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Biomedical subjects

B Richards

Publications and source records attributed to B Richards.

At least 55 records · Page 3Linked to original sources
PubMed1996

The effect of intravesical mitomycin C on recurrence of newly diagnosed superficial bladder cancer: a further report with 7 years of follow up.

PURPOSE: We determined the role, if any, of 1 and 5 instillations of intravesical mitomycin C in the treatment of newly diagnosed superficial bladder cancer. MATERIALS AND METHODS: A multicenter randomized clinical trial was done involving 502 patients with newly diagnosed superficial bladder cancer. After complete transurethral resection patients with newly diagnosed superficial bladder cancer. After complete resection patients were randomized into 1 of 3 treatment arms: no further treatment, 1 instillation of mitomycin C at resection and 1 instillation at resection and at 3-month intervals for 1 year (total 5 instillations). The dose of mitomycin C used was 40 mg./40 ml. water. End points were interval to first superficial recurrence, recurrence rate (defined as the number of positive cystoscopies per year) and progression-free interval rate (progression defined as the development of muscle invasive or metastatic disease, or death from bladder cancer). RESULTS: After median followup of 7 years 1 and 5 instillations of mitomycin C resulted in decreased recurrence rates and increased recurrence-free interval. The benefit of mitomycin C was observed in patients at low, medium and high risk for subsequent recurrence. There was suggestive but not conclusive evidence that 5 instillations of mitomycin C offered a slight advantage over 1 instillation. CONCLUSIONS: Our analysis confirms the positive benefit of mitomycin C to decrease the number of subsequent recurrences and increase the recurrence-free interval.

Administration, Intravesical↗
PubMed1996

Experiences in the use of multimedia software in medical education.

In the realm of computers for education it has always been the case that the imagination of the programmers and educationalist has demanded the more innovative facilities which were never present in the machines in current use but which were promised in the next generation. Whilst the educationalists did pioneering work with what they had, they could always see how a package could be improved with the next generation of hardware. Now the hardware can give them everything they need; but they will always want more. Sensible use of multi-media can prove to be useful in training all levels of workers within healthcare. It can combine the best of the text-book and the video, but above all the use of interaction should produce untold benefits.

Computer-Assisted Instruction↗
PubMed1995

Molecular analysis of mutations in mutator colorectal carcinoma cell lines.

The nature of mutations occurring in two colorectal carcinoma cell lines deficient in mismatch repair and displaying mutator phenotypes was determined. One of the lines (HCT116) exhibited a higher level of microsatellite instability than the second (DLD-1), although the rate of mutation at the selectable locus encoding the purine salvage enzyme hypoxanthine guanine phosphoribosyl transferase (HPRT) was equally elevated (about 350-450-fold relative to mismatch repair proficient cell lines). Transitions were the major class of mutations in the two mutator lines. In DLD-1 these mutations recurred at several sites that appeared to be hotspots. Frameshifts at a run of six guanine residues in the coding sequence for HPRT constituted 35% of mutations in HCT116. These frameshifts were highly unstable and reverted to wild type at high frequency. Larger deletions were also detected in HCT116. Although these deletions constituted a small proportion of mutations compared with the other types, our data suggest that the rate of deletion is elevated relative to mismatch repair proficient (hMLH1+) cell lines. These observations suggest that the gene(s) altered in DLD-1 may preferentially affect the repair of base mismatches while the alteration(s) in HCT116 may affect the repair of both mismatches and frameshifts.

Base Sequence↗
PubMed1995

Minor congenital anomalies, major congenital malformations and development in children conceived from cryopreserved embryos.

A total of 91 children (68 singletons, 20 twins and three triplets) who were conceived from cryopreserved embryos between 27 December 1989 and 18 January 1994, and 83 normally conceived control children (81 singletons and two twins) of a similar age, sex and social class, were assessed for minor congenital anomalies and major congenital malformations. Their development was assessed using the Griffiths Scales of Mental Development. The incidence of minor congenital anomalies (31.9% in the cryopreserved embryo group and 21.7% in the controls) and major congenital malformations (3.3 and 2.4% respectively) in our two groups of children was statistically similar. The relative risk (odds ratio and 95% confidence interval) in the cryopreserved embryo group compared with the controls was 1.7 (0.8, 3.3) for minor congenital anomalies and 1.4 (0.2, 8.5) for major congenital malformations. The minor congenital anomalies were mostly naevi and haemangiomas. The major congenital malformations included Down's syndrome, Beckwith-Wiedemann syndrome and hypophosphataemic rickets in the cryopreserved embryo group and hydronephrosis and gastroschisis in the controls. The Griffiths assessment showed that children from the cryopreserved embryo group and the controls were functioning at a similar level. The mean Griffiths quotient and subquotient values were greater than the standard 100 in children with or without congenital abnormalities. These results in the cryopreserved embryo group are reassuring in that the minor congenital anomaly and major congenital malformation rates were similar to those in normally conceived children of a similar age, sex and social class and their development was not adversely affected by cryopreservation.

Case-Control Studies↗
PubMed1995

Outcome in children from cryopreserved embryos.

A cohort of 91 children from cryopreserved embryos and 83 control children who were conceived normally had their development assessed using the Griffiths's scales of mental development. The controls (81 singletons and two twins) of a similar age, sex, and social class were selected from siblings, cousins, and peers of the cryopreserved embryo group (68 singleton, 20 twins, and three triplets). Children from cryopreserved embryos had a lower mean birth weight and mean gestational age and a higher proportion were born by caesarean section. One child from the cryopreserved embryo group had Down's syndrome, three had squints, and four had conductive hearing loss while in the control children, six had squints, and nine had conductive hearing loss. In both groups, including the child with Down's syndrome, the mean Griffiths's quotient was greater than the standard 100. In the children from cryopreserved embryos, the singleton and multiple birth subgroups had statistically similar assessment results. The mean (SD) Griffiths's quotient was 105.69 (13.55) in children from cryopreserved embryos and 108.18 (9.80) in controls at a chronological age of 25.08 (12.86) and 29.19 (14.65) months respectively. Overall, the development in children from cryopreserved embryos did not cause concern though formal testing had highlighted small differences compared with other children conceived normally and of a similar social class.

Birth Weight↗
PubMed1995

The interpersonal relationship in clinical practice. The Barrett-Lennard Relationship Inventory as an assessment instrument.

The biomedical model that has long been central to medical practice is gradually being expanded to a broader biopsychosocial model. Relationship-building skills commensurate with the new paradigm need to be understood by educators and taught to medical practitioners. The person-centered, or humanistic, model of psychologist Carl Rogers provides a theoretical approach for the development of effective biopsychosocial relationships. The Barrett-Lennard Relationship Inventory (BLRI) was developed in 1962 as an assessment instrument for the person-centered model. In this article, the person-centered model and the use of the BLRI as an assessment instrument of this model are discussed. Current and potential uses of the BLRI are explored.

Education, Medical↗
PubMed1995

The final analysis of the EORTC Genito-Urinary Tract Cancer Co-Operative Group phase III clinical trial (protocol 30805) comparing orchidectomy, orchidectomy plus cyproterone acetate and low dose stilboestrol in the management of metastatic carcinoma of the prostate.

This report is the final analysis of an EORTC Genito-Urinary Group Phase III trial (Protocol 30805) comparing orchidectomy, orchidectomy plus cyproterone acetate 50 mg 3 times a day and stilboestrol 1 mg daily in the management of metastatic carcinoma of the prostate. Three hundred and twenty-eight eligible patients admitted into the study have been followed up for a median period of 4 years. There was no difference in time to metastatic progression and overall survival between the treatment arms. The cardiovascular toxicity of stilboestrol 1 mg daily has resulted in more cardiovascular deaths as compared with the orchidectomy treatment arm. The outcome for individual patients has been determined by on-study prognostic factors, especially the performance status, rather than the treatment given.

Adenocarcinoma↗
PubMed1995

A multi-media hospital equipment database.

A computer database system has been built which records all the necessary information on each item of equipment. This includes the name of the Department, the location (building and room number), a description of the asset (manufacturer, model number, serial number). The purchase date and source of funding (e.g., state or charity) are then recorded. The details of the maintenance program (e.g., company contracted, service date, service cost) follow next. Last and of equal importance, there follows one or more pictures of the item of equipment. Any special features can then be identified. These pictures form an integral part of each record in the database. The system runs on a desk-top PC under a networked system.

Database Management Systems↗
PubMed1994

A strategy to reduce inappropriate red blood cell transfusion.

OBJECTIVE: To evaluate the effectiveness of policies intended to decrease unnecessary packed red cell transfusions. DESIGN AND SETTING: The transfusion records of a 550-bed acute care facility were obtained and two six-month periods, one before and one after the introduction of new transfusion policies, were compared. RESULTS: Meaningful reductions were seen in crossmatch requests, number of units crossmatched and units transfused. After standardising for rising patient numbers, units transfused per 1000 admissions fell by 28.8%. Units crossmatched fell by slightly more than did units transfused, resulting in lower crossmatch-to-transfusion ratios, and indicating more effective use of resources. Total requests fell while "group-and-screen" requests rose, showing a shift toward more appropriate ordering in the face of increasing workload. CONCLUSIONS: The transfusion policies have succeeded in curtailing unnecessary transfusion practices. They included the lowering of "transfusion-triggering" haemoglobin levels, registrar or consultant approval of transfusions and enforcement of patient consent and chart documentation of transfusion indications, verified by the laboratory. The surgical blood ordering schedule was reviewed under the overall direction of the transfusion committee. A strong institutional commitment is required to lift the profile of blood transfusion.

Blood Grouping and Crossmatching↗
PubMed1994

House officers in general medicine: their perception of educational value of rotation components.

As curriculum planners in general medicine residency training programmes we were concerned about house officers' anecdotal reports that hospital work requirements often overshadow individual learning goals. After each of five rotations, we asked residents to identify the educational 'usefulness' of certain rotation components which can be included in three categories; team members, work-related activities and educational events. Of 165 surveys distributed, 127 (77%) were returned. Data were analysed by residency year and by all years combined. The mean overall perception of learning was 3.9 out of a possible 5 points suggesting that residents do find some learning value. Results suggest that different residency years vary as to the significance of specific educational components. The importance of faculty/resident relationships to residents' perceptions of learning value was highlighted in particular.

Attitude of Health Personnel↗
PubMed1993

Environmental correlates of child copula verb growth.

A recurring result from studies which relate the frequency of input variables to rate of language development, is the link between auxiliary verb growth and yes-no questions addressed to children. Explanations for this relationship usually concentrate on the advantages of hearing stressed and non-contracted auxiliary forms in sentence-initial position over hearing unstressed, contracted forms in medial position in declaratives. If such accounts are correct, then it can be predicted that yes-no questions which place forms of COPULA be in initial position will also increase the rate of growth of children's COPULA verb development. This prediction was tested using a sample of 33 children, carefully matched for stage of language development at 1;9 and 2;0 years; rate of copula verb growth was then measured over the succeeding nine months. Analyses include an examination of the contribution of sub-categories of yes-no question, tag questions, and utterances containing sentence-final copulas to the growth of contracted and full copulas. Results confirm that the frequency of inverted copulas in yes-no questions predicts children's copula development. Nevertheless, caution is urged before interpreting the relationship in terms of a direct causal model.

Acoustic Stimulation↗
PubMed1993

Multiplex PCR amplification from the CFTR gene using DNA prepared from buccal brushes/swabs.

Traditionally, DNA used for PCR-based diagnostic analysis has originated from white cells fractionated from whole blood. Although this method yields substantial quantities of DNA, there are some drawbacks to the procedure, including the inconvenience of drawing blood, risk of exposure to blood-borne pathogens, liquid sample handling, and the somewhat involved extraction procedure. Alternatively, DNA for genetic diagnosis has been derived from finger stick blood samples, hair roots, cheek scrapings, and urine samples. Oral saline rinses have also been used extensively as a means of collecting buccal epithelial cells as a DNA source. However, this method still requires liquid sample handling. Herein, we present our results involving the rapid extraction of DNA from buccal cells collected on cytology brushes and swabs for use in PCR reactions, specifically the multiplex amplification of 5 exons within the CFTR gene. The quality of DNA isolated from buccal cells, collected in this manner, has been sufficient to reproducibly support multiplex amplification. Cheek cell samples and the DNA prepared from them as described here are highly stable. The success rate of PCR amplification on DNA prepared from buccal cells is 99%. In a blind study comparing the analysis of 12 mutations responsible for cystic fibrosis in multiplex products amplified with DNA from both blood and buccal cell samples from 464 individuals, there was 100% correlation of results for blood and cheek cell DNA, validating the use of DNA extracted from cheek cells collected on cytology brushes for use in genetic testing.

Base Sequence↗
PubMed1993

Identification of the M1101K mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene and complete detection of cystic fibrosis mutations in the Hutterite population.

The Hutterite population is a genetic isolate with an increased incidence of cystic fibrosis (CF). Previously we identified three CF haplotypes defined by polymorphisms flanking the CF transmembrane conductance regulator (CFTR) gene. delta F508 was present on one of the haplotypes in only 35% of CF chromosomes. We hypothesized that the other two CF haplotypes, one of which was the most common and the other of which is rare, each harbored different non-delta F508 mutations. Single-strand conformation polymorphism analysis detected a missense mutation, M1101K, in both chromosomes of a Hutterite patient carrying the two non-delta F508 haplotypes. M1101K appears to have originated on an uncommon CFTR allele and to be infrequent outside the Hutterite population. The presence of M1101K on two haplotypes is likely the result of a CFTR intragenic recombination which occurred since the founding, 10-12 generations ago, of the Hutterite population. The crossover was located between exons 14a and 17b, an interval of approximately 15 kbp. delta F508 and M1101K accounted for all of the CF mutations in patients from 16 CF families representing the three subdivisions of the Hutterite population.

Adolescent↗