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Biomedical subjects

A Hilton

Publications and source records attributed to A Hilton.

At least 19 recordsLinked to original sources
PubMed2001

The Kinemax total knee arthroplasty. Nine years' experience.

We reviewed the outcome of 422 primary cemented Kinemax total knee arthroplasties implanted into 369 patients over a period of five years, from January 1989. The operations were carried out at two NHS district general hospitals and one teaching hospital by 31 surgeons. During the period of review, 49 patients died and ten knees were lost to follow-up (68 knees). The mean Knee Society score improved from 28 before to 89 after surgery, and the mean function score increased from 23 to 79. The range of flexion improved from 92 degrees to 105 degrees. These improvements were maintained throughout the period of study. At the latest review radiolucent lines of 1 mm were seen around 15% of tibial components, 1.4% of patellar components and 9.5% of femoral components. In no case were these changes progressive. Using revision as the endpoint, cumulative survival was 99% after five years and 96.95% after nine years. All revisions were undertaken for deep infection or secondary trauma. Our study has shown that the Kinemax total knee replacement, when carried out with retention of the posterior cruciate ligament by surgeons of varying experience, produces very satisfactory results in the medium term.

Aged↗
PubMed2000

Sedation in the intensive care unit.

OBJECTIVE: To describe the goals of sedative use in the intensive care unit and review the pharmacology of commonly used sedative drugs as well as to review pertinent publications in the literature concerning the comparative pharmacology of these drugs, with emphasis on outcomes related to sedation and comparative pharmacoeconomics. DATA SOURCES: Publications in the scientific literature. DATA EXTRACTION: Computer search of the literature with selection of representative articles. SYNTHESIS: Proper choice and use of sedative drugs is based on knowledge of the pharmacology of commonly used agents and is an essential component of caring for patients in the intensive care unit. The large variability in pharmacokinetics and pharmacodynamics in the critically ill make it difficult to directly compare agents. Midazolam provides rapid and reliable amnesia, even when administered for low levels of sedation. Propofol may be useful when deeper levels of sedation and more rapid awakening are required. Lorazepam can be used for long-term sedation in more stable patients if rapidity of effect is not required. Further investigation in assessment of depth of sedation in the critically ill is needed. Continued study of costs, side effects, and appropriate dosing strategies of all sedative agents is needed to answer questions not sufficiently addressed in the current literature. CONCLUSION: An individualized approach to sedation based on knowledge of drug pharmacology is needed because of confounding variables including concurrent patient illness, depth of sedation, and concomitant use of analgesic agents. (Crit Care Med 2000; 28:854-866)

Decision Making↗
PubMed2000

Patient and family adjustment to kidney transplantation with and without an interim period of dialysis.

This exploratory study was designed to examine the process of patient and family adjustment to kidney transplantation and to compare differences between those who had and those who did not have dialysis pretransplant. To capitalize on benefits of longitudinal and cross-sectional designs, a mixed-method approach described by Aaronson and Kingry (1988) was used. Participants were recruited from two major transplant centers in Western Canada. Twenty patients with ESRD and their partners were studied longitudinally at three points: during the period before the kidney transplant assessment phase and then at 3 and 6 months posttransplant. Forty-seven ESRD patients and their partners comprised the cross-sectional sample. Participants comprising the cross-sectional sample provided responses from at least one of the three time points. Patients and/or their partners completed a series of questionnaires focusing on family functioning (Family Inventory of Life Events and Change [FILE], Feetham Family Functioning Survey [FFFS]); support and resources (Family Inventory of Resources for Management [FIRM]); as well as uncertainty (Uncertainty Stress Scale [USS]); sickness impact (Sickness Impact Profile [SIP]); and sense of coherence (Sense of Coherence Scale [SOC]). The findings indicated that patients and their partners were under considerable stress as they underwent kidney transplantation. Illness and family care strains as well as financial strains were significant. The participants expressed low to moderate uncertainty that decreased over time from the pretransplant to the posttransplant period. Patients on dialysis prior to transplant were more physically and psychologically affected than patients pre-empted to transplant. Those who were pre-empted to transplant reported minimal impact pretransplant but considerable improvement in their psychological and physical state posttransplant. In conclusion, transplantation without prior dialysis resulted in less physical and psychological impact for patients and their spouses. These findings point to a need for interdisciplinary education and support programs at both the pretransplant and posttransplant phase to help patients and their partners adjust to living with a kidney transplant. Given the beneficial effects of pre-emptive transplantation, emphasis must be placed on increasing the organ donor pool so that more pre-emptive transplants can be conducted.

Adaptation, Psychological↗
PubMed1997

The Comox Valley Nursing Centre.

With today's emphasis on health care reform across Canada, many individuals, groups and governments are seeking new approaches to the delivery of health care. Nursing organizations have argued for approaches that make better use of nurses' experience and expertise. Thus, a project in British Columbia, the Comox Valley Nursing Centre, warrants interest from nurses and policy makers for the way it broadened the nursing role to provide high quality, effective health care in specific community.

Adult↗
PubMed1995

Factors affecting acute-care nurses' use of research findings.

This study describes staff nurses' perceptions of hospital support for research and their expectations for research; and relationships between organizational factors, individual factors, and staff nurses' use of research. These factors were compared for groups of nurses by education level and hospital size. Stratified random sampling of 450 nurses was obtained from a provincial nurses' association. The mailed survey was completed by 183 nurses. Use of specific research findings was related to organizational factors and was congruent with earlier studies. Nurses' perceptions of their general use of research were related to individual characteristics such as interest in research and expectations to use research, which scored high regardless of educational level. Nurses' perceptions of organizational support and expectations differed significantly according to hospital size. This study suggests that the organizational context is influential, but nurses' value of, interest in, and expectations to use research may mediate this influence. Enhancing research-based practice will require attention to the organizational context of practice.

Acute Disease↗
PubMed1993

Reduction of tumor necrosis factor alpha and interleukin-1 beta levels in human synovial tissue by interleukin-4 and glucocorticoid.

The effects of recombinant human interleukin-4 (IL-4) and the glucocorticoid, dexamethasone, on tumor necrosis factor alpha (TNF alpha) and interleukin-1 beta (IL-1 beta) levels in cultures of rheumatoid and osteoarthritic synovial tissue were studied. Low concentrations of IL-4 and dexamethasone suppressed the levels of both cytokines in the supernatants of both types of tissue after stimulation with lipopolysaccharide (LPS); the IL-1 beta and TNF alpha levels were measured by ELISA. It is suggested that it is the monocyte/macrophage in the synovial tissues that is responsive to the inhibitors. It is proposed that glucocorticoids may act on synovial tissue in this manner in vivo and IL-4 may do so if administered intraarticularly.

Arthritis, Rheumatoid↗
PubMed1992

The human Y chromosome: overlapping DNA clones spanning the euchromatic region.

The human Y chromosome was physically mapped by assembling 196 recombinant DNA clones, each containing a segment of the chromosome, into a single overlapping array. This array included more than 98 percent of the euchromatic portion of the Y chromosome. First, a library of yeast artificial chromosome (YAC) clones was prepared from the genomic DNA of a human XYYYY male. The library was screened to identify clones containing 160 sequence-tagged sites and the map was then constructed from this information. In all, 207 Y-chromosomal DNA loci were assigned to 127 ordered intervals on the basis of their presence or absence in the YAC's, yielding ordered landmarks at an average spacing of 220 kilobases across the euchromatic region. The map reveals that Y-chromosomal genes are scattered among a patchwork of X-homologous, Y-specific repetitive, and single-copy DNA sequences. This map of overlapping clones and ordered, densely spaced markers should accelerate studies of the chromosome.

Base Sequence↗
PubMed1992

The human Y chromosome: a 43-interval map based on naturally occurring deletions.

A deletion map of the human Y chromosome was constructed by testing 96 individuals with partial Y chromosomes for the presence or absence of many DNA loci. The individuals studied included XX males, XY females, and persons in whom chromosome banding had revealed translocated, deleted, isodicentric, or ring Y chromosomes. Most of the 132 Y chromosomal loci mapped were sequence-tagged sites, detected by means of the polymerase chain reaction. These studies resolved the euchromatic region (short arm, centromere, and proximal long arm) of the Y chromosome into 43 ordered intervals, all defined by naturally occurring chromosomal breakpoints and averaging less than 800 kilobases in length. This deletion map should be useful in identifying Y chromosomal genes, in exploring the origin of chromosomal disorders, and in tracing the evolution of the Y chromosome.

Base Sequence↗
PubMed1992

Replacement of cisplatin with carboplatin in combination chemotherapy against ovarian cancer: long-term treatment results of a study of the Gynaecological Cancer Cooperative Group of the EORTC and experience at The Netherlands Cancer Institute.

Carboplatin-based chemotherapy has been evaluated in three studies of ovarian cancer patients. In the first, combination cisplatin and carboplatin plus doxorubicin/hexamethylmelamine/cyclophosphamide were compared as first-line treatment of ovarian cancer in 341 women with stage IIB to IV disease. There were no observed differences in results between the two treatment groups. In the second study, conventional doses of intravenous carboplatin (350 mg/m2, given on day 1) plus oral cyclophosphamide (100 mg/m2 days 2 to 6) were given to late-relapsing patients (12 to 72 months) previously treated with cisplatin. Mature data showed a 55% overall response rate, acceptable toxicity, and an absence of additive neurotoxicity. Finally, 65 patients with refractory disease or in early relapse after cisplatin therapy (within 12 months) were treated with high-dose carboplatin (800 mg/m2). Toxicity was severe, but the 45% combined response rate was considered encouraging and worthy of further evaluation. It was concluded that carboplatin is an appropriate replacement for cisplatin in the treatment of ovarian cancer.

Adult↗