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Biomedical subjects

C Bradley

Publications and source records attributed to C Bradley.

At least 37 records · Page 2Linked to original sources
PubMed2001

Treatment satisfaction and psychological well-being with insulin glargine compared with NPH in patients with Type 1 diabetes.

AIMS: To assess satisfaction with treatment and psychological well-being associated with insulin glargine and Neutral Protamine Hagedorn (NPH). Insulin glargine, a new long-acting insulin analogue, provides constant, peakless insulin release following once-daily administration and is associated with fewer hypoglycaemic episodes, despite metabolic control equivalent to that achieved with NPH human basal insulin. METHODS: The Diabetes Treatment Satisfaction Questionnaire (DTSQ) and Well-being Questionnaire (W-BQ) were completed at baseline and at weeks 8, 20 or 28 by 517 patients with Type 1 diabetes participating in a randomized, controlled European trial comparing insulin glargine and NPH. Analysis of covariance was performed on change from baseline scores (main effects: treatment and pooled site; covariate: baseline scores). RESULTS: Treatment satisfaction improved with insulin glargine at all time points, including endpoint, but deteriorated slightly with NPH. These differences were significant throughout the study (change from baseline to endpoint: +1.27 vs. -0.56; P = 0.0001). Outcomes were better with insulin glargine for the DTSQ items, Perceived Frequency of Hyperglycaemia and Hypoglycaemia, with statistically significant differences at week 28 and endpoint for hyperglycaemia (P = 0.0373 and 0.0379) and at week 20 for hypoglycaemia (P = 0.0024). There was no difference in psychological well-being between the treatment groups, with mean scores increasing in both. CONCLUSIONS: Study participants had treatment-independent improvements in General Well-being. Advantages for insulin glargine were seen in significantly improved Treatment Satisfaction throughout the study, together with lower Perceived Frequency of Hyperglycaemia than for patients on NPH, without a significant increase in Perceived Frequency of Hypoglycaemia.

Adolescent↗
PubMed2001

The ADKnowl: identifying knowledge deficits in diabetes care.

AIMS: To present the ADKnowl measure of diabetes-related knowledge and evaluate its use in identifying the nature and extent of patient and health professional knowledge deficits. METHOD: The ADKnowl was used in a large-scale study of 789 patients (451 treated with insulin and 338 treated with tablets and/or diet) attending for annual review at one of two hospital out-patient diabetes clinics RESULTS: Knowledge deficits were apparent in the patients. For example, 57% did not recognize the inaccuracy of the statement 'fresh fruit can be eaten freely with little effect on blood glucose levels'. Seventy-five percent of patients did not know that it is advisable to trim toenails to the shape of the toe. Knowledge deficits were identified for many other areas of diabetes management, e.g. prevention of hypoglycaemia, avoidance of ketoacidosis. Sixteen health professionals at the clinics answered the same items. Contrary to recommendations, 25% of health professionals thought that fresh fruit could be eaten freely. Seventy-five percent of health professionals did not know the current recommendations for trimming toenails. As expected, HbA1c did correlate with scores from two specific items, while HbA1c did not correlate with summed ADKnowl score. CONCLUSIONS: Patient knowledge deficits were identified. Some specific knowledge deficits among health professionals may be the cause of some patient knowledge deficits. The ADKnowl is a useful tool in assessing both patient and health professional knowledge deficits and is available for use in a context of continuing evaluation.

Body Mass Index↗
PubMed2001

Erythromycin as a gastrointestinal prokinetic agent.

Erythromycin is a potent stimulator of gastrointestinal (GI) motility and can be a useful agent to treat GI stasis in patients who are critically ill. However, it is not licensed for this indication and has serious drug interactions which may limit its utility. Erythromycin derivatives which lack antibiotic activity have been developed but are still undergoing pre-marketing investigations.

Anti-Bacterial Agents↗
PubMed2001

Steroids in sepsis--more effective than activated protein C?

Early studies using high doses of steroids in septic shock resulted in increased mortality. More recently, work by Annane et al. using lower doses closer to those that might constitute a stress dose of hydrocortisone have shown encouraging results with a 30% decrease in mortality in septic shock. Although this result is more impressive than the reduction in mortality resulting from the use of activated protein C in septic shock, the numbers of patients involved in the steroid study are low and the results remain unpublished in a peer-reviewed journal.

Anti-Inflammatory Agents↗
PubMed2001

Activated protein C in severe sepsis.

A recent large trial has shown that recombinant activated protein C reduced mortality in severe sepsis. This is the first real advance in the pharmacotherapy of sepsis since the introduction of antibiotics in the last century.

Anti-Infective Agents↗
PubMed2001

Crystalloid, colloid or small volume resuscitation?

Small volume resuscitation fluids are a combination of hypertonic crystalloid with a colloid. SVR fluids have the advantage of logistical convenience in the field situation. Clinical trials point to improved outcome in patients with penetrating trauma injury or traumatic brain injury. HSD may reduce the inflammatory process and has shown improved outcome in trauma patients who require intensive care. Trials so far have been carried out in small numbers of patients and improved survival benefit has only become evident on meta-analysis and sub-group analysis. Further large scale blinded randomized trials are required to confirm the promise of survival advantages.

Colloids↗
PubMed2001

Observation interval for evaluating the costs of surgical interventions for older women with a new diagnosis of breast cancer.

OBJECTIVE: To estimate the episodic costs of surgical treatments for breast cancer. METHODS: The surgical treatment period as the 6 weeks following diagnosis is defined. Using a sample of 205 women aged 65 and older and their Medicare claim files, the cost of treatment is estimated and the progression from first to subsequent surgical procedures during the 6-week interval is demonstrated with a decision tree. Two equations are then estimated: the probability of mastectomy versus breast conserving surgery (BCS) as first surgery using Probit regression and the log of total charges using a generalized linear regression model. RESULTS: It was found that only stage predicts the probability of mastectomy versus BCS and that 54% of women receiving BCS undergo a second surgery. Once all treatments in the initial surgical period are accounted, the difference between the adjusted cost of mastectomy alone and BCS followed by a second surgery was not statistically significant. Only a successful first BCS is statistically significantly (P <0.05) less costly than a mastectomy alone ($4,955 vs. $9,049). CONCLUSIONS: By defining a 6-week surgical treatment episode it is shown that BCS followed by subsequent surgeries is the more costly option for initial treatment. Given the high prevalence of second surgeries, previous work may have underestimated the costs of surgical interventions for breast cancer.

Aged↗
PubMed2001

Leptin and obesity in mother-child pairs.

Defects in the leptin gene or the leptin receptor may be a genetic cause of obesity, but little is known about the familial associations of leptin and obesity. This study compared plasma leptin and measures of obesity in a sample of 248 subjects (124 mother-offspring pairs); 34% were African American and 66% were white. Youth were aged 12 to 16 years. Plasma leptin and body mass index (BMI) were higher in mothers than in their offspring and, among the offspring, higher in girls than boys, even after correcting for BMI or body fat. Racial differences in leptin were present in both mothers and youth when adjusting for percentage body fat but disappeared when adjusting for BMI. In univariate analyses of the associations between mothers and offspring, BMI was associated with leptin in all groups but was most strongly associated in white pairs and in mother-son pairs. In multiple regression analyses, when adjusting for BMI, significant predictors of leptin levelfor the boys and girls together were gender, BMI, and pubertal status of the offspring; in girls only BMI was significant (R2 = 0.72), and in boys the significant predictors were their BMI (R2 = 0.66) followed by their pubertal status (R2 = 0.06) and the leptin level of their mothers (R2 = 0.02). When adjusting for body fat, the predictors were the offspring's percentage bodyfat (R2 = 0. 67) and mother's leptin (R2 = 0.03), with similar results in gender-specific analyses. The authors conclude that leptin levels of youth are most closely associated with their degree of obesity or body fat; mother's leptin and, for boys only, pubertal status also play a small role. Although the small association between maternal leptin on leptin in their offspring could be due to either heredity or shared environment, the results of this study suggest that individual obesity and environmental factors are important predictors of leptin levels in children.

Adolescent↗
PubMed2001

Risk and prevention of type II diabetes: offspring's views.

BACKGROUND: People with a parent with type II diabetes have an increased risk of the disease. There is increasing evidence for the possibility of prevention, particularly by attaining and maintaining normal weight and adequate levels of physical exercise. No prior studies have reported awareness of risk and prevention in this high-risk group. AIM: To explore beliefs about personal risk of diabetes and prevention in people with a parent with type II diabetes. DESIGN OF STUDY: A total of 254 adults with type II diabetes were identified from five randomly selected practices in south London. Self-report questionnaires were sent to 152 eligible offspring of these patients. A total of 105 of the offspring returned the self-report questionnaires and participated in the study. SETTING: Five randomly selected practices in south London. METHODS: Patients with type II diabetes in five randomly selected practices in south London were asked if we might contact their offspring. One randomly selected offspring (over 18 years of age) from each family completed a self-report questionnaire. RESULTS: Of 254 adults with type II diabetes 152 had eligible offspring. A total of 105 (69%) of the offspring participated in the study. A total of 69 (66%) of these offspring believed their personal risk of developing diabetes was 'low'. At least 28 (28%) and maybe as many as 73 (70%) underestimated the risk of diabetes in offspring. Compared with the number thinking their current risk was low significantly more (95 versus 69) thought that their risk would be low if neither of their parents had diabetes. Fifty-seven (54%) thought prevention was possible. Sixteen thought taking more exercise was important for prevention and only seven thought that weight control was important. Many had good general knowledge about diabetes and its complications but awareness of the relationship between diabetes and cardiovascular disease was poor. CONCLUSIONS: People with a parent with type II diabetes are usually aware that they have an increased risk of diabetes. However, they often underestimate that risk and know little about potentially useful preventive strategies. They need accurate information about these matters if they are to reduce their risk of diabetes and its complications.

Adult↗
PubMed2001

The effect of aloe vera gel/mild soap versus mild soap alone in preventing skin reactions in patients undergoing radiation therapy.

PURPOSE/OBJECTIVES: To determine whether the use of mild soap and aloe vera gel versus mild soap alone would decrease the incidence of skin reactions in patients undergoing radiation therapy. DATA SOURCES: Prospective, randomized, blinded clinical trial. SETTING: Radiation therapy outpatient clinic in a cancer center affiliated with a major teaching medical facility. SAMPLE: The mean age of the participants was 56 years. The group consisted of Caucasians (74%) and African Americans (26%). The ethnic mix was non-Hispanic (65%) and Hispanic (35%). METHODS: Prophylactic skin care began on the first day of radiation therapy. Patients cleansed the area with mild, unscented soap. Patients randomized into the experimental arm of the trial were instructed to liberally apply aloe vera gel to the area at various intervals throughout the day. FINDINGS: At low cumulative dose levels < or = 2,700 cGy, no difference existed in the effect of adding aloe. When the cumulative dose was high (> 2,700 cGy), the median time was five weeks prior to any skin changes in the aloe/soap arm versus three weeks in the soap only arm. When the cumulative dose increases over time, there seems to be a protective effect of adding aloe to the soap regimen. IMPLICATIONS FOR NURSING PRACTICE: Skin products used to treat radiation dermatitis vary among institutions. Nurses should be aware that some patients may be predisposed to skin problems. Nurses must be aware of newly developed products and research regarding these products so that effective treatment can be instituted.

Adolescent↗
PubMed2001

[Annexin V for flow cytometric detection of phosphatidylserine expression on lymphoma cells undergoing apoptosis].

OBJECTIVE: To quantitatively analyze apoptotic and secondary necrotic cells under apoptosis conditions. METHODS: The cells of Burkitt lymphoma cell line Raji were incubated with 1.0 mumol/L dexamethasone (DEX) for 2, 4 and 8 h, then stained with Annexin V-FITC (fluorescein isothiocyanate conjugated) which was used to detect the exposure of phosphatidylserine (PS) on the out membrane resulting from a loss of phospholipid asymmetry in the early stage of apoptosis, and also stained with propidium iodide (PI) which allows the analysis of secondary necrotic cells related with cell membrane and DNA damage, then apoptotic cells was quantified by flow cytometry (FMC). Furthermore, Annexin+/PI- and Annexin+/PI+ cells were sorted by fluoresence-activated cell sorter (FACS), and identified by electron microscopy (EM) and DNA gel electrophoresis. RESULTS: The results revealed that the percentage of apoptotic cells was increased and correlated well with incubation time (r = 0.97). The sensitivity of this method was shown by its detection limit 0.02%; the method was reproducible, and the coefficient variance (CV) was 4.2%. Meanwhile, the Annexin+/PI- and Annexin+/PI+ cells were identified as apoptotic and necrotic cells under EM, and the DNA extracted from the Annexin+/PI- cells was characterized by "ladder pattern". CONCLUSION: Annexin V assay for analyzing apoptotic cells is specific, sensitive, accurate, reproducible and quantitative for apoptosis investigation.

Annexin A5↗
PubMed2000

Outcome of surgery for thoracic outlet syndrome in Washington state workers' compensation.

OBJECTIVE: To determine the predictors of outcome of thoracic outlet syndrome (TOS) surgery in a population-based cohort of injured workers. METHODS: All injured workers in the Washington State Workers' Compensation system who received TOS surgery during 1986 to 1991 were identified by computerized bill payment records and validated by medical record review (n = 158). The main outcome measure was work disability status 1 year after surgery. Additional functional status and quality of life outcomes were determined by telephone survey an average of 4.8 years after operation. A sample of workers with a TOS diagnosis who did not receive surgery during 1987 to 1989 were identified as a comparison group (n = 95). RESULTS: Sixty percent of workers were still work disabled 1 year after surgery. The strongest predictors of remaining disabled were the amount of work disability before surgery (OR = 1.85; 95% CI, 1.51 to 2.28), longer time between injury and TOS diagnosis (OR = 1.34; 95% CI, 1.09 to 1.64), and older age at injury (OR = 1.07; 95% CI, 1.00 to 1.13). There was no relationship between type of surgery, presence of any provocative tests, or experience of surgeon and work disability outcome. In follow-up surveys an average of 4.8 years after surgery, 72.5% of workers still reported they were "limited a lot" in vigorous activities. Compared with a nonsurgical sample of TOS patients, those receiving surgery had 50% greater medical costs and were three to four times more likely to be work disabled. CONCLUSIONS: The outcome of TOS surgery among injured workers is worse than has generally been reported. The nonspecific neurogenic TOS diagnosis, the complexity of workers' compensation cases, and the adverse event profile are likely substantial contributors to the worse outcomes reported here. Well-designed prospective studies and randomized trials are required to elucidate any role of TOS surgery in nonspecific TOS.

Adult↗
PubMed2000

Managements for people with disorders of sexual preference and for convicted sexual offenders.

BACKGROUND: The reviewers recognise that it may be thought that convicted sex offenders and those with disorders of sexual preference are quite different groups. In combining them within this review we have taken the view that legal process alone should not define the population. Illegal behaviours in one jurisdiction may not be considered so in others. Studies of those who are convicted of sexual offending describe reconviction rates for sexual offences of up to 40-60%. It would seem important to know if there are interventions that might reduce this high rate of re-offending. This review examines antilibidinal management of those who have been convicted of sexual offences or who have disorders of sexual preference. OBJECTIVES: To determine the effectiveness of a range of management techniques to assist people who have disorders of sexual preference and those who have been convicted of sexual offences. SEARCH STRATEGY: Biological Abstracts, the Cochrane Schizophrenia Group Register of Trials, The Cochrane Library, EMBASE, MEDLINE, and PsychLIT were searched. Further references were sought from published trials and their authors. Relevant pharmaceutical manufacturers were contacted. SELECTION CRITERIA: All relevant randomised controlled trials. DATA COLLECTION AND ANALYSIS: Reviewers evaluated data independently and analysed on an intention-to-treat basis. Data were extracted for short and medium term outcomes. MAIN RESULTS: A single trial (McConaghy 1988) found the effect of antilibidinal medication (medroxyprogesterone acetate) plus imaginal desensitisation was no better than imaginal desensitisation for problematic/anomalous sexual behaviour and desire. A relapse prevention programme was trialed by Marques (Marques 1994) and participants were followed up for an average of 3 years. What data there are suggest that although there is no discernable effect on the outcome of sex offending (OR 0.76 CI 0. 26-2.28) those treated with response prevention do have less non-sexual violent offences (OR 0.3, CI 0.1-0.89, NNT 10 CI 5-85). In addition those committing both sexual and violent offences also declined in the response prevention group (OR 0.14 CI 0.02-0.98, NNT 20 CI 10-437). A large pragmatic trial investigated the value of group therapy for sex offenders (Romero 1983). This study finds no effect on recidivism at ten years. REVIEWER'S CONCLUSIONS: It is disappointing to find that this area lacks a strong evidence base, particularly in light of the controversial nature of the treatment and the high levels of interest in the area. The relapse prevention programme did seem to have some effect on violent reoffending but large, well-conducted randomised trials of long duration are essential if the effectiveness or otherwise of these treatments are to be established.

Humans↗
PubMed2000

Dealing with ceiling baseline treatment satisfaction level in patients with diabetes under flexible, functional insulin treatment: assessment of improvements in treatment satisfaction with a new insulin analogue.

Even a small improvement in satisfaction with treatment for a chronic disease can be valuable. However, sensitive measurements instruments are needed to assess the effects of treatment changes in patients already well satisfied with baseline treatment. Such instruments were thought to be necessary to deal with ceiling effects in scores of satisfaction with functional insulin treatment (FIT) accommodating full flexibility of food intake and lifestyle in diabetes by manipulation of insulin (FIT; Howorka et al. 2000). The Status(S) version of the Diabetes Treatment Satisfaction Questionnaire (DTSQ, Bradley 1994) was extended with items measuring specific components of FIT and its psychometric properties investigated in a validation study with 171 FIT patients with diabetes. A new Change(C) version of DTSQ extended for FIT was used together with the DTSQ(S) by 52 participants in a subsequent randomised cross-over study involving new fast-acting lispro vs. regular insulin, where treatment satisfaction was the primary outcome variable. Insulin lispro use improved satisfaction (p < or = 0.001) both, on classical and extended versions of DTSQ(S) and (C), despite high baseline levels of satisfaction. However, the DTSQ(C) augmented the effects of lispro (p = 0.0001) apparent on DTSQ(S) scores and revealed significant treatment effects (p < or = 0.01) not significant with DTSQ(S). In parallel, glycaemic control improved with lispro (e.g., HbA1c, p = 0.023). Improved satisfaction with treatment was more apparent with DTSQ(C) than DTSQ(S) in patients who at baseline were at or near ceiling for treatment satisfaction.

Adult↗
PubMed2000

Dexmedetomidine--a novel sedative for postoperative sedation.

Dexmedetomidine is new sedative being developed for use in postoperative sedation in ICU. It acts at a 2 adrenoceptors to produce sedation, anxiolysis and analgesia. Patients remain easily rousable and do not suffer significant respiratory depression, consequently dexmedetomidine may be continued post extubation.

Adrenergic alpha-Agonists↗
PubMed2000

Spironolactone in heart failure--a revived role for an old drug.

Spironolactone is an aldosterone antagonist which has been used as a mild potassium-sparing diuretic and in treatment of ascites in liver failure. Recent studies have shown that it has an additive effect to those of ACE inhibitors in heart failure treatment.

Angiotensin-Converting Enzyme Inhibitors↗