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Douglas E, Hall M, Needham S, McLoughlin C, Bradshaw S, Elliott R. Implementing a cycle ergometry protocol for patients with critical illness: a service evaluation. Physiotherapy 2019. [DOI: 10.1016/j.physio.2018.11.111] [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: 10/27/2022]
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Wadman MC, Schwedhelm SS, Watson S, Swanhorst J, Gibbs SG, Lowe JJ, Iwen PC, Hayes AK, Needham S, Johnson DW, Kalin DJ, Zeger WG, Muelleman RL. Emergency Department Processes for the Evaluation and Management of Persons Under Investigation for Ebola Virus Disease. Ann Emerg Med 2015; 66:306-14. [PMID: 26003001 DOI: 10.1016/j.annemergmed.2015.04.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 04/03/2015] [Accepted: 04/14/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Due to the recent Ebola virus outbreak in West Africa, patients with epidemiologic risk for Ebola virus disease and symptoms consistent with Ebola virus disease are presenting to emergency departments (EDs) and clinics in the United States. These individuals, identified as a person under investigation for Ebola virus disease, are initially screened using a molecular assay for Ebola virus. If this initial test is negative and the person under investigation has been symptomatic for < 3 days, a repeat test is required after 3 days of symptoms to verify the negative result. In the time interval before the second test result is available, manifestations of the underlying disease process for the person under investigation, whether due to Ebola virus disease or some other etiology, may require further investigation to direct appropriate therapy. MATERIALS AND METHODS ED administrators, physicians, and nurses proposed processes to provide care that is consistent with other ED patients. Biocontainment unit administrators, industrial hygienists, laboratory directors, physicians, and other medical personnel examined the ED processes and offered biocontainment unit personal protective equipment and process strategies designed to ensure safety for providers and patients. CONCLUSION ED processes for the safe and timely evaluation and management of the person under investigation for Ebola virus disease are presented with the ultimate goals of protecting providers and ensuring a consistent level of care while confirmatory testing is pending.
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Affiliation(s)
- Michael C Wadman
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE.
| | - Shelly S Schwedhelm
- Emergency Department, Trauma, Emergency Preparedness Services, Nebraska Medicine, Omaha, NE; Nebraska Biocontainment Unit, Nebraska Medicine, Omaha, NE
| | | | - John Swanhorst
- Nebraska Biocontainment Unit, Nebraska Medicine, Omaha, NE; Emergency Services, Nebraska Medicine, Omaha, NE
| | - Shawn G Gibbs
- Department of Environmental, Agricultural, and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE; Nebraska Biocontainment Unit, Nebraska Medicine, Omaha, NE
| | - John J Lowe
- Department of Environmental, Agricultural, and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE; Nebraska Biocontainment Unit, Nebraska Medicine, Omaha, NE
| | - Peter C Iwen
- Department of Pathology and Microbiology, Nebraska Public Health Laboratory, University of Nebraska Medical Center, Omaha, NE
| | - A Kim Hayes
- Division of Infection Control and Epidemiology, Nebraska Medicine, Omaha, NE
| | | | - Daniel W Johnson
- Department of Anesthesiology, Division of Critical Care, University of Nebraska Medical Center, Omaha, NE
| | - Daniel J Kalin
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Wesley G Zeger
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE; Nebraska Biocontainment Unit, Nebraska Medicine, Omaha, NE
| | - Robert L Muelleman
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE
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Zanetti-Domingues L, Webb S, Tynan C, Rolfe D, Hirsch M, Coles B, Needham S, Roberts S, Clarke D, Martin-Fernandez M. Simultaneous, Multicolour Single Molecule Imaging of the Entire Human Epidermal Growth Factor Receptor (HER) Family in Live Breast Cancer Cells. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt086.3] [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: 11/14/2022] Open
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Lamb CA, Speight RA, Needham S, Graham JY, Mansfield JC. Management of Crohn's disease. Gut 2010; 59:340. [PMID: 20207639 DOI: 10.1136/gut.2010.208637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- C A Lamb
- Gastroenterology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK.
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Abstract
Attempts to selectively reduce tumour blood flow have, in the past, concentrated on the use of hydralazine. However, although this vasodilator can be highly effective in experimental animals, it is only at such high concentration as to result in a severe and clinically unacceptable reduction in systemic blood pressure. At clinically acceptable levels, the drug appears to produce a small increase in tumour blood flow. We have used the techniques of magnetic resonance spectroscopy as indicators of metabolism and blood flow in a search for vasoactive drugs that would produce an effective reduction in tumour blood flow without causing severe hypotension or other serious side effects. Single injections of either prazosin or CGRP are shown to be substantially more effective than hydralazine in causing a reduction in tumour blood flow without massive reduction in blood pressure. Even more effective was CGRP given by continuous infusion. In this case a three-fold reduction in tumour blood flow could be obtained with a reduction of only 15-20% in systemic blood pressure. All these studies, however, have been made with transplanted animal tumours. Using high-dose hydralazine and primary tumours that were either radiation or chemically induced, we obtained a success rate of only about a 35% in causing selective reduction in blood flow. In contrast, in a transplanted tumour line derived from one of the non-responding radiation-induced primary lesions, the success rate was about 95%, consistent with the majority of animal studies using transplanted tumours.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- S B Field
- MRC Cyclotron Unit, Hammersmith Hospital, London, UK
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Abstract
The vast majority of studies on tumour vasculature are performed on transplanted tumours in rodents. However, it is known that there may be differences between primary and transplanted lesions. The purpose of this study is to test whether a specific vascular response is similar in primary tumours and in transplanted tumours derived from them. The technique used was to give an intraperitoneal injection of 5 mg kg-1 hydralazine, which is known to result in hypoxia in transplanted tumours. Changes in perfusion were indicated by changes in metabolism, monitored using 31P Magnetic Resonance Spectroscopy. The primary tumours were induced by local irradiation many months previously and only 4/11 (36%) of these responded to hydralazine. One of the non responders was subsequently transplanted into isogeneic mice to produce a tumour line which was histologically very similar to the primary. Of these 16/17 (94%) responded. The difference is statistically significant (P = 0.001). The reasons for this difference are not known. A number of possibilities are discussed and in the authors' opinion, the most likely cause is that it results from an artefact of transplantation.
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Affiliation(s)
- S B Field
- MRC Cyclotron Unit, Hammersmith Hospital, London, UK
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Radtka S, Dragotta N, Needham S, Smith SS, Tucker J. Texas Consortium for Physical Therapy Clinical Education. A model for Interinstitutional Consortium arrangements. Phys Ther 1983; 63:971-4. [PMID: 6856686 DOI: 10.1093/ptj/63.6.971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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: 01/22/2023]
Abstract
This article describes the Texas Consortium for Physical Therapy Clinical Education, which exemplifies one type of collaborative arrangement among universities. Coordination of physical therapy clinical education among five Texas universities is the major function of the Texas Consortium. Although originally developed from a federally funded project (1977-1980), it currently functions with sole financial support from the participating universities. The collaborative efforts of the Texas Consortium have resulted in 1) developing and implementing a common evaluation tool for students' clinical performance; 2) coordinating development of new clinical education centers, development of clinical instructors, and visits to students at clinical education centers; and 3) developing and using a shared computer program for data on clinical education centers. The successful functioning of the Texas Consortium with a resultant decrease in duplication of time, effort, and costs of clinical education demonstrates that this type of arrangement is feasible and beneficial.
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