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Biomedical subjects

A Wilson

Publications and source records attributed to A Wilson.

At least 217 records · Page 12Linked to original sources
PubMed1996

Tics status.

OBJECTIVES: To describe two patients with tics status, propose a definition of this syndrome and draw attention to its clinical significance. METHOD: Two patients suffering from Tourette's Syndrome who had developed episodes of continual motor tics that lasted from minutes to hours, were non-suppressible and intruded into normal functioning, were treated with an increase in the dose of haloperidol, in one case with the addition of clonazepam. RESULTS: The offset of the episodes was gradual and the tic disorder was worse after the episodes. One patient had further spontaneous episodes of tics status. CONCLUSIONS: The recognition of tics status has implications for the management as well as our understanding of the pathobiology of tics and Tourette's Syndrome. The definition of tics status should be standardised.

Adolescent↗
PubMed1996

Rocuronium bromide in dental day case anaesthesia--a comparison with atracurium and vecuronium.

We have compared intubating conditions at 60 seconds, onset times and reversal characteristics of the new steroidal nondepolarizing muscle relaxant rocuronium with atracurium and vecuronium. A dose of approximately 1.75 X ED90 of each agent was used to assess their relative suitability for brief day case dental procedures requiring intubation. The anaesthetic technique included propofol, fentanyl, nitrous oxide/oxygen and isoflurane. Electromyography was used to assess neuromuscular blockade. The percentage of good or excellent intubating conditions at 60 seconds was 80% for rocuronium but only 12.5% each for atracurium and vecuronium. The mean percentage block at 60 seconds was 55.1% for rocuronium, compared to 9.2% for atracurium and 8.3% for vecuronium. Rocuronium had the fastest onset time to maximum block (mean 313 sec) compared to atracurium (mean 391.9 sec) and vecuronium (mean 331.9 sec). The duration of action of rocuronium was shorter than either atracurium or vecuronium, times for spontaneous recovery to 75% block being 22.2 min, 29.6 min and 26.3 min respectively. The neostigmine evoked recovery indices were rocuronium 4.2 min, atracurium 6.6 min and vecuronium 3.7 min. Maximum blockade of greater than 97% was achieved with all three relaxants.

Adult↗
PubMed1996

The impact of thrombolytic therapy on arterial and graft occlusions: a critical analysis.

BACKGROUND: The indications for intraarterial thrombolytic therapy of lower extremity native arterial and synthetic graft occlusions prior to vascular reconstructions requires further refinement before firm conclusions can be made. STUDY DESIGN: A retrospective review of 55 patients undergoing 81 lytic treatments with high dose urokinase from February 1989 to February 1993 was performed. The cases were divided into three groups: Group I: successful thrombolysis with residual defects followed by surgical reconstruction or percutaneous transluminal angioplasty (PTA); Group II: successful thrombolysis alone; and Group III: failure of thrombolysis requiring reconstruction or leading to amputation. No effort was made to analyze the particular type of reconstruction. Follow-up ranged from 1 to 1627 days (4 years and 5 1/2 months). RESULTS: One, two, and three year patency rates were 47%, 24%, and 8% for Group I; 57%, 46%, and 46% for Group II; and 24%, 10%, and 10% for Group III respectively. The one, two and three year limb salvage rates were 92%, 76%, and 76% for Group I; 82%, 82%, and 82% for Group II; and 48%, 37%, and 37% for Group III respectively. Forty-one complications occurred in 35 of the 81 (43%) lytic treatments. CONCLUSIONS: Intraarterial thrombolytic therapy can be regarded as a possible consideration in the initial management of acute lower extremity arterial and synthetic graft occlusions especially in patients with multiple prior vascular reconstructions. Unsuccessful thrombolysis results in a poor outcome despite surgical reconstruction in the majority of cases.

Aged↗
PubMed1996

Anti-smoking advice in general practice consultations: general practitioners' attitudes, reported practice and perceived problems.

BACKGROUND: Anti-smoking advice from general practitioners has proven efficacy. However, general practitioners do not exploit a large proportion of opportunities to discuss smoking with patients. AIM: A study aimed to explore general practitioners attitudes towards discussing smoking with patients and to assess how these influence the quantity of anti-smoking advice that general practitioners report giving during routine consultations. It also aimed to determine the extent to which general practitioners report using evidence-based interventions against smoking and to discover the problems they experience when discussing smoking with patients. METHOD: A postal survey of all 468 general practitioners on the Leicestershire Family Health Services Authority list was conducted. General practitioners' attitudes were assessed by scoring 13 attitude statements using a six-point Likert-type scale. They were also asked to rank (from a list of 12 items) the five approaches that they found most productive and (from a list of 11 items) the five problems that they most commonly encountered when giving anti-smoking advice to patients. RESULTS: A total of 327 questionnaires (70%) were returned. Most respondents (97%) thought that their advice was more effective when linked to patients' presenting problems and 65% reported that linking their anti-smoking advice to patients' presenting complaints was one of their three most preferred approaches to discussing smoking. Advising all presenting smokers to quit was considered by 40% of respondents to be an appropriate use of time but 76% reported that patients' lack of motivation was one of the three most commonly encountered problems. An analysis of the ratings of the 13 statements suggested that general practitioners who reported the greatest smoking cessation activity during routine consultations held more positive attitudes towards discussing smoking with patients. CONCLUSION: This study suggests that general practitioners believe that their anti-smoking advice is more effective when linked to patients' presenting complaints, and this belief appears to be reflected in the way in which general practitioners approach smoking cessation with patients. The findings may indicate that general practitioners are unlikely to accept a role in a population-based anti-smoking strategy which demands that they discuss smoking with all presenting smokers.

Attitude of Health Personnel↗
PubMed1996

Measuring expectations for participative decision making among graduating nurses.

This paper reports on the initial stage of a research program that examines decisions nurses expect to participate in and the methods by which they expect to participate. This stage of the research focuses on the development of a scale, the Participative Decision Making Scale for Nurses (PDMSN), to measure expectations for participative decision making (PDM) among graduating nurses. It has four subscales that measure expectations for participation in clinical, unit, hospitalwide, and strategic decisions. The PDMSN was administered to two groups of graduating nursing students. Results indicate that the subscales of the PDMSN have high internal consistency; alpha coefficients in Study 1 and Study 2 ranged from .70 to .85 and from .76 to .90, respectively. Patterns of correlations among the subscales and significant correlations with an alternative scale measuring PDM indicate that it is a valid instrument.

Adult↗
PubMed1996

Undergraduate teaching in the community: can general practice deliver?

BACKGROUND: All UK medical schools are revising their curricula following the General Medical Council recommendations to increase general practice involvement in undergraduate education. However, workload in general practice has increased in recent years, raising questions about its ability to maintain, let alone extend, its educational activities. AIM: The aim of this study was examine whether recent changes in general practice have affected delivery of practice-based undergraduate education and to assess the extent to which practices will be able to increase their involvement in teaching. METHOD: A postal questionnaire survey was conducted of the lead clinical teachers and their partners in the practices to which students from Leicester Medical School had been attached in the last 2 years. RESULTS: The questionnaire was completed by 32 out of the 39 lead teachers and 134 of the 150 partners, an overall response rate of 88%. There was widespread support for departmental teaching requirements, but only 17 lead teachers (44%) felt that the suggested reduction by 25% of patients seen per session while teaching was feasible. A total of 14 lead teachers (47%) felt that the ability of their practice to deliver high-quality teaching had declined since 1990. Altogether, 113 (87%) of all doctors in teaching practices felt that time pressures had increased during this period, and 139 (88%) felt that present levels of remuneration were inadequate. The majority of these doctors felt that general practice was the preferred location for learning generic clinical skills and were interested in participating. Nevertheless, most were not prepared to increase their involvement in teaching under present arrangements. CONCLUSION: Practice-based teachers appreciate the need for quality teaching, remain enthusiastic about teaching and are, in principle, willing to take an increased teaching load. However, recent changes have made delivery of teaching more difficult, and if an expansion in practice-based teaching is to occur, more realistic levels of funding and support are a prerequisite.

Attitude of Health Personnel↗
PubMed1995

Fatty acids regulate Thy-1 antigen mRNA stability in T lymphocyte precursors.

In this study, we report the effect of fatty acids on the Thy-1 antigen mRNA decay. Low serum and synthetic medium culture conditions were used to demonstrate that fatty acids, which are important metabolites involved as second messengers in signal transduction, also influence the steady-state mRNA level. Detailed analysis demonstrated that polyunsaturated lipids attached to bovine serum albumin, such as linoleic, linolenic, and arachidonic acids, modulate gene expression specifically in the S1A T lymphoma cell line by inducing a 3-5-fold increase in the steady-state Thy-1 mRNA level, concomitant with a twofold increase in cell surface expression. A similar modulation was observed in the immature CD4-CD8- T cell precursors but not in mature thymocytes. Nuclear run-on and transfection experiments indicated that the observed Thy-1 mRNA level is post-transcriptionally regulated and that the presence of the coding region is sufficient for this adaptive response. A mechanism without a requirement for protein kinase C activation, but involving Ca2+ entry, could account for this difference in Thy-1 mRNA stability.

Animals↗
PubMed1995

Use of Read codes in development of a standard data set.

General practice has a wealth of data that could be used for purposes such as assessing health needs, planning, and audit. If this potential is to be realised appropriate data must be easily accessible and of high quality. This article describes the experience of an information project team in developing and coding a standard data set, with the aim of meeting the needs of commissioners, public health, and general practitioners. The Read coding classification seemed the logical choice for the standard data set because Read codes are the basis of a standard classification of general practice data. However, the coding structure has several weaknesses that were difficult to resolve, and the standard data set had to be changed to match available codes. This paper may prove helpful to similar project teams attempting to develop and use a standard data set.

Classification↗
PubMed1995

An HMG-box-containing T-cell factor required for thymocyte differentiation.

Two candidate genes for controlling thymocyte differentiation, T-cell factor-1 (Tcf-1) and lymphoid enhancer-binding factor (Lef-1), encode closely related DNA-binding HMG-box proteins. Their expression pattern is complex and largely overlapping during embryogenesis, yet restricted to lymphocytes postnatally. Here we generate two independent germline mutations in Tcf-1 and find that thymocyte development in (otherwise normal) mutant mice is blocked at the transition from the CD8+, immature single-positive to the CD4+/CD8+ double-positive stage. In contrast to wild-type mice, most of the immature single-positive cells in the mutants are not in the cell cycle and the number of immunocompetent T cells in peripheral lymphoid organs is reduced. We conclude that Tcf-1 controls an essential step in thymocyte differentiation.

Animals↗
PubMed1995

Inhibition of CD28-mediated T cell costimulation by the phosphoinositide 3-kinase inhibitor wortmannin.

T lymphocyte activation requires at least two signals, one via the antigen-specific T cell receptor and a second via the surface molecule CD28 which provides signals critical to interleukin-2 (IL-2) production and T cell proliferation. We have previously shown (Ward S. G., Westwick, J., Hall N. and Sansom D. M. Eur. J. Immunol. 1993. 23: 2572) that CD28 stimulates phosphoinositide (PI) 3-kinase activity, indicating that D-3 phosphoinositides may act as mediators of CD28-induced T cell costimulation. Here, we report that immunoprecipitation of CD28 molecules from Jurkat cells stimulated with the CD28-ligand B7, results in a ligand-dependent association of CD28 with PI 3-kinase. This association correlates with the appearance of PI 3-kinase enzymatic activity in CD28 immunoprecipitates and the formation of D-3 phosphoinositides. Consistent with the hypothesis that D-3 phosphoinositides are important mediators of CD28 signaling, treatment of T cells with the PI 3-kinase inhibitor wortmannin, inhibited both T cell proliferation and production of IL-2, but not the response of T cells to exogenous IL-2. Hence, abrogation of PI 3-kinase activity by wortmannin, appears sufficient to disrupt the costimulatory pathway utilized by CD28, indicating a central role for this enzyme in the CD28 signaling pathway.

Androstadienes↗
PubMed1995

Cell-mediated immune function and the outcome of chronic fatigue syndrome.

This study examined the importance of cell-mediated immunity in determining the long-term outcome of patients diagnosed with chronic fatigue syndrome (CSF). A total of 103 patients (74%) of 139 previously enrolled in one of two treatment trials conducted within a university hospital referral center was reviewed a mean of 3.2 yr after trial entry. Ongoing symptom severity, levels of disability and immunological function were assessed at follow-up. The relationship between immunological function at trial entry and measures of outcome was also evaluated. Sixty-five patients (63%) had improved, while only 6 (6%) reported no current symptoms. Thirty-one subjects (30%) were unable to perform any form of work and 26 (25%) were on a disability benefit directly attributable to CFS. Cell-mediated immune function, as measured at trial entry or follow-up, did not appear to affect outcome. Whilst improvement occurred in the majority of patients with CFS, a substantial proportion (37%) remained functionally impaired. Impairment of cell-mediated immunological function measured during the course of the illness may not be an important factor in determining long-term outcome.

Adult↗
PubMed1995

Social support, marital status and living arrangement correlates of cardiovascular disease risk factors in the elderly.

Marital status and indices of social support are associated with mortality due to coronary heart disease and stroke. This association seems not entirely due to differences in recognised cardiovascular disease risk factors. The Western Sydney Stroke risk in the Elderly Study examined the relationship between marital status, living arrangements, widowhood and extent of social support, and risk factors for cardiovascular disease in men and women aged over 65 years. Unmarried men had the lowest mean HDL-C levels. Men living alone had the highest mean systolic blood pressures. The lower mean HDL-C levels and higher DBP levels seen among widows were not statistically significant after adjustment for differences in past medical history and education levels. The extent of social support was not associated with any significant differences in cardiovascular risk factor levels among men or women. We conclude that some of the increased risk of cardiovascular disease associated with socio-demographic factors among men in this age-group may be due to differences in primary cardiovascular disease risk factors. However, some of the mechanisms underlying risk of cardiovascular disease in this age-group remains obscure.

Activities of Daily Living↗
PubMed1995

Repeatability of nutrient intakes estimated by a semiquantitative food frequency questionnaire in elderly subjects.

In order to evaluate the repeatability of nutrient values estimated from a semiquantitative food frequency questionnaire being used in a longitudinal study of the relationships between diet, hemostatic factors, and stroke risk in the elderly in Western Sydney, a subsample of 62 participants (24 men, 38 women) completed a repeat questionnaire approximately 1 month after baseline data were collected. The mean age was 78 years (range, 65 to 88; median, 78). Nutrient values calculated from the repeat questionnaire were not significantly different from the baseline results by paired t test. Intraclass correlation coefficients ranged from 0.63 for beta carotene to 0.82 for saturated fat. Quadratic weighted kappa values were calculated for quintile categories and these ranged from 0.50 for fiber to 0.86 for ethanol. These values are comparable to previously published results in elderly subjects and confirm that repeatability of nutrient intakes estimated using semiquantitative food frequency questionnaires is very high in the elderly. Older subjects may be more established in their dietary habits than younger subjects, so any tendency for repeatability to decrease due to impaired memory associated with advanced age is offset by a lower intraindividual variability in dietary habit.

Aged↗
PubMed1995

A case of feet.

Gastric reflux with regurgitation is not an uncommon feeding problem in the young child. It can cause acute distress for both the child and parents, as well as major disruptions to the family functioning. Reflux is commonly managed with a variety of strategies, including feeding management, practical techniques and medication. Resolution is quickly achieved in some instances, but in others, or where these strategies are not seen as desirable, there may be a need to consider alternatives.

Female↗
PubMed1995

The role of the rat hippocampal system in several effects of context in extinction.

The effect of fornix lesions on some effects of manipulating the context on performance in extinction were studied. In renewal, subjects' responding to an extinguished conditioned stimulus (CS) recovered when the CS was presented in the context in which it had been conditioned after extinction in a different context. In reinstatement, it recovered when the CS was tested after independent presentation of the unconditioned stimulus (US; an effect mediated by contextual conditioning.) In spontaneous recovery, it recovered after the passage of time, that is, when the CS was tested in a new temporal context. In the conditioned suppression method, fornix lesions had no effect on conditioning, extinction, renewal, or spontaneous recovery; however, they abolished the reinstatement effect. The results suggest that the hippocampal system may be important in the formation of context-US associations, but not in other types of learning about the context.

Animals↗