Biomedical subjects
B Kirby
Publications and source records attributed to B Kirby.
Using DRGs in developing referral policies for coronary care within a local health district.
This paper presents the results of a study into some specific aspects of the management of coronary heart disease within one district health authority. In particular, it is concerned with the appropriate balance of inpatient coronary care between the district general hospital and community hospitals in the light of current and potential changes in the clinical management of coronary cases. The study is an example of a multidisciplinary approach to local health planning which is beginning to emerge within the Exeter Health District, the methodology of which may be applicable to client groups within the medical specialties other than coronary cases, such as strokes or respiratory disorders. It also illustrates the use of spatial analysis and diagnosis-related groups in local planning.
Evaluation of a hemostasis model for teaching ovariohysterectomy in veterinary surgery.
OBJECTIVE: To evaluate the efficacy of a reusable plastic model mimicking the anatomy and hemodynamics of the canine female genital tract for teaching basic surgical skills and ovariohysterectomy. SAMPLE POPULATION: 40 veterinary students of the class of 1998. STUDY DESIGN: Prospective study. METHODS: Students'confidence level and experience in private practice was evaluated via questionnaire before training. Students in 2 groups performed an ovariohysterectomy on cadavers (group C, n = 20) or on the model (Group M, n = 20) for 2 hours. Students' psychomotor and basic surgical skills were objectively assessed by the following tests: ligation of a foam cylinder, passing a needle through the eyelets of an electronic suture board, and ligating latex tubing. Results were compared before and after training and within and between groups. The ability of students to perform an ovariohysterectomy in a live dog after training was compared between groups with a scoring system. RESULTS: Students in both groups had similar surgical experience and basic skills before training. The results of the psychomotor and basic surgical skills tests were better in group M after training than group C. The improvement of each student in performing these tasks also increased when students were trained with the model. Scores assigned to students performing an ovariohysterectomy in a live dog were higher in group M (31.45 +/- 1.15) than in group C (20.7 +/- 1.42). CONCLUSION: The model was more effective than cadavers in teaching basic surgical skills and ovariohysterectomy in dogs.
Investigation of cytomegalovirus and human herpes viruses 6 and 7 as possible causative antigens in psoriasis.
Psoriasis is probably a T-cell-mediated autoimmune disease. Infectious models of autoimmune diseases have been proposed and in psoriasis, it has been suggested that there may be molecular mimicry between streptococcal antigens and epidermal keratins. The immunological profile of stable psoriasis plaques suggests, however, that viral antigens may be important. We investigated, using polymerase chain reaction techniques, whether DNA from either cytomegalovirus (CMV) or human herpes viruses (HHV) 6 and 7 is present in the skin of patients (n = 10) with chronic plaque psoriasis. We also investigated 29 patients for the presence of serum IgG to CMV. We found no evidence of CMV or HHV 7 DNA in psoriasis plaques although DNA for HHV 6 was detected in both involved and uninvolved skin in 1 out of 10 patients. There was no statistically significant increase in prior CMV infection, as assessed by the presence or absence of serum IgG to CMV, in psoriasis, compared to our local population. Although there is circumstantial evidence that viral antigens may be important in the pathogenesis of psoriasis we found no evidence to link infection with CMV or HHV 6 and 7 with subsequent development of chronic plaque psoriasis.
Serum lipids and blood pressure in relation to age and sexual maturity.
This study was designed to examine serum lipid profile and blood pressure in relation to age and sexual maturity. Written informed consent to participate was obtained from 42% of the eligible population of two Devon communities. The blood pressure of 343 boys and 336 girls, aged 11-16 years, was recorded and sufficient blood for analysis was obtained from 320 boys and 301 girls. Of these, sexual maturity of 221 boys and 209 girls was visually assessed using the indices developed by Tanner. In girls there was a significant (p less than 0.05) correlation between age and serum triglyceride level (r = 0.16) and in boys both serum cholesterol and HDL-cholesterol were significantly (p less than 0.01) and negatively correlated with age (r = -0.25 and -0.18 respectively). Girls had significantly higher (p less than 0.05) levels of HDL-cholesterol than boys but neither sex demonstrated significant changes (p greater than 0.05) in serum lipids or lipoproteins with sexual maturity. No significant differences (p greater than 0.05) were detected between the mean diastolic blood pressures of boys and girls but older boys had significantly higher (p less than 0.05) systolic blood pressures than similarly aged girls. Age was positively and significantly correlated (p less than 0.01) with blood pressure in both boys (systolic, r = 0.49; diastolic, r = 0.30) and girls (systolic, r = 0.28; diastolic, r = 0.29). More mature children were demonstrated to have both higher systolic and diastolic blood pressures than less mature children (p less than 0.05) but when allowance was made for school year group through analysis of co-variance the relationship for diastolic blood pressure in boys no longer remained significant. Blood pressures observed in this study do not raise general cause for concern but the data indicate that unfavourable serum lipid and lipoprotein profiles are common.
In vitro activity of cefoxitin and parenterally administered cephalosporins against anaerobic bacteria.
The in vitro activity of cefoxitin against 221 recent isolates of anaerobic bacteria was compared with that of cefamandole and cefuroxime by the agar dilution technique. At achievable serum levels of 32 micrograms/ml, all three drugs were active against most groups of anaerobic bacteria tested. Cefoxitin was active against most strains of the Bacteroides fragilis group, whereas cefamandole and cefuroxime were relatively ineffective. Cefoxitin was least active against Clostridium species other than Clostridium perfringens, whereas cefamandole was very active and cefuroxime moderately active. A review of recent in vitro studies with cefoxitin and parenterally administered cephalosporins indicates that cefoxitin is the most active compound against the B. fragilis group and is least active against Clostridium species other than C. perfringens.
The assessment of recovery in patients after myocardial infarction using three generic quality-of-life measures.
BACKGROUND: To evaluate the sensitivity to change of three generic quality-of-life measures in patients after myocardial infarction (MI). METHODS: Patients admitted to the Coronary Care Unit of Royal Devon and Exeter Healthcare Trust over a 9-month period were selected on the basis of a first MI and under 80 years of age. Quality of life was assessed 6 weeks and 6 months after MI using the Sickness Impact Profile (SIP), Nottingham Health Profile (NHP), and McMaster Health Inventory Questionnaire (MHIQ). An index of whether these measures are sensitive to change over time was determined by dividing the mean change from 6 weeks to 6 months of each instrument subscale by the baseline standard deviation of that subscale. Values of 0.2, 0.5, and 0.8 and above represent modest, moderate, and good sensitivity, respectively. RESULTS: Eighty-eight patients completed and returned the quality-of-life measures at both 6 weeks and 6 months. Four SIP subscales achieved a sensitivity to change index of 0.20 to 0.50: body care and movement, emotional behavior, work, and eating. Other SIP, NHP, and MHIQ subscales showed sensitivity index values of less than 0.20. No sensitivity index values of 0.50 or more were observed. CONCLUSIONS: During the period of this study, all three generic quality-of-life measures displayed only modest levels of sensitivity to change. Other quality-of-life measures need to be developed for the assessment of cardiac patients. This is particularly important when choosing suitable quality-of-life measures to assess cardiac rehabilitation.
A review of the rational use of corticosteroids.
Understanding of the use of corticosteroids has been aided by knowledge of their effect on cellular protein synthesis and by an appreciation of how modification of their molecular structure alters their pharmacological action. Their ability to modulate the immune response and to diminish inflammation make them useful in rheumatology, respiratory diseases, allergies, endocrine and metabolic disorders, blood disorders, gastro-intestinal diseases, neurological and muscular diseases, renal diseases, cardiovascular disorders and skin diseases. They have been widely tried empirically and, sometimes, they have proved unequivocally effective. Often there has been a need for cooperative clinical trials to establish their efficacy, and initial enthusiasm for corticosteroids has been tempered by a better appreciation of their limitations, especially in infections and ophthalmology. Those areas where either controlled trials or other persuasive evidence has established a place for their use are reviewed.
Lipoproteins in the elderly.
Changes in lipid metabolism with age result in lower total serum cholesterol and low-density lipoprotein concentrations. There is no evidence that longevity and lipid profiles are influenced by genetic make-up. It is difficult to establish an optimum total serum cholesterol in the elderly but values established in younger subjects give a guide. High-density lipoprotein may be even more protective in the elderly and could turn out to be a better predictor of coronary disease. Screening for the treatment of hypercholesterolaemia should be carried out in the elderly. Although death is an inevitable fact, intervention in, for example, recently retired, apparently disease-free subjects is important. The first approach should be the introduction of changes in life style (increased exercise, stopping smoking, improved diet). Drugs may also be introduced if these interventions fail. Although drug therapy in the elderly may pose immediate problems due to poor renal and hepatic function, the adverse effects of long-term use have less relevance in the elderly.
Use of 0.1% tacrolimus ointment in patients with various forms of lupus erythematosus.
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Bronchitis symptoms in young teenagers who actively or passively smoke cigarettes.
This study was undertaken to examine the prevalence of bronchitis (cough with phlegm) symptoms in teenagers who either smoked cigarettes on a regular basis (active smokers) or were non-smokers but who are exposed to passive smoking (passive smokers) in the home. The study was undertaken in 1995 and repeated in 1998. The 1995 study was a cross sectional questionnaire survey of smoking habits in secondary school children aged 13-14 years and was undertaken as part of the ISAAC questionnaire survey. Thirty representative and randomly selected schools from throughout the Republic of Ireland took part in the study. In the 1995 study, 3066 students completed a questionnaire on their current smoking habits and symptoms of cough and phlegm. We found that 634 (20.7%) of these young teenagers actively smoked cigarettes with significantly more females smoking than males with 23.3% of girls compared to 17.6% boys (p = 0.0001). We found that 46.3% of non-smoking children were exposed to smoking in the home (passive smokers) with parental smoking accounting for most of the passive smoking. Bronchitis symptoms were more commonly reported in active smokers compared to non-smokers with an odds ratio of 3.02 (95% CI 2.34-3.88) (p < 0.0001) or in passive smokers compared to those not exposed to smoking with odds ratio of 1.82 (95% CI 1.32-2.52) (p < 0.0001). The 1998 study showed similar results for smoking habits, passive smoking and prevalence of bronchitis symptoms as with the 1995 study. These results document that increased bronchitis symptoms occur in teenagers exposed to active or passive smoking.
Asthma, hay fever and eczema in Irish teenagers (ISAAC protocol).
The national prevalence of asthma, hay fever and eczema, employing the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, was determined during 1995 in 3148 Junior Certificate secondary school children aged 13-14 years throughout the Republic of Ireland. The prevalence values for asthma, hay fever and eczema were 15.2%, 24.8% and 9.4% respectively. Although 5.4% reported having both asthma and hay fever, combinations of the other allergic conditions were less than 2%. Sex difference in prevalence rates for the various conditions occurred with asthma prevalence being higher for males, eczema in females, but hay fever was almost equally reported between males and females. This data documents the prevalence of teenage asthma with associated allergic conditions in the Republic of Ireland and will allow for present and future comparisons of these conditions with other countries world-wide using the ISAAC protocol.