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Biomedical subjects

C Green

Publications and source records attributed to C Green.

At least 109 records · Page 6Linked to original sources
PubMed1999

Ruby laser-assisted hair removal: a preliminary report of the correlation between efficacy of treatment and melanin content of hair and the growth phases of hair at a specific site.

An unpredictable response, even in patients with dark hair, often undermines successful ruby laser hair removal. A prospective clinical study was carried out to evaluate the roles of melanin content and growth phases of hair in treatment efficacy. Thirty-six volunteers with white skin and dark hair were recruited for the study, and were all treated using the Chromos 694 Depilation Ruby Laser. The overall efficacy of treatment was assessed at the end of 3 months. The efficacy of laser treatment is not due solely to the proportion of hair in the growing or static phase of the hair cycle. There is a lack of correlation between the melanin content and the overall efficacy of laser hair removal in those treated once, but patients with darker hair responded better after repeated treatments. The proportion of hair in the growth phase and the melanin content of hair do not contribute solely to the efficacy of ruby laser hair removal.

Hair↗
PubMed1999

A review of the use of health status measures in economic evaluation.

OBJECTIVE: To review the use of measures of health status in the assessment of benefits in economic evaluation, whether or not the measures were designed for this purpose. METHODS: The review was based on a systematic search of the literature. It provides a comprehensive assessment of the evidence where it exists and a balanced overview of opinion otherwise. RESULTS: Over 3000 papers were identified, of which 632 were found to be relevant. The review provides a set of recommendations. These include: a checklist of questions for selecting a measure for use in economic evaluation; a list of circumstances in which non-preference-based measures can be used; and recommendations surrounding the use of health state valuation techniques and multi-attribute utility scales. CONCLUSION: These recommendations should help to identify poor economic evaluations and hence guard against inefficient conclusions being drawn regarding the provision of health services.

Cost-Benefit Analysis↗
PubMed1999

A cytologic study of oral mucosal cell alterations in smokeless tobacco users and efficacy of a related cessation program.

PURPOSE: The primary objective of the study was to determine if oral tissue changes, as documented by cytologic study and reported to the smokeless tobacco user, provide incentive to discontinue use of smokeless tobacco products. METHOD: Smokeless tobacco users who presented for treatment in the University of Arkansas for Medical Sciences dental hygiene clinic served as the 10 subjects of this one-year study. Calibrated dental hygiene faculty collected cellular specimens from the oral mucosa of subjects at the site of smokeless tobacco placement and a clear site as control. Specimens were collected by a moistened tongue blade scrape, then fixed, stained, and diagnosed by faculty in the department of pathology. Subjects participated in a cessation program: a standardized session in which results of the cytologic findings and risks of smokeless tobacco usage were discussed, using visuals and pamphlets. The subjects, with the exception of the last, were contacted at three- and six-month intervals to determine their compliance with cessation recommendations. RESULTS: Three of the 10 subjects displayed significant tissue changes; these subjects discontinued smokeless tobacco use. The cytologic studies of the other seven subjects revealed only various amount of hyperkeratosis. CONCLUSION: Cytologic assessment and results may be a valuable component of a smokeless tobacco cessation program. This area merits further research.

Adult↗
PubMed1999

Substance use: whose problem is it?

Research evidence demonstrates that more young people in the UK are using illegal substances. Every child health professional has a central role to play in the area of substance use. The HAS Report (1996) advocates a 4 tiered approach identifying primary health care staff to providing services for adolescents who use substances. Assessment of a young person's health needs is crucial. Nurses are ideally placed to have an impact of health issues affecting young people and substance use cannot be ignored or treated separately. Child health professionals are ideally placed to provide meaningful education and information to young people at risk.

Adolescent↗
PubMed1998

A randomized trial of vascular hemostasis techniques to reduce femoral vascular complications after coronary intervention.

This report details a prospectively randomized clinical trial comparing mechanical clamp compression to hand applied pressure for attaining vascular hemostasis after coronary intervention. Effectiveness was determined by comparing the incidence of femoral vascular complications resulting from each of the 2 techniques. Eligible participants included 778 consecutive patients scheduled for percutaneous coronary intervention over an 8-month period. An unselected cohort of the eligible patients (n = 592), determined by the availability of cross-trained clinicians, underwent follow-up serial physical examinations by blinded observers for the duration of their hospital stay. A second, similarly determined cohort (n = 390), underwent color-duplex ultrasonography within 24 hours of sheath removal. Baseline demographic and clinical characteristics, sheath removal parameters, and subsequent outcomes were collected prospectively. The primary end point was a composite of ultrasound-defined femoral vascular complications: femoral artery thrombosis, echogenic hematoma, pseudoaneurysm, or arteriovenous fistulae formation. Complications diagnosed by physical examination constituted the second fundamental end point and included: persistent oozing, ecchymosis, hematoma, bruit, and pulsatile mass. Compared to manual compression, mechanical clamp hemostasis reduced the primary adverse end point by 63% (p = 0.041). Physical examination detected ecchymosis, oozing, and hematomas at equally high frequencies in the two cohorts. Although 65% of the patients in both treatment groups encountered at least one of these cosmetic complications, the diagnoses made by physical examination did not correlate with ultrasound-defined pathology. Multivariable stepwise logistic regression analysis identified a relationship of advanced age and lower body weight to vascular complications. Utilization of a mechanical clamp rather than conventional hand pressure to attain vascular hemostasis significantly reduces ultrasound-defined femoral vascular pathology. Discrepancies between physical examination and ultrasound diagnoses challenge the utility of clinical assessment alone and establish ultrasound as the diagnostic modality of choice.

Angioplasty, Balloon, Coronary↗
PubMed1998

Using the person trade-off approach to examine differences between individual and social values.

Health state valuations, elicited by methods such as the standard gamble and the time trade-off, give an indication of the value that an individual attaches to particular health states. As measures of individual values, it has been argued that such valuations serve as poor proxies for social preferences, which, it is suggested, are a function of other factors, such as the initial severity of the patient's health state. The person trade-off (PTO) method has been proposed as a technique which takes account of many of these other factors. This paper reports on a study using the PTO to investigate whether an individual's preferences over treatments for themselves differ from their preferences when they are asked to think about the treatment of other people. The results suggest that there is indeed a difference, although qualitative data suggests that health gain is an important determinant of social value. This latter finding runs counter to those of a number of other studies which suggest that concerns about pre-treatment severity are as, if not more, important. Possible explanations for the differences are put forward.

Adult↗
PubMed1998

A clinicopathological study of the effects of topical retinyl propionate cream in skin photoageing.

The clinical and histological effects of retinyl propionate cream (a retinyl ester) on extrinsic skin ageing (photo-ageing) in man were assessed in a double-blind randomized placebo-controlled study of 80 subjects, individual parameters of this being assessed for each treatment site (face, dorsal right forearm and hand, dorsal left forearm and hand) at intervals throughout the study, while skin surface replicas from sites of fine wrinkling around the eye and skin biopsies from the dorsal right forearm were also regularly reviewed throughout. Seventy-five subjects completed an initial 24-week study period, following which 60 elected to continue for a further 24 weeks. Although minimal trends towards improvement occurred, no statistically significant differences between the effects of the retinyl propionate cream and the placebo preparation were apparent for any of the clinical, histological or profilometric parameters of skin photoageing; however, in the very few subjects affected, actinic keratoses in the active group were reduced virtually to zero by week 48.

Administration, Cutaneous↗
PubMed1998

Activity patterns in Glossina longipennis: a field study using different sampling methods.

Studies n the daily activity of Glossina longipennis at Galana Ranch using a black odour-baited electrocuting target confirmed its crepuscular activity profile. Activity started at 05.00-05.30 hours and peaked at 06.00-06.30 hours, stopped by 09.00 hours, then started again at 17.00-17.30 hours with a peak at 18.30-19.00 hours, ceasing by 19.30 hours. Females made up 60% of the overall catch, and tended to arrive later than males. Other stationary sampling methods (trap, stationary ox) gave similar results. With the stationary methods, very few flies were caught outside the periods of peak activity (only 1.5% of the total between 09.00 and 17.00 hours); the ox was the only stationary bait to catch any flies between 10.00 and 16.00 hours. More flies were caught throughout the day at mobile baits (8.3% of the male and 2.3% of the female catch was taken between 09.00 and 17.00 hours). Mobile baits caught considerably more males than females (females were 17% of the catch). These males had on average higher fat and haematin reserves. Similar nutritional differences were not observed for females. There were fewer older females (ovarian category 3 or more) in mobile compared to stationary baits, and a lower proportion of the youngest males (wing fray category 1) at natural compared with artificial baits.

Age Factors↗
PubMed1998

New therapeutic products and difficult decisions. The case of recombinant factor VIII in the management of haemophilia A.

New and expensive therapeutic products can place great pressure on health care purchasers. Often, evidence to support the inclusion of such products in the purchasing process is lacking or confusing, yet demand can be organized and forceful. In this paper we use the example of the introduction of recombinant factor VIII (rFVIII) in the management of haemophilia A, to highlight some problems purchasers face in deciding whether to fund its use. The introduction of rFVIII involves substantial extra funding requirements and the benefits afforded by its use are unclear. Although a case can be made for the use of rFVIII on the grounds of subjective furture theoretical risks and intangible benefits, the purchasers of health care are charged with maximizing the present and obtainable benefits of the community at large, given finite resources. Guidelines produced by the United Kingdom Haemophilia Centre Directors Organization state rFVIII to be its treatment of choice for all haemophilia A patients, but offer no insight into the benefits attainable through the use of rFVIII, in terms of health outcomes. We report summary findings of Purchaser Intelligence Groups examining the use of rFVIII and offer comment on the problems associated with the implementation of therapeutic products such as rFVIII.

Cost-Benefit Analysis↗
PubMed1998

A new deleted allele in the human cytochrome P450 2A6 (CYP2A6) gene found in individuals showing poor metabolic capacity to coumarin and (+)-cis-3,5-dimethyl-2-(3-pyridyl)thiazolidin-4-one hydrochloride (SM-12502).

The S-oxidation of (4)-cis-3,5-dimethyl-2-(3-pyridyl)thiazolidin-4-one hydrochloride (SM-12502) and the 7-hydroxylation of coumarin are primarily catalyzed by cytochrome P450 2A6 (CYP2A6). The activities of SM-12502 S-oxidase and coumarin 7-hydroxylase were investigated with liver microsomes from 20 human individuals. Liver microsomes from individual H16 showed the lowest activities of both enzymes. The expression of CYP2A6 protein was not detectable in liver microsomes from individuals H4, H5, H7, H8, H12 and H16. CYP2A6 mRNA was hardly detectable in the liver of the individual H16. A new SacI-restriction fragment length polymorphism showing the lack of a 2.6 kb fragment was found in two of forty genomic DNA preparations from individuals H16 and No. 594, using CYP2A6 cDNA as a probe. This deletional 2.6 kb fragment was isolated from a genomic library prepared from one individuals showing normal coumarin 7-hydroxylase activity and was sequenced. This fragment contained a CYP2A6 gene region from 319 bp upstream of a putative exon 6 to a SacI site in exon 9, indicating that this region was deleted in the two individuals in this study. We also demonstrated by polymerase chain reaction analysis that the exon 8 of CYP2A6 gene was deleted in individuals H16 and No. 594. These results indicate that the reduced activity of SM-12502 S-oxidase and no activity of coumarin 7-hydroxylase are caused by the lack of CYP2A6 mRNA and CYP2A6 protein caused by the CYP2A6 gene deletion.

Aryl Hydrocarbon Hydroxylases↗
PubMed1998

Complications of modified Blalock-Taussig shunts mimicking pulmonary disease.

The modified Blalock-Taussig shunt is commonly performed as early palliation in cyanotic congenital heart disease. To highlight unusual diagnostic problems in such patients, two cases are reported in whom shunt complications were initially diagnosed as lobar pneumonia and tuberculosis, respectively. The children, an 8 month old boy and a 3 year old boy, had false aneurysm secondary to infection of the graft and dilatation of the left pulmonary artery caused by blood flow through the shunt, respectively.

Cardiac Surgical Procedures↗
PubMed1998

Intervention to improve physician documentation and knowledge of child sexual abuse: a randomized, controlled trial.

OBJECTIVE: To determine if written feedback improves the chart documentation and knowledge of physicians doing evaluations for child sexual abuse and to learn what other factors are associated with better documentation and knowledge. DESIGN: Randomized, controlled trial. SETTING: A statewide network of physicians performing child abuse evaluations. PARTICIPANTS: All physicians who performed evaluations for sexual abuse during 1991 to 1992. One hundred forty-seven physicians were randomized to control (n = 75) and intervention (n = 72) groups, 122 (83%) remained at follow-up, and 87 of the 122 (71%) had done evaluations for child sexual abuse. INTERVENTIONS: Tailored written feedback based on chart reviews and relevant articles were sent to a randomly selected one-half of the physicians during a 3-month period. MAIN OUTCOME MEASURES: The quality of documentation and physician knowledge before and after the intervention. RESULTS: Documentation by chart review of up to five randomly chosen records per physician (preintervention, n = 552; postintervention, n = 259) by reviewers blinded to intervention status and physician knowledge was assessed by survey (78% completion). Change in documentation and knowledge for physicians in the intervention group was not statistically significant compared with the control group. The risk ratio for a mean overall history rating of excellent/good was 0.89 (0.63, 1.25) and for a mean overall physical examination rating of excellent/good was 1.03 (0.73, 1.45). Both groups improved significantly during the time period. The largest improvements in the time period were in documenting the history of where abuse occurred, in the physical examination position, hymenal description, penile findings, and knowing that chlamydia infection should be assessed by culture. A structured medical record, female physicians, and credits in continuing medical education were associated with better documentation. CONCLUSIONS: Tailored feedback to the physician with directed educational materials did not seem to improve most aspects of documentation and knowledge of child sexual abuse, although notable improvement was seen during the time period studied. This study suggests that chart audits may not be the best use of resources for trying to improve physician behavior; credits in continuing medical education and use of structured records may be more likely to be beneficial.

Child↗