Search PubMed⌕ Search

Biomedical subjects

A Booth

Publications and source records attributed to A Booth.

At least 19 recordsLinked to original sources
PubMed2001

Developing the nurse's role in patient education: rehabilitation as a case example.

Over the past decade considerable emphasis has been placed on the nurse's role in patient education. Despite this numerous studies have suggested that this aspect of nursing practice is under-developed. Using rehabilitation as a case example this paper explores the nursing contribution to patient education in five conditions: multiple sclerosis; arthritis; myocardial infarction; spinal injury and stroke. Although the literature identifies considerable potential for nurses to take a lead role in patient education this is rarely achieved in practice. Analyses of printed curricula from a range of courses indicate that nurses are not adequately prepared for patient education and that a reorientation of nurse education is required.

Arthritis↗
PubMed2000

Assessing estradiol in biobehavioral studies using saliva and blood spots: simple radioimmunoassay protocols, reliability, and comparative validity.

We developed simple, reliable, and highly sensitive assay modifications of commercially available radioimmunoassay kits to measure estradiol in saliva and blood spot specimens. The saliva assay has average intra- and interassay coefficients of variation (CV) of 6.45 and 9.01%, with average analytical and serial dilution recoveries 100.65 and 89.25%. The blood spot assay has average intra- and interassay CVs of 7.57 and 8.22%, with analytical and serial dilution recoveries of 80.50 and 108.50%. The analytical sensitivity ranges of the saliva (0.25-7.50 pg/ml) and blood spot (2. 00-375 pg/ml) assays are sufficient to determine levels in the majority of pre- and postpubertal males and females. Blood spot assay results are correlated with serum estradiol levels for adult males, r (17) = 0.73, and females, r (18) = 0.96. In contrast, the serum-saliva correlation is only modest for adult females, r (14) = 0.60, and not significant for adult males. Substitution of blood spot assay results for serum values underestimates the known serum estradiol-behavior correlation by only 3.45%, whereas substitution of saliva assay results for serum values underestimates the association by 37.55%. The findings have important implications for the use and potential misuse of noninvasive measures of estradiol in studies of health and human development.

Adult↗
PubMed2000

Effectiveness of screening and monitoring tests for diabetic retinopathy--a systematic review.

AIMS: To determine which screening and monitoring tests for diabetic retinopathy are most effective and under what circumstances. METHODS: A systematic review of the English language literature, published from 1983 to April 1999. RESULTS: Available studies are generally limited in their ability to answer the important questions on the effectiveness of tests for early detection of diabetic retinopathy. No randomized controlled trials were identified although primary studies exist for two screening tests: ophthalmoscopy, either direct or indirect, and retinal photography, using either mydriasis or non-mydriasis. Retinal photography under mydriasis appears to be the most effective test, with the majority reporting levels of sensitivity in excess of 80%. However effectiveness is compromised when photographs are ungradable. Ophthalmoscopy can also reach acceptable standards of sensitivity and specificity. CONCLUSION: Based on an assessment of available cohort studies, the most effective strategy for testing is the use of mydriatic retinal photography with the additional use of ophthalmoscopy for cases where photographs are ungradable. This does not exclude the use of ophthalmoscopy alone for opportunistic case finding but there is evidence of considerable variation in effectiveness of this test.

Diabetic Retinopathy↗
PubMed2000

A systematic review of intra-arterial thrombolytic therapy for lower-limb ischaemia.

METHODS: a search of the major databases was carried out to identify randomised controlled trials of intra-arterial thrombolytic therapy in the treatment of limb ischaemia. The search was limited to English language articles, or those that provided a sufficiently detailed English summary, and to articles published after 1980. In addition, key journals were hand-searched and citations were also reviewed. Two reviewers independently performed data extraction and aggregate outcomes were obtained using a random effects meta-analysis. RESULTS: a total of 34 articles were found, but only 10 were reports of randomised controlled trials. Meta-analysis showed no significant differences between thrombolysis and surgery in terms of major amputation (relative risk (RR) 0.893 95% confidence interval (CI) 0.576, 1.383) and mortality (RR 1.24 95% CI 0.795, 1.9). However, there was an increased risk of haemorrhage with thrombolysis (RR 2.94 95% CI 1.1, 7.9). Sub-group analysis suggests that short-duration occlusions (relative risk reduction (RRR) 72%, numbers needed to benefit (NNB)=3) and occluded grafts (RRR 58%, NNB=4) may benefit from thrombolysis. However, thrombolysis should be avoided in occlusions of greater than 14 days - particularly native vessel occlusions. CONCLUSION: despite the theoretical advantages of thrombolysis, there is still insufficient evidence to justify its widespread use except in graft occlusions and short-duration ischaemia.

Amputation, Surgical↗
PubMed2000

Is there a positive volume-outcome relationship in peripheral vascular surgery? Results of a systematic review.

OBJECTIVES: to examine the evidence for the existence, or otherwise, of a positive volume-outcome relationship in the area of peripheral vascular surgery. DESIGN: systematic overview of prospective or retrospective volume-outcome studies. DATA SOURCES: seven bibliographic databases were searched for English-language articles published between 1986 and 1998. STUDY SELECTION: thirty-six articles published in peer-reviewed journals; excluding editorials, letters or abstracts; and addressing volume and outcome in peripheral vascular surgery. Criteria were applied and agreed by consensus between two of the authors. DATA EXTRACTION: the articles identified were independently assessed by two of the authors. Studies were categorised into three distinct areas - carotid endarterectomy- (17 studies), abdominal aortic aneurysm repair (16 studies) and other vascular interventions (four studies). Within each category studies were further classified according to full adjustment, partial adjustment or no adjustment for case mix. Where discrepancies arose, decisions were referred to a third author for arbitration. DATA SYNTHESIS: findings for carotid endarterectomy identified a positive volume-outcome relationship for both mortality and stroke at the physician level. There was less support for a positive relationship for mortality at the hospital level, and no evidence of benefits for stroke in higher volume hospitals. If only studies making a full adjustment for case mix are included, there is no clear support from statistically significant evidence for or against a positive volume-outcome relationship. For repair of unruptured abdominal aortic aneurysms there is evidence of a positive volume-outcome relationship at both the physician and hospital level, with evidence being particularly strong at the level of the hospital. For ruptured aneurysms the evidence is suggestive of there not being a positive volume-outcome relationship at the hospital level, while for physicians the evidence is more balanced with no clear support either way. For other vascular interventions there were insufficient studies (n=4) from which to draw meaningful conclusions. CONCLUSIONS: our results show that evidence of a relationship between volume and outcome in peripheral vascular surgery may be attributable to factors such as lack of adjustment for case-mix, different definitions of volume and poor quality of studies, especially those of retrospective design. Future studies should address these deficiencies by making full adjustment for case mix and by being prospective in design.

Aortic Aneurysm, Abdominal↗
PubMed2000

Structuring the pre-search reference interview: a useful technique for handling clinical questions.

OBJECTIVES: To explore whether structuring a literature search request form according to an evidence-based medicine (EBM) anatomy elicits more information, improves precision of search results, and is acceptable to participating librarians. METHODS: Multicenter before-and-after study involved six different libraries. Data from 195 minimally structured forms collected over four months (Phase 1) were compared with data from 185 EBM-structured forms collected over a further four-month period following a brief training intervention (Phase 2). Survey of librarians' attitudes toward using the EBM-structured forms was conducted early during Phase 2. RESULTS: 380 request forms, EBM-structured and minimally structured, were analyzed using SPSS. A statistically significant Pearson correlation was found between use of the EBM-structured form and complexity of the search strategy (P = 0.002). The correlation between clinical requests handled by the EBM-structured form and fewer items retrieved was also statistically significant (P = 0.028). However, librarians rated minimally structured forms more highly than EBM-structured forms against all dimensions except informativeness. CONCLUSIONS: Although use of the EBM-structured forms is associated with more precise searches and more detailed search strategies, considerable work remains on making these forms acceptable to both librarians and users. Nevertheless, with increased familiarity and improved training, information retrieval benefits could be translated into more effective search practice.

Data Interpretation, Statistical↗
PubMed1999

Mapping the evidence base of pathology.

Evidence-based medicine (EBM) is a paradigm that is beginning to exert an influence in related fields such as surgery, general practice, psychiatry, and now pathology. For example, a survey has shown that 70 per cent of therapeutic interventions in clinical haematology delivered in a district general hospital were based on research-derived evidence. A prerequisite to evidence-based pathology is availability of, and access to, the evidence base. As a discipline, pathology has certain characteristics that makes information retrieval more challenging. Nevertheless, a number of evidence-seeking techniques can be utilized to maximize the chances of success: focusing the question, use of an evidence-seeking protocol, and application of methodological filters. A number of key information sources are reviewed for their usefulness and a comparison is made with the yield from the World Wide Web. Conclusions are drawn from an example of the evidence-seeking process based on a clinical scenario involving immune thrombocytopenic purpura.

Databases, Bibliographic↗
PubMed1999

Salivary testosterone determination in studies of child health and development.

Measurement of hormones in children's saliva has excited interest because of numerous potential applications in developmental studies. Although assays of children's saliva for some hormones (e.g., cortisol) are widely available and used, the availability and use of assays of children's saliva testosterone is restricted. By adapting a commercially available serum testosterone kit, our laboratory has developed a reliable, efficient, and highly sensitive procedure for measuring testosterone in children's saliva that does not require separation or extraction. The minimum detection limit was 0.8 pg/mL. Intraassay coefficients of variation (CV) were between 3.66 and 6. 78% at concentrations 9.25 to 86.41 pg/mL, and interassay CVs were between 5.70 and 6.61% at concentrations of 7.3 to 118.51 pg/mL. The standard curve was highly reproducible (M slope = -0.70 and Mr = 0. 99). Method accuracy, determined by spike recovery, and linearity, determined by serial dilution, were 99.20 and 92.80%, respectively. Values from matched serum and saliva samples showed strong linear relationships. The assay captured near 99.09% of the range of individual differences in boys' (N = 90) and girls' (N = 85), ages 8-12, am and pm salivary testosterone levels. This assay can be easily applied to the investigation of testosterone-behavior relations in the context of studies on child health and development. It may help many child development researchers improve or expand their research activities.

Adult↗
PubMed1999

Assessing dehydroepiandrosterone in saliva: a simple radioimmunoassay for use in studies of children, adolescents and adults.

While salivary assays for some hormones are widely used, the availability of assays for salivary DHEA is limited. By adapting a commercially available radioimmunoassay serum kit, we developed a reliable, efficient and sensitive measure of DHEA in saliva that does not require separation or extraction. The minimum detection limit was 4.0 pg/ml. Intra-assay coefficients of variation (CV%) were on average 4.05, and inter-assay CVs averaged 9.70. Method accuracy, determined by spike recovery, and linearity, determined by serial dilution, averaged 99.55 and 92.03%. Levels in matched serum and saliva samples showed strong linear relationships for adult males and females. Specific guidelines are developed for sample collection, storage, and preparation procedures. Reference ranges for salivary DHEA levels are provided for 64 children ages 8-11, 96 adolescents ages 12-17 and 48 adults ages 30-45. Salivary DHEA levels are shown to reflect developmental, gender and diurnal differences.

Adolescent↗
PubMed1999

Testosterone and men's health.

Medical and behavioral research depicts the influence of testosterone on health in opposite ways, the former finding beneficial effects and the latter potentially detrimental ones. We investigate the relationship between testosterone and health risk behavior, indicators of disease, and overall health in a sample of 4393 men who were interviewed and medically examined. Analysis revealed that having a high level of testosterone, compared to a low level, increased the odds of health risk behavior. With respect to disease, high testosterone increased the odds of some health problems but decreased the chances of others. At very high levels testosterone loses many of its beneficial effects. Overall, men with high testosterone would be healthier if they did not engage in health risk behavior.

Adult↗
PubMed1999

Pharm-ing cyberspace: the Internet as a tool for evidence based pharmacotherapy.

Although the Internet lacks many of the features of a desirable drug information system, it has increasing potential to inform evidence-based patient management. This article considers three contributions that the Internet can make to evidence-based pharmacotherapy; as a delivery mechanism for textual documents, as a complementary source of intelligence and as a source of value-added information. Focusing on exemplar sites, rather than on drug and information sources in general, the author reviews the usefulness and availability of current resources. While limitations of the technology presently constrain its use for direct patient care and the quality of any information must be critically appraised, the Internet has already proved a valuable source for drug evaluation, education, research and audit.

Drug Information Services↗
PubMed1999

Polymorphic chloroplast simple sequence repeat primers for systematic and population studies in the genus Hordeum

In this study we report the development of primers to amplify polymorphic chloroplast simple sequence repeats in the genus Hordeum, which includes cultivated barley (H. vulgare ssp. vulgare) and its wild progenitor H. vulgare ssp. spontaneum. Polymorphic products were amplified in a wide range of Hordeum spp. and intraspecific variation was detected in both cultivated and wild barley. A decrease in cytoplasmic diversity was observed between sspp. spontaneum and vulgare as well as between ssp. vulgare landraces and cultivars, which is characteristic of domestication processes in many corp species. We also observed possible evidence for reticulate evolution of H. brachyantherum polyploids, with apparent multiple cytoplasmic introgressions during successive polyploidization events.

Journal Article↗
PubMed1999

A systematic review of foot ulcer in patients with Type 2 diabetes mellitus. I: prevention.

AIM: To evaluate the role of preventative strategies in reducing foot ulcers in patients with Type 2 diabetes mellitus, both in the general population and those identified to be at a raised risk. METHOD: A systematic review of interventions to prevent diabetic foot ulcers. RESULTS: Available studies are generally unsatisfactory in their ability to answer the important questions relating to prevention. However, where people with diabetes receive well-organized and regular care with rapid referral to appropriate specialist multidisciplinary teams when problems (or their precursors) occur, ulcer morbidity can be substantially reduced. CONCLUSION: Foot ulcers are common in people with diabetes and are costly in terms of both patient morbidity and the use of healthcare resources. Although it is nearly a decade since the St Vincent Declaration called for a marked reduction in morbidity to be achieved through better patient management, available evidence suggests that the process of care in Britain is still very variable in quality. Foot care for people with diabetes must be organized to provide monitoring, education and referral in a manner acceptable to patients and realistic for local healthcare providers.

Diabetes Mellitus, Type 2↗
PubMed1999

A systematic review of foot ulcer in patients with Type 2 diabetes mellitus. II: treatment.

AIM: To assess the value of treatments for foot ulcers in patients with Type 2 diabetes mellitus. METHODS: A systematic review of interventions to treat diabetic foot ulcers. RESULTS: The evidence base for treating infections and dressing wounds is poor. A number of new and potentially promising treatments are being developed but currently available studies are often small, inadequately powered and use different methods and outcomes. CONCLUSIONS: Given the prevalence, morbidity and healthcare costs of diabetic foot disease, it is surprising that available trials provide inadequate evidence to improve upon current empirically based treatment approaches. Substantial effort and resources should be deployed in order to investigate both new and existing treatments in a co-ordinated, systematic and consistent manner, so that a proper evidence base can be established for this important disease area.

Diabetes Mellitus, Type 2↗