserving the function of the vastus lateralis muscle.
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