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Wright B. Detailed planning to upgrade the sterile-products preparation area to a cleanroom. Am J Health Syst Pharm 1995; 52:1750, 1753-5. [PMID: 8528830 DOI: 10.1093/ajhp/52.16.1750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
In a project to establish a cleanroom, the pharmacy manager is the person who must motivate everyone and keep the momentum going. Involving departments other than pharmacy is the key to success. The project provides an opportunity to improve the department's performance with the aid of other departments.
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Ibrahim B, Sanderson JE, Wright B, Palmer R. Dual chamber pacing: how many patients remain in DDD mode over the long term? Heart 1995; 74:76-9. [PMID: 7662461 PMCID: PMC483952 DOI: 10.1136/hrt.74.1.76] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE DDD pacing is better than VVI pacing in complete heart block and sick sinus syndrome but is more expensive and demanding. In addition, some patients have to be programmed out of DDD mode and this may have an important impact on the cost-effectiveness of DDD pacing. The purpose of this study was to determine how many patients remain in DDD mode over the long term (up to 10 years). DESIGN A retrospective analysis of the outcome over 10 years of consecutive patients who had their pacemakers programmed initially in DDD mode. SETTING A district general hospital. PATIENTS 249 patients with DDD pacemakers. Sixty two patients (24.9%) had predominantly sick sinus syndrome and 180 (72.3%) had predominantly atrioventricular conduction disease. Mean (range) complete follow up for this group of patients was 32 months (1-10 years). RESULTS Cumulative survival of DDD mode was 83.5% at 60 months. Atrial fibrillation was the commonest reason for abandonment of DDD pacing. Atrial fibrillation developed in 30 patients (12%), with atrial flutter in three (1.2%). Loss of atrial sensing or pacing, pacemaker mediated tachycardia, and various other reasons accounted for reprogramming out of DDD mode in eight patients (3.2%). Overall, an atrial pacing mode was maintained in 91% and VVI pacing was needed in only 9%. CONCLUSIONS With careful use of programming facilities and appropriate secondary intervention, most patients with dual chamber pacemakers can be maintained successfully in DDD or an alternative atrial pacing mode until elective replacement, although atrial arrhythmia remains a significant problem. There are no good reasons, other than cost, for not using dual chamber pacing routinely as suggested by recent guidelines and this policy can be achieved successfully in a district general hospital pacing centre.
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Svec F, Hilton CW, Wright B, Browne E, Porter JR. The effect of DHEA given chronically to Zucker rats. PROCEEDINGS OF THE SOCIETY FOR EXPERIMENTAL BIOLOGY AND MEDICINE. SOCIETY FOR EXPERIMENTAL BIOLOGY AND MEDICINE (NEW YORK, N.Y.) 1995; 209:92-7. [PMID: 7536942 DOI: 10.3181/00379727-209-43883] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Dehydroepiandrosterone (DHEA) has been reported to exert antiglucocorticoid activity. When administered to obese, hypercorticosteronemic Zucker rats, it causes a diminution of food intake and a reduction in their rate of weight gain. This experiment was conducted to evaluate whether this biologic effect could be ascribed to chronic adrenal insufficiency. Obese and lean Zucker rats were treated with DHEA as a food supplement for 28 days. Upon sacrifice, organ weights and serum chemistries were measured, along with neurotransmitter levels in regions of the hypothalamus. Results showed that although the obese animals gained weight more slowly, had lower insulin levels, and ate less, their serum glucose, corticosterone, and ACTH levels were not different from control. Hypothalamic neurotransmitters in the obese rat were unaffected by chronic DHEA treatment. We concluded that, although DHEA clearly affects Zucker weight gain, it does not induce chronic adrenal insufficiency.
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Crowther J, Lo FB, Rawlings MW, Wright B. Determination of organically bound sulfur in swamp and terrestrial waters by continuous flow oxidation and ion chromatography. ENVIRONMENTAL SCIENCE & TECHNOLOGY 1995; 29:849-855. [PMID: 22176390 DOI: 10.1021/es00004a003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Meng TC, Fischl MA, Cheeseman SH, Spector SA, Resnick L, Boota A, Petrakis T, Wright B, Richman DD. Combination therapy with recombinant human soluble CD4-immunoglobulin G and zidovudine in patients with HIV infection: a phase I study. JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES AND HUMAN RETROVIROLOGY : OFFICIAL PUBLICATION OF THE INTERNATIONAL RETROVIROLOGY ASSOCIATION 1995; 8:152-60. [PMID: 7834398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
To determine the effect of zidovudine (ZDV) on the pharmacokinetic disposition of recombinant soluble CD4 immunoglobulin G (rCD4-IgG) and to evaluate the safety and preliminary activity of concurrent administration of ZDV with rCD4-IgG, we undertook an open-label, dose-escalating, 12-week study. The regimens of intravenous rCD4-IgG and oral ZDV we used were (a) 300 micrograms/kg rCD4-IgG twice per week and 300 mg ZDV per day, (b) 300 micrograms/kg rCD4-IgG twice per week and 600 mg ZDV per day, (c) 1,000 micrograms/kg rCD4-IgG twice per week and 300 mg ZDV per day, (d) 1,000 micrograms/kg rCD4-IgG twice per week and 600 mg ZDV per day, and (e) 3,000 micrograms/kg rCD4-IgG twice per week and 300 mg ZDV per day. Subjects were recruited from three AIDS clinical trials units. Forty-one patients with HIV infection who had CD4 cell counts < or = 500 cells/mm3 and < 120 days of previous ZDV therapy participated. Pharmacokinetic interactions were assessed with the second regimen. Mean calculated peak serum rCD4-IgG concentrations were 5.47 micrograms/ml with ZDV and 8.28 micrograms/ml without ZDV, with serum half-lives of 34.2 and 32.0 h, respectively. Antibodies to rCD4-IgG were not detected. Seven episodes of severe adverse events occurred in five patients: one episode each of severe nausea, fever, or abnormal liver function tests and four episodes of severe neutropenia. Mean hemoglobin and neutrophil counts decreased, and mean platelet counts increased in all regimens, but there were no significant differences among regimens, rCD4-IgG dose, or ZDV dose.(ABSTRACT TRUNCATED AT 250 WORDS)
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Wright B. Another human interest story. ACCIDENT AND EMERGENCY NURSING 1995; 3:1-2. [PMID: 7712216 DOI: 10.1016/0965-2302(95)90051-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Renshaw BR, Fanslow WC, Armitage RJ, Campbell KA, Liggitt D, Wright B, Davison BL, Maliszewski CR. Humoral immune responses in CD40 ligand-deficient mice. J Exp Med 1994; 180:1889-900. [PMID: 7964465 PMCID: PMC2191723 DOI: 10.1084/jem.180.5.1889] [Citation(s) in RCA: 487] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Individuals with X-linked hyper-IgM syndrome fail to express functional CD40 ligand (CD40L) and, as a consequence, are incapable of mounting protective antibody responses to opportunistic bacterial infections. To address the role of CD40L in humoral immunity, we created, through homologous recombination, mice deficient in CD40L expression. These mice exhibited no gross developmental deficiencies or health abnormalities and contained normal percentages of B and T cell subpopulations. CD40L-deficient mice did display selective deficiencies in humoral immunity; basal serum isotype levels were significantly lower than observed in normal mice, and IgE was undetectable. Furthermore, the CD40L-deficient mice failed to mount secondary antigen-specific responses to immunization with a thymus-dependent antigen, trinitrophenol-conjugated keyhole limpet hemocyanin (TNP-KLH). By contrast, the CD40L-deficient mice produced antigen-specific antibody of all isotypes except IgE in response to the thymus-independent antigen, DNP-Ficoll. These results underscore the requirement of CD40L for T cell-dependent antibody responses. Moreover, Ig class switching to isotypes other than IgE can occur in vivo in the absence of CD40L, supporting the notion that alternative B cell signaling pathways regulate responses to thymus-independent antigens.
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Gruss HJ, Hirschstein D, Wright B, Ulrich D, Caligiuri MA, Barcos M, Strockbine L, Armitage RJ, Dower SK. Expression and function of CD40 on Hodgkin and Reed-Sternberg cells and the possible relevance for Hodgkin's disease. Blood 1994; 84:2305-14. [PMID: 7522624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
CD40 was originally described as a B-cell-restricted antigen and was subsequently found to be a member of the tumor necrosis factor (TNF) receptor superfamily. CD40 is also expressed on dendritic cells, thymic epithelium, monocytes, and some carcinoma cell lines, and plays a critical role in cell contact-dependent activation. Primary and cultured Hodgkin and Reed-Sternberg (H-RS) cells, the presumed malignant cells of Hodgkin's disease (HD); were found to express high levels of cell surface CD40. We found that recombinant CD40 ligand (CD40L) induced interleukin-8 (IL-8) secretion and enhanced IL-6, TNF, and lymphotoxin-alpha (LT-alpha/TNF-beta) release from cultured H-RS cells. These cytokines play a significant role in the clinical presentation and pathology of HD, a tumor of cytokine-producing cells. CD40L had no mitogenic activity for HD-derived cell lines. In contrast, CD40L enhanced expression of costimulatory molecules intracellular adhesion molecule-T and B7-1 on cultured H-RS cells, both of which are overexpressed on primary H-RS cells. In addition, CD40L induced a 40% to 60% reduction of the expression of the HD-associated CD30 antigen, another member of the TNF receptor superfamily. Primary and cultured H-RS cells express not only CD30, but also CD40. CD40L has pleiotropic biologic activities on H-RS cells, and the CD40-CD40L interaction might be a critical element in the deregulated cytokine network and cell contact-dependent activation cascade typical for HD.
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Wright B. Road rage. ACCIDENT AND EMERGENCY NURSING 1994; 2:181. [PMID: 7804857 DOI: 10.1016/0965-2302(94)90018-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Sneyd JR, Simons PJ, Wright B. Use of proton nmr spectroscopy to measure propofol metabolites in the urine of the female Caucasian patient. Xenobiotica 1994; 24:1021-8. [PMID: 7900408 DOI: 10.3109/00498259409043299] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
1. Six female Caucasian patients received i.v. doses of propofol (2.7 +/- 0.3 (SE) mg/kg) for induction of anaesthesia. Anaesthesia was maintained with nitrous oxide, oxygen and enflurane for periods up to 3 h. A total urine collection was made from each subject for 24 h after administration of propofol; samples were concentrated and analysed for propofol metabolites by nmr spectroscopy. 2. By 24 h, 50.9 +/- 4.0% of the dose of propofol was recovered as metabolites. The proportions of propofol metabolites, 1-quinol glucuronide (1-QG), 4-quinol glucuronide (4-QG), propofol glucuronide (PG) and 4-quinol sulphate (4-QS) recovered in urine (0-24 h) of the patients were 12 +/- 1, 8 +/- 2, 76 +/- 4 and 4 +/- 1% respectively. However, one patient showed a metabolite profile in which PG comprised 93% and 1-QG 7% of the total metabolites. 3. Nmr spectroscopy has been shown to be a satisfactory method for the quantification of propofol metabolites in urine without the necessity for reference samples.
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Schilling RJ, Crisci C, Judkins KC, Zoltie N, Sloan JP, Wright B, Mehanna H, Hatchett R. Should relatives watch resuscitation? No room for spectators. BMJ : BRITISH MEDICAL JOURNAL 1994. [DOI: 10.1136/bmj.309.6951.406] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Zoltie N, Sloan JP, Wright B. Should relatives watch resuscitation? May affect doctors' performance. BMJ (CLINICAL RESEARCH ED.) 1994; 309:406-7. [PMID: 7993440 PMCID: PMC2541225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Wright B. Waiting for a bed. ACCIDENT AND EMERGENCY NURSING 1994; 2:121. [PMID: 7953841 DOI: 10.1016/0965-2302(94)90155-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Simms M, Wright B, Rees J. Primary carcinoma of the gallbladder: atypical presentation with gangrenous cholecystitis. Can Assoc Radiol J 1994; 45:228-30. [PMID: 8193973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Primary carcinoma of the gallbladder developing in patients with longstanding ulcerative colitis is a rare but recognized complication. The authors describe a 45-year-old patient who presented with gangrenous cholecystitis, which was detected by ultrasonography.
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Hofmann P, Iljinov AS, Kim YS, Mebel MV, Daniel H, David P, Haninger T, Hartmann FJ, Jastrzebski J, Kurcewicz W, Lieb J, Machner H, Plendl HS, Riepe G, Wright B, Ziock K. Fission of heavy nuclei induced by stopped antiprotons. I. Inclusive characteristics of fission fragments. PHYSICAL REVIEW. C, NUCLEAR PHYSICS 1994; 49:2555-2568. [PMID: 9969504 DOI: 10.1103/physrevc.49.2555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Williams C, Wright B. Sleep loss in elderly people. Br J Gen Pract 1994; 44:236. [PMID: 8204344 PMCID: PMC1238879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Wright B. Immunity from pain. ACCIDENT AND EMERGENCY NURSING 1994; 2:61-2. [PMID: 7953835 DOI: 10.1016/0965-2302(94)90061-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Wright B. Reluctant patients. ACCIDENT AND EMERGENCY NURSING 1994; 2:1. [PMID: 7953819 DOI: 10.1016/0965-2302(94)90122-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Wright B. Health care and privacy law in electronic commerce. HEALTHCARE FINANCIAL MANAGEMENT : JOURNAL OF THE HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION 1994; 48:66, 68-70. [PMID: 10145935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
As electronic data interchange (EDI) continues to gain acceptance and use, questions regarding protection of the confidentiality of private healthcare information have arisen. This article explains how a computer-based information system equipped with appropriate safeguards can be far better at ensuring privacy than a paper-based system.
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Bozzette SA, McCutchan JA, Spector SA, Wright B, Richman DD. A cross-sectional comparison of persons with syncytium- and non-syncytium-inducing human immunodeficiency virus. J Infect Dis 1993; 168:1374-9. [PMID: 7902382 DOI: 10.1093/infdis/168.6.1374] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The association between isolation of the syncytium-inducing (SI) phenotype of human immunodeficiency virus (HIV) and unfavorable clinical and immune status was evaluated in a cross-sectional study. Data on HIV phenotype were available for 341 of 878 persons entering clinical trials of antiretroviral therapies. Patients with SI virus were demographically similar to those with non-SI (NSI) virus but were more likely to have a diagnosis of AIDS and detectable circulating HIV p24 antigen. Patients with SI virus also had a lower CD4+ cell count and a higher serum level of beta 2-microglobulin. The association between phenotype and present status was explained statistically by CD4+ cell count. Phenotype, serum level of beta 2-microglobulin, and the presence of detectable p24 antigen were all independent predictors of present CD4+ cell count. The likelihood of finding SI virus increased with unfavorable virologic and immunologic parameters and varied with the amount of prior antiretroviral therapy.
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Aoki FY, Yassi A, Cheang M, Murdzak C, Hammond GW, Seklà LH, Wright B. Effects of acetaminophen on adverse effects of influenza vaccination in health care workers. CMAJ 1993; 149:1425-30. [PMID: 8221426 PMCID: PMC1485900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To evaluate the effects of acetaminophen on the incidence of adverse effects to, and the immunogenicity of, whole-virus influenza vaccine in health care workers. DESIGN Prospective, randomized, double-blind placebo-controlled trial. SETTING Health Sciences Centre, an acute care teaching hospital in Winnipeg. PARTICIPANTS Of 474 hospital personnel who agreed to undergo influenza vaccination during the 1990-91 season 262 volunteered to participate in the study. INTERVENTIONS A dose of 0.5 mL of inactivated trivalent whole-virus influenza vaccine was injected into the deltoid muscle. Volunteers were randomly assigned to ingest two capsules of acetaminophen in a half dose (162.5 mg per capsule) or a full dose (325 mg per capsule) or two identical placebo capsules. Capsules were to be taken at vaccination and at 4, 8 and 12 hours afterward. Subjects were asked to answer questions regarding six symptoms in a diary for the 3 days after vaccination and to record their ingestion of the study medication. MAIN OUTCOME MEASURES Incidence of local (sore arm) and systemic (headache, fever, muscle ache, nausea and diarrhea) side effects as well as serum titres of hemagglutination inhibition (HAI) antibody to vaccine antigens before vaccination and 2 weeks and 6 months afterward. RESULTS A total of 87, 87 and 88 subjects received the half dose, full dose and placebo respectively; 96% returned the diaries, 83% ingested all four doses of medication, and 87% volunteered all blood samples. Compared with the placebo group the incidence of sore arm was 25% to 28% lower in the half-dose and full-dose groups respectively at 24 hours after vaccination, and the rate of nausea was 90% lower in the full-dose group. The HAI titres were similar among the groups at the three test times. CONCLUSIONS The full dose of acetaminophen significantly reduced the incidence of sore arm and nausea without affecting the antibody response. Acetaminophen use may increase the acceptance of influenza vaccine by health care workers in whom concern about side effects is an impediment to vaccination.
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Abadie JM, Wright B, Correa G, Browne ES, Porter JR, Svec F. Effect of dehydroepiandrosterone on neurotransmitter levels and appetite regulation of the obese Zucker rat. The Obesity Research Program. Diabetes 1993; 42:662-9. [PMID: 7683287 DOI: 10.2337/diab.42.5.662] [Citation(s) in RCA: 59] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The obese Zucker rat is a model of youth-onset obesity associated with hyperphagia. In this study, dehydroepiandrosterone's effect at decreasing food intake and body weight in the obese Zucker rat was investigated. Rats were treated with a dehydroepiandrosterone-supplemented diet (0.0, 0.06, 0.15, 0.3, or 0.6%) for 7 days. The 0.3 and 0.6% treatment groups showed a dramatic decrease in daily food intake, which was evident the 1st day. In addition to the reduction in food intake, body weight changes also were affected significantly in the high-dose treatment groups. The possibility that these dehydroepiandrosterone-induced changes were correlated to perturbations in central neurotransmitter levels associated with appetite control was investigated. The hypothalamus, frontal cortex, striatum, and hippocampus of dehydroepiandrosterone-treated animals were assayed for neurotransmitters known to have inhibitory or stimulatory effects on feeding behavior (serotonin, dopamine, norepinephrine, and epinephrine). Significant differences from steroid-free controls were noted only in the levels of hypothalamic serotonin in animals treated with dehydroepiandrosterone. Serotonin in the hypothalamus has been shown to decrease feeding behavior. The magnitude of dehydroepiandrosterone's effect on hypothalamic serotonin correlated with its effect on feeding behavior. Thus, dehydroepiandrosterone may reduce hyperphagia by altering hypothalamic levels of serotonin.
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