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Biomedical subjects

B Smith

Publications and source records attributed to B Smith.

At least 181 records · Page 10Linked to original sources
PubMed1996

Responses and needs in a changing situation: staff who work with people with learning disability.

Questionnaires were sent to residential care staff working with people with learning disability both in hospital and community settings, to explore any changes resulting from implementation of the policy of care in the community. Information was obtained on the current job situation of staff, their opinions on the effect of the policy of care in the community, their training needs, and perceived job prospects for the future. Findings for staff working in a hospital setting are compared with those of staff working in the community and discussed in the context of changing demands and conditions.

Adult↗
PubMed1996

The inhibition of antigen-induced eosinophilia and bronchoconstriction by CDP840, a novel stereo-selective inhibitor of phosphodiesterase type 4.

1. The novel tri-aryl ethane CDP840, is a potent and selective inhibitor of cyclic AMP phosphodiesterase type 4 (PDE 4) extracted from tissues or recombinant PDE 4 isoforms expressed in yeast (IC50S: 4-45 nM). CDP840 is stereo-selective since its S enantiomer (CT 1731) is 10-50 times less active against all forms of PDE 4 tested while both enantiomers are inactive (IC50S: > 100 microM) against PDE types 1, 2, 3 and 5. 2. Oral administration of CDP840 caused a dose-dependent reduction of interleukin-5 (IL-5)-induced pleural eosinophilia in rats (ED50 = 0.03 mg kg-1). The eosinophils in pleural exudates from CDP840-treated animals contained higher levels of eosinophil peroxidase (EPO) than cells from control animals, suggesting a stabilizing effect on eosinophil degranulation. CDP840 was approximately equi-active with the steroid dexamethasone in this model and was 10-100 times more potent than the known PDE 4-selective inhibitors rolipram and RP73401. The activity of CDP840 was not influenced by adrenalectomy, beta-sympathomimetics or beta-sympatholytics. 3. Antigen-induced pulmonary eosinophilia in sensitized guinea-pigs was reduced dose-dependently by CDP840 (0.01-1 mg kg-1, i.p.) and intracellular EPO levels were significantly higher. CDP840 was more potent in these activities than CT1731 or rolipram and comparable in potency to RP73401. 4. Rolipram or CDP840 were less active than dexamethasone in preventing neutrophil accumulation, or exudate formation in carrageenan-induced pleurisy in rats and thus do not exhibit general anti-inflammatory activity. 5. In sensitized guinea-pigs, aerosols of the antigen ovalbumin caused a dose-dependent bronchoconstriction demonstrated by an increase in pulmonary inflation pressure. Administration of CDP840 (0.001-1.0 mg kg-1, i.p.), 1 h before antigen challenge, resulted in dose-dependent reduction in response to antigen. This activity was not due to bronchodilatation since higher doses of CDP840 (3 mg kg-1) did not significantly change the bronchoconstrictor response to histamine. Rolipram was approximately 10 times less active than CDP840 in preventing antigen-induced bronchoconstriction. 6. These results confirm the observations that selective PDE 4 inhibitors reduce antigen-induced bronchoconstriction and pulmonary eosinophilic inflammation. CDP840 is more potent than rolipram in inhibiting native or recombinant PDE 4. Unlike the recently described potent PDE 4 inhibitor RP73401, CDP840 is more active than rolipram in the rat IL-5 model following oral administration. The novel series of tri-aryl ethanes, of which CDP840 is the lead compound, could be the basis of an orally active prophylactic treatment for human asthma.

3',5'-Cyclic-AMP Phosphodiesterases↗
PubMed1996

Families are content to discontinue antiepileptic drugs at different risks than their physicians.

PURPOSE: To define the risk of seizure recurrence (RSR) that families and physicians would accept before discontinuing antiepileptic drugs (AEDs) for children with controlled epilepsy. METHODS: A questionnaire was completed by families of 76 children with epilepsy > or = 3 months seizure-free and by their attending epilepsy specialist (n = 4). RESULTS: Forty-two percent of families were unwilling to discontinue AEDs with an RSR of 25%. In contrast, 20% were willing to accept a > 75% RSR. Several factors differentiated the risk acceptable to families: previous seizure frequency (risk adverse with intermediate frequency), multiple seizure types (risk taking), grade or grades repeated in school (risk adverse), and the family's strategy of playing lotteries. Although families and physicians were prepared to accept similar median RSR (35 and 40%, respectively), individual answers did not correlate (r2 = -0.07). Physicians were unable to predict the families response (r2 = 0.09). CONCLUSIONS: Our current practice is to discontinue AEDs after 2 years of seizure-free results in seizure recurrence of 30-40%. This risk may seem excessive to more than half of families, whereas other families will risk stopping AEDs at higher risks of recurrence. Physicians are poor judges of the degree of risk that is acceptable to a particular family, which may account in part for the anxiety manifested by families at AED discontinuation.

Adolescent↗
PubMed1996

Laboratory studies of the effect of Pall extracorporeal leucocyte filters LG6 and AV6 on patients undergoing coronary bypass grafts.

A total of 14 patients with ischaemic heart disease undergoing coronary artery bypass grafts were studied for the effect of AV6 control filter and LG6 neutrophil filter, used in the extracorporeal circulation, on different laboratory parameters. There was no statistical difference between the effects of AV6 and LG6 filters on total white cells, neutrophils, monocytes, lymphocytes, platelets or haemoglobin. The expression of neutrophil activation antigens identified with a panel of monoclonal antibodies demonstrated that for the LG6 filter the leucocyte tyrosine phosphate CD45Ro fell during the procedure, whilst there were no significant changes in any of the other neutrophil antigens. The AV6 filter did not significantly diminish the expression of any of the neutrophil antigens. An indirect measure of superoxide production using Dihydrorhodamine 123 identified that the more activated cells appeared to be depleted across the LG6 filter which was not evident with the AV6 filter. These studies indicate that the LG6 is not capable of significantly depleting the neutrophil load generated during extracorporeal circulation but may be capable of selectively removing the more activated forms.

Aged↗
PubMed1996

Do self-management plans reduce morbidity in patients with asthma?

BACKGROUND: Self-management plans may help patients with asthma intervene when symptoms deteriorate, thus preventing asthma attacks. AIM: A study set out to test whether a self-management plan tailored to the circumstances of the individual reduces morbidity from asthma. METHOD: General practitioners who had participated in a national audit of asthma attacks were randomized into intervention and control groups. Six months after the intervention group had issued self-management plans to patients with asthma, both groups of practitioners completed morbidity questionnaires on patients. Morbidity outcomes were compared for the 6-month periods before and after the issue of the plans. RESULTS: In the 6 months before the study, the 376 patients enrolled by the intervention group experienced higher levels of morbidity than the 530 patients for whom details were recorded by the control group. In the 6 months after the issue of the plans, control group patients showed little change in levels of morbidity, but intervention group patients showed significant reductions in hospital admissions, consultations for asthma symptoms, asthma review consultations, courses of oral steroids and use of emergency nebulized bronchodilators. CONCLUSION: General practitioners appeared to operate enthusiast bias' and issued more self-management plans to patients with uncontrolled asthma. The reduction in morbidity in this group is probably a result of the use of the plans, but the verdict on whether plans reduce morbidity must be deemed 'not proven'.

Asthma↗
PubMed1996

Local carboplatin therapy in transgenic murine retinoblastoma.

PURPOSE: To determine the efficacy and toxicity associated with intraocular delivery of carboplatin in the treatment of murine transgenic hereditary retinoblastoma. METHODS: Forty-eight transgenic BLH-SV40 Tag retinoblastoma mice were administered five intravitreal injections of carboplatin in one eye. After 12 weeks, the eyes were examined histopathologically to evaluate tumor burden. Twelve rabbits were administered intravitreal injections of carboplatin in one eye, after which they underwent serial electroretinography. All experimental and control eyes were obtained for histopathology and electron microscopy. RESULTS: A dose-dependent inhibition of intraocular tumor growth by carboplatin was observed in transgenic retinoblastoma mice. Tumor development was inhibited in 50% of the mouse eyes at doses of 1.4 micrograms. In rabbits, retinal toxicity resulted when intravitreal injections of carboplatin were administered at doses of 10 micrograms or higher. CONCLUSIONS: Local delivery of carboplatin in serial doses effectively inhibits intraocular tumor growth in a dose-dependent manner in transgenic murine retinoblastoma.

Animals↗
PubMed1996

Laparoscopic excision of a cystic lymphangioma.

A 16-year-old female was evaluated for recurrent episodes of acute abdominal pain and distension. Initial abdominal radiographs were consistent with recurrent gastric volvulus. Following nasogastric tube decompression, reexamination revealed a mobile abdominal mass in the left upper quadrant. Contrast studies followed by computed tomography demonstrated a cyst measuring 9 X 7 X 6 cm with no obvious relationship to abdominal viscera. Laparoscopy was performed with a 10-mm port at the umbilicus and right upper quadrant,and a 5-mm port in the left lower quadrant. The cyst was excised from the mesentery of the proximal jejunum and placed in a laparoscopic sac. Controlled incision and drainage of the cyst within the sac facilitated its removal from the abdomen with neither enlargement of the trocar site nor intraabdominal spillage. To prevent recurrent gastric volvulus, a gastropexy was performed from the greater and lesser curvatures to the anterior abdominal wall. The histology was typical of a cystic lymphangioma. The patient was discharged on the third postoperative day without complication. Laparoscopic technique allowed the performance of both procedures without large incisions, This is the first reported laparoscopic excision of a cystic lymphangioma.

Adolescent↗
PubMed1996

Alaska Native cancer update: incidence rates 1989-1993.

Five-year average annual age-adjusted cancer incidence rates for Alaska Natives (Eskimos, Indians, and Aleuts) for the most recent period (1989-1993) are compared to rates of 20 years earlier. Rates for all cancers combined increased 28 and 25% in men and women, respectively, during the 25-year interval. Increases were seen in men in cancers of the lung, prostate, and colon and in women for cancers of the lung, breast, and corpus uteri. Rates are also compared to data from the the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program for United States whites. Rates for all cancers combined in Alaska Native women are now similar to those of United States whites, whereas rates in Alaska Native men are lower than the United States, but only 10% lower. Significant site-specific differences previously reported between Alaska Natives and United States whites persist.

Alaska↗
PubMed1996

Observations on the structure, process and clinical outcomes of asthma care in general practice.

BACKGROUND: There is a need to establish whether the structure of asthma care in general practice is associated with measures of process and with primary and secondary care clinical outcomes. Debate about how to resource general practice asthma care is hampered by a lack of observational data from throughout the United Kingdom (UK). AIM: To observe whether the present system of family health services authority (FHSA) accreditation of asthma clinics, based on measures of structure, is associated with measures of process or clinical outcome. METHOD: Two hundred and twenty-five UK practitioners enrolled in a project and recorded details of how they organized asthma care. Data from 6732 patients, concerning general practitioner and nurse consultations, asthma attacks, symptom control, emergency treatments and hospital attendances covering a 12-month period, were also provided. RESULTS: FHSA approval for a chronic disease management (CDM) asthma clinic was associated with favourable patterns of structure and process, but not of clinical outcome. Practice audit and the employment of a nurse with an asthma diploma were associated with favourable patterns of structure, process and clinical outcome. Practices (n = 143) that had recently audited asthma patient care (n = 4259) had fewer patients who had attended an accident and emergency department [121 (3%): 96 (4%), odds ratio 1.38, 95% confidence interval 1.04-1.83] or a hospital outpatients department [247 (6%): 180 (7%), 1.28, 1.04-1.56], or who had respiratory symptoms on assessment [2400 (56%): 1465 (59%), 1.34, 1.18-1.52] or days absent from work or school in the past 12 months [375 (9%): 296 (12%), 1.48, 1.25-1.74] than those that had not (82 practices, 2473 patients). CONCLUSION: Findings from a large UK sample of practices are subject to participant bias and show association rather than causal links. The present FHSA asthma CDM accreditation system, based on structure, is not associated with favourable clinical outcomes. This opens the debate as to whether accreditation should be linked to recent experience of audit, which does appear to be associated with favourable clinical outcomes.

Adolescent↗
PubMed1996

Clinical investigations of gastro-oesophageal reflux: Part 1.

Most people have at some time experienced the symptoms of heartburn associated with gastro-oesophageal reflux. Fortunately, these symptoms are usually short-lived and require no treatment, but in some patients severe and prolonged reflux of gastric juice into the mouth can cause dental erosion. This paper, the first in a two-part series, describes the aetiology of gastro-oesophageal reflux and associated problems that may be encountered.

Esophagogastric Junction↗
PubMed1996

Developmental versus conventional care: a comparison of clinical outcomes for very low birth weight infants.

The purpose of this research was to describe the clinical profile of very low birth weight (VLBW) infants receiving conventional versus developmental care during their hospitalization and to determine the appropriateness of developmental-care interventions. A phase-lag study with 124 preterm infants indicated that although there were no significant differences in individual clinical outcomes, developmental care had a significant effect on the physiologic stability of the infant over time. Developmental interventions were used for all infants receiving the developmental-care intervention, with varying frequency.

Developmental Biology↗
PubMed1995

Spine rehabilitation. Secondary and tertiary nonoperative care.

To achieve desirable behavioral outcomes, physicians treating spinal pain patients should be aware of appropriate algorithms for conservative care. Lower cost secondary rehabilitation can be effective if deconditioning, severity of physical symptoms, surgical equivocation, or psychosocial barriers to recovery are not present. Patients who have extended disability in excess of 6 months, recognized psychosocial barriers (depression, substance abuse, personality disorders, secondary gain), or severe deconditioning have a better prognosis with tertiary care.

Humans↗
PubMed1995

Patterns of splice variant CD44 expression by normal human urothelium in situ and in vitro and by bladder-carcinoma cell lines.

CD44 core and splice variant exon expression was investigated in the stratified transitional epithelium of the urinary tract and in normal and malignant bladder epithelial cell lines in vitro. Antibodies against core CD44 epitopes and splice exon variants v3, v4/5, v5 and v6 showed an intense reaction in the basal and lower intermediate urothelial cell layers, which was consistently lost from the upper intermediate and superficial cell layers. Seven independent cell lines established from normal human urothelium expressed complex multiple-spliced CD44 mRNA transcripts when tested by RT-PCR and were positive with antibodies against CD44 core epitopes and splice variants v3, v4/5, v5 and v6. Of the 13 bladder-carcinoma cell lines, all were positive for CD44 core. The more differentiated cell lines had retained some splice-variant antibody reactivity and showed multiple but less complex CD44 mRNA transcript patterns, compared with normal cells. Anaplastic cell lines did not react with variant antibodies and did not contain multiple-spliced CD44 transcripts. These data suggest that loss of alternatively-spliced CD44 may reflect a selection pressure in the evolution of anaplastic bladder cancers.

Antigens, Neoplasm↗
PubMed1995

Ambulatory blood pressure in pregnancy: comparison of the Spacelabs 90207 and Accutracker II monitors with intraarterial recordings.

OBJECTIVE: Our purpose was to compare systolic and diastolic blood pressures obtained with the Spacelabs 90207 (Spacelabs Medical Products, Dee Why, Australia) or Accutracker II (Suntech Medical Instruments, Melbourne, Australia) ambulatory blood pressure monitoring devices with intraarterial blood pressures in pregnant women. STUDY DESIGN: Direct (intraarterial) and resting blood pressures with the ambulatory blood pressure monitoring device were compared in 39 pregnant women (14 Accutracker II and 25 Spacelabs 90207). RESULTS: The Accutracker II device underestimated direct systolic pressure by -9 (-13, -3) mm Hg (median, interquartile range) (p = 0.028) but gave similar diastolic pressure. The Spacelabs 90207 device gave similar systolic pressures but overestimated direct diastolic pressure by 7 (2, 12) mm Hg (p < 0.001). Variability for systolic and diastolic blood pressures within subjects was similar with the two devices. Both received poor gradings by standards of the British Hypertension Society and did not meet criteria of the Association for the Advancement of Medical Instrumentation, with intraarterial recordings used as the reference. CONCLUSIONS: The Accutracker II device significantly underestimated resting direct systolic pressure, whereas the Spacelabs 90207 device significantly overestimated resting direct diastolic pressure in pregnant women. Although poor gradings were achieved for both devices when intraarterial pressures were used as the reference, this is similar to comparisons of routine mercury sphygmomanometry with intraarterial recordings and does not mean these devices are unsuitable for use in pregnancy.

Blood Pressure Monitoring, Ambulatory↗