Designing a conscious sedation program. A collaborative approach.

St. Elizabeth's Medical Center identified a need to change its guidelines for the administration of IVCS. A task force consisting of physicians, nurses, pharmacists, and administrators was formed for this purpose. Goals for the guidelines were identified utilizing resources provided from the Board of Registration in Nursing and the Board of Registration in Medicine, as well as other professional organizations and local hospitals. A consensus was reached and a document generated that received approval by the Medical Center. Implementation went smoothly because of widespread support for the goals of the policy. Quality improvement studies have been performed and the results have been used to change practice. The process is currently ongoing.

Relationship of H-ras-1, L-myc, and p53 polymorphisms with lung cancer risk and prognosis.

Proto-oncogenes (H-ras-1 and L-myc) and tumor-suppressor gene (p53) loci have been implicated in lung carcinogenesis. DNA restriction fragment length polymorphisms at these gene loci are being evaluated in a case-control study as markers predictive of risk for cancer or of prognosis when cancer is present. The cases and controls had a cigarette-smoking history of 40 or more pack years or other abnormalities in pulmonary function tests, their ages were closely matched (64 years for cases and 61 years for controls) and the ratio of Caucasians to African Americans was close to unity (cases, 0.95:1.00, controls, 1.00:0.88). The H-ras-1 gene contains an insertion deletion polymorphism. Inheritance of rare H-ras-1 alleles, defined by MspI digestion, confers a relative risk for lung cancer of 2.0 (95% confidence interval, 0.5-7.3) for Caucasians and 3.2 (0.9-11.6) for African Americans (74 cases, 67 controls). The L-myc gene sequence has a restriction site (EcoR1) polymorphism between the second and third exons. Inheritance of restriction site-present alleles was reported to confer poor prognosis (presence of lymph node metastases) in Japanese lung cancer patients. This hypothesis was tested in both case-control study subjects (56 cases, 55 controls) and additional surgical cases (40), but no evidence was found to support the hypothesis in the U.S. population. The p53 gene is a tumor-suppressor gene that can encode either a proline or an arginine in the 72nd residue. No associations was found between the minor allele (proline) and diagnosis of lung cancer (76 cases, 68 controls).(ABSTRACT TRUNCATED AT 250 WORDS)

Allelic frequency of a p53 polymorphism in human lung cancer.

p53 is a tumor suppressor gene that is mutated in diverse tumor types. Here we report the frequencies of common polymorphic variants at codon 72 of the p53 gene in germline DNA of lung cancer cases and controls as determined by a polymerase chain reaction strategy. The observed allelic distribution was found to be significantly different between African-Americans and Caucasians in this U.S. population. The frequency of polymorphic variants was similar in lung cancer cases and controls after adjustment for race. However, among lung cancer patients the proline variant at codon 72 was in excess in adenocarcinoma patients by comparison with other histologies.

Natural paucity of anaplerotic enzymes: basis for dependence of Arthrobacter pyridinolis on L-malate for growth.

Previous work has shown that in Arthrobacter pyridinolis the transport systems for glucose and several amino acids are respiration coupled, with malate oxidation occurring concomitantly with transport. The requisite malate has to be supplied exogenously, so that growth on glucose or certain amino acids only occurs if malate is also present in the medium. These and other data suggested that A. pyridinolis might be deficient in anaplerotic enzymes, which maintain intracellular levels of dicarboxylic acids. A comparative study was undertaken of anaplerotic enzymes in A. pyridinolis and in a closely related species, A. crystallopoietes, which has respiration-coupled transport of glucose but can grow on glucose without added malate. The paucity of anaplerotic enzymes in A. pyridinolis and its probable relationship to the malate requirement for growth on glucose were documented as follows: (i) A. crystallopoietes, but not A. pyridinolis, possesses phosphoenolpyruvate carboxylase activity, and neither species contains pyruvate carboxylase; (ii) both A. pyridinolis and A. crystallopoietes possess glyoxylate pathways that are induced by acetate but not by hexoses; (iii) isocitrate lyase-deficient mutants of A. pyridinolis fail to grow on rhamnose and fructose as well as acetate; and (iv) mutants of A. crystallopoietes that require malate for growth on glucose are deficient in phosphoenolpyruvate carboxylase.