Tufts-New England Medical Center Research Articles

Fetal cell-free plasma DNA concentrations in maternal blood are stable 24 hours after collection: analysis of first- and third-trimester samples.

The discovery of intact fetal cells in maternal blood has led to the possibility of noninvasive prenatal genetic testing. Although extensive work has been performed on maternal blood in the hope of developing a reliable method for the recovery of intact fetal cells, the total number of recoverable cells is quite small, averaging 19 nucleated fetal cells in 16 mL of blood (1)(2). This is contrasted by a relatively large amount of cell-free fetal DNA detectable in maternal plasma (3). Recent studies suggest that cell-free fetal DNA in maternal plasma can be used as a diagnostic tool for diseases of pregnancy, such as preeclampsia or preterm labor, or for fetal anomalies, such as Down syndrome (4)(5)(6)(7). Because of these potential applications, it is of great importance to determine whether cell-free fetal DNA concentrations remain stable in a test tube after phlebotomy. In this report we evaluate the effects of time after phlebotomy on the quantity of cell-free fetal DNA in blood samples from a pregnant woman and a woman who has just undergone termination of pregnancy. The post-termination samples were used because in the first trimester, there are relatively few fetal cells present in maternal blood. The termination procedure increases fetomaternal transfusion (8). We hypothesized that after phlebotomy, apoptotic fetal cells that die in the venipuncture tube would release their DNA. We also asked whether more fetal cells undergo apoptosis as a result of exposure to the maternal bloodstream and cytokines. In both cases, we hypothesized that cell-free fetal DNA concentrations would increase in the blood samples over time. This study was performed with Institutional Review Board approval and with informed consent from participants at Tufts-New England Medical Center. For early-gestation samples, 29 women who were 6–17 weeks pregnant were recruited from …

Tufts-New England Medical Center President and Chief Executive Officer Thomas F. O'Donnell Jr, to Step Down

Tufts-New England Medical Center President and Chief Executive Officer Thomas F. O'Donnell Jr, to Step Down

One in 5 at risk for congestive heart failure.

One in 5 at risk for congestive heart failure.

The Patient Visits Program: A Strategy to Highlight Patient Satisfaction and Refocus Organizational Culture

Seeking patient input may improve patients' perceptions of the quality of care and provide managers with helpful information for strategic decision making. In addition, the involvement of senior hospital leadership is critical to successful implementation of quality improvement initiatives and illustrates an organization's commitment to enhancing quality from the top down. IMPLEMENTING THE PVP: Senior management's Patient Visits Program (PVP) at Tufts-New England Medical Center is a structured, ongoing initiative in which senior clinicians are paired with nonclinician administrators. During an initial evaluation period (Aug 1999-Feb 2001), PVP teams visited with patients and their families on a monthly basis to talk to them about their experiences. Patient suggestions were then evaluated and acted on. The PVP has been beneficial for patients and for the hospital team members--clinicians and nonclinicians alike--who participated in the patient interviews. The PVP may serve as a mechanism to enhance organizational awareness of the importance of patient satisfaction. The program provides opportunities for immediate service recovery, and faster, broader-reaching responses to quality complaints due to the multispecialty nature of the PVP teams. In addition, based on early available data, the PVP shows promise as an interventional strategy to improve patient satisfaction scores. A structured, ongoing program such as the PVP is an effective strategy to highlight the value of patient satisfaction, refocus organizational culture, and generate specific suggestions for improving the quality of patient care.

Cardiovascular News

Cardiovascular News

A continuing dilemma: whether and how to screen for concerns about children's behavior.

1. Ellen Perrin, MD, MA* 2. Terry Stancin, PhD† 1. *Professor of Pediatrics, The Floating Hospital for Children, Tufts-New England Medical Center, Boston, MA 2. †Associate Professor of Pediatrics, MetroHealth Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH After completing this article, readers should be able to: 1. Describe the prevalence of child behavior problems in primary care settings. 2. List possible reasons that child behavior problems are underidentified by pediatricians. 3. Describe formal and informal procedures for identifying behavioral problems in children. 4. Delineate the advantages of and concerns about formal and informal methods for screening and assessing behavioral problems in children. 5. Decide whether and how to incorporate screening methods into practice. 6. Describe options for improving mental health services for children, including development of collaborative care practices. Pediatricians are accustomed to the use of screening in the course of primary care for children and adolescents. Screening for some problems, such as lead poisoning or anemia, involves relatively simple procedures compared with the more daunting task of screening for possible behavioral or developmental concerns. To merit population screening, a condition must be important, reasonably common, identifiable by screening before becoming evident clinically, have an effective treatment that is enhanced if provided early, and have an acceptable screening test available. Screening tests must be inexpensive to administer and score, be acceptable to patients, produce reliable results, and have adequate validity. It has been established that substantial variations and delays in children’s motor and cognitive development meet these criteria. (1) However, behavioral variations and problems are harder to define and to classify, and the boundaries of pediatricians’ responsibility are less clearly delineated. Clearly, behavioral and emotional difficulties are important in terms of both personal suffering and social consequences. High rates of depression, school failure, and violence are some indicators of late consequences. These problems are common, with up to 50% of parents expressing concern about their child’s behavior and many surveys documenting an identifiable emotional difficulty in 25% of school-age children. Limited but improving evidence documents the effectiveness of treatment for various mental health …

Sedation, analgesia, and neuromuscular blockade of the critically ill adult: Revised clinical practice guidelines for 2002

The critically ill and injured patient is invariably anxious, confused, uncomfortable, and in pain from immobility, wounds, and indwelling tubes and is generally distressed by the adverse environs of the intensive care unit. The restlessness associated with critical illness must nearly always, by necessity, be quelled with sedation and analgesia. Clinicians must sometimes use neuromuscular blockade as a last resort. The knowledge and practice of using sedatives, analgesics, and neuromuscular receptor blocking agents originated in and migrated out of the operating theater and postanesthesia recovery units. However, critical care clinicians have discovered that the sustained use of these agents in intensive care units has consequences that are different from those seen in the immediate perioperative period. The Society of Critical Care Medicine (SCCM) and the American College of Critical Care Medicine (ACCM) systematically reviewed, developed, and, in 1995, published clinical practice guidelines (CPGs) for sedation, analgesia, and neuromuscular blockade in the critically ill patient (1, 2). These CPGs are the most popular and requested of the SCCM and ACCM documents because of the complexities involved in achieving appropriate levels of sedation and analgesia without inducing complications. Recommendations stemming from the 1995 CPGs, although evidence based, were limited because of the lack of prospective randomized trials comparing agents. Since that time, new evidence has emerged and ACCM believes that the CPGs require updating. ACCM and SCCM have joined forces with the American Society of Health-System Pharmacists (ASHP) to develop new CPGs on the sustained use of sedatives, analgesics, and neuromuscular blocking agents in the critically ill adult (3, 4). The quality of care can be improved by implementing the best known and tested standards, measuring the consequences of what we do, and reducing variability found in practice through the use of protocols. CPGs, in tandem with protocol development, can serve as educational tools, improve outcomes, and reduce costs (5, 6). Evidence suggests that, in real practice, recommendations such as these are often not followed (7). “Clinical practice guidelines” are defined by the Institute of Medicine as “systematically developed statements to assist the practitioner and patient in decisions about appropriate health care for specific clinical circumstances” (8). Clinicians need to differentiate CPGs from a summary or review article (9–11). CPGs are vitally different from review articles and greatly valued for several reasons. Ideally, CPGs are created by a multidisciplinary task force of clinicians, including physicians, nurses, and pharmacists, as well as other health care professionals, under the auspices of the recommendations developed by critical evaluation of the graded scientific literature. CPGs are typically more comprehensive and far-reaching in scope than review articles and serve as virtual guiding lights by providing a useful construct of available evidence and expert decision-making against which individual decisions by clinicians and programs can be evaluated (12). A comprehensive literature search was performed to develop the CPGs. Published studies identified through a MEDLINE search (Sedation and Analgesia 1994 –2001; Neuromuscular blocking agents 1994–2001) were reviewed, as were the reference lists of the retrieved documents and abstracts from meetings of professional associations. The literature was critically evaluated for research design, patient selection, medication dose, administration route, combination treatment, test measures, statistics, and results. The medical literature ranged in quality from prospective randomized trials and retrospective observations to expert opinions (Table 1). Pertinent references were assigned a score to account for variance in quality. The recommendations of SCCM, ACCM, and ASHP (Joint Task Force) were graded according to the strength and quality of the scientific evidence (Table 2). A substantial effort was made by the Joint Task Force to adhere to the methodology for developing scientifically sound CPGs as prescribed by the American Medical Association, the Institute of Medicine, and the Canadian Medical Association (13–17). The 2002 clinical practice guidelines state the rationale, benefits, and harms of the recommendations, describe the expected health outcomes, and cite and rank the evidence. These CPGs will be reviewed and updated in three to five years. There are major additions, besides the updating of the science, to the 2001 CPGs being issued by the Joint Task Force (3, 4), compared with the 1995 guidelines. These guidelines are the most comprehensive documents in the fields of sedation, analgesia, and neuromuscular Address correspondence to Dr. Nasraway, Jr. at Tufts University School of Medicine, Department of Surgery, Tufts-New England Medical Center, 750 Washington Street, Box 4630, Boston, MA 02111 (snasraway@lifespan.org). Copyright © 2002 by the Society of Critical Care Medicine and the American Society of Health-System Pharmacists, Inc.

The history of physical medicine and rehabilitation as recorded in the diary of Dr. Frank Krusen: Part 4. Triumph over adversity (1954–1969)

This article, the last of four based on the diary of Dr. Frank H. Krusen, picks up the story of physiatry's conflict with other medical specialty groups within the American Medical Association. The conflict was focused on PM&R's use of the term “rehabilitation,” but the underlying motive of groups opposing physical medicine was to limit the scope of physiatric practice. Dr. Krusen organized a well-documented and successful defense of the specialty and opened the door to the development of comprehensive care of persons with disabilities. Also related here are Dr. Krusen's legislative and public relations contributions to PM&R from 1963 until his retirement from Tufts-New England Medical Center in 1969. Dr. Krusen retired to Cape Cod and died there in 1973.

Development of measurement techniques.

In the past few years we have witnessed an unexpected and unprecedented increase in the number of therapeutic trials in ALS, and it is reasonable to anticipate that this activity will continue, if not accelerate, in the future. Almost every major neurologic center in the United States and Europe is participating in an ALS trial. The evaluation of one drug alone involved over 60 centers and more than 1,500 patients. ALS conferences to review progress and plan for the future, which typically convened every 4 years, now occur every few months. At a recent American Academy of Neurology annual meeting, attendees to the sessions on ALS overflowed into the hallway. Several interrelated events appear responsible for this intensified activity: 1. The revolution in molecular biology has led to a number of promising new drugs produced by recombinant methodology that have potential major commercial value. 2. Molecular genetic research has provided new insight into the pathogenesis, if not the etiology, of some familial forms of this enigmatic disease. 3. There have been promising new data about the possible role of glutamate neurotoxicity in the sporadic forms. 4. The natural history of ALS has been defined in quantitative and reproducible terms. 5. There have been significant improvements in the construction of therapeutic trials, resulting in trials that are more reproducible and theoretically more efficient. 6. Although ALS is a relatively uncommon disease, there is reason to suspect that any therapeutic efficacy demonstrated in ALS might lead to the treatment of other late-life degenerative diseases, such as Alzheimer's and Parkinson's diseases. 7. Patients and their families, as well as the voluntary health organizations representing them, have become increasingly active in promoting and supporting efforts to find effective treatment. Over the past decade, the Neuromuscular Research Unit at Tufts-New England Medical Center has had …

Intravascular ultrasound studies to determine size and shape of patent ductus arteriosus and to assess extent of coil protrusion: Comparison with angiography: Ziyad M. Hijazi MD, Gerald R. Marx MD, Robert L. Geggel MD, Steven Schwartz MD, David R. Fulton MD. Tufts-New England Medical Center, Boston, MA

Intravascular ultrasound studies to determine size and shape of patent ductus arteriosus and to assess extent of coil protrusion: Comparison with angiography: Ziyad M. Hijazi MD, Gerald R. Marx MD, Robert L. Geggel MD, Steven Schwartz MD, David R. Fulton MD. Tufts-New England Medical Center, Boston, MA

Application of continuity equation method to quantify aortic valve area by transesophageal echocardiography: Approaches, accuracy, problems and potential: Giuseppina Magni, Dana Washburn, Jeifen Yao, Ajay Kanojia, Mani Vannan, Steven Schwartz, and Natesa Pandian. Tufts-New England Medical Center, Boston, Massachusetts

Application of continuity equation method to quantify aortic valve area by transesophageal echocardiography: Approaches, accuracy, problems and potential: Giuseppina Magni, Dana Washburn, Jeifen Yao, Ajay Kanojia, Mani Vannan, Steven Schwartz, and Natesa Pandian. Tufts-New England Medical Center, Boston, Massachusetts

Transthoracic and transesophageal echocardiographic findings of vegetative lesions are [formula omitted] of subsequent embolic events in patients with Active infective endocarditis : Stefano De Castro, Domenico Cartoni, Sergio Beni, Marco Fiorelli, Paola Santopadre, Giuseppina Magni, Mani Vannan, Steven Schwartz, Francesco Fedele and Natesa Pandian.. “La Sapienza” Univ of Rome Italy, Tufts-New England Medical Center, Boston, MA

Transthoracic and transesophageal echocardiographic findings of vegetative lesions are [formula omitted] of subsequent embolic events in patients with Active infective endocarditis : Stefano De Castro, Domenico Cartoni, Sergio Beni, Marco Fiorelli, Paola Santopadre, Giuseppina Magni, Mani Vannan, Steven Schwartz, Francesco Fedele and Natesa Pandian.. “La Sapienza” Univ of Rome Italy, Tufts-New England Medical Center, Boston, MA

Aortic regurgitation flow volume and rate can be reliably quantified by 3-D echocardiographic measurement of color Doppler ar jet volume: Philippe Acar MD, Michael Jones MD, Takahiro Shiota MD, Alain Delabays MD, Izumi Yamada MD, David Sahn MD, Natesa Pandian MD, Tufts-New England Medical Center, Boston, MA NIH-LAMS, Bethesda, MD, Oregon Health Sciences University, Portland, OR

Aortic regurgitation flow volume and rate can be reliably quantified by 3-D echocardiographic measurement of color Doppler ar jet volume: Philippe Acar MD, Michael Jones MD, Takahiro Shiota MD, Alain Delabays MD, Izumi Yamada MD, David Sahn MD, Natesa Pandian MD, Tufts-New England Medical Center, Boston, MA NIH-LAMS, Bethesda, MD, Oregon Health Sciences University, Portland, OR

Planimetry of aortic valve orifice in transthoracic two-dimensional echocardiographic short-axis images is a simple, reproducible and accurate approach to quantify aortic valve area in patients with calcific aortic stenosis: Giuseppina Magni MD, Marjory Caldiera RCDS, Qi-Ling Cao MD, Dana Washburn MD, Stefano De Castro MD, Mani Vannan MD, Steven Schwartz MD, and Natesa Pandian MD. Tufts-New England Medical Center, Boston,

Planimetry of aortic valve orifice in transthoracic two-dimensional echocardiographic short-axis images is a simple, reproducible and accurate approach to quantify aortic valve area in patients with calcific aortic stenosis: Giuseppina Magni MD, Marjory Caldiera RCDS, Qi-Ling Cao MD, Dana Washburn MD, Stefano De Castro MD, Mani Vannan MD, Steven Schwartz MD, and Natesa Pandian MD. Tufts-New England Medical Center, Boston,

Analysis of metal binding by the HPN protein of Helicobacter pylori: Joanne V. Gilbert, Andrew Wright, F. William Sunderman, Jr., and [formula omitted]. Department of Medicine and the GRASP Digestive Disease Center, Tufts-New England Medical Center Hospital, Department of Molecular Biology and Microbiology, Tufts Univ. School of Medicine, Boston MA 02111, and Departments of Laboratory Medicine and Pharmacology, Univ. of

Analysis of metal binding by the HPN protein of Helicobacter pylori: Joanne V. Gilbert, Andrew Wright, F. William Sunderman, Jr., and [formula omitted]. Department of Medicine and the GRASP Digestive Disease Center, Tufts-New England Medical Center Hospital, Department of Molecular Biology and Microbiology, Tufts Univ. School of Medicine, Boston MA 02111, and Departments of Laboratory Medicine and Pharmacology, Univ. of

Emulsifiers in antifoam/anti-gas preparations are bactericidal in vitro for Helicobacter pylori: [formula omitted] and Andrew G. Plaut, Department of Medicine and GRASP Digestive Disease Center, Tufts-New England Medical Center Hospital, Boston, MA 02111

Emulsifiers in antifoam/anti-gas preparations are bactericidal in vitro for Helicobacter pylori: [formula omitted] and Andrew G. Plaut, Department of Medicine and GRASP Digestive Disease Center, Tufts-New England Medical Center Hospital, Boston, MA 02111

VENTILATORY CARE OF THE INJURED CHILD

University of Florida College of Medicine, Jacksonville, Florida 32209 and Gainesville, Florida 32610; and Tufts-New England Medical Center, Boston, Massachusetts 02111.

Constitutive & LPS-inducible proIL-1β promoter activity is cell-specific: T. Lebedeva, C. Mao, & A. K. Singh, Dept. of Medicine, Tufts-New England Medical Center, Boston, MA, USA

Constitutive & LPS-inducible proIL-1β promoter activity is cell-specific: T. Lebedeva, C. Mao, & A. K. Singh, Dept. of Medicine, Tufts-New England Medical Center, Boston, MA, USA

Discussion: Howto Improve the Outcome of Anaerobic Infections

Journal Article Discussion: Howto Improve the Outcome of Anaerobic Infections Get access Sherwood Gorbach Sherwood Gorbach Reprints or correspondence: Dr. Sherwood Gorbach, Tufts-New England Medical Center, 136 Harrison Avenue, Boston, Massachusetts 02111. Search for other works by this author on: Oxford Academic PubMed Google Scholar Clinical Infectious Diseases, Volume 18, Issue Supplement_4, May 1994, Pages S311–S314, https://doi.org/10.1093/clinids/18.Supplement_4.S311 Published: 01 May 1994

Color Doppler Flow Imaging in Cardiac Diagnosis

EchocardiographyVolume 6, Issue 2 p. 99-117 Color Doppler Flow Imaging in Cardiac Diagnosis NATESA G. PANDIAN M.D., Corresponding Author NATESA G. PANDIAN M.D. Noninvasive Cardiac Laboratory, Departments of Medicine and Radiology, New England Medical Center Hospitals, Tufts University School of Medicine, Boston, Massachusetts; and Department of Cardiology, Kilpauk Medical College, Madras, IndiaAddress for correspondence: Natesa G. Pandian, M.D., Tufts-New England Medical Center, Box 32, 750 Washington Street, Boston, MA 02111.Search for more papers by this authorBRENDA S. KUSAY B.S., BRENDA S. KUSAY B.S. Noninvasive Cardiac Laboratory, Departments of Medicine and Radiology, New England Medical Center Hospitals, Tufts University School of Medicine, Boston, Massachusetts; and Department of Cardiology, Kilpauk Medical College, Madras, IndiaSearch for more papers by this authorMARJORY CALDEIRA R.D.M.S., MARJORY CALDEIRA R.D.M.S. Noninvasive Cardiac Laboratory, Departments of Medicine and Radiology, New England Medical Center Hospitals, Tufts University School of Medicine, Boston, Massachusetts; and Department of Cardiology, Kilpauk Medical College, Madras, IndiaSearch for more papers by this authorJANET SIMONETTI B.S., JANET SIMONETTI B.S. Noninvasive Cardiac Laboratory, Departments of Medicine and Radiology, New England Medical Center Hospitals, Tufts University School of Medicine, Boston, Massachusetts; and Department of Cardiology, Kilpauk Medical College, Madras, IndiaSearch for more papers by this authorD. ELANGOVAN M.D., D. ELANGOVAN M.D. Noninvasive Cardiac Laboratory, Departments of Medicine and Radiology, New England Medical Center Hospitals, Tufts University School of Medicine, Boston, Massachusetts; and Department of Cardiology, Kilpauk Medical College, Madras, IndiaSearch for more papers by this authorS. THANIKACHALAM M.D., S. THANIKACHALAM M.D. Noninvasive Cardiac Laboratory, Departments of Medicine and Radiology, New England Medical Center Hospitals, Tufts University School of Medicine, Boston, Massachusetts; and Department of Cardiology, Kilpauk Medical College, Madras, IndiaSearch for more papers by this author NATESA G. PANDIAN M.D., Corresponding Author NATESA G. PANDIAN M.D. Noninvasive Cardiac Laboratory, Departments of Medicine and Radiology, New England Medical Center Hospitals, Tufts University School of Medicine, Boston, Massachusetts; and Department of Cardiology, Kilpauk Medical College, Madras, IndiaAddress for correspondence: Natesa G. Pandian, M.D., Tufts-New England Medical Center, Box 32, 750 Washington Street, Boston, MA 02111.Search for more papers by this authorBRENDA S. KUSAY B.S., BRENDA S. KUSAY B.S. Noninvasive Cardiac Laboratory, Departments of Medicine and Radiology, New England Medical Center Hospitals, Tufts University School of Medicine, Boston, Massachusetts; and Department of Cardiology, Kilpauk Medical College, Madras, IndiaSearch for more papers by this authorMARJORY CALDEIRA R.D.M.S., MARJORY CALDEIRA R.D.M.S. Noninvasive Cardiac Laboratory, Departments of Medicine and Radiology, New England Medical Center Hospitals, Tufts University School of Medicine, Boston, Massachusetts; and Department of Cardiology, Kilpauk Medical College, Madras, IndiaSearch for more papers by this authorJANET SIMONETTI B.S., JANET SIMONETTI B.S. Noninvasive Cardiac Laboratory, Departments of Medicine and Radiology, New England Medical Center Hospitals, Tufts University School of Medicine, Boston, Massachusetts; and Department of Cardiology, Kilpauk Medical College, Madras, IndiaSearch for more papers by this authorD. ELANGOVAN M.D., D. ELANGOVAN M.D. Noninvasive Cardiac Laboratory, Departments of Medicine and Radiology, New England Medical Center Hospitals, Tufts University School of Medicine, Boston, Massachusetts; and Department of Cardiology, Kilpauk Medical College, Madras, IndiaSearch for more papers by this authorS. THANIKACHALAM M.D., S. THANIKACHALAM M.D. Noninvasive Cardiac Laboratory, Departments of Medicine and Radiology, New England Medical Center Hospitals, Tufts University School of Medicine, Boston, Massachusetts; and Department of Cardiology, Kilpauk Medical College, Madras, IndiaSearch for more papers by this author First published: March 1989 https://doi.org/10.1111/j.1540-8175.1989.tb00293.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume6, Issue2March 1989Pages 99-117 RelatedInformation