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Biomedical subjects

A Jarrett

Publications and source records attributed to A Jarrett.

At least 19 recordsLinked to original sources
PubMed1994

A study on the effects of low haemoglobin on postnatal women.

OBJECTIVE: to assess the effect of low haemoglobin (Hb) on the mental and physical health of postnatal women. DESIGN: survey conducted between May 1991 and February 1992. SETTING: maternity unit in district general hospital in the UK. PARTICIPANTS: 1010 postnatal women who had delivered a live baby, did not stay in hospital for seven or more days postnatally, whose baby was not admitted to the neonatal unit and who did not have a current psychiatric disorder. MEASUREMENTS: Hb levels at 'booking', 34 weeks gestation, three days and six weeks post delivery; the Edinburgh Postnatal Depression Scale (EPDS) and a self-completion questionnaire at ten days, four weeks and six weeks post delivery. FINDINGS: women with a low Hb are more likely to be under 25 years of age, primiparous, be anaemic at 34 weeks gestation, not to have had a normal delivery, have had a blood loss greater than 250 ml and to have had heavy lochia postnatally. Low Hb levels were not associated with high EPDS scores. Low Hb levels were related to reports of low energy, breathlessness, faintness/dizziness, painful perineal sutures and tingling in fingers and toes at ten days post delivery. Whilst tiredness persisted to six weeks post delivery the other symptoms disappeared. IMPLICATIONS FOR PRACTICE: in order to reduce the incidence of postnatal anaemia a review of policies for testing is recommended so that the incidence of physical problems in the first six weeks can be reduced. There is a need for further research into the causes and potential alleviation of tiredness.

Adolescent↗
PubMed1993

Response to the National Cancer Institute Alert. The effect of practice guidelines on two hospitals in the same medical community.

BACKGROUND: Despite the recent increase in medical practice guideline development and dissemination, physician compliance with the guidelines has often been low. Previous research has suggested that physicians at hospitals with low volumes of cases and weakened financial status were more likely to omit indicated diagnostic testing or appropriate treatment. The authors sought to determine whether differences in compliance to a widely disseminated set of guidelines would exist even among the most dominant hospital providers within the same medical community. METHODS: Two hospitals, together providing nearly half of the cancer surgery within a metropolitan area, were studied for their compliance to the May 1988 National Cancer Institute (NCI) Clinical Alert regarding adjuvant therapy after primary treatment for node negative breast cancer. A case series consecutive collection of 549 women treated at the study hospitals for 2 years before and two years after the Alert determined those patients who had received any form or combination of adjuvant therapy after primary surgical treatment (lumpectomy or modified radical mastectomy). RESULTS: Following modified radical mastectomy, for women age 50 and older, the university hospital (U) provided adjuvant therapy to a higher percentage of patients than the community hospital (C) both before (25.6% versus 4.7%, P < 0.005) and after (58.9% versus 23.2%, P < 0.001) the Alert. For women younger than 50 years of age, the two hospitals were equally likely to provide adjuvant therapy both before and after the Alert. Following lumpectomy, hospital U increased the percentage of women receiving adjuvant therapy following the Alert in women younger than 50 years of age (25-75.8%, P < 0.001) and in women age 50 and older (33.3-56.5%, P < 0.025). Hospital C provided no adjuvant therapy before or after the Alert. Preferences for breast conserving surgical treatment were significantly (P < 0.001) different with hospital U performing a higher percentage of lumpectomies than hospital C both before (50.9% versus 14.9%) and after (57.6% versus 16.8%) the Alert. CONCLUSIONS: Significant differences in compliance with practice guidelines may be found even among the most dominant hospital providers of cancer services within the same medical community. The role of the surgeon in referring patients to the oncologist greatly influences the ultimate provision of adjuvant therapy. Strategies for enhancing compliance should be considered integral to the process of guideline development.

Age Factors↗
PubMed1993

Intensive care, survival, and expense of treating critically ill cancer patients.

OBJECTIVE: To determine the survival and factors affecting the survival of patients with solid tumors and hematologic cancers who were admitted to the intensive care unit, the time these patients spent at home (meaningful survival) before they died, and the cost per year of life gained and per year of life gained at home. DESIGN: Survival and cost-effectiveness analysis. SETTING: A tertiary-care cancer center at a university medical center. PATIENTS: Every patient admitted to the intensive care unit between July 1, 1988, and June 30, 1990, was entered into the study. This group comprised 83 patients with solid tumors and 64 patients with hematologic cancers. MAIN OUTCOME MEASURES: Factors affecting survival, such as age, sex, malignancy, length of stay in the intensive care unit, and necessity for mechanical ventilator assistance, as well as cost per year of life gained and cost per year of life gained at home. RESULTS: The only factor that significantly affected survival was the requirement for mechanically assisted ventilation for patients with hematologic cancers. More than three fourths of the patients in either group spent less than 3 months at home before dying. The cost per year of life gained for patients with solid tumors was $82,845 and for patients with hematologic cancers was $189,339. The cost per year of life gained at home was $95,142 for patients with solid tumors and $449,544 for patients with hematologic cancers. CONCLUSION: The majority of patients with solid tumors and hematologic cancers admitted to the intensive care unit die before discharge, or, if they survive the hospital admission, they spend a minimal amount of time at home before dying. This limited survival is achieved at considerable cost. Physicians who treat patients with neoplastic disease should discuss potential outcomes and the possibility of withdrawing life-supportive therapy if appropriate with the patient and family, so that a reasonable strategy can be agreed on before the initiation of therapy.

Adult↗
PubMed1989

Inability to demonstrate an ultrashort loop feedback mechanism for luteinizing hormone in humans.

hCG has biological properties similar to those of LH, but can be measured separately from LH by current radioimmunometric assays. To investigate the possible existence of an autoregulatory mechanism for LH in humans, we compared the basal LH concentrations and the LH response to a GnRH stimulus with and without prior administration of hCG. On two separate occasions, at least 1 week apart, six normal (eugonadal) males and six normal postmenopausal females were given, in random order, either 10,000 IU hCG or saline followed by iv injection of a 200-micrograms bolus of GnRH. Blood samples were then taken 30, 60, 90, 120, 180, 240, and 300 min after GnRH. Serum concentrations of LH and hCG were measured at each time by two monoclonal antibody sandwich assays developed in our laboratory. After exogenous hCG, serum hCG concentrations rose rapidly to 200-500 IU/L (15,000-35,000 pg/mL) in both the men and women, remaining at this high level throughout the study. In the men, sex steroid concentrations did not change in response to the hCG during the 9 study hours. Compared to saline-treated controls, hCG had no significant effect in either men or postmenopausal women on the basal LH concentration or the response to a GnRH bolus, as determined by peak response and area under the LH/time curve between 0-300 min after GnRH. We conclude that an ultrashort loop feedback mechanism for LH on its own secretion does not exist in humans, as assessed by the present protocol.

Adult↗
PubMed1988

The dansyl chloride technique for stratum corneum renewal as an indicator of changes in epidermal mitotic activity following topical treatment.

Using a hypomitotic agent, triamcinolone acetonide, and a hypermitotic agent, retinyl propionate, we investigated the relationship between epidermal mitotic activity and stratum corneum renewal time of topically treated skin as determined by the dansyl chloride staining technique. Treatment with the base cream resulted in a reduction in renewal time compared with an untreated control site. The predicted increase in renewal time with the hypomitotic agent and reduction with the hypermitotic agent was only observed when daily treatment was commenced 2 weeks prior to and continued after dansyl chloride staining and not when treatment was started after staining. These results indicate that in order to use cell renewal methods to demonstrate changes in mitotic activity brought about by topical treatments, it is necessary to pre-treat the skin with the test material to establish full epidermal equilibrium at the changed mitotic state before labelling with dansyl chloride. Meaningful claims for effects on cell renewal of specific cosmetic ingredients should only be made after comparison with a base cream treated site, both having been allowed to equilibrate, rather than on the basis of comparison with untreated skin.

Administration, Topical↗
PubMed1979

Granular layer induction following the topical application of proliferating agents.

Evidence is provided for a possible dermal influence on the epidermis. Topical vitamin A stimulates a number of dermal cells with different enzyme reactions, and these invade the epidermis at about the time a granular layer is induced in mouse tail scale epidermis. N-hexadecane also induced a granular layer formation in the tail scale epidermis but the application of this agent only results in the invasion of the epidermis by non-specific esterase cells. These non-specific esterase cells are present in the follicular zone where a granular layer is usually present. It appears that dendritic cells may be responsible for the formation of a granular layer and that these cells in some way influence the keratinocytes to discharge their lyosomal enzymes and thus form a granular layer. It appears unlikely that the dendritic cells actually contribute their own acid hydrolases to the cell cytolysis necessary for the production of granular layer.

Acid Phosphatase↗
PubMed1977

Voluntary nystagmus.

Voluntary nystagmus is a pendular, rapid, conjugate, primarily horizontal, benign nystagmus initiated and maintained by voluntary effort. The amplitude is variable, but always low. The rate is constant and rapid. Convergence is variable--apparently essential in some, nonessential in others, but related in all of our cases. This condition appears to have a familial component and is more common than originally thought. Voluntary nystagmus should be considered when dealing with any patient exhibiting nystagmus in order to minimize the possibility of misdiagnosis as occurred in one of our cases.

Adolescent↗
PubMed1975

Enzyme changes in lichen planus.

Untreated cases of lichen planus have been studied by histochemical techniques. The acid phosphatase reaction in the transitional zone has been quantitatively estimated and compared with the adjacent relatively normal epidermis. It was found that despite a thickened and accentuated granular layer as seen by routine histological methods there was a marked reduction in the intensity of the acid phosphatase reaction. The glucose-6-phosphate dehydrogenase reaction was marked in the upper layers of the epidermis in active lesions of lichen planus. This is similar to psoriasis, but different from normal human epidermis. The suggestion by other authors that lichen planus is an inborn error of metabolism is discussed. The dendritic cells of the epidermis as studied by the ATPase reaction are virtually absent in regions of active lichen planus and the possible significance of this is mentioned. The horny layer gives a dense reaction for phospholipids in lichen planus and this is similar to psoriatic keratin. The significance of this finding is considered.

Acid Phosphatase↗
PubMed1975

Bio-assay of corticosteroids for topical application.

Five commercially available corticosteroid creams were compared with respect to their thinning action on mouse tail epidermis. The greatest effects were produced by Synalar and Sintisone; hydrocortisone had the least action. In addition it was shown that the epidermal thickening induced by vitamin A could be significantly reduced by Ledercort cream. The thinning action of the fluorinated steroids on the epidermis is an important property of these agents when used for the treatment of dermatoses having a hyperactive epidermis. The mouse tail test is considered to be a useful screening test for new topical applications of these substances.

Administration, Topical↗