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Biomedical subjects

A Wilkes

Publications and source records attributed to A Wilkes.

10 recordsLinked to original sources
PubMed1999

A chemiluminescence test for predicting the outcome of transfusing incompatible blood.

A chemiluminescent test (CLT) which measures the metabolic response of human monocytes to sensitized red cells was developed to distinguish antibodies capable of causing the increased destruction of transfused incompatible red cells from antibodies which are clinically benign. Thirty sera containing IgG antibodies to high-frequency antigens were tested; 27 of these sera were also tested using the monocyte monolayer assay (MMA). The clinical significance of antibodies in 14 of the sera was known: three (anti-Ata (two), -JMH) caused accelerated clearance of 51Cr-labelled cells, five (anti-'MiIII', -Yta, three unidentified) caused haemolytic transfusion reactions and six (anti-Yta, -Ge, -JMH, -Xga, -Kna (two)) did not appear to affect red cell survival. Overall, results from the MMA and CLT showed good agreement; seven sera were negative in both assays, 18 sera were positive in both assays and two sera were positive in the MMA but negative in the CLT. There was no clear relationship between the activity of different antibodies and the level of sensitization as determined by flow cytometry. Antibody activity could be either increased or decreased by incubation of sensitized red cells with fresh serum. MMA results were in concordance with the clinical significance of antibodies where known in eight of 10 cases. CLT results were in concordance with clinical significance in 12 of 14 cases. Both assays gave false-positive results with serum from a patient with anti-Kna who had received red cell transfusions without adverse effect. This appeared to be due to the ability of anti-Kna to cross-link complement receptor 1 (CR1) on red cells to CR1 on monocytes; negative results were obtained using autologous monocytes.

Blood Group Antigens↗
PubMed1998

The ability of the chemiluminescence test to predict clinical outcome and the necessity for amniocenteses in pregnancies at risk of haemolytic disease of the newborn.

The chemiluminescence test measures the ability of anti-D to sensitise red cells for recognition by monocytes. It predicts clinical outcome in haemolytic disease of the newborn with greater precision than quantification of anti-D levels by AutoAnalyzer. However, whether or not the chemiluminescence test can, or should, affect clinical management is not clear. Of 56 alloimmunised women referred to a single fetal medicine unit, 30 underwent a total 63 amniocenteses to establish the extent of fetal haemolysis. Overall, chemiluminescence test results were a better predictor of amniocenteses with elevated bilirubin levels than the AutoAnalyzer (P < 0.01). Chemiluminescence results > 30% were always associated with elevated bilirubin levels. The chemiluminescence test might be used to prompt the direct evaluation of fetal haemolysis in patients with borderline levels of anti-D (5-15 IU/mL). However, the ability of the test to predict amniocenteses with normal bilirubin levels was less clear.

Amniocentesis↗
PubMed1997

Health human resource development in rural China.

China has made significant progress in increasing the quantity of health workers in rural areas. Attention is shifting to improving the quality of health workers. This article documents several features of health workers in rural China. Many have not received formal training to a level implied by their rank and title, and there is no clear relationship between the skills of health workers and the functions they perform. Many better-qualified personnel have left lower level health facilities for more attractive employment in higher level and urban facilities. A system of professional licensing is currently being considered that will link educational requirements to employment and promotion. This article outlines some of the issues that should be taken into consideration in formulating this system. In particular, licensing may have unequal impacts on rich and poorer areas. This article argues that other regulatory measures will be necessary if licensing is to be an effective mechanism for controlling the quality of health workers, and contribute to the provision of affordable health services in both rich and poor areas.

China↗
PubMed1997

The impact of China's health sector reform on county hospitals.

The article describes the impact of China's health sector reform on relatively small hospitals in rural counties. It uses one county hospital to illustrate how pressures to increase revenue, combined with distortionary pricing policies, have led to cost increases. It argues that the introduction of hospital insurance could accelerate the cost increases unless measures are taken to control costs. These measures will include improvements to hospital management and changes to mechanisms of payment for hospital services. Government will have to play an active role to ensure that county hospitals serve the needs of rural people.

China↗
PubMed1995

Cytologic screening after hysterectomy for benign disease.

OBJECTIVE: Our purpose was to determine the effectiveness of vaginal cytology tests after hysterectomy for benign disease. STUDY DESIGN: We studied a 10-year retrospective cohort of patients after hysterectomy (n = 697 women, 9074 woman years). Patients were excluded if they had any type of invasive gynecologic malignancy. The main outcome variable was development of a vaginal cytologic abnormality, evaluated with Kaplan-Meier estimates and proportional hazards regression. RESULTS: We found 33 abnormal cytology results; most were of little clinical significance except for two biopsy-proven dysplasia cases. When we controlled for age, the risk was 4.67 for patients with a history of a cervical cytologic abnormality (95% confidence interval 2.1 to 10.6). We needed 633 tests to detect one true positive case of vaginal dysplasia. CONCLUSIONS: The low incidence of vaginal dysplasia and carcinoma, combined with the high false-positive rate, supports decreasing the number of screening tests performed for these low-risk patients.

Adult↗
PubMedDate not supplied

Benchmarking and networking through collaborative groups.

The search for better ways to deliver healthcare services at lower cost led a group of hospitals in the Carolinas, 2 years ago, to pioneer a new concept, the collaborative group. A collaborative group typically is composed of five or six similar (but not competing) hospitals that work together closely to help each other make the changes necessary to survive in an increasingly competitive marketplace. Hospital staff members at all levels are able to work together to discover improvement opportunities through benchmarking teams and networking efforts. This article describes their experiences, achievements, and lessons learned.

Efficiency, Organizational↗