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Biomedical subjects

B Lindsay

Publications and source records attributed to B Lindsay.

At least 19 recordsLinked to original sources
PubMed2001

Specialist epilepsy nurses for treating epilepsy.

BACKGROUND: Epilepsy is the most common serious neurological condition after stroke, with a 0.5 per cent prevalence, and a two to three per cent life time risk of being given a diagnosis of epilepsy in the developed world. As a result of the perceived deficiencies and suggestions to improve the quality of care offered to people with epilepsy, two models of service provision have been suggested by researchers: specialist epilepsy out-patient clinics (as opposed to the management of patients in general neurology clinics or general medical clinics) and nurse-based liaison services between primary (GP) and secondary/tertiary (hospital based) care. OBJECTIVES: The aim of this review is to overview the evidence from controlled trials investigating the effectiveness of specialist epilepsy nurses compared to routine care. SEARCH STRATEGY: The following databases were searched: The Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 1999), MEDLINE, GEARS, BIDS (EMBASE=Excepta Medica), ECRI, Effectiveness Healthcare Bulletin, Effectiveness Matters, Bandolier, Evidence Based Purchasing, National Research Register, Vignettes and expert panels from Standing Group on Health Technology Assessment, PsycLit database, World Wide Web sites and reference lists of articles. SELECTION CRITERIA: All randomized controlled and quasi-randomized trials which considered specialist epilepsy nurse interventions with standard or alternative care were included in this review. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected trials for inclusion and extracted the relevant data. The following outcomes were assessed: (a) seizure frequency (b) appropriateness of medication prescribed (c) social or psychological functioning scores (d) knowledge about epilepsy scores (e) objective measures of general health status/quality of life (f) patients' reports of information received (g) number of days spent on sick leave/missing school and employment status (h) costs of care (i) adverse effects. MAIN RESULTS: Three trials were included, two based in general practice and one in a neurology centre. The population of patients differed between trials, for example one study excluded patients with learning disabilities, and one only recruited patients with a new diagnosis. In view of this heterogeneity we decided not to pool results in a meta-analysis. As yet, there is no convincing evidence that specialist epilepsy nurses improve outcomes for people with epilepsy overall. Important outcomes (e.g. seizure frequency, psychosocial functioning, knowledge of epilepsy, general health status, work days lost, depression and anxiety scores) show no significant improvement. There is some evidence that those patients who have not had an epileptic seizure in the last six months are less at risk for depression. There is also evidence that newly diagnosed patients whose knowledge about epilepsy is poor may improve their epilepsy knowledge scores after nurse intervention. REVIEWER'S CONCLUSIONS: It is clearly plausible that specialist epilepsy nurses could improve quality in epilepsy care. However, there is as yet little evidence to support this assumption as the present research base is small. Further research is needed to investigate the effectiveness of specialist epilepsy nurses before such recommendations can be made.

Epilepsy↗
PubMed2001

Epilepsy clinics versus general neurology or medical clinics.

BACKGROUND: Epilepsy is the most common serious neurological condition after stroke, with a 0.5 per cent prevalence, and a two to three per cent life time risk of being given a diagnosis of epilepsy in the developed world. As a result of perceived deficiencies of the quality of care offered to people with epilepsy, two models of service provision have been suggested by researchers: specialist epilepsy out-patient clinics (as opposed to the management of patients in general neurology clinics or general medical clinics) and nurse-based liaison services between primary (GP) and secondary/tertiary (hospital based) care. OBJECTIVES: The aim of this review was to overview the evidence from controlled trials investigating the effectiveness of specialist epilepsy clinics compared to routine care. A second similar review investigating the effectiveness of specialist epilepsy nurses is also underway. SEARCH STRATEGY: We searched the Cochrane Epilepsy Group trials register, the Cochrane Controlled Trials Register (Cochrane Library Issue 4, 1999), MEDLINE (January 1966 to December 1999), GEARS, BIDS (EMBASE=Excepta Medica(1998-99)), ECRI, Effectiveness Healthcare Bulletin, Effectiveness Matters, Bandolier, Evidence Based Purchasing, National Research Register, Vignettes and expert panels from Standing Group on Health Technology Assessment, PsycLit database, World Wide Web sites and reference lists of articles. In addition, we contacted experts in the field. SELECTION CRITERIA: All randomized controlled and quasi-randomized trials which considered specialist epilepsy clinic interventions with standard or alternative care were included in this review. DATA COLLECTION AND ANALYSIS: No controlled trials of suitable quality were identified for inclusion in the review. MAIN RESULTS: No controlled trials of suitable quality were identified for inclusion in the review. REVIEWER'S CONCLUSIONS: It is not known whether specialist epilepsy clinics improve outcomes for people with epilepsy. As yet, there is no high quality evidence which describes their effectiveness in improving care for people with epilepsy.

Epilepsy↗
PubMed1992

Computer-assisted analysis of mixtures (C.A.MAM): statistical algorithms.

This paper presents various algorithmic approaches for computing the maximum likelihood estimator of the mixing distribution of a one-parameter family of densities and provides a unifying computer-oriented concept for the statistical analysis of unobserved heterogeneity (i.e., observations stemming from different subpopulations) in a univariate sample. The case with unknown number of population subgroups as well as the case with known number of population subgroups, with emphasis on the first, is considered in the computer package C.A.MAN (Computer Assisted Mixture Analysis). It includes an algorithmic menu with choices of the EM algorithm, the vertex exchange algorithm, a combination of both, as well as the vertex direction method. To ensure reliable convergence, a step-length menu is provided for the three latter methods, each achieving monotonicity for the direction of choice. C.A.MAN has the option to work with restricted support size-that is, the case when the number of components is known a priori. In the latter case, the EM algorithm is used. Applications of mixture modelling in medical problems are discussed.

Algorithms↗
PubMed1990

Cardiovascular response to isokinetic endurance exercise testing.

The purpose of this study was to compare specific cardiovascular responses; maximal heart rate (MHR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and the calculated pressure rate product (PRP) [SPB X HR X 10(-2)] achieved during a Cybex+ isokinetic endurance test to those generated during a maximal graded exercise test (GXT). Nine untrained college females underwent a Bruce GXT and a maximal effort Cybex knee endurance test. Independent t-tests were used to analyze the differences between the means for MHR, SPB, DBP, and PRP elicited during both tests. There was no significant difference (p less than 0.01) between SBP and DBP means elicited during either test. MHR was significantly higher on the GXT with Cybex values ranging from 71 to 88% of GXT values. PRP was significantly lower during Cybex exercise but ranged from 58 to 102% of maximal GXT values. The results of this study demonstrate the high demands that a Cybex endurance test places on the cardiovascular system of this healthy population and also emphasize the need to carefully evaluate and monitor these parameters for clients of all ages and diagnoses.

Adult↗
PubMed1989

Pacemaker-implantation complication rates: an analysis of some contributing factors.

An examination of 632 consecutive pacemaker implantations performed at a single institution by 29 implanting physicians over a 5 year period was made to determine which factors affected the 37 perioperative complications experienced. The introducer method of vein access contributed significantly to the complication rate, which was also related to the number of physician implanters on the staff and the makeup of the implantation teams. Of greatest interest was the substantially large incidence of complications experienced by implanters who performed fewer than 12 implantations per year, and particularly the incidence of lead-related complications.

Electrodes, Implanted↗
PubMed1980

Muscular contraction headache and dental imbalance.

A physical explanation for the contraction of the muscles of mastication, in muscular contraction headache, is described. It is suggested the role of tension is over emphasized as the main aetiological factor. In the younger dentate group, the presence of dental imbalance requires diagnosis by a dental practitioner. In the older, edentulous group, the family physician can easily diagnose mandibular overclosure from the facies (Fig. 1) or absence of molar teeth (Fig. 7) especially if combined with wearing the same set of dentures for more than ten years. When these signs are present, the family physician should consider referring such patients for a dental opinion.

Adolescent↗
PubMed1977

Relation between cell wall turnover and cell growth in Bacillus subtilis.

The kinetics of cell wall turnover in Bacillus subtilis have been examined in detail. After pulse labeling of the peptidoglycan with N-acetylglucosamine, the newly formed peptidoglycan is stable for approximately three-quarters of a generation and is then degraded by a process that follows first-order kinetics. Deprivation of an auxotroph of amino acids required for protein synthesis results in a cessation of turnover. If a period of amino acid starvation occurs during the lag phase of turnover, then the initiation of turnover is delayed for a period of time equivalent to the starvation period. During amino acid starvation, new cell wall peptidoglycan is synthesized and added to preexisting cell wall. This peptidoglycan after resumption of growth is also subject to degradation (turnover). It is suggested that cell wall turnover is dependent on cell growth and elongation. Several possible control mechanisms for cell wall autolytic enzymes are discussed in light of these observations.

Acetylglucosamine↗
PubMed1976

Characterization of the N-acetylmuramic acid L-alanine amidase from Bacillus subtilis.

The N-acetylmuramic acid L-alanine amidase from Bacillus subtilis W-23 has been purified to apparent homogeneity. The enzyme is a monomer of molecular weight 51,000, which binds extremely tightly to homologous cell walls but not to heterologous cell walls, even of the closely related strain B. subtilis ATCC 6051. This difference in binding is only in part due to differences in teichoic acid between these two strains and to a large extent appears to represent differences in the arrangement of the peptidoglycan. A comparison of the amidase from B. subtilis W-23 and the enzyme previously purified from B. subtilis ATCC 6051 (Herbold and Glaser, 1975) shows that the two proteins, which cleave the same bond and are of the same size, do not cross-react immunologically and that the two enzymes are, therefore, not closely related in structure.

Amidohydrolases↗