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Biomedical subjects

C Collins

Publications and source records attributed to C Collins.

At least 109 records · Page 6Linked to original sources
PubMed1994

The market and health sector reform.

A new international orthodoxy has developed on health sector reform. The dominant theme of the orthodoxy is the alleged benefits of market style reforms for health development. This is shaping changes formulated, and being implemented, in the British NHS and other European health services (including Central and Eastern Europe), Latin America and a number of developing health systems in Africa and Asia. Sets out a ten-point description of the orthodoxy. Contends that the orthodoxy is showing distinct signs of restricting the analysis and development of health management and planning. This is a matter for considerable concern as the adoption of market-style reforms can generate unforeseen and, in some cases, negative consequences. There is clearly a need for strengthening management research and development as a basis for effective health sector reform.

Consumer Behavior↗
PubMed1994

Patterns of predeath service use by dementia patients with a family caregiver.

OBJECTIVE: To describe site of death and patterns of predeath service use (hospital, nursing home, and in-home services) among persons with dementia who have a family caregiver. DESIGN: Family caregivers who experienced the death of their relative while participating in a 5-year longitudinal study were surveyed retrospectively about service use patterns in the 90 days before the death of their relative. SETTING: Community. SUBJECTS: Eighty-two family caregivers of a person with dementia who experienced the death of their relative while participating in a longitudinal study (n = 326) were included in this analysis. All participants were providing care to a relative with dementia in the home at entry into the study. MAIN OUTCOME MEASURES: Survey items were used to identify site of death and measure use of the following services in the 90 days before death: hospital, nursing home, skilled nursing services, home health aides, and physician home visits. RESULTS: Sixty-nine percent of the caregivers were spouses, and 28% were adult children. Family caregivers had been providing care for an average of 6 years (SD = 3.9) before the death of their relative. The most frequent setting for patient death was home (42%), followed by nursing home (32%) and hospital (26%). The average number of days spent at home in the 90 days before death by the sample was more than 60 days. Thirty-four percent of the dementia patients were cared for exclusively in the home in the 90 days before death, and 34% spent more than half of the 90 days before death at home. Hospital stays were brief, and less than one-fourth of the sample spent all of the 90 days before death in an institutional setting. Twenty-one percent of the sample used no in-home services in the 90 days before death, 48% of the sample did not use skilled nursing services, and only 27% received a physician home visit. CONCLUSIONS: The results of this study suggest that dementia patients who have a family caregiver receive a significant proportion of their care at home in the 90 days before death. A hospice approach may help address the needs for assistance of families who provide terminal care in the home for a relative with dementia.

Aged↗
PubMed1994

Community service issues before nursing home placement of persons with dementia.

Family caregivers of persons with dementia (N = 98) [corrected] who placed their relative in a nursing home while participating in a longitudinal study were surveyed about their experiences with community services (adult day care, in-home services, and physician home visits). One third (34%) of the sample reported that at least one service issue (affordability, eligibility, access, or service quality) had a strong influence on the nursing home placement, whereas 40% reported that the availability of at least one additional service would have delayed the nursing home placement of their relative. Caregivers who were employed reported higher levels of unmet service needs. The results of this study support the existence of a group of dementia caregivers with a high need for and willingness to use community service interventions in the preinstitutional period.

Aged↗
PubMed1994

Decentralization and primary health care: some negative implications in developing countries.

Decentralization is a highly popular concept, being a key element of Primary Health Care policies. There are, however, certain negative implications of decentralization that must be taken into account. These are analyzed in this article with particular reference to developing countries. The authors criticize the tendency for decentralization to be associated with state limitations, and discuss the dilemma of relating decentralization, which is the enhancement of the different, to equity, which is the promotion of equivalence. Those situations in which decentralization can strengthen political domination are described. The authors conclude by setting out a checklist of warning questions and issues to be taken into account to ensure that decentralization genuinely facilitates the Primary Health Care orientation of health policy.

Developing Countries↗
PubMed1994

International experience and health sector reform: the challenge for developing health systems.

Health sector reform is a priority issue in many countries and there is great scope for an international exchange of experiences. We should not be amiss, however, to the problems and dangers of such international exchange. Focusing on the situation of developing countries, three critical problems are identified: tendencies to the universalism of a market approach, a one-way transmission of ideas, and the lack of policy analysis. In order to contribute to a more constructive process of international exchange, four recommendations are proposed in the areas of training and the approach to management, management research, strengthening health policy analysis, and developing new exchanges between countries.

Communication↗
PubMed1994

The role of the supervisor and training.

The supervision of health personnel has always been important in the health sector. The introduction of decentralization and quality assurance, however, has made it even more relevant. This paper looks at the various roles of the supervisor and indicates key criteria for understanding the possible burden of supervision. An important factor here is the training of supervision, and this is discussed in terms of the content and means of training. Finally, it is suggested that improvements in supervision can be developed through action research.

Administrative Personnel↗
PubMed1993

Measurement and prediction of the short-term response of soft tissue sarcomas to chemotherapy.

BACKGROUND: Preoperative chemotherapy has been advocated for the treatment of soft tissue sarcomas, yet there is little information about how these tumors respond pathologically to therapy or whether tumor response can be predicted from a pretreatment biopsy. METHODS: Biopsy was done of 25 intermediate- or high-grade soft tissue sarcomas before they were treated with three cycles of doxorubicin and cisplatin and resected. The authors compared the pathologic features of the treated tumors with clinical and radiologic evidence of response to identify the pathologic features that best reflected chemotherapeutic effect. They analyzed the pretreatment biopsy specimens by light microscopic study and flow cytometry to identify parameters that predict short-term response to chemotherapy. RESULTS: In the treated tumors, the clearest indicator of early chemotherapeutic effect was the percentage of the resected mass composed of viable neoplasm. Eleven of 25 resection specimens contained less than 15% viable neoplasm (patients with pathologic response); 9 of these had 5% or less. Flow cytometric estimates of the proliferative rate in the initial biopsy specimen predicted early chemotherapeutic effect; 7 of 10 tumors with S-phase fractions (SPF) greater than 6% responded pathologically, whereas only 3 of 12 tumors with lower SPF responded (P = 0.041). Initial tumor grade, cell type, percent tumor necrosis, mitotic rate, cellularity, and ploidy did not predict chemotherapy response. CONCLUSION: These results indicate that soft tissue sarcomas often respond dramatically to chemotherapy, that the amount of residual viable sarcoma is an indicator of short-term effect, and that flow cytometric estimates of cell proliferation predict early response to chemotherapy.

Adolescent↗
PubMed1993

Mapping of the human NMDA receptor subunit (NMDAR1) and the proposed NMDA receptor glutamate-binding subunit (NMDARA1) to chromosomes 9q34.3 and chromosome 8, respectively.

A role for the N-methyl-D-aspartate (NMDA) receptor in the molecular pathology underlying Huntington disease (HD) has been proposed on the basis of neurochemical studies in HD and the ability of the NMDA receptor to mediate neuronal cell death. The molecular cloning of the human NMDA receptor subunit (NMDAR1) and a proposed glutamate-binding subunit of the NMDA receptor (NMDARA1) have provided an opportunity to test the hypothesis that either of these genes might be directly involved in the causation of HD. We have mapped NMDAR1 to 9q34.3 using in situ hybridization studies and NMDARA1 to human chromosome 8 using a somatic cell hybrid panel. Because the gene causing HD has been localized to chromosome 4p16.3, the chromosome assignments reported here are inconsistent with either of these genes playing a causative role in the molecular pathology of HD. However, it is noteworthy that the gene for torsion dystonia has also been localized by genetic studies to 9q34.3, the same regional map location as NMDAR1.

Animals↗
PubMed1993

Isolation of new nonsense and frameshift mutants in the immunoglobulin mu heavy-chain gene of hybridoma cells.

In order to expand the experimental material available for genetic and biochemical analyses of the natural immunoglobulin genes, we have isolated a variety of mutant mouse hybridoma cell lines. Some of these mutants have partial or complete deletions of the mu gene. Other mutants have nonsense or frameshift mutations in the exons encoding the variable and the second and third constant region domains of the mu heavy chain. When combined with earlier mutant data, this collection of genotypically and phenotypically tight mutants of known sequence spans most of the 10 kb of the mu gene, providing material for a variety of studies of genetic recombination and mRNA metabolism.

Amino Acid Sequence↗
PubMed1993

Local infusion balloon angioplasty to obviate restenosis compared with conventional balloon angioplasty in an experimental model of atherosclerosis.

Balloon angioplasty is an accepted treatment for arterial obstruction; however, a substantial percentage of initially successfully treated lesions recur in the first 4 to 6 months. There is increasing interest in local treatment of lesions undergoing angioplasty to prevent restenosis, and an infusion catheter has been developed for this purpose. This study compared infusion balloon angioplasty by means of saline solution with conventional balloon angioplasty in atherosclerotic iliac arteries of 18 cholesterol-fed New Zealand white rabbits. Values for minimum stenosis diameter assessed angiographically immediately after maximum infusion balloon angioplasty (2.1 +/- 0.6 mm) and after conventional balloon angioplasty (2.3 +/- 0.3 mm, p = NS) were similar. In follow-up studies up to 5 weeks after angioplasty, the angiographic minimum stenosis diameter remained similar in the two treatment groups, but the histologically assessed intimal area was greater after infusion angioplasty (1.54 +/- 0.92 mm vs 1.02 +/- 0.75 mm in conventionally treated arteries, p = 0.0001). Infusion balloon angioplasty merits further evaluation as a treatment strategy for the simultaneous dilatation of atherosclerotic lesions with delivery of therapeutic agents to minimize restenosis.

Animals↗
PubMed1993

Pacemaker function during irradiation: in vivo and in vitro effect.

With an ageing population in Australia, one would expect the probability of treating cancer patients who have a cardiac pacemaker to increase. In this paper the effect of ionizing radiation and electromagnetic interference on pacemaker function is discussed. A case of a cancer patient, with pacemaker, treated with radiotherapy without ill effect, is described. Concurrently, four pacemakers were tested in vitro with gamma radiation from a 60 Cobalt machine and no adverse effect was found. A list of precautions is recommended.

Aged↗
PubMed1993

Quantification of melanin and iron content in uveal malignant melanomas and correlation with magnetic resonance image.

Eleven patients with uveal malignant melanomas (MM) were studied by magnetic resonance (MR) imaging before enucleation. The MR appearances varied, but often were different from those previously reported to be characteristic of these tumours. Using an image analyser to assess quantitatively the melanin and iron content of each tumour, a wide range of tumour melanin concentrations was found, but universally low tumour iron concentrations. These values were compared with MR appearances that were quantified and expressed as contrast to noise ratios. The correlation between T1 and T2 shortening and increasing melanin content did not reach statistical significance. There was no correlation between MR appearances and iron content. The theories postulated to explain the diverse MR appearances of uveal MMs are discussed and variations in tumour melanin content and differences in scanner strengths are suggested as the most likely explanations.

Adult↗
PubMed1993

Contribution of melanogenic proteins to the heterogeneous pigmentation of human melanocytes.

Human melanocytes from individuals with different skin types, as well as from the skin of the same individual, are heterogeneous in their melanin content. This heterogeneity may be attributed to differences in the activity and expression of the three melanogenic proteins: tyrosinase and tyrosinase-related proteins 1 and 2 (gp75 and DOPAchrome tautomerase, respectively), which in turn are affected by certain regulatory factors. Established melanocyte strains that exhibited intrinsic melanogenic heterogeneity could be separated into subpopulations according to density and melanin content by Percoll density gradient centrifugation. The least melanotic subpopulation consisted of melanocytes that contained an active tyrosinase enzyme and a low amount of melanin. Tyrosinase activity and the quantities of tyrosinase enzyme, tyrosinase-related protein-1 and DOPAchrome tautomerase gradually increased with increased melanin content and Percoll density of the isolated melanocyte subpopulations. We have found a direct correlation between melanin content, tyrosinase activity and the expression of the three melanogenic proteins in melanocyte strains established from different skin types. Addition of the two epidermal cytokines, tumor necrosis factor-alpha or interleukin-1 alpha, to cultures of human melanocytes from different skin types caused decreased proliferation, tyrosinase activity and expression of tyrosinase, tyrosinase-related protein-1 and DOPAchrome tautomerase. Similar results were obtained when Percoll-derived melanocyte subpopulations were treated with tumor necrosis factor-alpha and interleukin-1 alpha. These results indicate that the variation in melanin content in human melanocytes is due to differences in the activity and expression of the melanogenic proteins, which are influenced by autocrine and paracrine factors.

Cell Separation↗
PubMed1993

Penetration of the Kilkenny Health Project Education Programme.

The Kilkenny Health Project (KHP) was established in 1985 as a community-based research and demonstration programme for cardiovascular disease in County Kilkenny, Ireland, and as a pilot programme for future national initiatives. This article examines the penetration of the Project into the community, the extent of knowledge of, contact with, or participation in its activities.

Adult↗
PubMed1993

Samarium-153-EDTMP biodistribution and dosimetry estimation.

Fifty-two patients were treated with single doses of 153Sm-EDTMP in a Phase I escalating dose protocol for palliation of bone pain from metastatic prostate carcinoma. Samarium-153 (T1/2 46.3 hr), maximum beta-particle energies 810 keV (20%), 710 keV (30%), 640 keV (50%), gamma photon 103 keV (28%), was complexed to the tetraphosphonate chelate, EDTMP. Five groups of patients were treated at doses of 1.0, 1.5, 2.0, 2.5, and 3.0 mCi/kg to evaluate toxicity from treatment. Patients were screened prior to treatment and followed after treatment with 99mTc-MDP bone scans. Biodistribution data on this group of patients were acquired and showed rapid uptake of 153Sm-EDTMP into bone with complete clearance of nonskeletal radiotoxicity by 6-8 hr. Also included are complete sets of dosimetry estimations on an additional seven patients who received 0.5 mCi/kg 153Sm-EDTMP Ca++ as part of a multiple dose therapy trial. Estimated radiation absorbed doses to bone surfaces averaged 25,000 mrad/mCi (6686 Gy/MBq), and urinary bladder doses averaged 3600 mrad/mCi (964 Gy/MBq).

Bone Neoplasms↗
PubMed1993

Samarium-153-EDTMP in bone metastases of hormone refractory prostate carcinoma: a phase I/II trial.

Samarium-153-ethylenediaminetetramethylene phosphoric acid (EDTMP), a bone-seeking radiopharmaceutical, was given to prostate cancer patients in a dose escalation protocol for pain palliation to determine the maximally tolerated dose. Fifty-two patients with hormone refractory prostate cancer with bony metastases were treated with doses beginning at 0.5 mCi/kg (18.5 MBq/kg), escalating in 0.5-mCi (18.5 MBq) increments to 3.0 mCi/kg (111 MBq/kg). Pain response after treatment was assessed as well as hematologic and serum chemistry parameters. Pain palliation with a mean duration of 2.6 mo was present in 74% of the patients. Toxicity was exclusively hematologic at the highest dose levels. No infectious or bleeding complications occurred, with 45 of the 52 (86%) patients demonstrating complete hematologic recovery. Patients receiving higher doses had significantly greater reductions in serum prostate specific antigen and serum prostatic acid phosphatase levels. The patients receiving greater doses also showed a trend toward improved survival.

Aged↗