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Biomedical subjects

A Stevens

Publications and source records attributed to A Stevens.

At least 109 records · Page 6Linked to original sources
PubMed1998

Day case surgery trends in England: the influences of target setting and of general practitioner fundholding.

OBJECTIVES: To describe the trends in the proportion of elective surgery carried out as day cases, and the impact of the setting of targets and the introduction of general practitioner (GP) fundholding on the use of day surgery. METHODS: Cross-sectional analysis of Hospital Episode Statistics for England. 1990/1991 to 1994/1995, comparing procedures for which targets were and were not set, and comparing types of purchaser (GP fundholder and health authority). RESULTS: Elective surgical procedures increased from 2.7 million in 1990/1991 to 3.9 million in 1994/1995, a 44% increase. Increased numbers of day cases (up 117%) accounted for almost all of the increased total activity. The proportion of day cases rose from 35% to 53% over the period. Those procedures for which targets were set (over 25% of elective surgery) had a slightly lower day case proportion in 1990/1991 (34% compared to 36%) but slightly higher by 1994/1995 (57% compared to 52%). GP fundholders generally had slightly lower proportions treated as day cases compared to health authorities. CONCLUSIONS: Day cases were additional to, rather than a substitute for, inpatient treatments. Setting day case targets may have been associated with growth in use of day surgery, but there was no association with type of purchaser.

Ambulatory Surgical Procedures↗
PubMed1998

Basaloid follicular hamartoma, total body hair loss and SLE.

We describe a patient with systemic lupus erythematosus (SLE) and antiphospholipid antibody syndrome (APLS) who developed a plaque-like lesion around the mouth and lost all body hair. Biopsies of the circumoral lesion and scalp, were originally reported as containing extensive basal cell carcinoma, but on review, both showed the typical appearance of a benign malformation of the hair follicle known as basaloid follicular hamartoma. Regrowth of hair and partial resolution of the peri-oral plaque occurred with more aggressive treatment of her SLE, but the basaloid follicular hamartomas in her scalp skin persisted. There is a known, but rare, association between this pattern of basaloid follicular hamartoma, alopecia and myasthenia gravis, but only two cases have been described in association with SLE and none with APLS.

Adult↗
PubMed1998

A randomized double blind trial of verbal NSAID education compared to verbal and written education.

OBJECTIVE: We performed a double blind randomized controlled trial to investigate whether patients taking nonsteroidal antiinflammatory drugs (NSAID) knew more about these drugs at followup depending on whether they were randomized to receiving or not receiving an NSAID information sheet. The patients were unaware they were in a study. METHODS: All patients received verbal education on the side effects of NSAID that was standardized and always given by the same rheumatologist. Thirty patients randomly received an NSAID information sheet and 26 patients did not. At next clinic followup, after reading a letter of explanation about the study and signing a consent form, patients completed a questionnaire asking about their knowledge of NSAID. RESULTS: Outcome variables assessed within the questionnaire included whether NSAID : (1) can decrease inflammation; (2) help with pain; (3) cause stomach upset and bleeding in the bowels. None of these variables were statistically significant. The only variable that was statistically significantly different between the groups was their report of whether they had received an information sheet about NSAID (p<0.00004). A greater proportion of patients who received the NSAID information sheet correctly reported they had received one compared to those who had not received one and who said they had not received one (85% in the former group, 70% in the latter group). The group who received the NSAID information sheet were more apt to say that NSAID can help with their pain (odds ratio 6.1, p<0.05). Education level was positively correlated with knowledge (p<0.04). However, level of education explained only 11% of the variance in overall knowledge scores (r=0.34) among all patients. CONCLUSION: An information sheet may not add educational value over verbal information by a physician in a clinic setting.

Adult↗
PubMed1998

The development of rheumatoid arthritis after recombinant hepatitis B vaccination.

OBJECTIVE: Hepatitis B vaccination has been associated with reactive arthritis and rarely rheumatoid arthritis (RA). We defined the clinical, serologic, and immunogenetic background of patients developing RA, soon after recombinant hepatitis B vaccination. METHODS: The clinical, serologic, and HLA antigens of a cluster of firefighters who developed arthritis after prophylactic recombinant hepatitis B vaccination (5 subjects), as well as a second group of sporadic cases of arthritis (6 patients) after hepatitis B vaccination are described. RESULTS: Ten of 11 patients fulfilled revised American College of Rheumatology criteria for RA. All cases had persistent arthritis for more than 6 months; at 48 months followup 2 cases no longer had inflammatory arthritis. Nine patients required disease modifying antirheumatic drugs. Five subjects were HLA-DR4 positive. HLA class II genes expressing the RA shared motif were identified in 9/11 patients genotyped for HLA-DRbeta1 and DQbeta1 alleles (0401, 0101, or 0404). All the firefighters shared the HLA-DRbeta1 allele 0301 and the DQbeta1 allele 0201, with which it is in linkage disequilibrium. CONCLUSION: These polymorphic residues in the binding site of the MHC class II molecules of the affected patients appear capable of binding some peptide sequences of the recombinant vaccine peptides they received and may be responsible for hepatitis B vaccine triggering development of RA in these cases. Recombinant hepatitis B vaccine may trigger the development of RA in MHC class II genetically susceptible individuals.

Adult↗
PubMed1998

The contribution of glycation to cataract formation in diabetes.

BACKGROUND: Despite extensive research, the mechanisms responsible for Type II diabetic cataract formation are still unknown. Recent data have favored non-enzymatic glycation. However, the pathways by which hyperglycemia leads to cataract are still unknown. Two possible routes were explored; modification of the lens proteins leading to Advanced Glycation Endproduct (AGE) formation and modification of the ATPase pumps leading to osmotic stress. METHODS: The extent of AGE formation was monitored in fetal bovine eyes using non-tryptophan fluorescence. The amount of carbohydrate bound the proteins was measured after reduction with radiolabelled sodium borohydride. Secondary structure estimations were performed by analysis of data obtained using circular dichroism. The effect of glycation on the Na, K-ATPase ion pumps was investigated by comparing the uptake of radioactive 86Rb in the presence of high concentrations of glucose and fructose. RESULTS: These studies were aimed at determining which of these mechanisms is the more likely route for cataract formation. The first mechanism was examined using two approaches. Firstly, by investigating the effects of increased glucose on the secondary and tertiary structure of lens proteins. Detailed analysis of the structures of the lens proteins in the presence of 200 mM glucose revealed that only alpha-crystallin was slightly affected. More important, however, this change did not lead to any significant aggregation. The second approach involved comparing the mechanism of action and possible benefits of anti-glycating agents. CONCLUSION: It is concluded that Type II diabetes cataracts are unlikely to arise as a result of AGE formation, but rather they form because of disruption of the cells, as a result of osmotic stress, brought about by glycation of the ion pumps.

Cataract↗
PubMed1997

Lithium toxicity in yeast is due to the inhibition of RNA processing enzymes.

Hal2p is an enzyme that converts pAp (adenosine 3',5' bisphosphate), a product of sulfate assimilation, into 5' AMP and Pi. Overexpression of Hal2p confers lithium resistance in yeast, and its activity is inhibited by submillimolar amounts of Li+ in vitro. Here we report that pAp accumulation in HAL2 mutants inhibits the 5'-->3' exoribonucleases Xrn1p and Rat1p. Li+ treatment of a wild-type yeast strain also inhibits the exonucleases, as a result of pAp accumulation due to inhibition of Hal2p; 5' processing of the 5.8S rRNA and snoRNAs, degradation of pre-rRNA spacer fragments and mRNA turnover are inhibited. Lithium also inhibits the activity of RNase MRP by a mechanism which is not mediated by pAp. A mutation in the RNase MRP RNA confers Li+ hypersensitivity and is synthetically lethal with mutations in either HAL2 or XRN1. We propose that Li+ toxicity in yeast is due to synthetic lethality evoked between Xrn1p and RNase MRP. Similar mechanisms may contribute to the effects of Li+ on development and in human neurobiology.

Adenosine Diphosphate↗
PubMed1997

Structural modifications of RNA influence the 5' exoribonucleolytic hydrolysis by XRN1 and HKE1 of Saccharomyces cerevisiae.

Two 5' exoribonucleases, XRN1 and HKE1, of Saccharomyces cerevisiae have been found to have very important cellular roles, XRN1 playing a key role in mRNA turnover and HKE1 in pre-rRNA processing. Here, an analysis of strong secondary structures in RNA that cause blocks or stalls (accumulation of RNA fragments that are shortened from the 5' end to the site of the secondary structure insertion) in the processive exoribonucleolytic hydrolysis reactions is reported. With both enzymes, oligo(G) tracts of lengths 18, 16, and 9 stall quite effectively, and the stalls are close to the start of the oligo(G) stretch. Two strong stem-loop structures cause measurable but low-level stalls with both enzymes. If the stem-loop structure is placed close to the 5' end of the RNA, substantial inhibition of overall RNA hydrolysis occurs with HKE1 and less, but measurable, inhibition with XRN1. RNA structural modification caused by protein complexing has been investigated by using poly(A) binding protein. The hydrolysis of poly(A) by XRN1 is inhibited by poly(A) binding protein, while HKE1 activity is not affected.

Base Sequence↗
PubMed1997

Binding of 1-anilinonaphthalene-8-sulfonic acid to alpha-crystallin.

alpha-Crystallin was found to exhibit a time-dependent uptake of the hydrophobic probe, 1-anilinonaphthalene-8-sulfonic acid (ANS), similar to that typically observed with lipid membranes. Analysis of the interaction of ANS with alpha-crystallin revealed two types of interactive processes, partitioning and binding. The predominant process involved partitioning, with a coefficient of 300 M-1. The binding component had the following characteristics: 1 binding site/24 subunits and a Kd of about 9 microM. The binding was unaffected by the number of subunits used in the assembly of the alpha-aggregate, since both the alpha m- and alpha c-forms had similar binding characteristics. No discernible differences were observed in the binding of ANS to homopolymers of alpha A and alpha B subunits, suggesting that the hydrophobic sites to which ANS bound were similar in both the A and B subunits. The majority of the fluorescence was lost when the protein was incubated in 3 M urea, a concentration of denaturant where the protein is still intact, suggesting that the ANS binding sites are located near the surface of the protein. The decrease was attributed to a decrease in the quantum yield of the bound dye.

Anilino Naphthalenesulfonates↗
PubMed1997

Increased duration and altered topography of EEG microstates during cognitive tasks in chronic schizophrenia.

The surface EEGs of 32 medicated chronic schizophrenic patients, 12 unmedicated chronic schizophrenics and 35 matched healthy controls were analyzed by adaptive segmentation of continuous EEG during a rest condition, a mental arithmetic task, and a CNV paradigm. Results indicate increased duration of brain microstates in both unmedicated and medicated schizophrenics as well as reduced topographic variability. These findings did not vary across the different tasks. Comparing different cognitive tasks, schizophrenics and controls alike showed task-related changes of electric field topography, of EEG microstate duration and of the number of very short microstates (single-peak segments). However, the topography of the microstates during the tasks differed significantly in both medicated and unmedicated schizophenics from that of controls. Age, sex and educational levels did not influence these findings. Neuroleptic medication correlated negatively with microstate duration in a dose-dependent way. There was an inverse relationship between topographic variability and negative symptoms as well as BPRS scores. It is concluded that the temporo-spatial characteristics of brain electric activity indicate an impoverished array of functional modes and enhanced stability of brain electrical microstates in schizophrenia.

Adult↗
PubMed1997

Identifying new health care technologies in the United Kingdom.

We aimed to establish a 1996 baseline of new health care technologies that are predicted to have an impact on the United Kingdom's National Health Service in the next five years. One thousand and ninety-nine health care technologies were identified from a variety of sources. Further work will attempt to determine the most efficient method of identifying and monitoring new health care technologies.

Diffusion of Innovation↗
PubMed1997

Estimating the burden of disease in an English region.

BACKGROUND: Health Authorities seeking to make appropriate investments in health care require information about the nature of the burden of disease in their populations. The World Bank instrument called DALY-Disability Adjusted Life Year-has been used in the South and West Region to measure this burden. METHOD: The burden of disease caused by a selection of diseases has been calculated using DALYs, which combine premature mortality and disability. An estimate of the total burden has been estimated by ICD chapter. RESULTS: Premature mortality accounts for 52 per cent of the burden of disease and disability 48 per cent. Mental illness, for which its DALY value is largely derived from disability not premature mortality, contributes the third largest component of the total burden, after heart disease and cancer. DISCUSSION: DALYs can be calculated using UK data, and, with an appreciation of the theoretical issues which surround the calculations, can be used to describe the burden of disease in a population. Although designed to assist investment decisions in developing countries, the DALY is likely to be valuable in established market economies.

Algorithms↗
PubMed1997

Should general practitioners refer patients directly to physical therapists?

Several advantages have been claimed for general practitioners having direct access to physical therapy (defined as having a practice-based physical therapist or open access to a hospital-based physical therapist), and general practice fundholders are increasingly committing resources to ensure such services are available to their patients. This may lead to potential increases in costs as a larger total number of patients are treated owing to improved access and awareness of such services. A review of the available published literature found eight studies that compared two or more models of providing physical therapy services. Analysis of the studies revealed that there are several advantages for patients who are referred directly for physical therapy. The main advantages are significant reductions in waiting times, convenience, reduced costs for the patient and a lower cost per treated patient. There is also some evidence that the recovery time may be slightly better for patients who have direct access to a physical therapist.

Family Practice↗
PubMed1997

Graft-versus-host disease-like eruption in a patient with non-Hodgkin's lymphoma.

Graft-versus-host disease (GVHD) is most commonly seen as a complication of bone marrow transplantation, although it can occur whenever tissue or blood products are given whereby immunologically competent donor lymphocytes react against host tissues. A 65-year-old man with non-Hodgkin's lymphoma developed a severe widespread erosive eruption of the skin and mucosal surfaces. Clinically and histologically it was identical to cutaneous GVHD even though the patient had never received tissue or blood products. He failed to respond to conventional therapy for GVHD, but his skin improved significantly on treating his underlying lymphoma, which eventually proved fatal. There are two previous reports of GVHD associated with malignancy but we believe this to be the first case secondary to a lymphoma.

Aged↗