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Biomedical subjects

A Smith

Publications and source records attributed to A Smith.

At least 271 records · Page 15Linked to original sources
PubMed2001

Fluoroquinolones: place in ocular therapy.

The fluoroquinolones have become widely used antibacterial agents in the treatment of ocular infections, with topical, intravitreal and systemic routes of administration being used. In general, fluoroquinolones (such as ciprofloxacin, ofloxacin, lomefloxacin and norfloxacin) have good activity against gram-negative and gram-positive bacteria. Therapeutic concentrations are achieved in the cornea after topical administration so that the fluoroqinolones have largely replaced combination therapy for the treatment of bacterial keratitis. However, a second line agent is needed when resistance is likely, such as in disease caused by streptococcal species. Reversal of resistance to quinolones may not occur with withdrawal of the antibacterial. This stresses the importance of prudent prescribing to reduce the occurrence of resistance to quinolones. When used in therapeutic topical dosages, corneal toxicity does not occur. Similarly, retinal toxicity is not seen when fluoroquinolones are used at therapeutic dosages, systemically or topically. Corneal precipitation occurs, particularly with ciprofloxacin and to a lesser extent norfloxacin, but does not appear to interfere with healing. In the treatment of endophthalmitis there is reasonable penetration of systemic fluoroquinolones into the vitreous but sufficiently high concentrations to reach the minimum inhibitory concentration for 90% of isolates (MIC90) of all important micro-organisms may not be guaranteed. Systemic administration may be useful for prophylaxis after ocular trauma.

Animals↗
PubMed2001

Gamma-aminobutyric acid type B receptors with specific heterodimer composition and postsynaptic actions in hippocampal neurons are targets of anticonvulsant gabapentin action.

Gamma-aminobutyric acid (GABA) activates two qualitatively different inhibitory mechanisms through ionotropic GABA(A) multisubunit chloride channel receptors and metabotropic GABA(B) G protein-coupled receptors. Evidence suggests that pharmacologically distinct GABA(B) receptor subtypes mediate presynaptic inhibition of neurotransmitter release by reducing Ca2+ conductance, and postsynaptic inhibition of neuronal excitability by activating inwardly rectifying K+ (Kir) conductance. However, the cloning of GABA(B) gb1 and gb2 receptor genes and identification of the functional GABA(B) gb1-gb2 receptor heterodimer have so far failed to substantiate the existence of pharmacologically distinct receptor subtypes. The anticonvulsant, antihyperalgesic, and anxiolytic agent gabapentin (Neurontin) is a 3-alkylated GABA analog with an unknown mechanism of action. Here we report that gabapentin is an agonist at the GABA(B) gb1a-gb2 heterodimer coupled to Kir 3.1/3.2 inwardly rectifying K+ channels in Xenopus laevis oocytes. Gabapentin was practically inactive at the human gb1b-gb2 heterodimer, a novel human gb1c-gb2 heterodimer and did not block GABA agonism at these heterodimer subtypes. Gabapentin was not an agonist at recombinant GABA(A) receptors as well. In CA1 pyramidal neurons of rat hippocampal slices, gabapentin activated postsynaptic K+ currents, probably via the gb1a-gb2 heterodimer coupled to inward rectifiers, but did not presynaptically depress monosynaptic GABA(A) inhibitory postsynaptic currents. Gabapentin is the first GABA(B) receptor subtype-selective agonist identified providing proof of pharmacologically and physiologically distinct receptor subtypes. This selective agonism of postsynaptic GABA(B) receptor subtypes by gabapentin in hippocampal neurons may be its key therapeutic advantage as an anticonvulsant.

Acetates↗
PubMed2001

Solid variant of alveolar rhabdomyosarcoma with unbalanced t(2;13) and hypotetraploidy, without MYCN amplification.

The histological subtype of alveolar rhabdomyosarcoma (AR) is characterised by the cytogenetic translocation t(2;13)(q35;q14) in approximately 70% of cases, a rearrangement rarely present in the embryonal rhabdomyosarcoma (ER) subtype. The MYCN gene is amplified in some cases of AR. We present a young man with an unusual pattern, namely solid variant of AR with hypotetraploidy and the t(2;13) in an unbalanced form. The MYCN gene was not amplified on FISH, but showed increased copy number, consistent with ploidy.

Adult↗
PubMed2001

Domestic violence laws: the voices of battered women.

This article reports the findings from an exploratory survey of battered women's views about mandatory arrest, mandatory reporting by doctors and nurses, no-drop policies, confidentiality laws, privilege laws, court-victim advocate programs, and specialized domestic violence courts. Although there was general support for the adoption of these laws, some variation based on demographic and situational circumstance was found. These findings raise questions about the universalistic nature of polices developed to address the problem of domestic violence. Battered women are not a homogeneous group, and public policy may be better designed to accommodate the individual needs of victims.

Attitude to Health↗
PubMed2001

The treatment of hypertension in patients with diabetes.

The most common cause of end-stage renal disease in the United States is diabetes mellitus. Data from the Diabetes Control and Complications Trial (DCCT) and the United Kingdom Prospective Diabetes Study (UKPDS) demonstrated that near-normalization of blood glucose levels results in a significant reduction in the development and progression of diabetic nephropathy. The UKPDS, however, clearly demonstrated that tight control of blood pressure in patients with diabetes is associated with reductions in macrovascular disease. Hypertension is also a major contributor to the development of diabetic renal disease. It is currently recommended that individuals with diabetes maintain a blood pressure level of less than 130/85 to maximize renal protection. It is essential that health care practitioners are aware of the importance of assessing early evidence of renal disease such as microalbuminuria and monitoring the progression of nephropathy. This article reviews current guidelines for the management of hypertension in patients with diabetes. In particular, the rationale for the use of the major pharmacologic therapies available for the treatment of hypertension is explored.

Algorithms↗
PubMed2001

Achievements of the Grand River Conservation Authority, Ontario, Canada.

Winning the 2000 International River prize resulted from a significant investment by the community of Ontario over a long period of time in the Grand River Conservation Authority, GRCA. Innovative partnerships with the business community, government, universities, First Nations tribes, environment groups and the general community have been the hallmark of a broad-based river management program that has returned the Grand River to a healthy environment and usable resource. Recognising this, the Grand River received special recognition from the Canadian Heritage Rivers Board--as a designated Heritage River. Not content with the achievements of the past, the GRCA has turned its attention to the future needs of this river system and to increasing the depth and breadth of community partnerships.

Awards and Prizes↗
PubMed2001

Recruitment of labelled monocytes by experimental venous thrombi.

OBJECTIVE: Infusing monocytes that have been stimulated to produce fibrinolytic activators and factors that regulate cell proliferation, migration and maturation, might enhance venous thrombus resolution. The aim of this study was to determine the time course of infused monocyte recruitment into venous thrombus in an appropriate model of this disease. DESIGN AND METHODS: Thrombus was induced in the inferior vena cava of male Wistar rats using reduced flow (80-90% stenosis). The vessel wall was examined at 1hr by scanning electron microscopy. Resolving thrombi with surrounding vena cava were obtained at 1, 7, 14 and 21 days after induction (n = 8). Sections, taken at 0.5 mm intervals (10-15 sections per thrombus), were stained using haematoxylin, Martius Scarlet Blue and antibodies against monocytes, platelets and fibrin. Sections from human venous thrombi (n = 4) were similarly stained. The area occupied by monocytes (in relative pixel units, RPU) was determined using computer aided image analysis. Peripheral rat blood monocytes were extracted, fluorescently labelled and injected intravenously into 7 rats prior to thrombus induction, Vena cava with thrombus was harvested 1 h, 2, 3, 4, 7, 14 and 25 days after induction and their fluorescence measured. The fluorescent content of the caval wall and thrombus was analysed in greater detail at 2 and 25 days after thrombus induction (n = 4 at each time interval). RESULTS: Experimental thrombi were structurally similar to human thrombus and resolved within 14-21 days. Scanning electron microscopy showed minimal endothelial damage at 1 h with signs of early thrombus formation (platelet, red cell leukocyte and fibrin deposition). Neutrophils were the predominant leukocyte in the thrombus at 1 day, with monocytes making up only 0.3% (0.04% sem) of the area of the thrombus. There was a steady increase in thrombus monocyte content and by 21 days the percentage area of thrombus covered by monocytes had increased by over 35 fold to 11.5% (2.3% sem) (p <0.001). Initially, monocytes appeared around the edge of the thrombus and became more evenly distributed through the thrombus as resolution progressed. Labelled monocytes could be found in the circulation up to 1 week after infusion. The fluorescent content (RPU) of the thrombus increased over 25 days (mean RPU At 2 days 0.012, sem 0.005; mean RPU at 25 days 1.062, sem 0.252, p = 0.008). The number of labelled monocytes in the vessel wall peaked at 2 days and decreased thereafter. CONCLUSION: The structure of thrombi produced by this model was comparable to that of human venous thrombi. Endogenous and injected monocytes migrated into the thrombus during natural resolution, possibly via the vein wall. Monocyte targeting could therefore be used to develop novel treatments for venous thrombosis, with the aim of reducing post-thrombotic complications.

Animals↗
PubMed2001

Water recycling at the Millennium Dome.

Thames Water is working with the New Millennium Experience Company to provide a water recycling system for the Millennium Dome which will supply 500 m3/d of reclaimed water for WC and urinal flushing. The system will treat water from three sources: rainwater--from the Dome roof greywater--from handbasins in the toilet blocks groundwater--from beneath the Dome site The treatment technologies will range from "natural" reedbeds for the rainwater, to more sophisticated options, including biological aerated filters and membranes for the greywater and groundwater. Pilot scale trials were used to design the optimum configuration. In addition to the recycling system, water efficient devices will be installed in three of the core toilet blocks as part of a programme of research into the effectiveness of conservation measures. Data on water usage and customer behaviour will be collected via a comprehensive metering system. Information from the Dome project on the economics and efficiency of on-site recycling at large scale and data on water efficient devices, customer perception and behaviour will be of great value to the water industry. For Thames Water, the project provides vital input to the development of future water resource strategies.

Conservation of Natural Resources↗
PubMed2001

The effect of hand-grip stabilization on isokinetic torque at the knee.

Isokinetic dynamometers commonly measure muscle strength during conditioning and rehabilitation. Previous studies have shown that stabilization can affect isokinetic torque production. However, the effect of stabilization with hand-grip use has not been examined, and there are inconsistencies in the literature regarding its use. Fifteen men (mean age +/- SD = 24 +/- 3 years, height = 187 +/- 6 cm, mass = 84 +/- 10 kg) and 15 women (age = 25 +/- 4 years, height = 167 +/- 8 cm, mass = 62 +/- 6 kg) were tested on a Cybex 6000 dynamometer. Torque and joint angle signals, as well as quadriceps and hamstrings electromyographic (EMG) signals, were recorded during maximal knee flexion/extension at speeds of 60, 180, and 300 degrees x s(-1). Subjects performed the testing both with (stabilized) and without (nonstabilized with arms folded across the chest) hand-grip use. Repeated-measures analysis of variance (ANOVA) revealed a significant-motion (flexion, extension), X-condition (stabilized, non-stabilized) interaction in the data from the men in which hand-grip stabilization resulted in an 8.4% increase in knee extensor torque vs. a 0.2% increase in knee flexor torque. Stabilization did not significantly affect torque in women. The EMG analyses did not indicate a significant change in either agonist drive or antagonist cocontraction that accounted for the enhanced torque output with hand-grip use. This study found that hand-grip use enhanced knee extension maximal torque in men, but did not affect torque in women. The EMG data did not account for the changes in the torque data. Differences between men and women may have been due to mechanical factors and grip strength. These results indicate that hand-grip use needs to be considered when examining gender differences in knee strength and when studying knee flexion-extension ratios.

Adult↗
PubMed2001

Family influences in a cross-sectional survey of higher child attendance.

BACKGROUND: A quarter of all consultations are for children, but there is little quantitative evidence documenting what parental factors are important in the decision to consult. AIM: To assess parental factors in higher child attendance (three or more times per year)--the 32% responsible for most (69%) general practice consultations with children. DESIGN OF STUDY: A random sample of 4000 individuals (one per household), including 670 children. SETTING: Six general practices within a 30-mile radius of the administrative centre. METHOD: Parents completed a postal questionnaire for themselves and their child. The adult questionnaire documented lifestyle, attitude to doctors and medicine, Kokko's personality types, perceived health, health anxiety, number of medical problems, medically unexplained somatic symptoms, and willingness to tolerate symptoms. The child questionnaire documented perceived health, the number of medical problems, somatic symptom inventory, willingness to tolerate symptoms, and self-reported attendance. RESULTS: (Adjusted odds ratios, test for trend, 95% confidence intervals.) A response rate of 490/670 (73%) paired adult and child questionnaires was obtained. Reported higher attendance was valid compared with the notes (likelihood ratio positive test = 5.2, negative test = 0.24), and was independently predicted by the child's age, medical problems, council house occupancy, and by the parents' assessment of the severity of the child's ill health. After controlling for these variables, higher attendance was more likely if the parents were higher attenders (adjusted OR = 3.71, 95% CI = 2.31-5.98), and if they perceived their children had medically unexplained physical symptoms (MUPS) (for 0, 1, 2, 3+ symptoms; adjusted ORs (95% CIs) = 1, 3.1 (1.7-5.7), 2.30 (0.97-5.5), 4.2 (1.8-9.6) respectively, P < or = 0.001). Attendance was less likely if they were willing to tolerate symptoms in their children (score for seven normally self-limiting scenarios = 0-17, 18-29 and 30+; adjusted ORs = 1, 0.71, 0.39 respectively, z for trend P = 0.03), willingness to tolerate symptoms and parental perception of child MUPS were associated with council house tenancy and health anxiety. Parents' perception of child MUPS also related to perception of child health and the parents' own MUPS. Parents of higher attenders were more likely to be depressed (HAD depression scale = 0-7, 8-10, 11+ respectively; adjusted ORs (95% CIs) = 1, 2.04 (1.27-3.27), 1.60 (0.75-3.42)) or anxious (anxiety scale 0-7, 8-10, 11+, respectively; adjusted ORs [95% CIs] = 1, 1.60 [0.99-2.58], 1.97 [1.20-3.26]). CONCLUSION: Important parental factors are council house tenancy, the parents' perception of and willingness to tolerate, somatic symptoms in the child, and the parents' own attendance history, health anxiety, and perception of somatic symptoms Doctors should be sensitive to the parental and family factors that underlie the decision to consult and of the needs of parents of high-attending children.

Adolescent↗
PubMed2001

Psychosocial, lifestyle, and health status variables in predicting high attendance among adults.

BACKGROUND: Increasing consultation rates have implications for the organisation of health services, the quality of care, and understanding the decision to consult. Most quantitative studies have concentrated on very high attenders--not those attending five or more times a year, who are responsible for most (60%) consultations--and have assessed neither the role of lifestyle nor patients' attitudes. AIMS: To assess associations with higher than average attendance (five or more times ayear). DESIGN OF STUDY: Postal questionnaire sent to a random sample. SETTING: Four thousand adults (one per household) from six general practices. METHOD: Data were analysed to identify predictors significantly associated with higher than average attendance. RESULTS: The response rate was 74%. Sef-reported attendance agreed with the notes (r = 0.80, likelihood ratio for a positive test = 9.4). Higher attendance was independently predicted by the severity of ill health (COOP score = 0-7, 8-9, and 10+; adjusted odds ratios= 1, 1.72, 1.91 respectively; test for trend P<0.001) and the number of reported medical problems (COOP score = 0, 1, 2, and 3+ respectively; adjusted ORs = 1, 2.05, 2.31, 4.29; P<0.001). After controlling for sociodemographic variables, medical problems, the severity of physical ill health, and other confounders, high attendance was more likely in those with medically unexplained somatic symptoms (0, 1-2, 3-5, and 6+ symptoms respectively, ORs = 1, 1.15, 1.48, and 1.62; P<0.001); health anxiety (Whitely Index = 0, 1-5, 6-7 and 8+ respectively, ORs = 1, 1.22, 1.77, and 2.78; P<0.001); and poor perceived health ('very good', 'good', 'poor' respectively, ORs = 1, 1.61, and 2.93; P<0.001). Attendance was less likely in those with negative attitudes to repeated surgery use (OR = 0.61, 95% CI = 0.47-0.78), or to doctors (Negdoc scale <18, 18-20, and 21+ respectively; ORs = 1, 0.87, 0.67; P<0.001), in those usually trying the pharmacy first (OR = 0.61, 95% CI 0.48-0.78), and those consuming alcohol (0, 1, 2, 3+ units/day respectively; ORs = 1, 0.62, 0.41, 0.29; P<0.001). Anxiety or depression predicted perceived health, unexplained symptoms, and health anxiety. CONCLUSION: Strategies to manage somatic symptoms, health anxiety, dealing with the causes of--or treating--anxiety and depression, and encouraging use of the pharmacy have the potential both to help patients manage symptoms and in the decision to consult. Sensitivity to the psychological factors contributing to the decision to consult should help doctors achieve a better shared understanding with their patients and help inform appropriate treatment strategies.

Adolescent↗
PubMed2001

Nursing in a time of change: a case for critical thinking.

Like all professionals, nurses live with the inevitability of change. The extent to which change is experienced as a crisis rather than as an opportunity is determined by the degree of control that nurses have over the change process. This paper outlines the determinants of change, examines the impact of change on nursing practice, explores professional ways of knowing and proposes critical thinking as a means by which nurses can interpret and manipulate change and illustrates a curriculum approach that facilitates the acquisition of the capacity to think critically.

Humans↗
PubMed2001

Second dose of MMR vaccine: health professionals' level of confidence in the vaccine and attitudes towards the second dose.

Public concerns have been raised about the safety of MMR vaccine following the publication of two studies linking the vaccine to inflammatory bowel disease and to a syndrome of Ileal-lymphoid-nodular hyperplasia, non-specific colitis and pervasive developmental disorder. Our study had two aims, to determine whether health professionals' confidence in MMR vaccine was affected and to assess professional knowledge and attitudes towards the second dose of MMR. In July 1998 we undertook a questionnaire survey of general practitioners, practice nurses and health visitors in an inner city area. A significant fall was found in professional confidence following the two publications and the subsequent media coverage (from 59.4% to 40.9%). Forty percent of respondents were unsure about the need for a second dose of MMR vaccine and more than one in ten professionals stated that it was not necessary. It is reasonable to assume that this reduced confidence in the safety of MMR and the professional uncertainty about the second dose have contributed to the observed decline in MMR uptake rates. More professional and public education appears to be needed.

Attitude of Health Personnel↗
PubMed2001

An audit of the investigation and use of anti-D immunoglobulin prophylaxis in Tayside.

OBJECTIVES: To audit the implementation of national guidelines on the investigation and management of RhD disease in Tayside. SETTING: Tayside region. DESIGN: An eight month retrospective audit. RESULTS: Two hundred and eighty eight completed pregnancies in RhD negative women were observed from a total of 1879 deliveries. Of these, 120 RhD negative and 169 RhD positive babies were delivered from women who had not previously been sensitised. At delivery, anti-D was used appropriately in all cases. Of those assessed to require anti-D (n = 168), 91% received it within 24 hours of delivery. In 59 RhD negative subjects, 75 potential sensitising events occurred antenatally. In 45 of these, the event occurred after 20 weeks gestation and 44 received appropriate anti-D. In 11 (23.7%) of these, no foetomaternal haemorrhage assessment was carried out. CONCLUSION: Despite a significant increase in awareness of antenatal prophylaxis since a previous audit in the region, there is still a significant failure to request FMH assessments following potential antenatal sensitising episodes and after delivery. During the audit period, an EDTA plasma gell-based antibody detection system was commissioned in the region. This has allowed the introduction of internal laboratory referral for FMH assessment. This has allowed accurate knowledge on the possible occurrence of FMH at delivery, but has not had a significant impact on antenatal events.

Female↗