Search PubMed⌕ Search

Biomedical subjects

A Jones

Publications and source records attributed to A Jones.

At least 73 records · Page 4Linked to original sources
PubMed2004

Evaluation of delivery of enhanced diabetes care to patients of South Asian ethnicity: the United Kingdom Asian Diabetes Study (UKADS).

AIMS: We tested the hypothesis that enhanced care for diabetes, tailored to the needs of the South Asian community with Type 2 diabetes, would improve risk factors for diabetic vascular complications and ultimately reduce morbidity and mortality. PATIENTS AND METHODS: The study was a cluster randomized controlled trial (RCT) with general practice the unit of randomization. Six West Midlands general practices with a high proportion of South Asian patients were randomized to 'enhanced care' using Asian link workers and extra community diabetes specialist nurse sessions (intervention) or continued standard practice care (control). RESULTS: Of 401 patients recruited to the study, 361 (90%), comprising 178 from Coventry and 183 from Birmingham were eligible and included in the analyses. The mean age at baseline (standard deviation, SD) was 58.9 (11.7 years) with median (interquartile range; IQR) duration of diabetes 6.5 (3-11) years. At one year follow-up there was a significant difference in reduction of systolic (4.6 mmHg, P = 0.035) and diastolic blood pressure (3.4 mmHg, P = 0.003) and total cholesterol (0.4 mmol/l, P = 0.005), comparing the intervention and control groups. After adjusting for baseline measurement and age, only differential reduction in diastolic blood pressure remained significant. There was no significant change in HbA(1c) and no difference between the groups. CONCLUSIONS: Using link workers and extra community diabetes specialist nurse input together with treatment protocols in primary care might prove a useful strategy in working towards NSF targets for diabetes management. In this study, small reductions in blood pressure and cholesterol were achieved. Improvement in glycaemic control may require longer and possibly different strategies. Further research is required to evaluate fully the effectiveness, including the costs and longer term sustainability of culturally sensitive initiatives.

Aged↗
PubMed2004

The management of transverse maxillary deficiency.

The correction of transverse maxillary deficiency can be an important component of an orthodontic treatment plan. A number of different techniques are available for the correction of such discrepancies. The aim of this article is to review the methods available to clinicians discussing their indications, advantages and disadvantages.

Humans↗
PubMed2003

Transition from open to laparoscopic adrenalectomy: the need for advanced training.

BACKGROUND: We sought to determine the learning curve for laparoscopic adrenalectomy (LA), current use of the procedure, and if indications for adrenalectomy had changed in the past decade. METHODS: A retrospective chart review was performed for all adrenalectomies after 1990. Practicing community surgeons in Oregon were mailed a questionnaire. RESULTS: Seventy-five LAs were performed at the Oregon Health and Sciences University and Portland VA Medical Center. Average operating room (OR) time was 161 min and average estimated blood loss (EBL) was 84 ml. There were four complications and two conversions. Comparing the first 20 to the last 20 patients, OR times were 154 vs 159 min (not significant), and EBL was 102 vs 47 ml ( p < 0.05). There were two vs one complications ( p > 0.05) and one conversion each. Most residents completed less than two procedures during training, and community surgeons performed none during training. Of 17 currently performing LA, 14 had postresidency training. Open technique was used more often for hormonal ablation and malignancy. CONCLUSION: Operative time and complications do not decrease with experience, but EBL does. Few, if any, residents acquire enough experience to perform LA in practice. The procedure is performed laparoscopically more often for benign disease.

Adrenal Gland Neoplasms↗
PubMed2003

Cerebellar granule cell Cre recombinase expression.

The cerebellum maintains balance and orientation, refines motor action, stores motor memories, and contributes to the timing aspects of cognition. We generated two mouse lines for making Cre recombinase-mediated gene disruptions largely confined to adult cerebellar granule cells. For this purpose we chose the GABA(A) receptor alpha6 subunit gene, whose expression marks this cell type. Here we describe mouse lines expressing Cre recombinase generated by 1) Cre knocked into the native alpha6 subunit gene by homologous recombination in embryonic stem cells; and 2) Cre recombined into an alpha6 subunit gene carried on a bacterial artificial chromosome (BAC) genomic clone. The fidelity of Cre expression was tested by crossing the mouse lines with the ROSA26 reporter mice. The particular alpha6BAC clone we identified will be valuable for delivering other gene products to cerebellar granule cells.

Animals↗
PubMed2003

Granulomatous mycosis fungoides presenting as an acquired ichthyosis.

We report a case of a 69-year-old gentleman who presented with a 3-month history of unexplained fevers and malaise who developed generalized pruritus, alopecia and an ichthyosiform erythematous eruption on his forearms, legs, chest and back. Skin histology, immunophenotyping and molecular features were consistent with granulomatous mycosis fungoides. He has been successfully treated with twice weekly PUVA photochemotherapy.

Aged↗
PubMed2003

Some benefits experienced by hospice nurses from group clinical supervision.

A small clinical supervision group consisting of five hospice nurses met together in their workplace 1 h weekly for 12 weeks. Issues concerning professional practice were examined with the help of a researcher (A.J.) who acted as facilitator. At the end of the group's life A.J. asked all nurses to complete a questionnaire related to the workplace and 12 identified helpful factors. Two weeks later the hospice nurses were interviewed in group format and asked to consider the reasons for their choice of answers. The data revealed that collectively--interpersonal learning (output), identification, catharsis, family re-enactment, group cohesiveness and self-understanding were experienced by the hospice nurses as the most helpful factors to the group. Existential factors, guidance, universality, interpersonal learning (input), instillation of hope and altruism were identified as less important. Variations in individual responses showed different ways in which a group might meet the needs of its members. The study concludes with the suggestion that work discussion groups can offer nurses the means to calm, regulate and plan their interactions with themselves and others. Clinical supervision is an effective format for exploring issues concerning professional practice, allowing nurses to: learn from each other, offer support, recognize how others see and esteem them as fellow workers, and moderate concerns and anxiety related to their work. Group work is likely to raise anxiety in all participants, however, and preparation and support are required for the group facilitator. Carefully chosen membership is also considered important to the safety of members and successes of the group.

Attitude of Health Personnel↗
PubMed2003

Perceptions on the development of a care pathway for people diagnosed with schizophrenia on acute psychiatric units.

Policy development and practice for hospital mental health care has shifted towards a user-focused and evidence-based direction. Important within this policy development has been a guideline for inpatient care, particularly the establishment of an inpatient Acute Care Forum. A vehicle to both commission and develop this agenda is the Implementation of a care pathway. A research study was designed to explore how a care pathway could be developed for inpatients diagnosed with schizophrenia. Interviews with a range of health care professionals and observation of the process of care pathway development were the data-collection tools. Analysis was driven by emergent themes across the data set. Themes were then presented as one possible interpretation of the factors to be considered for the development of a care pathway for people diagnosed with schizophrenia. Clinicians experienced many difficulties in finding and including evidence-based practice (EBP) within a care pathway. Professions on the whole felt that there was a certain futility to psychiatric care given the paucity of evidence to support practice. This may contribute towards the poor use of hospital care as a therapeutic intervention as part of the wider spectrum of care. Difficulties arise when trying to develop a care pathway with EBP, given the paucity of knowledge on why certain interventions are only partially effective. The development of a care pathway may inform the priorities of the inpatient Acute Care Forum for people diagnosed with schizophrenia. A care pathway should not be constrained, however, to EBP and should incorporate therapeutic activities to improve the overall experience of service users. Limitations on the study and the collection of evidence supporting these conclusions conclude the paper.

Attitude of Health Personnel↗
PubMed2003

Can undergraduate education have an effect on the ways in which pre-registration house officers conceptualise communication?

AIMS: In 1994 Manchester Medical School introduced a learner-centred course using problem-based learning (PBL), which emphasises effective communication skills. This study explored how 2 cohorts of graduates conceptualised communication within their role as pre-registration house officer (PRHOs). METHODS: Graduates from the last year of the traditional and first year of the new course were interviewed 3 months after starting work. They were asked how well their courses had prepared them for working as PRHOs and were given a specific question about communication skills. Interviews were tape-recorded, transcribed, coded and analysed. RESULTS: In all, 24 traditional course graduates (TCGs) and 23 new course graduates (NCGs) were interviewed. Traditional course graduates tended to conceptualise communication as informing people rather than as involving negotiation or having therapeutic effects. Most TCGs considered good communicators 'were born that way' and did not think communication skills could be learned. Many NCGs had a richer concept of communication that recognised communication has therapeutic benefits for patients and involved negotiation. They understood it was possible to teach communication skills. However, a minority of NCGs conceptualised communication in a similar way to TCGs. CONCLUSION: Our study suggests that the new course has helped NCGs acquire a more complex concept of communication in their role as PRHOs.

Cohort Studies↗
PubMed2003

Higher energy monophasic DC cardioversion for persistent atrial fibrillation: is it time to start at 360 joules?

BACKGROUND: Electrical direct-current cardioversion (DCCV) has become a routine therapy for atrial fibrillation (AF), although some uncertainty remains regarding the optimal energy settings. AIMS: This study examines whether the use of a higher initial energy monophasic shock of 360 joules (J) for external DCCV, in patients with persistent AF would prove more effective, yet as safe, as the use of a lower initial energy 200 J shock. METHODS: A cohort of 107 patients with persistent AF was prospectively randomized to an initial synchronized DCCV shock of 360 J versus 200 J (n = 50 vs 57), followed by a similar shock sequence thereafter of four further shocks of 360 J for the two groups. In all patients the levels of troponin I (cTnI) were measured precardioversion and 18-20 hours later, the following day. In a subgroup of 36 patients in each group, the levels of creatine kinase (CK) and aspartate transaminase (AST) were measured pre- and 18-20 hours postcardioversion. RESULTS: The success rate for DCCV was significantly higher in the 360 J group compared to the 200 J group (96.0% vs 75.4%, P = 0.003). The mean CK IU/L levels (1137.5.0 vs 2411.8, P = 0.014) and AST levels (39.83 vs 52.86, P = 0.010) were significantly lower in the 360 J group compared to the 200 J group. There was no statistical rise in cTnI (microg/L) in either group (P = 1.00). The average number of shocks delivered (1.84 vs 2.56, P = 0.006) was significantly less in the 360 J group than in the 200 J group, although total energy requirements for DCCV were similar for the two groups (662.4 J vs 762.4 J, P = 0.67). CONCLUSION: For patients with persistent AF the use of a higher initial-energy monophasic shock of 360 J achieves a significantly greater success rate, with less skeletal muscle damage (and no cardiac muscle damage) as compared with the traditional starting energy of a 200 J DC shock.

Adult↗
PubMed2003

Near patient cholesterol testing in patients with peripheral arterial disease.

AIMS: To assess the bias, precision and utility of the Bioscanner 2000 for near patient testing of total cholesterol (NPTC) in patients with peripheral arterial disease (PAD). METHODS: One hundred consecutive patients attending a hospital-based clinic with symptomatic PAD underwent non-fasting NPTC using finger prick blood sample and a laboratory total cholesterol (TC) using blood drawn from an antecubital fossa vein. RESULTS: The Bioscanner 2000 showed good precision with a coefficient of variation of 1.8-3.8%. NPTC was significantly lower than laboratory TC (mean (S.D.) 4.67 (1.1) vs. 5.12 (1.2) mmol/l), p < or = 0.01, paired Student's t-test. Comparing the two methods using Deming regression revealed a 15% negative bias for the Bioscanner 2000 compared to laboratory testing, which was demonstrated to be a systematic bias using a Bland-Altman plot. Almost half (46%) of the readings differed by > 0.5 mmol/l, 16% by > 1.0 mmol/l and 3% by > 2 mmol/l. This means that if the cut-off for statin treatment were taken as a TC of 5.0 or 3.5 mmol/l then, based on NPTC, alone 18 and 6% of patients, respectively, would not have received a statin. CONCLUSIONS: In the present study, NPTC significantly under-estimated TC when compared to laboratory testing. However, in the majority of cases, this would not have affected the decision to prescribe a statin and NPTC testing allows the immediate institution or titration of statin treatment.

Aged↗
PubMed2003

The subjective experience of early postoperative pain following retrobulbar anaesthesia for enucleation and primary orbital implant.

INTRODUCTION: We performed a prospective audit of the level of postoperative pain experienced by patients following enucleation with insertion of a primary orbital implant after preincisional regional retrobulbar anaesthesia using bupivacaine 0.75% with 1:100,000 adrenaline. MATERIALS AND METHODS: An 11-point numerical ranking box scale was used to measure the subjective experience of postoperative pain following enucleation with insertion of a primary orbital implant in 40 patients with uveal melanoma. Surgery was performed under general anaesthesia with a supplementary peroperative retrobulbar injection of bupivacaine 0.75%/adrenaline 1:100,000. Pain scores were measured for the first 8 hours following administration of the block. RESULTS: The sample included 19 female and 21 male patients with a mean age of 66.7 years (31-87). At four hours post block, 80% were still pain free with 17% experiencing only mild to moderate pain (BS-11 = 1-4). Thirty-four (85%), twenty-eight (70%) and twenty-seven (67%) patients remained pain free at 2, 3 and 4 hours, respectively with no additional analgesia. The remainder scored BS-11 of 1-4 in 92% of cases. Twenty percent required supplementary analgesia (paracetemol in 78% cases) by 5 hours and 57% by 8 hours. BS-11 at 8 hours were 0 in 50%, 1-4 in 22% and 5-10 in 10% of patients (17% asleep). No complications using this technique were recorded. DISCUSSION: Using a preincisional retrobulbar injection of bupivacaine with adrenaline, BS-11 pain scores remained low with no or minimal additional analgesia for up to 4 hours post surgery. In combination with oral analgesia, effective pain control was provided in most cases for up to 8 hours post block.

Adult↗
PubMed2003

Hepatitis C and B-cell lymphoma.

The association between the hepatitis C virus and B-cell non-Hodgkin's lymphomas is controversial. We review the epidemiological evidence behind the association, and look at the reasons behind the variation in study findings. There is increasing evidence of the pathogenesis of hepatitis C-associated lymphoma. Treatment of the hepatitis C virus with antiviral therapy may lead to the regression of some low-grade lymphomas. The management of other hepatitis C-associated lymphomas is similar to that of conventional lymphoma, although viral reactivation and subsequent immune reconstitution hepatitis can complicate chemotherapy.

Hepatitis C↗
PubMed2003

Combining trastuzumab (Herceptin) with hormonal therapy in breast cancer: what can be expected and why?

Hormonal therapy and the humanised anti-HER2 monoclonal antibody trastuzumab (Herceptin) represent one of the oldest and one of the newest treatment modalities for breast cancer, respectively. Recent data have suggested that HER2 overexpression is associated with resistance to hormonal therapy and there is considerable preclinical evidence to support the existence of interaction or 'cross talk' between HER2 and estrogen-receptor (ER) signalling pathways in breast cancer. Preclinical data also demonstrate that adding trastuzumab to hormonal therapy results in greater antitumour activity than either agent alone. The existence of an inverse relationship between ER expression and HER2 overexpression has also been well established clinically. Thus, a range of clinical trials are now ongoing to determine whether the addition of trastuzumab to hormonal therapy will provide breast cancer patients with benefits in clinical practice. This review describes the rationale for these trials and discusses the potential of therapeutic regimens combining trastuzumab with hormonal therapy.

Antibodies, Monoclonal↗
PubMed2003

Use of videotape to assess mobility in a controlled randomized crossover trial of physiotherapy in chronic multiple sclerosis.

OBJECTIVES: To determine to what degree assessment of mobility based on comparison of videotape recordings before and after courses of physiotherapy in patients with chronic multiple sclerosis (MS) is reliable, correlates with 'live' assessments and indicates benefit. DESIGN: Prospective data collection within a randomized crossover controlled trial of physiotherapy at home, as an outpatient, or 'no therapy' in 40 patients. SETTING: Hospital outpatients: outpatient and home physiotherapy. OUTCOMES: Mobility change based on a comparison of short video recordings before and after each treatment period was scored independently by two physiotherapists blinded to therapy type and other measures of outcome. Scores were compared with changes in the Rivermead Mobility Index (RMI) and other indices assessed by a physiotherapist in the patient's home. RESULTS: The two video observers agreed substantially on patient outcome. Changes in walking based on video correlated with RMI for home treatment (r = 0.41, p = 0.008) but not for hospital or no treatment periods (r = 0.14 and 0.15): video changes correlated with the 'live' assessor's global change score inconsistently ('no therapy' r = 0.48, p = 0.002, hospital r = 0.30, p = 0.06 and home r = 0.17, p = 0.30 treatment periods). Based on video data alone, improved mobility was evident following home therapy for only one observer but not for the other or the averaged scores of both. CONCLUSION: There was substantial agreement between two observers deciding on change in mobility based on independent blinded evaluation of short video sequences. However the correlations of these with 'live' assessments were variable. Physiotherapy had a less clear benefit on mobility based on video analysis alone compared with 'live' assessments. The study highlights the need for more objective measures of habitual mobility over longer periods.

Adult↗
PubMed2003

The effect of enamel matrix proteins on periodontal regeneration as determined by histological analyses.

BACKGROUND: Therapeutic approaches to periodontal regeneration in the past have utilized bone replacement grafts, growth factors, barrier membranes, or combinations of these approaches. More recently, enamel extracellular matrix proteins have been introduced to stimulate periodontal regeneration. One factor thought to have an impact on the outcome of the regenerative process is the initial size of the periodontal defect. This is particularly the case when using proteins to stimulate regeneration, because the concepts of guided tissue regeneration emphasize the need for space maintenance to allow for selected cell repopulation. The goal of this study was to evaluate periodontal regeneration in intrabony defects of various sizes treated with enamel matrix proteins. METHODS: Periodontal defects ranging in size from 1 to 6 mm were created bilaterally around 3 teeth in the mandibles of baboons. Plaque was allowed to accumulate around ligatures placed into the defects. After 2 months, the ligatures were removed, the teeth were scaled and root planed, and a notch was placed at the base of the defect. On one side of the mandible, neutral ethylene diamine tetracetic acid and enamel matrix proteins were used to treat the defects. The other side served as a control, with neutral ethylene diamine tetracetic acid treatment alone after scaling and root planing. Flaps were sutured and the animals were allowed to heal without oral hygiene procedures. After 5 months, the animals were sacrificed and the teeth were processed for histological evaluation. RESULTS: Periodontal regeneration occurred in all sizes of the periodontal defects. Qualitatively, new cementum, periodontal ligament with Sharpey's fibers, and new bone tissue were observed. In general, enamel matrix protein treatment resulted in greater tissue formation than controls. In many instances, dramatic tissue formation occurred far coronal to the base of the defects. In addition, horizontal bone fill occurred in defects that were initially 4 or 6 mm wide. The resultant width of the periodontal ligament was similar in all defects regardless of the original defect width. The cementum width was slightly greater in the wider (4 and 6 mm) defects compared to the more narrow (1 and 2 mm) defects. When evaluating the combined 1 and 2 mm defects, the height of new cementum with enamel matrix protein treatment was 45% greater than the control, with 31% greater new bone height versus the control. In the combined wider defects (4 and 6 mm), new tissue height was more similar between enamel matrix protein-treated defects and control defects. The results from the wider defects must be interpreted cautiously, because the interproximal bone heights were resorbed more adjacent to the wider defects during the plaque accumulation period and likely limited the potential for regeneration. CONCLUSIONS: The treatment of various sized periodontal defects with enamel matrix proteins stimulated substantial periodontal regeneration. In many cases, dramatic amounts of new cementum, Sharpey's fibers, periodontal ligament, and bone tissue were formed far coronal to the notch at the base of the defect, especially considering the width of the original defects. This periodontal regeneration occurred in the absence of exogenous growth factors, bone replacement grafts, barrier membranes, or their combination.

Alveolar Bone Loss↗
PubMed2002

Block sequential adriamycin CMF--optimal non-myeloablative chemotherapy for high risk adjuvant breast cancer?

After the publication of the 10-year survival data from Milan on the adjuvant use of the block sequential regimen consisting of four cycles of adriamycin followed by eight cycles of intravenous CMF, many centres adopted this as standard of care for high risk, multiple node-positive breast cancer. For this reason it was identified as the standard arm for the Anglo-Celtic adjuvant high-dose chemotherapy trial. This study reports on the experience of this regimen in 329 women with early breast cancer involving at least four axillary nodes, who were treated outside any adjuvant chemotherapy trial. At a median follow-up of 3 years, the overall 5-year disease-free survival is 61%, and the overall survival is 70%. These data confirm the efficacy of this regimen in non-trial patients, and, for the same high risk subgroup, indicate that this approach offers an outcome at least as good as that seen in the CALGB 9344 AC-Taxol arm, and the NCIC days 1 and 8 CEF.

Adult↗