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Biomedical subjects

A Scott

Publications and source records attributed to A Scott.

At least 73 records · Page 4Linked to original sources
PubMed2001

A randomized controlled trial of direct access for laparoscopic sterilization.

OBJECTIVES: The aim of this study was to establish and evaluate a direct access service for laparoscopic sterilization. METHODS: A pragmatic randomized controlled trial was carried out on a total of 232 women referred to Aberdeen Royal Infirmary for sterilization between 1 June 1996 and 31 March 1997, from 57 general practices around Aberdeen, Scotland, comprising 75 from general practices that had received criteria for direct access, and 157 from control practices. The main outcome measures were: patients' waiting times to appointments and operation, satisfaction, short-term regret, operative complications and costs; conjoint analysis of patient preferences; GPs' adherence to referral criteria; GP and gynaecologist satisfaction; and NHS costs. RESULTS: Analysis was by intention to treat. There were no inappropriate direct referrals. Waiting time was lower in the intervention group, but there were more visits post-operatively to the GP. Patient and doctor satisfaction was equally high in both groups. There was no difference in operative complication rate, nor in total cost to patients or to the NHS. GPs and gynaecologists strongly supported direct access, but women preferred to meet both a gynaecologist and a GP before sterilization (routine referral). Other attributes of care important to patients included written information, although waiting time was not important. Of all women referred for sterilization during the study period, only 31% were suitable for direct referral. CONCLUSIONS: Patients preferred routine referral, and there were no differences in patient costs or satisfaction. There was, however, strong medical support for direct referral. Restrictive direct referral criteria may limit the uptake. These findings are important for future planning of direct referral services. Important methodological lessons were also learnt about the conduct of trials involving the primary-secondary care interface.

Adult↗
PubMed2001

Neuropsychological assessment, depression, and past exposure to organic solvents.

This study assessed neuropsychological performance in persons with a history of exposure to organic solvents and nonexposed healthy controls. Structured clinical interviews were also done to determine current Axis I diagnosis of mood disorder to assess the contribution of mood disorder to neuropsychological performance. Solvent-exposed participants were found to have significantly reduced scores on 3 of 5 neuropsychological clusters (learning and memory, visuospatial, psychomotor speed) compared to controls. No differences were found between the groups on measures of general intelligence. Within the exposed group, 50% met current Axis I criteria for mood disorder. Hierarchical multiple regression, controlling for age and education, revealed that mood disorder was significantly related to performance on only the visuospatial domain. There was no association between mood disorder and measures of learning and memory, attention, motor speed, and general intelligence. Higher ratings of past exposure were associated with poorer scores on learning and memory tests and slower times on speeded tests. These findings are consistent with other research documenting deficits in neuropsychological and psychiatric functioning in exposed workers.

Adult↗
PubMed2001

Temporal bone dissection: a possible route for prion transmission?

The aim of this study was to determine whether neural tissue is present in the bone 'dust' given off during temporal bone drilling. Bone 'dust' from three temporal bone dissections was collected and examined. Evidence of neural tissue was present in two out of the three specimens. Neural tissue is present in the bone dust given off during temporal bone drilling. This poses the question as to the risk of prion transmission during such dissection.

Creutzfeldt-Jakob Syndrome↗
PubMed2001

Sebaceous carcinoma of the nasal vestibule.

Sebaceous carcinoma is a rare disease arising from holocrine adnexal components of the skin. Fewer than 400 cases have been reported worldwide and only about 19 are from the nose. We present a sebaceous cancer of the nasal vestibule in a patient who, with adequate excision, is disease-free after two years.

Humans↗
PubMed2001

Rapid presumptive diagnosis of hantavirus cardiopulmonary syndrome by peripheral blood smear review.

Hantavirus cardiopulmonary syndrome (HCPS) is a rare but frequently lethal acute zoonotic viral infection in rural North America. The rapidity of progression from febrile prodrome to cardiogenic shock and noncardiogenic pulmonary edema requiring intensive care creates high diagnostic urgency and a need for a rapid screening tool. In this retrospective cohort study, 2 pathologists scored blinded peripheral blood smears from 52 patients with HCPS and 128 seronegative patients referred for diagnosis of suspected hantavirus infection. During the prodromal phase, thrombocytopenia was the only consistent abnormality and could be used to indicate hantavirus serologic testing. After the onset of pulmonary edema detected radiographically, the presence of 4 of 5 findings (thrombocytopenia, myelocytosis, hemoconcentration, lack of significant toxic granulation in neutrophils, and more than 10% of lymphocytes with immunoblastic morphologic features) has a sensitivity for HCPS of 96% and a specificity of 99% and missed no patients with HCPS who required intensive care. While each abnormality is commonly seen, the combination of at least 4 of these CBC count data and peripheral blood smear findings can guide early treatment and patient transport decisions until rapid, specific, serologic testing becomes widely available.

Adult↗
PubMed2001

The prevention of osteoporotic progression by means of steroid loaded TCPL drug delivery systems.

Numerous studies have suggested that there is a link between the age-related decreases in Estradiol and adrenal androgens, and the subsequent development of senile osteoporosis. The specific objectives of this investigation were: 1) to deliver Dehydroepiandrosterone (DHEA), Diosgenin (DG), and Estradiol (E) at sustained levels by Tri-Calcium Phosphate Lysine drug delivery systems (TCPL), and 2) to study the effects of the sustained delivery of DHEA, DG, and E on the bone turnover of adult female rats following withdrawal of the endogenous hormonal milieu by means of ovariectomization (OVX). In this study, 20 female Sprague-Dawley rats were randomly divided into five groups containing four rats per group. The rats in Group 1 served as intact controls. Animals in groups 2-5 were ovariectomized, and groups 3-5 were implanted immediately with TCPL drug delivery capsules containing DHEA, DG, and E, respectively. Group 2 served as the SHAM (OVX only) group. At the end of 33 days post implantation, the vital organs, reproductive organs, and femurs were collected and evaluated. Bone histomorphometric analyses as well as mechanical strength testing was performed. Data obtained from this study demonstrated that body weights were increased in all OVX animals, and that E replacement resulted in body weights that were not significantly different from intact controls. No differences were seen in the wet weights of any vital organs. However, a decrease in the weights of the cervix and oviducts were evident in all ovariectomized groups, with the exception of the E group. Thirty-three days following OVX, the OVX-only group exhibited an increased inner medullary area, decreased thickness of the cortical layer of bone, and decreased mechanical strength. The group treated with DHEA and the group treated with E were shown to maintain both the medullary area and the cortical thickness (as compared to the intact control group). The three point bending test of the femora showed that OVX-only induced a slight decline in mechanical strength, and that DHEA and DG, but not E, showed increases in mechanical strength. Results of this experiment suggest that DHEA and E may reduce bone remodeling as evidenced by the reduction in the medullary area, and that DHEA may possibly be used in postmenopausal patients to reduce osteoporotic progression.

Animals↗
PubMed2001

The use of estrogen, DHEA, and diosgenin in a sustained delivery setting as a novel treatment approach for osteoporosis in the ovariectomized adult rat model.

It is well established that the pattern of bone loss from the cortex in osteoporotic bone begins from the endosteal surface of the cortex, where there is enlargement of the medullary canal at the expense of the inner cortex. Bone loss does not occur at the periosteal surface. The objective of the following study was to induce osteoporosis in female rats by ovariectomy, followed by treatment with sustained delivery of Diosgenin (DG), dehydroepiandrosterone (DHEA), or estrogen (E) after clinical signs of osteoporosis. Female Sprague Dawley rats were divided randomly into five groups containing four rats/group. Rats comprising group 1 were left intact and served as a control group. Animals in groups 2-5 were ovariectomized (OVX) and, after a 14 day delay to allow for induction of osteoporosis, were implanted with TCPL capsules containing DG, DHEA, and E, respectively. The experiment was ceased after 33 days of treatment, at which time the vital and reproductive organs for each group were collected, weighed, and analyzed histomorphometrically for differences. Further analysis of the progression of osteoporosis in the experimental animals was obtained by performing x-ray analysis of each group on a semi-weekly basis. By collecting and analyzing the femurs from each animal, we were also able to obtain important information about the histologic changes associated with osteoporosis (left femur), as well as data regarding the effects of osteoporosis on the mechanical strength of bone via three point bending analysis (right femur). The data generated by this study revealed important information as to the efficacy and safety of the alternative treatments DHEA, E, and DG for osteoporosis. First, histomorphometric analysis revealed that treatment with DHEA, E, and DG reduced the endosteal perimeter and cortical area to values very similar to controls (intact). Second, results of the bending stress and modulus in OVX and treated animals were not statistically different from the intact control animals, which suggests that the material properties of the bone were unaltered. Third, there is an increase in total body weight associated with OVX that is reduced to control levels after replacement therapy. Finally, OVX also resulted in reproductive tissue atrophy, which was reversed by all three of the treatment regimens in this study. These data suggest that bone loss after OVX can be significantly reduced by supplementation with sustained levels of DHEA, E, and DG without jeopardizing other body organs.

Animals↗
PubMed2001

Diet restriction in rat toxicity studies: automated gravimetric dispensing equipment for allocating daily rations of powdered rodent diet into pouches and 7-day feeders.

Survival of ad libitum-fed rats has declined in the 2-year carcinogenicity bioassay. Restriction of the number of calories, without compromise of the overall nutrition offered to animals including rats, results in increased lifespan of animals. Diet restriction in rats is best achieved through offering of rations of feed daily instead of weekly, as is routinely done in ad libitum studies. The objective of this project was to develop an accurate and precise method of dispensing daily rations of feed. A gravimetric vibratory-type dispenser was used to dispense target weights of 15 and 20 g of powdered certified rodent diet into either labeled pouches or seven-well carousel feeders. The tolerance of the dispenser was the target weight +/- 3%. The amount of food offered to the diet-restricted rats was approximately 25% lower than that consumed by rats offered diet ad libitum. After 2 years, male rats offered 20 g and female rats offered 15 g of powdered rodent diet daily had remarkably lower body weights than did animals offered the diet ad libitum. Generally, the rats ate the entire ration of food offered to them each day. Survival of the diet-restricted rats was 70% to 82% at the end of a 2-year study. This investigation demonstrates that modest reduction of food intake, resulting in increased survival of Sprague Dawley rats in 2-year carcinogenicity bioassays, can be achieved reliably and efficiently through use of an accurate and precise automated method of dispensing powdered diet for use in multiple rat studies. In addition, this method of food dispensing provides a practical way to administer test compound in the diet under the conditions of diet restriction.

Animal Feed↗
PubMed2001

More reliable minority ethnic population estimates and proportions for local areas: which areas to select and other choices to be made--an exploratory analysis.

Central and Local Government and other organisations are interested, for a variety of purposes, in obtaining better--more reliable--estimates of the proportions of the total populations in local authority districts which belong to the minority ethnic population. In inter-censal periods, this aim could be met, for example, by an increase in the size of the Labour Force Survey sample in selected areas. This article considers the optimal sample size for each area under different criteria to improve the reliability of its estimated minority ethnic proportion.

Censuses↗
PubMed2001

The dynamics of living arrangements in later life: evidence from the British Household Panel Survey.

Living arrangements are a key dimension of quality of life and well-being in old age. Availability of family care, as well as social and economic support, is in part a function of whom you live with. In order to be able to forecast future changes in household composition, particularly in relation to planning and targeting particular community care services, information is needed on the probability of a person experiencing a change in their living arrangements, and the life course events that may act as triggers for such changes. This article uses data from the British Household Panel Survey (1991-99) to analyse the dynamics of living arrangements in later life.

Adult↗
PubMed2001

The sizes and characteristics of the minority ethnic populations of Great Britain--latest estimates.

This article presents estimates of the minority ethnic populations of Great Britain in 2000 and describes the regional distributions of the different groups. It also discusses changes in the sizes of the different minority ethnic populations during the 1990s. The paper provides information on some key demographic features of these populations at the end of the 1990s--age and sex structures, proportions born in the United Kingdom and whether children lived with their natural parents.

Adolescent↗
PubMed2000

Confirmation of the mapping of the Camurati-Englemann locus to 19q13. 2 and refinement to a 3.2-cM region.

Camurati-Englemann syndrome (DPD1) is an autosomal dominant condition associated with progressive cortical sclerosis of the diaphyses of all the long bones. Clinical features include abnormal gait, muscle weakness and wasting, and generalized fatigue. The DPD1 gene was recently mapped to a 15.1-cM region on chromosome 19q13.2. We have narrowed the region containing the DPD1 gene to a 3.2-cM region flanked by short tandem repeat markers, D19S881 and D19S718. TGFB1, a candidate gene mapped within this region, was excluded.

Camurati-Engelmann Syndrome↗
PubMed2000

An essential role in liver development for transcription factor XBP-1.

XBP-1 is a CREB/ATF family transcription factor highly expressed in hepatocellular carcinomas. Here we report that XBP-1 is essential for liver growth. Mice lacking XBP-1 displayed hypoplastic fetal livers, whose reduced hematopoiesis resulted in death from anemia. Nevertheless, XBP-1-deficient hematopoietic progenitors had no cell-autonomous defect in differentiation. Rather, hepatocyte development itself was severely impaired by two measures: diminished growth rate and prominent apoptosis. Specific target genes of XBP-1 in the liver were identified as alphaFP, which may be a regulator of hepatocyte growth, and three acute phase protein family members. Therefore, XBP-1 is a transcription factor essential for hepatocyte growth.

Animals↗
PubMed2000

Evaluating the effect of new hospital specialties on GP prescription costs.

The aim of this paper is to examine whether the introduction of new hospital specialties contributed to an increase in GP prescription costs. New specialties were introduced in Dr Gray's hospital, Grampian, North-East Scotland in 1994. Data on prescription costs and volume for groups of drugs associated with the new specialties were obtained for all GP practices in Moray (study practices) and Kincardine and Deeside (control practices). Comparing the periods January-April in 1994 with 1995, and 1995 with 1996, an upward trend in GP prescription costs was detected for ulcer healing drugs and anti-depressants. The trend in Kincardine and Deeside also pointed to rising prescription costs, although to a lesser extent. The number of patients referred to the psychiatric and gynaecology specialties expanded after the introduction of these specialties at Dr Gray's. In conclusion, there is some evidence to support the proposition that the introduction of new specialties at Dr Gray's was associated with an increase in the growth of prescription costs within Moray. Further research should establish more clearly whether this is as a result of increased referrals by GPs or the prescribing of more expensive drugs by consultants. The results have implications for the setting of prescribing budgets.

Drug Costs↗
PubMed2000

The "supply hypothesis" and medical practice variation in primary care: testing economic and clinical models of inter-practitioner variation.

Medical practice variation (MPV) is marked, apparently ubiquitous across the health sector, well documented, and continues to be a focus of professional and policy interest. MPV have stimulated two paths of investigation, one economic in emphasis and the other more-clinical in orientation; while health economists have stressed the potential role of income incentives in medical decision-making, health services research has tended to emphasise clinical ambiguity as a factor in practitioner decisions. Both sets of explanations converge in an implicit "supply hypothesis" that posits contextual practitioner and practice attributes as influential in clinical decisions. Data on inter-practitioner variation are taken from a large and representative regional survey of general practitioners in New Zealand, a country in which unsubsidised fee-for-service is the predominant mode of remuneration in primary care. The paper assesses the impact on three important areas of clinical decision-making prescribing, test ordering, request for follow-up -- of three key conceptual dimensions -- income incentives, physician agency, and clinical ambiguity (operationalised as local doctor density, practitioner encounter initiation, and diagnostic uncertainty respectively). Predictions are made about inter-practitioner variations in the rate of clinical activity in the three areas. The results of the analysis using multi-level statistical techniques are: 1. the extent of competition -- local doctor density -- seems to have no effect on the pattern of clinical decision-making; 2. doctor-initiated visits are, if anything, associated with lower rates of intervention; 3. diagnostic uncertainty is associated with higher rates of investigations and follow-up, both of which have clinical plausibility; 4. there is no significant interaction effect between density and uncertainty. It is concluded that, for the clinical activities studied and for the practitioner attributes as operationalised in this investigation, a clinical, rather than an economic, model of practitioner decision-making provides a more plausible interpretation of inter-practitioner variation in rates of clinical activity in general practice. The "supply hypothesis" requires further analytical refinement and empirical assessment before it can be applied as a generic explanatory framework for MPV.

Family Practice↗