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1.
Pediatr Blood Cancer ; 62(7): 1228-31, 2015 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-25732529

RESUMEN

BACKGROUND: Shwachman-Diamond Syndrome (SDS) is an autosomal recessive disorder characterized by bone marrow failure and exocrine pancreatic dysfunction. Heart failure has been described in patients with SDS. Circumferential strain (ε(cc)) is a measure of cardiac performance that may identify dysfunction when standard measures are normal. PROCEDURES: Patients with SDS were identified and the echocardiographic database queried. Cardiac anatomy and function were recorded, and ε(cc) was measured retrospectively. RESULTS: From 1995-2013, 27 patients with biallelic SBDS mutations confirming the diagnosis of SDS were identified at our institution: 14 had at least one echocardiogram available; 10 underwent HSCT, with echocardiograms available in nine. Ejection fraction (EF) was normal in all 14 patients evaluated; however, ε(cc) was decreased in 4/12 studies prior to HSCT. In two patients, ε(cc) was abnormal both before and after HSCT, in one, ε(cc) changed from normal to abnormal after HSCT, and in one, ε(cc) was normal after HSCT despite being abnormal prior. Echocardiogram reports were also available for six patients in the North American SDS registry, all with normal EF. CONCLUSIONS: While EF was normal in all patients with SDS, ε(cc) was abnormal in 33% prior to HSCT and 33% of those who had undergone HSCT. This suggests that SDS is associated with systolic dysfunction. Further studies are needed to define the incidence of dysfunction in this group and the progression to heart failure.


Asunto(s)
Enfermedades de la Médula Ósea/complicaciones , Ecocardiografía , Insuficiencia Pancreática Exocrina/complicaciones , Ventrículos Cardíacos/diagnóstico por imagen , Lipomatosis/complicaciones , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/etiología , Adolescente , Adulto , Enfermedades de la Médula Ósea/diagnóstico por imagen , Niño , Preescolar , Insuficiencia Pancreática Exocrina/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Ventrículos Cardíacos/patología , Humanos , Lactante , Lipomatosis/diagnóstico por imagen , Masculino , Pronóstico , Estudios Retrospectivos , Síndrome de Shwachman-Diamond , Adulto Joven
2.
Cureus ; 14(9): e29241, 2022 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-36262950

RESUMEN

Attention Deficit Hyperactivity Disorder, also known as ADHD, is a neurodevelopmental disorder diagnosed in children. The exact cause of ADHD is not known, but, along with genetic factors, it is possible that environmental factors including toxins and diet may affect symptom severity. Of these dietary components, artificial food coloring (AFC), while approved by the Food and Drug Administration (FDA), has been suspected to be associated with ADHD symptoms. Of the nine FDA-certified food colors, two are used for artificial blue coloring: Blue No. 1 and Blue No. 2. There is limited literature describing the possible role of blue AFC in causing symptoms of ADHD in children. This paper provides a review of the literature surrounding artificial food coloring and its ability to affect the neurodevelopment of children in a way that could increase the behavioral indicators of ADHD. To do this, search criteria were established using a combination of MeSH terms about blue AFCs and ADHD and were entered into PubMed, along with limits on article types and publication dates from January 2000 to June 2022. There was a total of 20 articles that met this search criterion. These articles were reviewed by authors, and the ones not relevant to the topic were excluded. In total, four studies were chosen to be included in this article. After reviewing the literature, it was found that restriction diets, specifically those excluding AFCs, may affect symptom severity. The source of these changes is not known, but possible mechanisms include AFCs causing nutritional deficiencies and allergic reactions or altering neurotransmitter levels. More research is necessary to describe the neurotoxicity of artificial blue dyes in humans.

3.
Int J Radiat Oncol Biol Phys ; 114(2): 266-274, 2022 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-35675855

RESUMEN

PURPOSE: The immunoinflammatory state has been shown to be associated with poor outcomes after radiation therapy (RT). We conducted an a priori designed validation study using serum specimens from Radiation Therapy Oncology Group (RTOG) 0521. It was hypothesized the pretreatment inflammatory state would correlate with clinical outcomes. METHODS AND MATERIALS: Patients on RTOG 0521 had serum banked for biomarker validation. This study was designed to validate previous findings showing an association between elevations in C-reactive protein (CRP) and shorter biochemical disease free survival (bDFS). CRP levels were measured in pretreatment samples. An exploratory panel of related cytokines was also measured including: monocyte chemotactic protein-1, granulocyte-macrophage colony-stimulating factor, interferon-γ, interleukin (IL)-1b, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12, IL-13, IL-17A, IL-23, and tumor necrosis factor. The primary endpoint examined was bDFS. Additional exploratory endpoints included overall survival, distant metastases, and toxicity events attributed to RT. RESULTS: Two hundred and two patients in RTOG/NRG 0521 had serum samples available. Median age was 66 years (48-83), and 90% of patients were White. There was not an association between CRP and bDFS (adjusted hazard ratio [HR], 1.07 per 1 log increase in CRP; 95% confidence interval, 0.83-1.38; P = .60). In the exploratory, unplanned analysis, pretreatment IL-10 was significantly associated with worse bDFS (adjusted HR, 1.61 per log increase; P = .0027) and distant metastases (HR, 1.55 per log increase; P = .028). The association of IL-10 with bDFS was maintained on a multiplicity adjustment. The exploratory analyses of pretreatment levels of interferon-γ, IL-1b, IL-2, IL-13, IL-23 were negatively associated with grade 2 or higher pollakiuria (adjusted odds ratio, 0.64, 0.65, 0.71, 0.72, and 0.74, respectively, all P < .05), and IL-6 was negatively associated with grade 2 or higher erectile dysfunction (odds ratio, 0.62; P = .027). CONCLUSIONS: Pretreatment CRP was not associated with a poorer bDFS after RT. In a hypothesis- generating analysis, higher baseline levels of IL-10 were associated with lower rates of bDFS. These findings require additional prospective evaluation.


Asunto(s)
Citocinas , Inmunidad , Inflamación , Neoplasias de la Próstata , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Proteína C-Reactiva/análisis , Citocinas/sangre , Supervivencia sin Enfermedad , Humanos , Inflamación/sangre , Inflamación/inmunología , Masculino , Persona de Mediana Edad , Neoplasias de la Próstata/sangre , Neoplasias de la Próstata/inmunología , Neoplasias de la Próstata/radioterapia
4.
J Nurs Educ ; 48(8): 460-4, 2009 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-19681536

RESUMEN

Freshman nursing students returning for their second semester after summer break benefited by reviewing previously learned clinical skills presented in a Skills-a-Thon. Skills stations were established and facilitated by faculty and senior students. Senior students were first trained in mentoring and specific steps in skills competencies. Freshman students demonstrated skills in various mock clinical situations including catheter insertion, sterile dressings, medications, and physical assessment. The strategy reinforced learning and provided an opportunity for students to experience risk-free skills performance among peers. Freshman students gained proficiency and appreciated guidance by senior students without the pressures of testing. Seniors benefited from a condensed version of the program to review their own skills prior to the event. Responses were positive, with students reporting improved performance and confidence with hands-on application in a non-threatening environment. Nursing faculty observed improvement in skill performance and competence, and plan to offer future events.


Asunto(s)
Actitud del Personal de Salud , Competencia Clínica , Enfermería Práctica/educación , Autoeficacia , Estudiantes de Enfermería/psicología , Docentes de Enfermería/organización & administración , Humanos , Mentores/psicología , Investigación en Educación de Enfermería , Grupo Paritario , Evaluación de Programas y Proyectos de Salud , Desempeño Psicomotor , Encuestas y Cuestionarios , Pensamiento
5.
Can J Occup Ther ; 75(1): 51-60, 2008 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-18323369

RESUMEN

BACKGROUND: Program management models have raised concerns among occupational therapists about professional standards related to clinical competence, performance review procedures, and quality improvement initiatives. PURPOSE: This paper describes how a chart-stimulated recall (CSR) peer-review process and interview tool was revised, implemented, and evaluated as a pilot project to assess the clinical competence of occupational therapy staff at a large urban health centre in southern Ontario. METHODS: Fourteen pairs (n=28) of occupational therapists representing various practice areas participated in this project. Half served as peer assessors and half as interviewees. Peer assessors conducted an independent chart review followed by a one-hour personal interview with a peer partner to discuss clinical management issues related to the client cases. Each interviewer rated his or her partner's clinical competence in eight areas of performance using a 7-point Likert scale. FINDINGS: Results indicated that the CSR tool could discriminate among occupational therapists in terms of overall levels of clinical competence and also identify specific areas of concern that could be targeted for professional development. Feedback from participants was positive. CONCLUSIONS: The CSR tool was found to be useful for assessing clinical competence of occupational therapists in this large health centre as a quality improvement initiative within that discipline group. Further research is needed to establish the reliability and validity of the CSR tool.


Asunto(s)
Competencia Clínica , Evaluación del Rendimiento de Empleados/métodos , Servicio de Terapia Ocupacional en Hospital/organización & administración , Hospitales Urbanos/organización & administración , Humanos , Ontario , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Garantía de la Calidad de Atención de Salud/organización & administración
6.
J Dev Behav Pediatr ; 39(3): 228-237, 2018 04.
Artículo en Inglés | MEDLINE | ID: mdl-29176360

RESUMEN

OBJECTIVE: Racial/ethnic and socioeconomic disparities in infant development in the United States have lifelong consequences. Discrimination predicts poorer health and academic outcomes. This study explored for the first time intergenerational consequences of women's experiences of discrimination reported during pregnancy for their infants' social-emotional development in the first year of life. METHODS: Data come from a longitudinal study with predominantly Black and Latina, socioeconomically disadvantaged, urban young women (N = 704, Mage = 18.53) across pregnancy through 1 year postpartum. Women were recruited from community hospitals and health centers in a Northeastern US city. Linear regression analyses examined whether women's experiences of everyday discrimination reported during pregnancy predicted social-emotional development outcomes among their infants at 6 months and 1 year of age, controlling for potentially confounding medical and sociodemographic factors. Path analyses tested if pregnancy distress, anxiety, or depressive symptoms mediated significant associations. RESULTS: Everyday discrimination reported during pregnancy prospectively predicted greater inhibition/separation problems and greater negative emotionality, but did not predict attention skills or positive emotionality, at 6 months and 1 year. Depressive symptoms mediated the association of discrimination with negative emotionality at 6 months, and pregnancy distress, anxiety, and depressive symptoms mediated the association of discrimination with negative emotionality at 1 year. CONCLUSION: Findings support that there are intergenerational consequences of discrimination, extending past findings to infant social-emotional development outcomes in the first year of life. It may be important to address discrimination before and during pregnancy and enhance support to mothers and infants exposed to discrimination to promote health equity across the life span.


Asunto(s)
Ansiedad/epidemiología , Desarrollo Infantil/fisiología , Depresión/epidemiología , Discriminación Social/estadística & datos numéricos , Estrés Psicológico/epidemiología , Adolescente , Adulto , Negro o Afroamericano/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Lactante , Estudios Longitudinales , Masculino , Embarazo , Población Urbana/estadística & datos numéricos , Adulto Joven
7.
Acupunct Electrother Res ; 32(1-2): 81-6, 2007.
Artículo en Inglés | MEDLINE | ID: mdl-18077939

RESUMEN

Low Level Laser Therapy is used for a wide variety of conditions including superficial skin sores, musculoskeletal and joint problems, and dentistry. Knowledge of the penetration depth of laser radiation in human skin is an essential prerequisite to identifying its method of action. Mathematical simulations and estimates from the literature suggest that the depth of penetration of laser radiation using wavelengths from 630nm up to 1100nm may be up to 50mm. The aim of this study is to directly measure the penetration depth of a Low Level Laser in human tissue. Human abdominal skin samples up to 0.784mm thickness were harvested by dermatome following abdominoplasty procedures. These samples were irradiated by a Gallium Aluminium Arsenide Laser (Wavelength 850nm near infra-red invisible light, 100mW, 24kHz, 0.28mm diameter probe) and the transmitted radiation measured with an Ophir Optronics 'Nova' external energy meter. The intensity of laser radiation reduced by 66% after being transmitted through a 0.784mm sample of human abdominal tissue. In this study most laser radiation was absorbed within the first 1mm of skin.


Asunto(s)
Rayos Láser , Fenómenos Fisiológicos de la Piel , Piel/anatomía & histología , Epidermis/anatomía & histología , Epidermis/efectos de la radiación , Humanos , Técnicas In Vitro , Rayos Infrarrojos , Terapia por Luz de Baja Intensidad
8.
Int J Radiat Oncol Biol Phys ; 98(2): 409-418, 2017 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-28463161

RESUMEN

PURPOSE: To assess the feasibility of measuring symptomatic adverse events (AEs) in a multicenter clinical trial using the National Cancer Institute's Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). METHODS AND MATERIALS: Patients enrolled in NRG Oncology's RTOG 1012 (Prophylactic Manuka Honey for Reduction of Chemoradiation Induced Esophagitis-Related Pain during Treatment of Lung Cancer) were asked to self-report 53 PRO-CTCAE items representing 30 symptomatic AEs at 6 time points (baseline; weekly ×4 during treatment; 12 weeks after treatment). Reporting was conducted via wireless tablet computers in clinic waiting areas. Compliance was defined as the proportion of visits when an expected PRO-CTCAE assessment was completed. RESULTS: Among 226 study sites participating in RTOG 1012, 100% completed 35-minute PRO-CTCAE training for clinical research associates (CRAs); 80 sites enrolled patients, of which 34 (43%) required tablet computers to be provided. All 152 patients in RTOG 1012 agreed to self-report using the PRO-CTCAE (median age 66 years; 47% female; 84% white). Median time for CRAs to learn the system was 60 minutes (range, 30-240 minutes), and median time for CRAs to teach a patient to self-report was 10 minutes (range, 2-60 minutes). Compliance was high, particularly during active treatment, when patients self-reported at 86% of expected time points, although compliance was lower after treatment (72%). Common reasons for noncompliance were institutional errors, such as forgetting to provide computers to participants; patients missing clinic visits; Internet connectivity; and patients feeling "too sick." CONCLUSIONS: Most patients enrolled in a multicenter chemoradiotherapy trial were willing and able to self-report symptomatic AEs at visits using tablet computers. Minimal effort was required by local site staff to support this system. The observed causes of missing data may be obviated by allowing patients to self-report electronically between visits, and by using central compliance monitoring. These approaches are being incorporated into ongoing studies.


Asunto(s)
Quimioradioterapia/efectos adversos , Esofagitis/complicaciones , Neoplasias Pulmonares/terapia , Microcomputadores/estadística & datos numéricos , Dolor/prevención & control , Cooperación del Paciente/estadística & datos numéricos , Medición de Resultados Informados por el Paciente , Autoinforme/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Apiterapia/métodos , Trastornos de Deglución/etiología , Trastornos de Deglución/terapia , Estudios de Factibilidad , Femenino , Miel , Humanos , Internet , Masculino , Persona de Mediana Edad , National Cancer Institute (U.S.) , Evaluación de Síntomas/estadística & datos numéricos , Factores de Tiempo , Estados Unidos
9.
FASEB J ; 17(13): 1800-11, 2003 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-14519659

RESUMEN

We investigated the effects of mechanical stretch and induced stimulation of lung parenchyma on the activation of proinflammatory transcription factors in normal mice and in a mouse model of asthma. Mechanical stretching of lung parenchyma led to increased activation of NF-kappaB and AP-1 transcription factors. Incubation of lung parenchyma with methacholine increased the activation of NF-kappaB, which was further augmented by stretch. Activation of NF-kappaB in response to mechanical stretch was associated with the phosphorylation and degradation of IkappaBalpha and the activation of IkappaB kinase. Stretch-induced activation of NF-kappaB involves activation of stretch-activated (SA) channels and the production of free radicals. Mechanical stretch and/or treatment with methacholine resulted in an increased activation of ERK1/2 and p38 MAP kinase, and the inhibition of the activity of these kinases partially blocked the stretch-induced NF-kappaB and AP-1 activation. A greater level of NF-kappaB and ERK1/2 activity was observed in the asthmatic mice, which was further increased by mechanical stretching. The level of cyclooxygenase-2, an NF-kappaB-regulated enzyme, was also higher in lung parenchyma from asthmatic mice than in normal mice. Our data suggest that mechanical stretching of lung parenchyma activates NF-kappaB and AP-1, at least in part, through the activation of MAP kinase signaling pathways.


Asunto(s)
Asma/metabolismo , Pulmón/metabolismo , Proteínas Quinasas Activadas por Mitógenos/metabolismo , FN-kappa B/metabolismo , Factor de Transcripción AP-1/metabolismo , Animales , Asma/enzimología , Broncoconstrictores/farmacología , Técnicas de Cultivo , ADN/metabolismo , Activación Enzimática , Radicales Libres/metabolismo , Quinasa I-kappa B , Proteínas I-kappa B/metabolismo , Pulmón/efectos de los fármacos , Pulmón/enzimología , Sustancias Macromoleculares , Proteínas de Transporte de Membrana/metabolismo , Cloruro de Metacolina/farmacología , Ratones , Ratones Endogámicos C57BL , Proteínas Quinasas Activadas por Mitógenos/fisiología , Inhibidor NF-kappaB alfa , Proteínas Serina-Treonina Quinasas/metabolismo , Estrés Mecánico , Proteínas Quinasas p38 Activadas por Mitógenos
10.
Clin J Oncol Nurs ; 18(4): 414-20, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-24956980

RESUMEN

A policy regarding rapid response to chemotherapy overdoses was developed by the authors in an attempt to minimize morbidity and mortality. The parameters of a chemotherapy overdose were defined to promote early recognition of an overdose incident. Resources needed to guide potential therapeutic interventions and required monitoring were developed. The policy defines the immediate actions to be taken in the event of a chemotherapy overdose. The availability of a chemotherapy overdose policy provides an enhanced level of safety for patients by ensuring that appropriate treatment is initiated without delay. The development of the policy was in response to the reporting of a tragic error at another institution. Healthcare providers must recognize and address potential areas of vulnerability to maximize patient safety.


Asunto(s)
Antineoplásicos/efectos adversos , Sobredosis de Droga/prevención & control , Errores de Medicación/prevención & control , Política Organizacional , Documentación , Personal de Salud/educación , Humanos , Monitoreo Fisiológico , Educación del Paciente como Asunto
11.
Pract Radiat Oncol ; 4(3): 187-191, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24766686

RESUMEN

PURPOSE: Missing data are a significant problem in clinical trials, particularly for quality of life (QOL), which cannot be obtained retrospectively. The purpose of this study was to evaluate the feasibility of an electronic web-based strategy for QOL data collection in a cooperative group radiation oncology trial setting. METHODS AND MATERIALS: Radiation Therapy Oncology Group (RTOG) 0828 was a prospective National Cancer Institute cooperative group companion study of RTOG-0415, a randomized study of conventional versus hypofractionated radiation. Forty-nine English-speaking patients with favorable risk prostate cancer who enrolled on RTOG-0415 consented to using web-based technology for completing QOL. In RTOG-0415, using paper forms, the 6-month QOL compliance rate was 52%. The purpose of RTOG-0828 was to test the feasibility of a web-based strategy with the goal of increasing the 6-month QOL completion rate by 25% (from 52% to 77%) for a relative improvement of ~50%. The web-based tool used in this study was VisionTree Optimal Care (VTOC; VisionTree Software, Inc, San Diego, CA), a Health-Insurance-Portability-Accountability-Act secure, online technology that allows real-time tracking and e-mail reminders. The primary endpoint was the 6-month compliance rate for the validated QOL instrument, Expanded Prostate Index Composite. RESULTS: The QOL completion rate at baseline was 98%. Compared with the prior 52% QOL completion rate at 6 months using paper forms, the QOL web-based completion rate at 6 months was 90% (2-sided P value < .001). At 12 months, the EPIC completion rate was 82% (compared with 36% using paper forms). CONCLUSIONS: This RTOG study suggests that a web-based strategy to collect QOL appears to be feasible in the cooperative group radiation oncology trial setting and is associated with an increase in the 6-month QOL compliance rate compared with the prior method of using paper forms. The RTOG plans to further test this strategy in a head-and-neck cancer trial across all participating RTOG sites.


Asunto(s)
Recolección de Datos/métodos , Registros Electrónicos de Salud , Neoplasias de la Próstata/radioterapia , Calidad de Vida , Oncología por Radiación/métodos , Anciano , Sistemas de Información en Hospital , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Encuestas y Cuestionarios
12.
J Appl Physiol (1985) ; 112(5): 898-903, 2012 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-22134689

RESUMEN

We hypothesized that ablation of smooth muscle α-actin (SM α-A), a contractile-cytoskeletal protein expressed in airway smooth muscle (ASM) cells, abolishes ASM shortening capacity and decreases lung stiffness. In both SM α-A knockout and wild-type (WT) mice, airway resistance (Raw) determined by the forced oscillation technique rose in response to intravenous methacholine (Mch). However, the slope of Raw (cmH(2)O·ml(-1)·s) vs. log(2) Mch dose (µg·kg(-1)·min(-1)) was lower (P = 0.007) in mutant (0.54 ± 0.14) than in WT mice (1.23 ± 0.19). RT-PCR analysis performed on lung tissues confirmed that mutant mice lacked SM α-A mRNA and showed that these mice had robust expressions of both SM γ-A mRNA and skeletal muscle (SKM) α-A mRNA, which were not expressed in WT mice, and an enhanced SM22 mRNA expression relative to that in WT mice. Compared with corresponding spontaneously breathing mice, mechanical ventilation-induced lung mechanical strain increased the expression of SM α-A mRNA in WT lungs; in mutant mice, it augmented the expressions of SM γ-A mRNA and SM22 mRNA and did not alter that of SKM α-A mRNA. In mutant mice, the expression of SM γ-A mRNA in the lung during spontaneous breathing and its enhanced expression following mechanical ventilation are consistent with the likely possibility that in the absence of SM α-A, SM γ-A underwent polymerization and interacted with smooth muscle myosin to produce ASM shortening during cholinergic stimulation. Thus our data are consistent with ASM in mutant mice experiencing compensatory mechanisms that modulated its contractile muscle capacity.


Asunto(s)
Actinas/genética , Actinas/metabolismo , Pulmón/metabolismo , Pulmón/fisiología , Contracción Muscular/fisiología , Músculo Liso/metabolismo , Músculo Liso/fisiología , Resistencia de las Vías Respiratorias/efectos de los fármacos , Resistencia de las Vías Respiratorias/genética , Resistencia de las Vías Respiratorias/fisiología , Animales , Proteínas Contráctiles/genética , Proteínas Contráctiles/metabolismo , Pulmón/efectos de los fármacos , Cloruro de Metacolina/farmacología , Ratones , Ratones Endogámicos C57BL , Ratones Noqueados , Proteínas de Microfilamentos/genética , Proteínas de Microfilamentos/metabolismo , Contracción Muscular/efectos de los fármacos , Contracción Muscular/genética , Proteínas Musculares/genética , Proteínas Musculares/metabolismo , Músculo Esquelético/efectos de los fármacos , Músculo Esquelético/metabolismo , Músculo Esquelético/fisiología , Miocitos del Músculo Liso/efectos de los fármacos , Miocitos del Músculo Liso/metabolismo , Miocitos del Músculo Liso/fisiología , ARN Mensajero/genética , Respiración Artificial/métodos , Miosinas del Músculo Liso/efectos de los fármacos , Miosinas del Músculo Liso/genética , Miosinas del Músculo Liso/metabolismo , Miosinas del Músculo Liso/fisiología
13.
Am J Infect Control ; 40(5): 411-5, 2012 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-21962934

RESUMEN

BACKGROUND: Screening for methicillin-resistant Staphylocccus aureus (MRSA) is advocated as part of control measures, but screening all patients on admission to hospital may not be cost-effective. OBJECTIVE: Our objective was to evaluate the additional yield of screening all patients on admission compared with only patients with risk factors and to assess cost aspects. METHODS: A prospective, nonrandomized observational study of screening nonrisk patients ≤72 hours of admission compared with only screening patients with risk factors over 3 years in a tertiary referral hospital was conducted. We also assessed the costs of screening both groups. RESULTS: A total of 48 of 892 (5%) patients was MRSA positive; 28 of 314 (9%) during year 1, 12 of 257 (5%) during year 2, and 8 of 321 (2%) during year 3. There were significantly fewer MRSA-positive patients among nonrisk compared with MRSA-risk patients: 4 of 340 (1%) versus 44 of 552 (8%), P ≤ .0001, respectively. However, screening nonrisk patients increased the number of screening samples by 62% with a proportionate increase in the costs of screening. A backward stepwise logistic regression model identified age > 70 years, diagnosis of chronic pulmonary disease, previous MRSA infection, and admission to hospital during the previous 18 months as the most important independent predictors to discriminate between MRSA-positive and MRSA-negative patients on admission (94.3% accuracy, P < .001). CONCLUSION: Screening patients without risk factors increased the number of screenings and costs but resulted in few additional cases being detected. In a hospital where MRSA is endemic, targeted screening of at-risk patients on admission remains the most efficient strategy for the early identification of MRSA-positive patients.


Asunto(s)
Portador Sano/epidemiología , Pruebas Diagnósticas de Rutina/métodos , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Infecciones Estafilocócicas/epidemiología , Anciano , Anciano de 80 o más Años , Portador Sano/microbiología , Costos y Análisis de Costo , Pruebas Diagnósticas de Rutina/economía , Femenino , Hospitales , Humanos , Masculino , Tamizaje Masivo/economía , Tamizaje Masivo/métodos , Persona de Mediana Edad , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Infecciones Estafilocócicas/microbiología
14.
Infect Control Hosp Epidemiol ; 31(4): 374-81, 2010 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-20184438

RESUMEN

OBJECTIVES: (1) To determine whether rapid screening with polymerase chain reaction (PCR) assays leads to the earlier isolation of patients at risk for methicillin-resistant Staphylococcus aureus (MRSA) colonization, (2) to assess compliance with routine MRSA screening protocols, (3) to confirm the diagnostic accuracy of the Xpert MRSA real-time PCR assay (Cepheid) by comparison with culture, and (4) to compare turnaround times for PCR assay results with those for culture results. DESIGN: Before-and-after study conducted in a 700-bed acute tertiary care referral hospital. Study periods were (1) a 5-week period before PCR testing began, (2) a 10-week period when the PCR assay was used, and (3) a 5-week period after PCR testing was discontinued. RESULTS: Among 489 at-risk patients, MRSA was isolated from 20 (33%) of 60 patients during period 1, 77 (22%) of 349 patients during period 2, and 18 (23%) of 80 patients during period 3. Twenty-two (27%) of 82 at-risk patients were not screened during period 1, compared with 40 (10%) of 389 at-risk patients not screened during period 2 (P < .001). More MRSA-positive patients were preemptively isolated during periods 1 and 3 compared with period 2 (34 [24%] of 140 vs 28 [8%] of 389; P < .001); however, more MRSA-positive patients were isolated after notification of MRSA-positive results during period 2 (47 [13%] of 349) compared with periods 1 and 3 (2 [1%] of 140; P < .001). The sensitivity, specificity, positive predictive value, and negative predictive value of the PCR assay were 95%, 97%, 82%, and 99%, respectively. The mean turnaround time from receipt of specimens in the laboratory to PCR assay result was 2.6 hours. CONCLUSIONS: Rapid screening with the Xpert MRSA PCR assay facilitated compliance with screening policies and the earlier isolation of MRSA-positive patients. Discrepant results confirm that PCR testing should be used as a screening tool rather than as a diagnostic tool.


Asunto(s)
Compuestos Cromogénicos , Medios de Cultivo , Tamizaje Masivo/métodos , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Reacción en Cadena de la Polimerasa/métodos , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/microbiología , Agar , Técnicas de Tipificación Bacteriana , Técnicas Bacteriológicas , Adhesión a Directriz , Humanos , Staphylococcus aureus Resistente a Meticilina/clasificación , Staphylococcus aureus Resistente a Meticilina/genética , Pruebas de Sensibilidad Microbiana/métodos , Valor Predictivo de las Pruebas , Factores de Riesgo , Sensibilidad y Especificidad , Factores de Tiempo
15.
Lasers Med Sci ; 24(2): 137-9, 2009 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-18183472

RESUMEN

Trichiasis, the misdirection of eyelashes arising from their normal sites of origin, may cause discomfort, corneal abrasions, ulceration and scarring. The therapies currently used for this condition have a variety of success rates and complications. In this report we describe epilation using a ruby laser to treat ten patients (11 lids). In six patients laser treatment was completely successful in achieving alopecia, in three patients the treatment was partly successful, and one patient was lost to follow up. In all cases ruby laser treatment was well tolerated, and there were no reported complications; thus, ruby laser treatment can be a viable and well-tolerated option for the relief of the symptoms of trichiasis.


Asunto(s)
Pestañas , Enfermedades del Cabello/terapia , Remoción del Cabello/métodos , Láseres de Estado Sólido/uso terapéutico , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Resultado del Tratamiento
16.
Lasers Med Sci ; 21(1): 49-53, 2006 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-16583184

RESUMEN

The internal energy meter reading of a Chromos pulsed dye laser (PDL) set at 50% of maximum pumping energy was recorded at the start of every clinical session over an 898 day period and compared with the measurement from an Ophir Optronics 'Nova' external energy meter. This quick and inexpensive process improved quality control procedures for the use of the PDL and enabled the performance of laser components such as the dye, pumping mechanism and optics to be monitored. The stability of the laser output energy was also monitored during three simulated clinics on days 665, 870 and 898. External energy meter readings were recorded every 100 pulses during each simulated clinic comprising six series of 500 pulses. As the energy output was shown to be stable during each clinic (SD<4.7%) recalibration during treatments of up to 500 pulses with this laser was deemed to be unnecessary. However, it was noted that this output energy stability was maintained by varying the pumping energy from 42 to 88% of maximum. Subsequent measurements of pulse width conducted with an ET-2000 Silicon Photodetector demonstrated that although the nominal pulse width was 450 mus, this varied from 240 to 390 mus as the pumping energy increased from 20 to 50%.


Asunto(s)
Rayos Láser/normas , Ensayo de Materiales , Control de Calidad
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