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Brand S, Daga S, Mistry K, Morsy M, Bagul A, Hamer R, Malik S. Sikh and Muslim perspectives on kidney transplantation: phase 1 of the DiGiT project - a qualitative descriptive study. BMJ Open 2023; 13:e059668. [PMID: 38040423 PMCID: PMC10693862 DOI: 10.1136/bmjopen-2021-059668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 10/06/2023] [Indexed: 12/03/2023] Open
Abstract
OBJECTIVES Kidney transplantation offers patients better quality of life and survival compared with dialysis. The risk of end stage renal disease is higher among ethnic minorities and they experience longer wait times on transplant lists. This inequality stems from a high need for kidney transplantation combined with a low rate of deceased donation among ethnic minority groups. This study aimed to explore the perspectives around living donor kidney transplantation of members of the Sikh and Muslim communities with an aim to develop a digital intervention to overcome any barriers. DESIGN A qualitative descriptive study using in person focus groups. SETTING University Teaching Hospital and Transplant Centre. PARTICIPANTS Convenience sampling of participants from the transplant population. Three focus groups were held with 20 participants, all were of South Asian ethnicity belonging to the Sikh and Muslim communities. METHODS Interviews were digitally audio-recorded and transcribed verbatim; transcripts were analysed thematically. RESULTS Four themes were identified: (a) religious issues; (b) lack of knowledge within the community; (c) time; (d) cultural identification with transplantation. CONCLUSIONS Not only is the information given and when it is delivered important, but also the person giving the information is crucial to enhance consideration of live donor kidney transplantation. Information should be in a first language where possible and overtly align to religious considerations. A more integrated approach to transplantation counselling should be adopted which includes healthcare professionals and credible members of the target cultural group. TRIAL REGISTRATION NUMBER NCT04327167.
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Affiliation(s)
- Sarah Brand
- Department of Nephrology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sunil Daga
- Department of Nephrology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kirit Mistry
- South Asian Health Action Charity, Leicester, UK
| | - Mohamed Morsy
- Department of Nephrology and Transplantation, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Atul Bagul
- Department of Nephrology and Transplantation, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Rizwan Hamer
- Department of Renal Transplantation and Nephrology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Shafi Malik
- Department of Nephrology and Transplantation, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Hamer R, Hameed A, Damery S, Jenkins K, Dasgupta I, Baharani J. Do we practice what we preach? Dialysis modality choice among healthcare workers in the United Kingdom. Semin Dial 2023; 36:407-413. [PMID: 37272333 DOI: 10.1111/sdi.13160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 05/16/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND In the United Kingdom, over 80% of end-stage kidney disease patients receive in-center hemodialysis. We conducted a survey of UK renal healthcare workers on their preferred dialysis modality if they needed dialysis themselves. METHODS An anonymized online survey was disseminated to all renal healthcare workers in the United Kingdom. We asked "Assume you are an otherwise well 40-year-old (and, separately, 75-year-old) person approaching end stage kidney disease, you have no living kidney donor options at present. There are no contraindications to any dialysis options. Which dialysis therapy would you choose?" We also asked about factors influencing their choice. RESULTS 858 individuals with a median age of 44.3 years responded. 70.2% were female, 37.4% doctors, and 31.1% were senior nurses. There was a preference for peritoneal dialysis over in-center hemodialysis (50.47% v. 6.18%; p < 0.001 for 40-year-old and 49.18% v. 17.83%; p < 0.001 for 75-year-old assumption) and home hemodialysis (50.47% v. 39.28%; p < 0.001 for 40-year-old and 49.18% v. 18.41% for 75-year-old assumption). There was a preference for home hemodialysis over in-center hemodialysis for 40-year-old (39.28% v. 6.18%; p < 0.001) but not for 75-year-old. On logistic regression, senior doctors were more likely to opt for PD when compared to nurses. Nurses, allied healthcare professionals, and those of Asian/British Asian ethnicity were more likely to choose in-center hemodialysis. CONCLUSIONS Most healthcare workers in renal medicine would choose home-based treatment for themselves although the majority of end-stage kidney disease patients receive in-center hemodialysis in the United Kingdom; the reasons for the discrepancy need to be explored.
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Affiliation(s)
- Rizwan Hamer
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | | | - Sarah Damery
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Karen Jenkins
- East Kent Hospitals University NHS Foundation Trust, Kent, UK
| | - Indranil Dasgupta
- Birmingham Heartlands Hospital, Birmingham, UK
- Warwick Medical School, University of Warwick, Coventry, UK
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Ringwaldt EM, Brook BW, Buettel JC, Cunningham CX, Fuller C, Gardiner R, Hamer R, Jones M, Martin AM, Carver S. Host, environment, and anthropogenic factors drive landscape dynamics of an environmentally transmitted pathogen: Sarcoptic mange in the bare-nosed wombat. J Anim Ecol 2023; 92:1786-1801. [PMID: 37221666 DOI: 10.1111/1365-2656.13960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/09/2023] [Indexed: 05/25/2023]
Abstract
Understanding the spatial dynamics and drivers of wildlife pathogens is constrained by sampling logistics, with implications for advancing the field of landscape epidemiology and targeted allocation of management resources. However, visually apparent wildlife diseases, when combined with remote-surveillance and distribution modelling technologies, present an opportunity to overcome this landscape-scale problem. Here, we investigated dynamics and drivers of landscape-scale wildlife disease, using clinical signs of sarcoptic mange (caused by Sarcoptes scabiei) in its bare-nosed wombat (BNW; Vombatus ursinus) host. We used 53,089 camera-trap observations from over 3261 locations across the 68,401 km2 area of Tasmania, Australia, combined with landscape data and ensemble species distribution modelling (SDM). We investigated: (1) landscape variables predicted to drive habitat suitability of the host; (2) host and landscape variables associated with clinical signs of disease in the host; and (3) predicted locations and environmental conditions at greatest risk of disease occurrence, including some Bass Strait islands where BNW translocations are proposed. We showed that the Tasmanian landscape, and ecosystems therein, are nearly ubiquitously suited to BNWs. Only high mean annual precipitation reduced habitat suitability for the host. In contrast, clinical signs of sarcoptic mange disease in BNWs were widespread, but heterogeneously distributed across the landscape. Mange (which is environmentally transmitted in BNWs) was most likely to be observed in areas of increased host habitat suitability, lower annual precipitation, near sources of freshwater and where topographic roughness was minimal (e.g. human modified landscapes, such as farmland and intensive land-use areas, shrub and grass lands). Thus, a confluence of host, environmental and anthropogenic variables appear to influence the risk of environmental transmission of S. scabiei. We identified that the Bass Strait Islands are highly suitable for BNWs and predicted a mix of high and low suitability for the pathogen. This study is the largest spatial assessment of sarcoptic mange in any host species, and advances understanding of the landscape epidemiology of environmentally transmitted S. scabiei. This research illustrates how host-pathogen co-suitability can be useful for allocating management resources in the landscape.
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Affiliation(s)
- E M Ringwaldt
- School of Natural Sciences, Biological Science, University of Tasmania, Hobart, Tasmania, Australia
| | - B W Brook
- School of Natural Sciences, Biological Science, University of Tasmania, Hobart, Tasmania, Australia
| | - J C Buettel
- School of Natural Sciences, Biological Science, University of Tasmania, Hobart, Tasmania, Australia
| | - C X Cunningham
- School of Natural Sciences, Biological Science, University of Tasmania, Hobart, Tasmania, Australia
- School of Environmental and Forest Sciences, University of Washington, Seattle, Washington, USA
| | - C Fuller
- School of Natural Sciences, Biological Science, University of Tasmania, Hobart, Tasmania, Australia
| | - R Gardiner
- School of Science, Engineering and Technology, University of Sunshine Coast, Sippy Downs, Queensland, Australia
| | - R Hamer
- School of Natural Sciences, Biological Science, University of Tasmania, Hobart, Tasmania, Australia
| | - M Jones
- School of Natural Sciences, Biological Science, University of Tasmania, Hobart, Tasmania, Australia
| | - A M Martin
- Caesar Kleberg Wildlife Research Institute, Texas A&M University-Kingsville, Kingsville, Texas, USA
| | - S Carver
- School of Natural Sciences, Biological Science, University of Tasmania, Hobart, Tasmania, Australia
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Selvaskandan H, Hull KL, Adenwalla S, Ahmed S, Cusu MC, Graham-Brown M, Gray L, Hall M, Hamer R, Kanbar A, Kanji H, Lambie M, Lee HS, Mahdi K, Major R, Medcalf JF, Natarajan S, Oseya B, Stringer S, Tabinor M, Burton J. Risk factors associated with COVID-19 severity among patients on maintenance haemodialysis: a retrospective multicentre cross-sectional study in the UK. BMJ Open 2022; 12:e054869. [PMID: 35636784 PMCID: PMC9152624 DOI: 10.1136/bmjopen-2021-054869] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To assess the applicability of risk factors for severe COVID-19 defined in the general population for patients on haemodialysis. SETTING A retrospective cross-sectional study performed across thirty four haemodialysis units in midlands of the UK. PARTICIPANTS All 274 patients on maintenance haemodialysis who tested positive for SARS-CoV-2 on PCR testing between March and August 2020, in participating haemodialysis centres. EXPOSURE The utility of obesity, diabetes status, ethnicity, Charlson Comorbidity Index (CCI) and socioeconomic deprivation scores were investigated as risk factors for severe COVID-19. MAIN OUTCOMES AND MEASURES Severe COVID-19, defined as requiring supplemental oxygen or respiratory support, or a C reactive protein of ≥75 mg/dL (RECOVERY trial definitions), and its association with obesity, diabetes status, ethnicity, CCI, and socioeconomic deprivation. RESULTS 63.5% (174/274 patients) developed severe disease. Socioeconomic deprivation associated with severity, being most pronounced between the most and least deprived quartiles (OR 2.81, 95% CI 1.22 to 6.47, p=0.015), after adjusting for age, sex and ethnicity. There was no association between obesity, diabetes status, ethnicity or CCI with COVID-19 severity. We found no evidence of temporal evolution of cases (p=0.209) or clustering that would impact our findings. CONCLUSION The incidence of severe COVID-19 is high among patients on haemodialysis; this cohort should be considered high risk. There was strong evidence of an association between socioeconomic deprivation and COVID-19 severity. Other risk factors that apply to the general population may not apply to this cohort.
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Affiliation(s)
- Haresh Selvaskandan
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Katherine L Hull
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Sherna Adenwalla
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Safa Ahmed
- Department of Renal Transplantation and Nephrology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Maria-Cristina Cusu
- Department of Renal Medicine, Northampton General Hospital NHS Trust, Northampton, UK
| | - Matthew Graham-Brown
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Laura Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Matt Hall
- Nottingham Renal and Transplant Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Rizwan Hamer
- Department of Renal Transplantation and Nephrology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Ammar Kanbar
- Department of Renal Medicine, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Hemali Kanji
- Department of Renal Transplantation and Nephrology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Mark Lambie
- School of Medicine, Keele University, Keele, UK
| | - Han Sean Lee
- Nottingham Renal and Transplant Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Khalid Mahdi
- Department of Renal Medicine, Lincoln County Hospital, Lincoln, UK
| | - Rupert Major
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Health Sciences, University Hospital of Leicester, Leicester, UK
| | - James F Medcalf
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | | | - Boavojuvie Oseya
- Department of Renal Medicine, Northampton General Hospital NHS Trust, Northampton, UK
| | - Stephanie Stringer
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Matthew Tabinor
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - James Burton
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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Selvaskandan H, Baharani J, Hamer R. Regional variations in nephrology trainee confidence with clinical skills may relate to the availability of local training opportunities in the UK: results from a national survey. Clin Exp Nephrol 2022; 26:886-897. [PMID: 35524893 PMCID: PMC9077353 DOI: 10.1007/s10157-022-02228-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/15/2022] [Indexed: 11/16/2022]
Abstract
Background The United Kingdom offers a standardised training program for nephrology fellows. However, local training opportunities vary resulting in mismatches between trainee interests and accessible opportunities. This may impact trainee confidence, satisfaction, and future service provision. Methods A survey assessing confidence with key procedures and sub-specialities was disseminated. Associations with region of training were probed using Chi square tests, with significance set at p < 0.0008 following a Bonferroni correction. Results were compared to trainee views on available opportunities for development. Results 139 responses were received (32% response rate, demographics representative of the UK nephrology trainee cohort). Procedural independence varied from 98% for temporary femoral vascular catheters to 5% for peritoneal dialysis catheters (PDIs). Independence with inserting tunnelled vascular catheters varied with region (p < 0.0001). Trainees expressed a desire for formal training in kidney ultrasound scanning and PDIs, corresponding with procedures they had least opportunity to become independent with. Trainees felt least confident managing kidney disease in pregnancy. Suggestions for improving training included protected time for garnering sub-speciality knowledge, developing procedural skills and for experiencing practice in other nephrology units. Conclusions A mismatch between trainee interests and professional development opportunities exists, which may threaten trainee autonomy and impact patient care particularly with regards to peritoneal dialysis. Provisions to facilitate trainee directed development need to be made while balancing the rigors of service provision. Such measures could prove critical to promoting trainee well-being and preventing attrition within the nephrology workforce.
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Affiliation(s)
- Haresh Selvaskandan
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK. .,Department of Cardiovascular Sciences, Mayer IgA Nephropathy Laboratories, University of Leicester, Hodgkin Building, Lancaster Road, Leicester, LE1 7HB, UK.
| | - Jyoti Baharani
- Department of Renal Medicine, Birmingham Heartlands Hospital, University Hospitals of Birmingham, Birmingham, UK
| | - Rizwan Hamer
- Department of Renal Transplantation and Nephrology, University Hospitals of Coventry and Warwickshire, Coventry, UK
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Kaies Ibrahim Elsayed Ali H, Mohamed M, Hamer R. MO700: Outcomes of Remote Patient Monitoring among Peritoneal Dialysis Population in the Covid-19 ERA. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac078.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Automated peritoneal dialysis (APD) is a growing PD modality but as with other home dialysis methods, the lack of monitoring of patients' adherence to prescriptions is a limitation with potential negative impact on clinical outcome parameters. Remote patient monitoring (RPM-PD) allowing the clinical team to have access to dialysis data and adjust the treatment may overcome this limitation. As a result of the coronavirus disease 2019 (COVID-19) pandemic, the importance of RPM programs has raised to allow the physicians ensure optimal care of PD patients. In addition, to avoid the increased risk of complications or technique failure, the present study sought to determine clinical outcomes associated with RPM use in patients on APD therapy.
METHOD
We performed a systematic review in PubMed, MEDLINE, Embase and Cochrane databases to select studies that met the inclusion criteria. The search terms used were: peritoneal dialysis, remote monitoring, sharesource, outcomes, peritonitis, hospitalization, technique failure and adherence. These search terms were individually used and then combined in different databases. References within the chosen studies were reviewed. We followed the recommendations of Cochrane collaboration and the Quality of Reporting of Meta-analyses guidelines. STATA package-15 was used. We combined all study-specific estimates using inverse-variant weighted averages of logarithmic relative risk in random effects model. Confidence interval including the value of 1 was used evident for statistically significant estimate. Heterogeneity was evaluated using the Higgins I² statistic. Heterogeneity was estimated when the level of P-value was < 0.1. Results of the random effects model were spread out on the forest plot graph.
RESULTS
Twenty-two studies were included in our meta-analysis. In qualitative analysis: five studies showed that RPM in APD patients had lower hospitalization rates compared to traditional PD. Five studies showed better adherence in the RPM-PD group. Five studies showed better outcomes among RPM-APD patients in terms of symptom control, management of fluid balance, blood pressure control, dialysis prescription and electrolyte management. Five studies showed that RPM-APD had better outcomes in terms of patient independence, quality of life, patient and caregiver satisfaction. Five studies showed better cost-effectiveness in RPM-PD compared to traditional PD. Four studies showed better cost-effectiveness in RMP-PD. Three studies showed lower technique failure rates in RPM-PD compared to traditional PD. Three studies showed lower mortality rates in RPM-PD compared to traditional PD. Three studies showed better quality of life and patient satisfaction in RPM-PD. In quantitative analysis, RPM-PD patients had lower rates of technique failure (log relative risk = −0.32, 95% CI: −0.59 to −0.04), lower hospitalization rates (SMD = −0.84, 95% CI: −1.24 to −0.45), lower mortality rates (log RR = −0.26, 95% CI: −0.44 to −0.08) in comparison to traditional PD.
CONCLUSION
RPM-PD has better outcomes in terms of cost-effectiveness, patient adherence, hospital admissions, rate of peritonitis, technique failure, mortality rates, symptom control, quality of life, patient and caregiver satisfaction.
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Affiliation(s)
| | | | - Rizwan Hamer
- University Hospitals of Coventry and Warwickshire, Renal, UK
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Malik S, Hamer R, Shabir S, Youssouf S, Morsy M, Rashid R, Waqar S, Ghouri N. Effects of fasting on solid organ transplant recipients during Ramadan - a practical guide for healthcare professionals. Clin Med (Lond) 2021; 21:e492-e498. [PMID: 38594852 DOI: 10.7861/clinmed.2021-0250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Fasting in the month of Ramadan is an obligatory act for healthy adult Muslims. It requires abstinence from food and drink from dawn to sunset. Although there are exemptions from fasting, many patients are keen to fulfil what they see as a religious obligation, even if this may be against medical advice in some cases. Solid organ transplant (SOT) recipients often ask healthcare professionals for advice on fasting. Studies on the effect of fasting in transplant patients have all been done in the Middle East and North Africa where the average fasting duration is between 12 and 14 hours. In comparison, in temperate regions in the summer, fasting duration can be as long as 20 hours. Fasting when patients have to take immunosuppression 12 hours apart with little time variation poses unique challenges. In this review, current literature is reviewed, and a decision-making tool has been developed to assist clinicians in discussing the risks of fasting in transplant recipients, with consideration also given to circumstances such as the COVID-19 pandemic. Our review highlights that SOT recipients wishing to fast should undergo a thorough risk assessment, ideally 3 months before Ramadan. They may require medication changes and a plan for regular monitoring of graft function and electrolytes in order to fast safely. Recommendations have been based on risk tiers (very high risk, high risk and low/moderate risk) established by the International Diabetes Federation and the Diabetes and Ramadan International Alliance. Patients in the 'very high risk' and 'high risk' categories should be encouraged to explore alternative options to fasting such as winter fasting or Fidyah. Those in the 'low/moderate' category may be able to cautiously fast with guidance from their clinician. Prior to the commencement of Ramadan, all patients must receive up-to-date education on sick-day rules, instructions on when to terminate their fast or abstain from fasting.
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Affiliation(s)
- Shafi Malik
- University Hospitals Coventry and Warwickshire NHS Trust, UK, and honorary clinical lecturer, University of Leicester, Leicester, UK.
| | - Rizwan Hamer
- University Hospitals Coventry and Warwickshire NHS Trust, UK
| | | | | | - Mohamed Morsy
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | | | - Nazim Ghouri
- University of Glasgow, Glasgow, UK, and consultant physician in diabetes, endocrinology and general medicine, Queen Elizabeth University Hospital, Glasgow, UK
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Malik S, Bhanji A, Abuleiss H, Hamer R, Shah SH, Rashad R, Junglee N, Waqar S, Ghouri N. Effects of fasting on patients with chronic kidney disease during Ramadan and practical guidance for healthcare professionals. Clin Kidney J 2021; 14:1524-1534. [PMID: 34079617 PMCID: PMC7929006 DOI: 10.1093/ckj/sfab032] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/11/2021] [Indexed: 12/30/2022] Open
Abstract
There are an estimated 1.8 billion Muslims worldwide, with the majority of them choosing to fast during the month of Ramadan. Fasting, which requires abstinence from food and drink from dawn to sunset can be up to 20 h per day during the summer months in temperate regions. Fasting can be especially challenging in patients on haemodialysis and peritoneal dialysis. Moreover, there is concern that those with chronic kidney disease (CKD) can experience electrolyte imbalance and worsening of renal function. In this article, current literature is reviewed and a decision-making management tool has been developed to assist clinicians in discussing the risks of fasting in patients with CKD, with consideration also given to circumstances such as the coronavirus disease 2019 pandemic. Our review highlights that patients with CKD wishing to fast should undergo a thorough risk assessment ideally within a month before Ramadan, as they may require medication changes and a plan for regular monitoring of renal function and electrolytes in order to fast safely. Recommendations have been based on risk tiers (very high risk, high risk and low-moderate risk) established by the International Diabetes Federation and the Diabetes and Ramadan International Alliance. Patients in the very high risk and high risk categories should be encouraged to explore alternative options to fasting, while those in the low-moderate category may be able to fast safely with guidance from their clinician. Prior to the commencement of Ramadan, all patients must receive up-to-date education on sick-day rules and instructions on when to terminate their fast or abstain from fasting.
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Affiliation(s)
- Shafi Malik
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK.,University of Leicester, Leicester, UK
| | - Amir Bhanji
- Wessex Kidney Centre, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | | | - Rizwan Hamer
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | | | - Naushad Junglee
- University Hospital Llandough, Cardiff and Vale, University Health Board, Cardiff, Wales
| | - Salman Waqar
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nazim Ghouri
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, Scotland.,Department of Diabetes and Endocrinology, Queen, Elizabeth University Hospital, Glasgow, Scotland
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Hameed M, Stephens C, Hamer R. Prevalence, indication and duration of proton pump inhibitor use in patients from unselected admissions. Clin Med (Lond) 2020; 20:s29. [DOI: 10.7861/clinmed.20-2-s29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Krishnan NS, Zehnder D, Daga S, Lowe D, Lam FT, Kashi H, Tan LC, Imray C, Hamer R, Briggs D, Raymond N, Higgins RM. Behaviour of non-donor specific antibodies during rapid re-synthesis of donor specific HLA antibodies after antibody incompatible renal transplantation. PLoS One 2013; 8:e68663. [PMID: 23922659 PMCID: PMC3724842 DOI: 10.1371/journal.pone.0068663] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 05/31/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND HLA directed antibodies play an important role in acute and chronic allograft rejection. During viral infection of a patient with HLA antibodies, the HLA antibody levels may rise even though there is no new immunization with antigen. However it is not known whether the converse occurs, and whether changes on non-donor specific antibodies are associated with any outcomes following HLA antibody incompatible renal transplantation. METHODS 55 patients, 31 women and 24 men, who underwent HLAi renal transplant in our center from September 2005 to September 2010 were included in the studies. We analysed the data using two different approaches, based on; i) DSA levels and ii) rejection episode post transplant. HLA antibody levels were measured during the early post transplant period and corresponding CMV, VZV and Anti-HBs IgG antibody levels and blood group IgG, IgM and IgA antibodies were quantified. RESULTS Despite a significant DSA antibody rise no significant non-donor specific HLA antibody, viral or blood group antibody rise was found. In rejection episode analyses, multiple logistic regression modelling showed that change in the DSA was significantly associated with rejection (p = 0.002), even when adjusted for other antibody levels. No other antibody levels were predictive of rejection. Increase in DSA from pre treatment to a post transplant peak of 1000 was equivalent to an increased chance of rejection with an odds ratio of 1.47 (1.08, 2.00). CONCLUSION In spite of increases or decreases in the DSA levels, there were no changes in the viral or the blood group antibodies in these patients. Thus the DSA rise is specific in contrast to the viral, blood group or third party antibodies post transplantation. Increases in the DSA post transplant in comparison to pre-treatment are strongly associated with occurrence of rejection.
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Affiliation(s)
- Nithya S Krishnan
- Department of Nephrology, University Hospitals Coventry and Warwickshire National Health Service Trust, Coventry, United Kingdom.
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Sinha D, Lambie M, Krishnan N, McSorley K, Hamer R, Lowe D, Briggs D, Fletcher S, Zehnder D, Higgins RM. Cryofiltration in the Treatment of Cryoglobulinemia and HLA Antibody-Incompatible Transplantation. Ther Apher Dial 2011; 16:91-6. [DOI: 10.1111/j.1744-9987.2011.01004.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hamer R, Krishnan N, Lowe D, Briggs D, Zehnder D, Higgins R. C5b-9 inhibitor (eculizumab) for antibody-mediated rejection in renal transplantation. Indian Journal of Transplantation 2011. [DOI: 10.1016/s2212-0017(11)60120-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Higgins R, Lowe D, Hathaway M, Lam FT, Kashi H, Tan LC, Imray C, Fletcher S, Chen K, Krishnan N, Hamer R, Zehnder D, Briggs D. Double filtration plasmapheresis in antibody-incompatible kidney transplantation. Ther Apher Dial 2010; 14:392-9. [PMID: 20649760 DOI: 10.1111/j.1744-9987.2010.00821.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Double filtration plasmapheresis (DFPP) was used in preference to plasma exchange in our program of antibody-incompatible transplantation, to treat higher volumes of plasma. Forty-two patients had 259 sessions of DFPP, 201 pre-transplant and 58 post-transplant. At the first treatment session, the mean plasma volume treated was 3.81 L (range 3-6 L), 55.5 mL/kg (range 36.2-83.6 mL/kg). Serum IgG fell by mean 59.4% (SD 10.2%), and IgM by 69.3% (SD 16.1%). Nine patients did not require increases in plasma volumes treated, and six did not tolerate higher plasma volumes. In the remaining patients, the mean maximum plasma volume treated pre-transplant was 6.67 L (range 4-15 L), 96.1 mL/kg (range 60.2-208.9 mL/kg). The complement dependent cytotoxic crossmatch was positive in 14 cases pre-treatment, and remained positive in six (42.8%) cases. The flow cytometric crossmatch was positive in 29 cases pre-treatment, and in 21 (72.4%) after DFPP. Post-transplant, DFPP was ineffective at reducing donor specific antibody levels during periods of rapid donor specific antibody synthesis. Post-transplant, the one year graft survival rate was 94%, although there was a high rate of early rejection. In summary, DFPP enabled the treatment of plasma volumes that were almost double those that would have been feasible with plasma exchange. Despite this, most patients were transplanted with a positive crossmatch, and DFPP post-transplant was unable to control rising antibody levels.
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Affiliation(s)
- Rob Higgins
- Transplant Unit, University Hospitals Coventry and Warwickshire, Coventry, UK.
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14
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Lowe D, Higgins R, Zehnder D, Hathaway M, Hamer R, Krishnan N, Briggs D. THE SINGNIFICANCE OF IGG SUBCLASSES IN HLA ANTIBODY INCOMPATIBLE KIDNEY TRANSPLANTATION. Transplantation 2010. [DOI: 10.1097/00007890-201007272-00514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Higgins R, Zehnder D, Chen K, Lowe D, McKinnell J, Lam FT, Kashi H, Tan LC, Imray C, Fletcher S, Krishnan N, Hamer R, Briggs D. The histological development of acute antibody-mediated rejection in HLA antibody-incompatible renal transplantation. Nephrol Dial Transplant 2009; 25:1306-12. [DOI: 10.1093/ndt/gfp610] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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16
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Heytens E, Parrington J, Coward K, Young C, Lambrecht S, Yoon SY, Fissore RA, Hamer R, Deane CM, Ruas M, Grasa P, Soleimani R, Cuvelier CA, Gerris J, Dhont M, Deforce D, Leybaert L, De Sutter P. Reduced amounts and abnormal forms of phospholipase C zeta (PLCzeta) in spermatozoa from infertile men. Hum Reprod 2009; 24:2417-28. [PMID: 19584136 DOI: 10.1093/humrep/dep207] [Citation(s) in RCA: 197] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In mammals, oocyte activation at fertilization is thought to be induced by the sperm-specific phospholipase C zeta (PLCzeta). However, it still remains to be conclusively shown that PLCzeta is the endogenous agent of oocyte activation. Some types of human infertility appear to be caused by failure of the sperm to activate and this may be due to specific defects in PLCzeta. METHODS AND RESULTS Immunofluorescence studies showed PLCzeta to be localized in the equatorial region of sperm from fertile men, but sperm deficient in oocyte activation exhibited no specific signal in this same region. Immunoblot analysis revealed reduced amounts of PLCzeta in sperm from infertile men, and in some cases, the presence of an abnormally low molecular weight form of PLCzeta. In one non-globozoospermic case, DNA analysis identified a point mutation in the PLCzeta gene that leads to a significant amino acid change in the catalytic region of the protein. Structural modelling suggested that this defect may have important effects upon the structure and function of the PLCzeta protein. cRNA corresponding to mutant PLCzeta failed to induce calcium oscillations when microinjected into mouse oocytes. Injection of infertile human sperm into mouse oocytes failed to activate the oocyte or trigger calcium oscillations. Injection of such infertile sperm followed by two calcium pulses, induced by assisted oocyte activation, activated the oocytes without inducing the typical pattern of calcium oscillations. CONCLUSIONS Our findings illustrate the importance of PLCzeta during fertilization and suggest that mutant forms of PLCzeta may underlie certain types of human male infertility.
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Affiliation(s)
- E Heytens
- Department of Reproductive Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
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Higgins R, Hamer R, Briggs D, Krishnan N, Fletcher S, Short A, Lowe D, McSorley K, Zehnder D. DOUBLE FILTRATION PLASMAPHERESIS FACILITATES HLA ANTIBODY INCOMPATIBLE RENAL TRANSPLANTATION, BUT IS LESS EFFECTIVE DURING ANTIBODY RESYNTHESIS POST-TRANSPLANTATION. Transplantation 2008. [DOI: 10.1097/01.tp.0000332340.71206.d0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Higgins R, Zehnder D, Chen K, Fletcher S, Kashi H, Tan LC, Imray C, Lam FT, Hamer R, Krishnan N. TREATMENT OF ACUTE ANTIBODY-MEDIATED REJECTION; SPECIFIC ANTI-T LYMPHOCYTE THERAPY IS EFFECTIVE, WHILE SPECIFIC ANTI-B LYMPHOCYTE THERAPY IS NOT. Transplantation 2008. [DOI: 10.1097/01.tp.0000331112.79328.8a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Higgins R, Hathaway M, Lowe D, Zehnder D, Krishnan N, Hamer R, Briggs D. NEW CHOICES FOR PATIENTS NEEDING KIDNEY TRANSPLANTATION ACROSS ANTIBODY BARRIERS. J Ren Care 2008; 34:85-93. [DOI: 10.1111/j.1755-6686.2008.00025.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Esnouf RM, Hamer R, Sussman JL, Silman I, Trudgian D, Yang ZR, Prilusky J. Honing thein silicotoolkit for detecting protein disorder. Acta Crystallogr D Biol Crystallogr 2006; 62:1260-6. [PMID: 17001103 DOI: 10.1107/s0907444906033580] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2006] [Accepted: 08/21/2006] [Indexed: 11/10/2022]
Abstract
Not all proteins form well defined three-dimensional structures in their native states. Some amino-acid sequences appear to strongly favour the disordered state, whereas some can apparently transition between disordered and ordered states under the influence of changes in the biological environment, thereby playing an important role in processes such as signalling. Although important biologically, for the structural biologist disordered regions of proteins can be disastrous even preventing successful structure determination. The accurate prediction of disorder is therefore important, not least for directing the design of expression constructs so as to maximize the chances of successful structure determination. Such design criteria have become integral to the construct-design strategies of laboratories within the Structural Proteomics In Europe (SPINE) consortium. This paper assesses the current state of the art in disorder prediction in terms of prediction reliability and considers how best to use these methods to guide construct design. Finally, it presents a brief discussion as to how methods of prediction might be improved in the future.
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Affiliation(s)
- Robert M Esnouf
- Division of Structural Biology, University of Oxford, Wellcome Trust Centre for Human Genetics, Oxford, England.
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21
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Albeck S, Alzari P, Andreini C, Banci L, Berry IM, Bertini I, Cambillau C, Canard B, Carter L, Cohen SX, Diprose JM, Dym O, Esnouf RM, Felder C, Ferron F, Guillemot F, Hamer R, Ben Jelloul M, Laskowski RA, Laurent T, Longhi S, Lopez R, Luchinat C, Malet H, Mochel T, Morris RJ, Moulinier L, Oinn T, Pajon A, Peleg Y, Perrakis A, Poch O, Prilusky J, Rachedi A, Ripp R, Rosato A, Silman I, Stuart DI, Sussman JL, Thierry JC, Thompson JD, Thornton JM, Unger T, Vaughan B, Vranken W, Watson JD, Whamond G, Henrick K. SPINE bioinformatics and data-management aspects of high-throughput structural biology. Acta Crystallogr D Biol Crystallogr 2006; 62:1184-95. [PMID: 17001095 PMCID: PMC7161634 DOI: 10.1107/s090744490602991x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Accepted: 07/31/2006] [Indexed: 05/12/2023]
Abstract
SPINE (Structural Proteomics In Europe) was established in 2002 as an integrated research project to develop new methods and technologies for high‐throughput structural biology. Development areas were broken down into workpackages and this article gives an overview of ongoing activity in the bioinformatics workpackage. Developments cover target selection, target registration, wet and dry laboratory data management and structure annotation as they pertain to high‐throughput studies. Some individual projects and developments are discussed in detail, while those that are covered elsewhere in this issue are treated more briefly. In particular, this overview focuses on the infrastructure of the software that allows the experimentalist to move projects through different areas that are crucial to high‐throughput studies, leading to the collation of large data sets which are managed and eventually archived and/or deposited.
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Affiliation(s)
- S Albeck
- The Israel Proteomics Center, The Department of Structural Biology, The Weizmann Institute of Science, Rehovot, Israel
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22
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Affiliation(s)
- Rizwan Hamer
- Renal Unit, Morriston Hospital, Morriston, Swansea SA6 6NL, Wales, UK.
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23
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Abstract
We analyze the determinants of HMO information technology outsourcing using two studies. Study 1 examines the effect of asset specificity on outsourcing for development and operation activities, using HMO specific fixed effects to control for differences between HMOs. Study 2 regresses the HMO specific fixed effects from Study 1, which measure an HMO's propensity to outsource, on HMO characteristics. The data comes from a 1995 InterStudy survey about information technology organization of HMOs. While HMOs split roughly equally in outsourcing information technology development activities, they are extremely unlikely to outsource the day-to-day operation of information systems. The greater an HMO's information technology capability and the complexity of information systems supported, the less likely is an HMO to outsource. While HMOs less than two years old, for-profit HMOs, local or Blue Cross-affiliated HMOs, and mixed HMOs are more likely to outsource, federally qualified HMOs are less likely to outsource. Policy and managerial implications for the adoption and diffusion of new ways of organizing information technology, such as application service providers (ASPs), are discussed.
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Affiliation(s)
- D R Wholey
- Division of Health Services Research, University of Minnesota, Minneapolis 55455-0392, USA.
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24
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Fiedler N, Kelly-McNeil K, Mohr S, Lehrer P, Opiekun RE, Lee C, Wainman T, Hamer R, Weisel C, Edelberg R, Lioy PJ. Controlled human exposure to methyl tertiary butyl ether in gasoline: symptoms, psychophysiologic and neurobehavioral responses of self-reported sensitive persons. Environ Health Perspect 2000; 108:753-63. [PMID: 10964796 PMCID: PMC1638278 DOI: 10.1289/ehp.00108753] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The 1990 Clean Air Act mandated oxygenation of gasoline in regions where carbon monoxide standards were not met. To achieve this standard, methyl tertiary butyl ether (MTBE) was increased to 15% by volume during winter months in many locations. Subsequent to the increase of MTBE in gasoline, commuters reported increases in symptoms such as headache, nausea, and eye, nose, and throat irritation. The present study compared 12 individuals selected based on self-report of symptoms (self-reported sensitives; SRSs) associated with MTBE to 19 controls without self-reported sensitivities. In a double-blind, repeated measures, controlled exposure, subjects were exposed for 15 min to clean air, gasoline, gasoline with 11% MTBE, and gasoline with 15% MTBE. Symptoms, odor ratings, neurobehavioral performance on a task of driving simulation, and psychophysiologic responses (heart and respiration rate, end-tidal CO(2), finger pulse volume, electromyograph, finger temperature) were measured before, during, and immediately after exposure. Relative to controls, SRSs reported significantly more total symptoms when exposed to gasoline with 15% MTBE than when exposed to gasoline with 11% MTBE or to clean air. However, these differences in symptoms were not accompanied by significant differences in neurobehavioral performance or psychophysiologic responses. No significant differences in symptoms or neurobehavioral or psychophysiologic responses were observed when exposure to gasoline with 11% MTBE was compared to clean air or to gasoline. Thus, the present study, although showing increased total symptoms among SRSs when exposed to gasoline with 15% MTBE, did not support a dose-response relationship for MTBE exposure nor the symptom specificity associated with MTBE in epidemiologic studies.
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Affiliation(s)
- N Fiedler
- UMDNJ-Robert Wood Johnson Medical School, Department of Environmental and Community Medicine, Piscataway, New Jersey 08854, USA.
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25
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Abstract
This article examines the information technology functions, staffing and cost, services provided, and advanced technologies among health maintenance organizations (HMOs) using a national sample of HMOs from mid-1995. HMOs have a well-developed capability to use data from administrative functions, such as claims processing. Nationally affiliated HMOs and HMOs in markets with greater HMO penetration support more IT functions. Relatively little work has been completed integrating clinical with administrative systems.
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Affiliation(s)
- D R Wholey
- Division of Health Services Research and Policy, School of Public Health, University of Minnesota, Minneapolis, USA
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26
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Hamer R. Goals 2000: for MDs: managerial competency. For HMOs: administrative retooling. Manag Care 1999; 8:38. [PMID: 10977322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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27
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Abstract
The growth of managed care in general suggests that a substantially larger number of rural primary care physicians will be asked to enter into risk-bearing contracts with Health Maintenance Organizations (HMOs) in the near future. This article describes the different types of payment and risk-sharing arrangements that exist between HMOs and primary care physicians and presents survey data relating to their prevalence in rural areas. Also, it describes in detail the payment arrangements used by four HMOs that contract with rural primary care physicians. The concluding discussion highlights policy issues regarding risk-sharing arrangements that are especially pertinent in rural settings.
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Affiliation(s)
- J B Christianson
- Institute for Health Services Research, School of Public Health, University of Minnesota, Minneapolis 55455, USA
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28
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Abstract
After leaving in-vitro fertilization (IVF) treatment, both successful and unsuccessful women are generally lost to follow-up. In order to assess overall life satisfaction as well as marital and sexual adjustment after the completion of infertility treatment, three groups of women were studied: group 1 (n = 41), successful IVF women; group 2 (n = 16), unsuccessful IVF women who adopted; and group 3 (n = 18), unsuccessful IVF women who remained childless. All women who had completed a minimum of three IVF cycles between the years 1982 and 1993 were invited to participate in a 'life after infertility' follow-up study. Those who agreed were mailed a lengthy questionnaire which included questions about their reproductive history and infertility treatment, the impact of infertility on their marital and sexual relationship and their final thoughts about treatment. Four standardized questionnaires were also administered. Results revealed that women who became biological mothers through IVF were significantly more satisfied with their lives than women who were unsuccessful in IVF and remained childless (F = 8.62, P < 0.001). Childless women reported that infertility had exerted a significantly greater negative impact on their marriages than that reported by the other two groups. There were no significant differences, however, between the three groups on the standardized measures of marital and sexual satisfaction.
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Affiliation(s)
- S R Leiblum
- Department of Psychiatry, UMDNJ-Robert Wood Johnson Medical School, Piscataway, NJ, USA
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29
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Sleeper S, Wholey DR, Hamer R, Schwartz S, Inoferio V. Trust me: technical and institutional determinants of health maintenance organizations shifting risk to physicians. J Health Soc Behav 1998; 39:189-200. [PMID: 9785693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
This paper examines the factors that influence a Health Maintenance Organization (HMO) to shift risk to doctors through an incentive arrangement called capitation, where physicians are paid a fixed amount per patient for a period of time for any and all medical services required by the patient. Multispecialty-medical-group (Group) HMOs are more likely to shift risk than Independent Physician Associations (IPA) HMOs. Within IPA HMOs, larger enrollment per physician is positively associated with more risk shifting. We find that institutional factors signaling legitimacy play an important role in determining risk shifting. For-profit HMOs are less likely to shift risk, which we interpret as reflecting consumer distrust of for-profit HMOs. However, for-profit HMOs that are federally qualified, which we interpret as a signal of legitimacy, are more likely to shift risk.
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Affiliation(s)
- S Sleeper
- Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, PA 15213-3890, USA. ssaz+@andrew.cmu.edu
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30
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Lehrer P, Carr RE, Smetankine A, Vaschillo E, Peper E, Porges S, Edelberg R, Hamer R, Hochron S. Respiratory sinus arrhythmia versus neck/trapezius EMG and incentive inspirometry biofeedback for asthma: a pilot study. Appl Psychophysiol Biofeedback 1997; 22:95-109. [PMID: 9341966 DOI: 10.1023/a:1026224211993] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This pilot study compared biofeedback to increase respiratory sinus arrhythmia (RSA) with EMG and incentive inspirometry biofeedback in asthmatic adults. A three-group design (Waiting List Control n = 5, RSA biofeedback n = 6, and EMG biofeedback n = 6) was used. Six sessions of training were given in each of the biofeedback groups. In each of three testing sessions, five min. of respiratory resistance and EKG were obtained before and after a 20-min biofeedback session. Additional five-min epochs of data were collected at the beginning and end of the biofeedback period (or, in the control group, self-relaxation). Decreases in respiratory impedance occurred only in the RSA biofeedback group. Traub-Hering-Mayer (THM) waves (.03-.12 Hz) in heart period increased significantly in amplitude during RSA biofeedback. Subjects did not report significantly more relaxation during EMG or RSA biofeedback than during the control condition. However, decreases in pulmonary impedance, across groups, were associated with increases in relaxation. The results are consistent with Vaschillo's theory that RSA biofeedback exercises homeostatic autonomic reflex mechanisms through increasing the amplitude of cardiac oscillations. However, deep breathing during RSA biofeedback is a possible alternate explanation.
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Affiliation(s)
- P Lehrer
- UMDNJ-RW Johnson Medical School, Piscataway, NJ 08854, USA
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31
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Hamer R, VanAntwerp S. Study results show decline in HMO operating margins. Healthc Financ Manage 1997; 51:78-80, 82, 84. [PMID: 10167846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
In the early 1990s, virtually all HMOs reported healthy profits, especially in markets with low managed care penetration. However, a recent survey has revealed that HMO operating margins experienced sharp declines in 1995. Some reasons for these declines include: more competition as the healthcare marketplace has become more saturated with HMOs; aggressive price negotiations by employers; and rising HMO medical and administrative expenses. The study also revealed that all types of HMOs experienced operating margin declines, demonstrating that organizational structure was an unlikely contributing factor.
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Affiliation(s)
- R Hamer
- InterStudy Publications, Bloomington, MN, USA
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32
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Abstract
Exertional rhabdomyolysis occurs when exercise, often of the eccentric type, damages myofibrils and sarcolemma, with release of the enzyme creatine kinase and pigmented myoglobin into the serum. Severe muscle soreness and dark urine are the hallmark symptoms, and renal failure may develop. Formerly a disease of military recruits, it is now seen more often in exercisers. Although a genetic trait may predispose, the illness probably can be avoided by common sense behavior such as a gradual increase in exercise intensity, proper hydration before, during, and after exercise, and avoiding exercise in extremely hot or humid environments.
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Affiliation(s)
- R Hamer
- Department of Student Health, University of California, Santa Barbara, USA
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33
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Abstract
A 2-item questionnaire was derived from 10 DSM-IV criteria for pathological gambling. Subjects were 362 men, 191 classified as pathological gamblers and 171 as nonproblem-gambling controls. The two items were significant in sensitivity and negative predictive value and significant in specificity and positive predictive value.
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Affiliation(s)
- E E Johnson
- Psychiatry Department, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Piscataway 08854, USA
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34
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Keller Ashton A, Hamer R, Rosen RC. Serotonin reuptake inhibitor-induced sexual dysfunction and its treatment: a large-scale retrospective study of 596 psychiatric outpatients. J Sex Marital Ther 1997; 23:165-175. [PMID: 9292832 DOI: 10.1080/00926239708403922] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
In the present study, a large-scale retrospective case review was undertaken to assess the incidence and type of sexual dysfunctions associated with serotonin reuptake inhibitor (SRI) therapy, in addition to the effects of three pharmacological antidotes (yohimbine, amantadine, cyproheptadine) on SRI-induced sexual dysfunctions. A retrospective chart review was conducted on 596 patients treated with SRIs in an outpatient psychiatric practice between July 1991 and September 1994. Patients who reported new-onset sexual dysfunction during this time were categorized as having SRI-induced sexual dysfunctions. Sexual difficulties were characterized by type and duration, and the background characteristics and psychiatric diagnoses of all patients were recorded. Psychiatric outcome and sexual functioning at follow-up were independently assessed by a single psychiatrist by means of a 4-point rating scale. Sexual dysfunction symptoms were clearly associated with SRI administration in 97 (16.3%) cases. The most common problems reported were orgasmic delay or anorgasmia and hypoactive sexual desire. Sexual difficulties were more frequent among men (23.4%) and married patients of both sexes (22.3%), whereas psychiatric diagnosis and type of SRI were unrelated to the occurrence of sexual problems. Of the patients with sexual dysfunction, 45 (46.4%) opted for a trial of antidote therapy with yohimbine, amantadine, or cyproheptadine. All three antidotes were found to be safe and relatively effective, although yohimbine was significantly more effective than amantadine or cyproheptadine in reversing SRI-induced sexual dysfunction.
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35
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Hamer R. Hypoglycemia in bosnia. West J Med 1996; 165:399. [PMID: 18751059 PMCID: PMC1303889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- R Hamer
- Student Health Service, University of California, Santa Barbara
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36
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Lehrer PM, Hochron S, Carr R, Edelberg R, Hamer R, Jackson A, Porges S. Behavioral task-induced bronchodilation in asthma during active and passive tasks: a possible cholinergic link to psychologically induced airway changes. Psychosom Med 1996; 58:413-22. [PMID: 8902893 DOI: 10.1097/00006842-199609000-00004] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This study investigated pulmonary and autonomic reactions to active and passive behavioral laboratory tasks among asthmatic subjects. It also examined the relationship between airway irritability, as measured by the methacholine challenge test (MCT), and autonomic activity and reactivity to these tasks. Fifty-one asthmatic and 37 nonasthmatic subjects were exposed to psychological laboratory tasks involving either active (mental arithmetic and reaction time) or passive (films depicting shop accidents and thoracic surgery) response. The MCT was given to asthmatics in a separate session. Active tasks reduced respiratory impedance, as measured by forced oscillation pneumography. They also increased heart rate and appeared to block vagal activity, as measured by respiratory sinus arrhythmia (RSA). Airway irritability as assessed by the MCT was positively related to amplitude of RSA and to skin conductance levels. Our data suggest that active and passive behavioral tasks may produce different pulmonary effects among both asthmatic and nonasthmatic individuals. Engaging in tasks requiring active responses may produce temporary improvements in pulmonary function. No autonomic differences were obtained between asthmatics and nonasthmatics in physiological response to stress, but greater cholinergic receptor sensitivity was suggested among high responders to methacholine.
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Affiliation(s)
- P M Lehrer
- Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, Department of Psychiatry, Piscataway 08854-5635, USA
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Abstract
A Forum for Our Readers Forum provides an opportunity for our readers to comment on the articles that we publish. Illustrative figures are welcome. Address correspondence to Forum, The Physician and Sportsmedicine, 4530 W 77th St, Minneapolis, MN 55435.
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Affiliation(s)
- R Hamer
- a Santa Barbara , California
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Slappendel RJ, Frielink RA, Mol JA, Noordzij A, Hamer R. An enzyme-linked immunosorbent assay (ELISA) for von Willebrand factor antigen (vWf-Ag) in canine plasma. Vet Immunol Immunopathol 1992; 33:145-54. [PMID: 1632075 DOI: 10.1016/0165-2427(92)90041-n] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A quantitative enzyme-linked immunosorbent assay (ELISA) has been developed to measure canine von Willebrand factor antigen (vWf-Ag) in plasma of the dog. A vWf-Ag antiserum was raised in rabbits and purified by preabsorption with the low molecular weight vWf-Ag-deficient fraction of canine cryoprecipitate, followed by affinity chromatography on protein-A Sepharose. The rabbit anticanine vWf-Ag IgG was used to bind the vWf-Ag of the test plasmas to the solid phase and to prepare the enzyme-antibody conjugate in ELISA. Normal rat serum was used as blocking agent. The standard curve was linear (r2 greater than 0.98) and reproducible after logit-log transformation. The interassay coefficient of variation (CV) in test plasmas with various vWf-Ag concentrations was never greater than 7.7%. Assayed values in dilutions of pooled normal canine plasma added to canine vWf-Ag-deficient plasma were linear between 0 and 100% (r2 = 0.99) and indicated excellent analytical recovery of vWf-Ag. In 18 dogs with various internal diseases, including von Willebrand's disease and haemophilia A, the coefficient of correlation between the results of the ELISA and those of electroimmunodiffusion (EID) was 0.93.
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Affiliation(s)
- R J Slappendel
- Department of Clinical Sciences of Companion Animals, Medical Faculty, University of Utrecht, Netherlands
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Abstract
Is the NaCl signal perceived as a small increase in the concentration of NaCl in extracellular fluid? We used 8 g NaCl/100 g soluble nutrients and fed only a hypertonic (1.4% NaCl) or a hypotonic (0.45% NaCl) drink to Dahl salt-sensitive (DS) rats. After 12 weeks, 11 rats receiving the hypertonic drink had a mean blood pressure of 195 mm Hg versus 195 mm Hg in 12 rats receiving the hypotonic drink. Thus, the high-NaCl signal seems unrelated to a higher NaCl concentration in extracellular fluid, thereby suggesting volume signals. Most volume controls are near the third brain ventricle (3V). As a working hypothesis, high dietary NaCl may swell the tissues surrounding 3V, which is slitlike. Such swelling would partially close the upper part of the slit and cause ependymal cells and nerve fibers on opposite walls to touch, possibly leading to hypertension in susceptible humans or rats. To test this, we stereotaxically blocked the aqueduct with inert silicone to produce hydrocephalus of 3V in DS rats and thus prevent ependymal cells and nerve fibers from touching. After blocking or sham-blocking the aqueduct, either a 6% NaCl diet or a 0.23% NaCl diet was started. Intra-arterial blood pressure was taken after 6 weeks. A group of 28 sham-blocked rats and a group of 29 blocked rats, all fed a 0.23% low NaCl diet, had equal blood pressures averaging 130 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J Y Lee
- University of Minnesota Hospital, Minneapolis, Minnesota 55455
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Colenda CC, Schoedel K, Hamer R. The delivery of health services to demented patients at a university hospital: a pilot study. Gerontologist 1988; 28:659-62. [PMID: 3229650 DOI: 10.1093/geront/28.5.659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Ngwingtin L, Hardy F, Hamer R, Glomaud D. [Changes in the pH and volume of gastric contents during pregnancy and labor]. Cah Anesthesiol 1987; 35:607-9. [PMID: 3442755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We measured the volume and pH of gastric contents of 97 patients after induction of anaesthesia. The patients were divided into 3 groups: group I (N = 39): elective cesarean section, group II (N = 44): elective gynecological surgery, group III (N = 14): emergency cesarean section. The study was undertaken to ascertain whether pregnancy and labour would modify the volume and mean pH of gastric contents. Mean pH of gastric contents in the 3 groups were respectively 2.57; +/- 0.23; 3.21 +/- 0.29; and 2.77 +/- 0.42. There were no significant differences between the groups: Pregnancy and labour do not influence gastric pH. As far as gastric volume is concerned there is a significant difference between Group I and III (p less than 0.01) and Group II and III (p less than 0.01).
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Affiliation(s)
- L Ngwingtin
- Département d'Anesthésie-Réanimation, Hôpital Delafontaine, Saint-Denis
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Levenson JL, Hamer R, Silverman JJ, Rossiter LF. Psychopathology in medical inpatients and its relationship to length of hospital stay: a pilot study. Int J Psychiatry Med 1986; 16:231-6. [PMID: 3804584 DOI: 10.2190/k51b-h0vh-cf2k-d0wj] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A composite screening instrument measuring depression, anxiety, cognitive dysfunction, and pain identified 40 percent of a sample of general medical inpatients (30% of total patients before exclusions) as having significant psychopathology or pain, a reasonable number based on clinical incidence literature. These identified patients' hospital length of stay did not differ from the length of stay for other patients. The screen identified 21 percent as very depressed, 19 percent as very anxious, 15 percent as having cognitive dysfunction, and 11 percent with high pain levels. Depression, anxiety, and pain frequently occurred together. Further study is required to refine the instrument and assess its effectiveness at targeting patients for psychiatric intervention.
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Schulz PM, Schulz SC, Hamer R, Resnick RJ, Friedel RO, Goldberg SC. The impact of borderline and schizotypal personality disorders on patients and their families. Hosp Community Psychiatry 1985; 36:879-81. [PMID: 4029915 DOI: 10.1176/ps.36.8.879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Roelofsen B, Sanderink G, Middelkoop E, Hamer R, Op den Kamp JA. Murine erythrocytes contain high levels of lysophospholipase activity. Biochim Biophys Acta 1984; 792:99-102. [PMID: 6692003 DOI: 10.1016/0005-2760(84)90288-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Murine erythrocytes were found to be unique in the high levels of lysophospholipase activity in the cytosol of these cells. The specific activity of the enzyme in the cytosol of the murine cells is 10-times higher than in the cytosol of rabbit erythrocytes and approximately three orders of magnitude higher than those in the red cells of rat, man, pig and ox.
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Abstract
Two cases of retropharyngeal abscess are presented. The first case, that of a 4-year-old boy, was classical, diagnosed early, and treated with prompt incision and drainage. The second case was that of a 51-year-old man who developed complete upper airway obstruction, pneumothorax, and congestive heart failure prior to surgical drainage. These cases are presented to remind emergency physicians of this formidable entity and of the need for constant vigil in the management of this life-threatening pre-antibiotic relic.
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Ruchlin HS, Hamer R, Braham RL. Cost of hospital care and third party payer reimbursement. N Y State J Med 1981; 81:411-5. [PMID: 6938841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Abstract
A female drug abuser inadvertently injected an intravenous injection of an oral anorexiant, phentaramine (Preludin), into her own brachial artery. Severe hand pain, vasospasm, and ischemia occurred. Treatment with regional axillary block, intravenous dextran, intra-arterial priscoline, and salicylate anticoagulation may have influenced a favorable outcome. Intimal damage, vasospasm, and various additive effects after intra-arterial injection contribute to the potential for serious sequelae. Prompt diagnosis, vasodilatation, elevation and compression, pain relief and, in some cases, surgery appear to improve salvage of what is frequently a major extremity injury.
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Goldberg SC, Shenoy RS, Sadler A, Hamer R, Ross B. The effects of a drug holiday on relapse and tardive dyskinesia in chronic schizophrenics [proceedings]. Psychopharmacol Bull 1981; 17:116-7. [PMID: 7232638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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