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Neame R, Olson M. How can sharing clinical information be made to work? Stud Health Technol Inform 1999; 52 Pt 1:315-8. [PMID: 10384470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
There is a recognised need to share clinical information in order to improve integrity, continuity, safety and speed of delivering patient care. This remains a serious weakness in the conceptualisation of existing health information management systems. The evolution of structured (e.g., HL7) messaging standards has been driven largely from an administrative information viewpoint, as have many of the initiatives driving the development of electronic patient record (EPR) systems. Neither appears to address crucial needs for clinical data exchanges often across wide areas to meet the needs of best quality, cost-effective and low risk patient care delivery. The present reality is that clinical messaging is complex, rigid and ineffective, and the business case for its users is not compelling. Administrative and financial arrangements need to be developed which support the more widespread use of clinical data exchanges. This paper underlines the importance of web technology as a key element in the communications strategy and as an adjunct (or alternative) to more structured messaging environments. It also raises some of the fundamental structural problems, which impact the use of messaging in healthcare, and puts forward proposals as to how these may best be addressed and resolved.
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Aboulafia DM, Olson M, Bundow D. CLINICAL CHARACTERISTICS OF ADVANCED PULMONARY KS (PKS): A DIFFICULT DISEASE TO TREAT. J Acquir Immune Defic Syndr 1999. [DOI: 10.1097/00126334-199905010-00073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Stevens R, Mikat-Stevens M, Flanigan R, Waters W, Furry P, Sheikh T, Frey K, Olson M, Kleinman B. Does the Choice of Anesthetic Technique Affect the Recovery of Bowel Function After Radical Prostatectomy? J Urol 1999. [DOI: 10.1016/s0022-5347(01)61730-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Tigges S, Pitts S, Mukundan S, Morrison D, Olson M, Shahriara A. External validation of the Ottawa knee rules in an urban trauma center in the United States. AJR Am J Roentgenol 1999; 172:1069-71. [PMID: 10587149 DOI: 10.2214/ajr.172.4.10587149] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We evaluated the Ottawa knee rules in a high-volume teaching hospital in the United States to determine whether the rules could be safely used to decide whether patients with acute blunt knee trauma should undergo radiography. SUBJECTS AND METHODS During a 13-month period, 378 patients with acute blunt knee trauma were prospectively examined using the Ottawa knee rules. Data collected included the presence or absence of fracture predictors and the results of radiography. RESULTS A fracture was seen in 43 (11%) of the 378 patients who met inclusion criteria. The knee rules predicted 42 of the 43 fractures; sensitivity was 98%, and specificity was 19%. Radiography of 65 patients (17%) who had no predictors for fracture could have been avoided if the knee rules had been used to screen for radiography. CONCLUSION The Ottawa knee rules are highly sensitive for fracture in this setting and may safely be used to decide whether patients with acute blunt knee trauma should undergo radiography.
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Karlsson H, Olson M, Arvidsson G, Laurell F, Bäder U, Borsutzky A, Wallenstein R, Wickström S, Gustafsson M. Nanosecond optical parametric oscillator based on large-aperture periodically poled RbTiOAsO(4). OPTICS LETTERS 1999; 24:330-332. [PMID: 18071496 DOI: 10.1364/ol.24.000330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We report on optical parametric oscillators (OPO's) based on periodically poled RbTiOAsO(4) (PP RTA), which are pumped by Q -switched solid-state lasers. With a diode-pumped Nd:YVO(4) laser (pulse energy, 800microJ ; pulse duration, 5.5 ns; repetition rate, 1 kHz) the PP RTA OPO generated 1.58-microm signal and 3.26-microm idler radiation with a signal pulse energy of 45microJ . The large aperture of 3 mmx3 mm of the PP RTA crystal also permitted OPO operation with pump pulse energies as high as 65 mJ, provided by a flash-lamp-pumped Q -switched Nd:YAG laser (pulse duration, 20 ns; repetition rate, 10 Hz). With this pump source the OPO generated signal pulse energies as high as 17 mJ, corresponding to an efficiency of 26%. The performance of this OPO shows that large-aperture PP RTA crystals are well suited for pulsed nanosecond OPO operation with pump pulse energies of tens of millijoules.
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Olson M. [The health care system in the USA does not welcome patients with "minor complaints". It takes days before they are seen by a family physician]. LAKARTIDNINGEN 1998; 95:5672-5. [PMID: 9863312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Stevens RA, Mikat-Stevens M, Flanigan R, Waters WB, Furry P, Sheikh T, Frey K, Olson M, Kleinman B. Does the choice of anesthetic technique affect the recovery of bowel function after radical prostatectomy? Urology 1998; 52:213-8. [PMID: 9697784 DOI: 10.1016/s0090-4295(98)00147-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Return of bowel function after radical prostatectomy surgery may be the limiting factor in discharging these patients from the hospital. Recent studies have shown that postoperative epidural infusion of bupivacaine decreases time to return of bowel function compared with intravenous and epidural morphine in patients after abdominal surgery. This study focuses on the role of the intraoperative anesthetic technique on recovery of bowel function, intraoperative blood loss, and the incidence of postoperative deep venous thrombosis (DVT) in patients undergoing radical retropubic prostatectomy and pelvic lymphadenectomy. METHODS Forty patients undergoing prostatectomy were randomized to either group A (general endotracheal anesthesia, including muscle relaxation and mechanical ventilation, followed by postoperative intravenous morphine patient-controlled analgesia) or group B (thoracic epidural anesthesia using bupivacaine, combined with "light" general anesthesia using a laryngeal mask airway and spontaneous ventilation, followed by epidural morphine analgesia). Intra- and postoperative data were collected on blood loss, volumes of crystalloid and colloid infused, blood transfused, duration of anesthesia and surgery, anesthetic and surgical complications, time to recovery of bowel function, quality of postoperative pain control, and time to discharge from hospital. Each patient underwent lower extremity venous ultrasonography to detect DVT. RESULTS Twenty-one patients received general anesthesia and 19 received combined epidural and general anesthesia. Intraoperative blood loss was significantly lower in the epidural group, and times to first flatus and first bowel movement were also shorter in this group. There were no significant differences in duration of anesthesia or surgery, quality of postoperative analgesia, side effects of analgesia, or time to discharge from hospital. There was no DVT detected in any patient. CONCLUSIONS The combined anesthetic technique of thoracic epidural anesthesia and "light" general anesthesia with spontaneous ventilation decreased intraoperative blood loss and shortened the time to return of bowel function. However, this earlier return of bowel function was not great enough to realize a difference in time to hospital discharge. There was no evidence of increased complications secondary to epidural anesthesia or of prolonged anesthetic time necessary to place epidural catheters.
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Bittner V, Kelsey S, Olson M, Gamble B, Rogers W, Boyette A, Pakstis D, Zell K. Coronary angiography results have minimal impact on use of lipid-lowering agents in women: pilot phase data from WISE. J Am Coll Cardiol 1998. [DOI: 10.1016/s0735-1097(98)81451-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Christenson RH, Apple FS, Morgan DL, Alonsozana GL, Mascotti K, Olson M, McCormack RT, Wians FH, Keffer JH, Duh SH. Cardiac troponin I measurement with the ACCESS immunoassay system: analytical and clinical performance characteristics. Clin Chem 1998; 44:52-60. [PMID: 9550558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We evaluated the ACCESS cardiac troponin I (cTnI) immunoassay as a marker for myocardial infarction (MI). Total imprecision was 6.0% to 13.5%, the minimum detectable concentration was 0.007 microg/L, and the limit of quantitation was 0.046 microg/L. Comparison of cTnI measurement between the ACCESS and Stratus systems (n = 114) showed a proportional difference: ACCESS cTnI = 0.0996 Stratus cTnI + 0.049 microg/L (r = 0.811). Fifty-nine of 61 ambulatory patients without cardiac symptoms had no detectable cTnI (95% range, 0.00 to 0.025 microg/L). The optimum cutoff for discriminating MI (n = 289, 45 with MI) was 0.15 microg/L by receiver operator characteristic curve analysis; at this cutoff, the ACCESS cTnI assay showed a sensitivity of 88.9% (95% CI, 79.7-98.1%) and specificity of 91.8% (95% CI, 88.4-95.2%). The ACCESS cTnI assay results showed 89.4% and 93.0% concordance with the MB isoenzyme of creatine kinase (CK-MB) mass and Stratus cTnI results, respectively, for classification of patients with suspected MI. The ACCESS cTnI assay appears to show sensitivity and specificity comparable with those of both CK-MB mass and Stratus cTnI assays for the diagnosis of MI in patients presenting within 12 h of onset of symptoms.
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Olson M. Understanding addiction. J Obstet Gynecol Neonatal Nurs 1998; 27:12. [PMID: 9475121 DOI: 10.1111/j.1552-6909.1998.tb02583.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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LaVenture M, Olson M, Brand B, Crouse B. Creating a statewide immunization registry. A tool for physicians and public health. MINNESOTA MEDICINE 1997; 80:50-2. [PMID: 9427823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Sparrow DG, Gard S, Buret A, Ceri H, Olson M, Morck DW. Expression of tumor necrosis factor alpha and granulocyte-macrophage colony-stimulating factor by bovine endothelial cells in vitro. Clin Infect Dis 1997; 25 Suppl 2:S178-9. [PMID: 9310669 DOI: 10.1086/516182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Abstract
This study explored the experience of receiving Therapeutic Touch (TT) from the point of view of recipients with no prior experience with TT. Eleven female graduate students who were part of a larger study were interviewed after the second of two TT sessions and statements from the transcripts were analyzed for words, phrases, or sentences that fell into one of five categories: (a) relaxation, (b) physical sensations, (c) cognitive activity, (d) emotional (feelings), and (e) spiritual/transcendent. All participants reported feeling relaxed and had physical sensations and cognitive activity during the TT sessions, and most of the statements fit into these categories. Fewer statements reflected emotional or spiritual experiences and not all participants had these experiences. The sensations associated with TT may occur developmentally. Initially, physical and cognitive experiences are identified. The deeper, meaningful sensations may occur after an individual has more experience with the intervention.
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Olson M, Sneed N, LaVia M, Virella G, Bonadonna R, Michel Y. Stress-induced immunosuppression and therapeutic touch. Altern Ther Health Med 1997; 3:68-74. [PMID: 9061991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The specific aim of this study was to evaluate the effectiveness of therapeutic touch in reducing the adverse immunological effects of stress in a sample of highly stressed students. Long-term goals are to develop methods by which a variety of stress-reduction techniques can be tested for efficacy. DESIGN Experimental. SETTING A large urban medical university in a southern coastal city. SUBJECTS Healthy medical and nursing students who are taking professional board examinations. INTERVENTION Therapeutic touch. MAIN OUTCOME MEASURES T-lymphocyte function (CD25) and immunoglobulin levels. RESULTS Subjects who received therapeutic touch and subjects who did not had significantly different levels of IgA and IgM; CD25 (mitogen-stimulated T-lymphocyte function) and IgG levels differed in the expected direction between the two groups, but the differences were not statistically significant. Apoptosis (programmed cell death) was significantly different between the two groups. CONCLUSIONS The small sample size requires cautious interpretation of the results. This is a pilot study designed to provide evidence to show that further study of therapeutic touch as an intervention that may be useful in reducing the adverse immunologic consequences of anxiety related to stress in otherwise healthy students is warranted. Change in immune function related to anxiety and the relief of anxiety can be measured. Subsequent power analysis suggests sample sizes of 90 subjects per group are required to confirm the conclusions.
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Neame RL, Olson M. Measures implemented to project personal privacy for an on-line national patient index: a case study. TOPICS IN HEALTH INFORMATION MANAGEMENT 1996; 17:18-25. [PMID: 10162537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Increasing use of electronic data storage and exchange is inevitable. Although of considerable benefit to all concerned, they pose a potential threat to personal privacy. Measures to protect personal privacy in national information networks are essential. These and related security issues require the highest priority in strategic planning because experience shows that poor handling of security is the single factor most likely to lead to rejection of a system. It is increasingly important to be able to identify individuals uniquely for health-related purposes, and implementation of an on-line master index is the approach that has been adopted in New Zealand to address this need. Such an index, however, contains personal information, the privacy of which must be respected. Substituting the unique identifier for all personal details in electronic messages can provide a degree of security as long as access to the index is controlled and usage is monitored. The article outlines the measures, technical and otherwise, implemented to manage security concerns successfully in that context.
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Flanigan RC, McKay TC, Olson M, Shankey TV, Pyle J, Waters WB. Limited efficacy of preoperative computed tomographic scanning for the evaluation of lymph node metastasis in patients before radical prostatectomy. Urology 1996; 48:428-32. [PMID: 8804497 DOI: 10.1016/s0090-4295(96)00161-6] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate the efficacy of preoperative computed tomographic (CT) scanning in patients with presumed localized prostatectomy prior to radical retropubic prostatectomy. METHODS A retrospective study of 173 consecutive patients believed to be candidates for radical retropubic prostatectomy who underwent preoperative CT scanning regardless of preoperative prostate-specific antigen (PSA) value, clinical stage, or Gleason grade was undertaken. All patients underwent radical retropubic prostatectomy with bilateral pelvic lymph node dissection or aspiration needle biopsy of abnormal nodes on CT scanning. RESULTS One hundred sixty-five of 173 patients (95.4%) were believed to have normal CT scans preoperatively. Of these 165 patients, 156 (94.5%) were found to have negative lymph nodes confirmed histologically at the time of lymphadenectomy. Nine patients (5.5%) were found to have lymph node metastases confirmed histologically, despite a negative CT scan. Computed tomographic scanning understaged 9 of 12 (75%) patients with proven metastases. Incidental abdominal pathology of clinical significance was documented in 4 patients (2.3%), including 2 with renal cell cancers, 1 with colon cancer, and 1 with a large (8 cm) abdominal aortic aneurysm. Prostate-specific antigen levels in patients with metastatic lymph nodes ranged from 0.7 to 130 ng/mL (Hybritech Tandem assay), with a mean level of 42 ng/mL. Although 9 of 33 patients (27.3%) with PSA levels greater than 25 ng/mL had node metastases, only 3 of these 33 patients (9.1%) were correctly diagnosed by CT scanning. CONCLUSIONS Although additional numbers of patients with high PSA levels need to be evaluated, we could not find any justification for routine preoperative CT scanning in patients with a PSA of less than 25 ng/mL. These results suggest that significant savings can be realized by abandoning the practice of routine CT scanning for lymph node metastasis in all patients with newly diagnosed prostate cancer.
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Griffin JH, Wheeler JS, Olson M, Melian E. Prostate carcinoma metastatic to the penis: magnetic resonance imaging and brachytherapy. J Urol 1996; 155:1701-2. [PMID: 8627860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Simon MC, Olson M, Scott E, Hack A, Su G, Singh H. Terminal myeloid gene expression and differentiation requires the transcription factor PU.1. Curr Top Microbiol Immunol 1996; 211:113-9. [PMID: 8585941 DOI: 10.1007/978-3-642-85232-9_11] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Coyne T, Olson M, Bradham K, Garcon M, Gregory P, Scherch L. Dietary satisfaction correlated with adherence in the Modification of Diet in Renal Disease Study. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 1995; 95:1301-6. [PMID: 7594127 DOI: 10.1016/s0002-8223(95)00341-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To measure satisfaction with modified protein eating patterns and the relationship of satisfaction to adherence and sociodemographic factors in a clinical trial. DESIGN Participants completed the Dietary Satisfaction Questionnaire at baseline, at 6-month follow-up visits, at annual visits, and at the final visit. Satisfaction with diet was rated on a visual analog scale from 1 (dislike extremely) to 5 (like very much). Adherence to protein goals was assessed using urine urea nitrogen excretion from monthly 24-hour urine samples. SUBJECTS 840 adults with chronic renal disease. INTERVENTION Individual participants, randomly assigned to a usual-protein, low-protein, or very-low-protein group, received monthly counseling from a dietitian for an average of 26 months. STATISTICS Analyses of variance and two-sample t tests compared, among study/diet groups, satisfaction with diet, its relationship to adherence and sociodemographic characteristics, and changes in satisfaction over time. Paired t tests compared changes within diet groups from baseline to final visit. RESULTS From the baseline visit to the final visit, satisfaction with the prescribed eating pattern increased slightly in the usual-protein group, declined slightly in the low-protein group, and declined significantly in the very-low-protein group. Participants in all of the eating pattern groups who were more satisfied at the final visit had mean protein intakes closer to their assigned protein goals. This relationship was significant in the low-protein group (P < .05). In men, satisfaction with diet declined significantly from baseline to the final follow-up visit in the very-low-protein group. APPLICATIONS The Modification of Diet in Renal Disease Study Dietary Satisfaction Questionnaire may be useful in other research and clinical settings to assess and enhance dietary adherence.
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Abstract
This four-group, repeated-measures experimental design divided 40 healthy professional caregivers/students into high- and low-anxiety groups and further into "therapeutic touch" and comparison groups. The effectiveness of the use of therapeutic touch in reducing anxiety was evaluated, as were the methodologies used. Three self-report measures of anxiety (Profile of Mood States, Spielberger's State/Trait Anxiety Inventory, and visual analogue scales) were evaluated for equivalence and concurrent validity to determine their potential for use in future studies. The correlations among these instruments were highly significant. The small sample size prevented differences between groups from reaching statistical significance, but the reduction of anxiety in the high-anxiety group was greater for those who had received therapeutic touch than for those who did not. Using variability data, the sample size necessary to find statistically significant differences between those who had therapeutic touch and those who did not was determined.
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Abstract
We hypothesized that altered pharmacokinetics in the inflamed prostate gland might account for the treatment failure of clinically diagnosed chronic bacterial prostatitis. We employed a rat model of chronic bacterial prostatitis to investigate any pharmacokinetic differences that may exist between uninflamed and inflamed prostate glands. Four groups of animals were studied (treated and untreated control and prostatitis groups). Seven days of norfloxacin therapy cured 60% of the animals with well-established bacterial prostatitis compared with a spontaneous cure rate of 10% in the nontreated prostatitis animals. Norfloxacin levels did not change significantly between the infected and noninfected prostate glands. We conclude that failure of antibiotic therapy in chronic bacterial prostatitis is not due to significantly altered norfloxacin pharmacokinetics in the chronically inflamed prostate gland but rather to the difficulty of eradicating protected bacterial microcolonies within an infection-induced altered microenvironment deep within the prostate gland.
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Nickel JC, Costerton JW, McLean RJ, Olson M. Bacterial biofilms: influence on the pathogenesis, diagnosis and treatment of urinary tract infections. J Antimicrob Chemother 1994; 33 Suppl A:31-41. [PMID: 7928835 DOI: 10.1093/jac/33.suppl_a.31] [Citation(s) in RCA: 115] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The bacterial biofilm theory which describes bacterial populations in natural and pathogenic ecological systems in terms of a free-floating or 'planktonic' population of bacteria interacting with a more important matrix enclosed 'sessile' population of bacteria associated with or adherent to a surface, may help explain some of the problems linked to our understanding the nature of urinary tract infections. This paper reviews the role of bacterial biofilm formation in catheter-associated infection, prostatitis and struvite (infected stone) calculogenesis stressing, the importance of bacterial biofilms in the pathogenesis, persistence and hence the treatment of urinary tract infection.
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Romano EL, Soyano A, Montaño RF, Ratcliffe M, Olson M, Suarez G, Martínez N, Worsley G. Treatment of ABO hemolytic disease with synthetic blood group trisaccharides. Vox Sang 1994; 66:194-9. [PMID: 8036789 DOI: 10.1111/j.1423-0410.1994.tb00309.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Thirteen infants, 10 with A-O and 3 with B-O hemolytic disease of the newborn (ABO-HDN), were treated with synthetic A or B blood group trisaccharides (ATS, BTS) which cause dissociation of maternal antibody bound to infant red cells. The clinical outcome was compared with that of a control group of 21 infants treated with phototherapy during the preceding year. Exchange transfusion was required in 2 out of 13 infants in the experimental group and in 7 in the control group. A randomized prospective controlled study is necessary to confirm these results.
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Shapiro RS, Derse AR, Gottlieb M, Schiedermayer D, Olson M. Willingness to perform euthanasia. A survey of physician attitudes. ARCHIVES OF INTERNAL MEDICINE 1994; 154:575-84. [PMID: 8122951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND In the United States, few studies have examined important variables in physician attitudes toward the practice of euthanasia, such as the patient's underlying disease, mental capacity, and age, and the physician's specialty and religion. We administered a case-based survey to analyze the impact of such specific variables on physician attitudes toward the practice. METHODS A four-section survey solicited (1) physician responses to three hypothetical cases in which patients requested euthanasia; (2) physicians' general opinions about euthanasia and how its legalization might affect them personally and professionally; and (3) demographic information. Analysis focused on physicians' characteristics as they related to their responses to the various aspects of euthanasia elicited in the survey. Univariate and multivariate analyses, using logistic regression, were performed. RESULTS Completed and analyzable surveys were returned by 740 physicians. We found that physicians felt more comfortable with euthanasia requests from nondecisional, nonterminal patients who had left advance directives than they did with requests from decisional patients suffering from grave illnesses or injuries, or from decisional patients who had early signs of a progressive but nonlethal neurologic disease. We also found that physicians' specialties and religions correlated with their responses to the hypothetical cases and with their generalized attitudes toward euthanasia. CONCLUSIONS Given the disparity in responding physicians' attitudes toward euthanasia, along with the fact that values based on religious affiliation or profession may underlie many physicians' opposition to the practice, we conclude that if euthanasia is to be legalized, safeguards protective of patients and physicians must be incorporated.
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