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Biomedical subjects

C Kennedy

Publications and source records attributed to C Kennedy.

At least 37 records · Page 2Linked to original sources
PubMed2003

Hepatitis C infection among dental personnel in the West of Scotland, UK.

Hepatitis C virus (HCV) is considered a serious occupational hazard for healthcare workers, particularly those performing exposure-prone procedures. In the UK, the majority of dental procedures are classified as exposure prone. In order to gauge the prevalence and determinants of infection among dental healthcare workers, a voluntary anonymous survey of HCV infection among primary care dental workers employed in the West of Scotland was undertaken, in which occupational and personal risk data were collected in parallel with a blood specimen. The overall prevalence of HCV antibodies was 0.1% (1/880, 95% CI 0-0.6); this is no greater than the estimated prevalence of HCV infection in the local population. Personal risk data collected suggested that the single infection identified was acquired through a non-occupational route. These results suggest that HCV infection is not a major occupational risk for dental healthcare workers.

Dental Auxiliaries↗
PubMed2003

Reliability of telemedicine for diagnosing and managing eye problems in accident and emergency departments.

OBJECTIVES: To assess the accuracy and efficiency of telemedicine in diagnosing and managing eye problems presenting to accident and emergency departments. DESIGN: A controlled trial with a face-to-face and telemedicine phases, each involving 40 patients undergoing two consecutive consultations. In the face-to-face phase, both consultations were in person; in the telemedicine phase, observer 1 used videoconferencing technology at 384 kbit/s (separate nonslit lamp-torchlight and slit lamp examinations) and observer 2 saw the patient face to face. Setting The accident and emergency department at Moorfields Eye Hospital.Participants In total, 80 consenting new patients presenting to the department. MAIN OUTCOME MEASURES: (1) Agreement levels between the two observers for each phase (judged by an independent masked investigator), (2) length of consultation, and (3) number of unnecessary recalls. RESULTS: Agreement rates were as follows. Face-to-face phase: total agreement (30/40=75%), trivial disagreement (8/40=20%), clinically important disagreement (2/40=5%). Telemedicine phase (torchlight): complete agreement (16/40=40%), trivial disagreement (20/40=50%), clinically important disagreement (4/40=10%). Telemedicine phase (slit lamp): total agreement (23/40=58%), trivial disagreement (15/40=37%), clinically important disagreement (2/40=5%). Agreement levels in the telemedicine phase with torchlight examination were significantly lower (chi(2)=10.07, P=0.007) for any disagreement. Telemedicine consultations erred on the side of clinical caution and were no slower than face-to-face consultations (mean 6 min for observer 1 in both phases). Recalls were more likely (chi(2)=5.16, P=0.02) after telemedicine consultations with torchlight only (9/40) compared with face-to-face consultations (2/40). Although there were more significant disagreements using the telemedicine, in each case the telemedicine diagnosis and management erred on the side of safety; hence, no patient would have suffered by wrong management because of the consultation using telemedicine. CONCLUSIONS: Telemedicine was found to be an accurate, safe, and efficient method of diagnosing and managing these patients, especially if slit lamp images were used. Advice using telemedicine erred on the side of caution, which resulted in more recalls.

Emergency Service, Hospital↗
PubMed2003

Determining clinician satisfaction with telemedicine.

We compared two methods of assessing clinician satisfaction with telemedicine. Clinicians completed a self-administered questionnaire with a preference ranking scale and a discrete choice method. Sixty-three clinicians completed the questionnaire (a 78% response rate). The preference ranking method showed that clinicians ranked the level of skill of the other clinician as the most important (55%) attribute of a teleconsultation and the completeness of the history as the second most important attribute (42%). The discrete choice method showed that clinicians ranked completeness of the patient's history as the most important attribute and risk of receiving wrong advice as the second most important. The use of discrete choice preferences provides an alternative and more objective method for collecting data about preferences in telemedicine. However, its use is not simple and requires the participants to be engaged in person rather than sent a questionnaire by post.

Adult↗
PubMed2002

Pulmonary metastatic melanoma -- the survival benefit associated with positron emission tomography scanning.

OBJECTIVE: Positron emission tomography (PET) scanning is more sensitive at detecting metastatic disease than conventional radiological techniques. For patients with pulmonary metastatic melanoma, we investigate if PET scanning to detect occult extra pulmonary disease prior to thoracotomy and metastectomy is associated with improved survival compared to patients staged by conventional radiology. METHODS: Between November 1984 and December 1999, 121 patients (90 males, 31 females) have undergone a thoracotomy and pulmonary metastectomy for metastatic melanoma. The age range was 19-84 years (mean 57, median 59). In every case all palpable nodules were removed and the diagnosis confirmed histologically. A total of 68 (56%) patients had a PET scan preoperatively, 53 (44%) underwent conventional or nuclear imaging. Patients with only radiologically isolated pulmonary disease are included. RESULTS: Survival is 100% complete and totals 238 pt/years (mean 2.2 years, median 1.4 years). Survival (+/-SE) at 1, 3, 5 and 7 years for all patients is 68% (+/-4.5) (n=67), 36.6% (+/-5.2) (n=27), 22.1% (+/-4.8) (n=15) and 13.5% (+/-4.2) (n=7), respectively. Survival (+/-SE) was significantly better at 3 and 5 years in patients who underwent a PET scan preoperatively (Log rank P=0.002). There was no significant difference in survival by 7 years. CONCLUSIONS: There is a significant survival benefit associated with excluding extra pulmonary disease using a PET scan prior to thoracotomy and metastectomy. We recommend that PET scanning be used in the investigation of patients with pulmonary metastatic melanoma prior to metastectomy.

Humans↗
PubMed2002

Regional variation in P2 receptor expression in the rat pulmonary arterial circulation.

The P2 receptors that mediate contraction of the rat isolated small (SPA, 200-500 micro m i.d.) and large (LPA, 1-1.5 mM i.d.) intrapulmonary arteries were characterized. 2 In endothelium-denuded vessels the contractile order of potency was alpha,beta-methyleneATP (alpha,beta-meATP)>>UDP=UTP=ATP=2-methylthioATP>ADP in the SPA and alpha,beta-meATP=UTP>or=UDP>2-methylthioATP, ATP>>ADP in the LPA. alpha,beta-meATP, 2-methylthioATP and ATP had significantly greater effects in the SPA than the LPA (P<0.001), but there was no difference in the potency of UTP or UDP between the vessels. 3 In the SPA, P2X1 receptor desensitisation by alpha,beta-meATP (100 microM) inhibited contractions to alpha,beta-meATP (10 nM-300 microM), but not those to UTP or UDP (100 nM-300 microM). In the LPA, prolonged exposure to alpha,beta-meATP (100 microM) did not desensitize P2X receptors. 4 Pyridoxalphosphate-6-azophenyl-2',4'-disulphonic acid (PPADS), suramin and reactive blue 2 (RB2) (30-300 microM) inhibited contractions evoked by alpha,beta-meATP. UTP and UDP were potentiated by PPADS, unaffected by RB2 and inhibited, but not abolished by suramin. 1 and 3 mM suramin produced no further inhibition, indicating suramin-resistant components in the responses to UTP and UDP. 5 Thus, both P2X and P2Y receptors mediate contraction of rat large and small intrapulmonary arteries. P2Y agonist potency and sensitivity to antagonists were similar in small and large vessels, but P2X agonists were more potent in small arteries. This indicates differential expression of P2X, but not P2Y receptors along the pulmonary arterial tree.

Animals↗
PubMed2002

Child sexual abuse treatment: misinterpretation and mismanagement of child sexual behavior.

OBJECTIVE: The purpose of the study was to examine caregiver understanding of the impact of child sexual abuse and the management of abused children in residential treatment. METHODS: A purposive sample of 20 registered nurses and child care workers were interviewed about their experiences working in residential treatment and their knowledge about child development and child sexual abuse and its application to practice. Data from interviews and field notes were analysed using dimensional analysis. FINDINGS: Caregivers had limited knowledge of the sequelae of child sexual abuse. Developmentally appropriate behaviour of sexually abused children, as well as behavioural manifestations of child sexual abuse, were often misinterpreted and mismanaged. CONCLUSION: Residential care of sexually abused children should be based on sound developmental principles and caregiver sensitivity.

Adolescent↗
PubMed2002

Manual therapy for mechanical neck disorders: a systematic review.

Neck disorders are common, disabling and costly. Randomized trials were reviewed using a Cochrane format, to determine if manual therapy improves pain, function and patient satisfaction in adults suffering from neck disorders with and without radicular findings or headache. Sequenced computerized searches ended in December 1997. Two independent reviewers extracted data while three assessed trial quality. Standard mean difference and relative risks were translated to number needed to treat (NNT) and the percent treatment advantage. The 20 selected trials' quality was 2.4 (SD: 1.04) on the 5-point scale described by Jadad. Trials were clinically heterogenous. Manipulation alone, mobilizations alone, manipulation/mobilization and treatments including massage consistently showed similar effects to placebo, wait period or control. Multimodal manual therapy care including exercise were superior to a control, to certain physical medicine methods and to rest for pain and patient satisfaction. The NNT for a clinically important reduction in pain varied from 2 to 11 and treatment advantage from 6% to 41% at the cost of benign transient side-effects. While results remain inconclusive, some clinical themes have emerged. For mechanical neck disorder with or without headache, it appears that to be most beneficial, manual therapies should be done with exercise for improving pain and patient satisfaction. Manipulation and mobilization alone appear to be less effective. Factorial design would help delineate the magnitude of effect for each component of care.

Adult↗
PubMed2002

Clinical practice guideline on the use of manipulation or mobilization in the treatment of adults with mechanical neck disorders.

PURPOSE: An evidence-based clinical practice guideline was developed to ascertain the risks and benefits for manipulation or mobilization in treating mechanical neck disorders with or without radicular findings or cerviogenic headache. Pain, function, patient satisfaction and adverse events were appraised. METHODS: The practice guideline development cycle/model and Cochrane reviewing process, critiquing past reviews, randomized trials and surveys were used. RESULTS: Manipulation and mobilization alone showed similar effects as placebo, wait period, or control group, and appeared similar in benefit for pain relief. While high-technology exercises were superior to manipulation alone for improving long-term pain scores, manipulation plus low-technology exercise had the same effect. Patient satisfaction scores favoured manipulation plus low-technology exercise over manipulation alone, and high-technology exercise alone. Multi-modal care including some combination of manipulation or mobilizations and exercise was superior to control, other physical medicine methods, and rest. Based on weak evidence, estimates for serious complication for manipulation ranged from one in 20,000 to five in 10,000,000. RECOMMENDATIONS: Stronger evidence suggests a multi-modal management strategy using mobilization or manipulation plus exercise is beneficial for relief of mechanical neck pain. Weaker evidence suggest less benefit to either manipulation/mobilization done alone than when used with exercise. The risk rate is uncertain.

Evidence-Based Medicine↗
PubMed2001

Fatal hemorrhage in stented esophageal carcinoma: tumor necrosis of the aorta.

We report a case of fatal hematemesis in a patient with an esophageal stent for palliation of malignant dysphagia. Post-mortem examination showed tumor thrombi in the vasa vasorum of the aorta causing aortic wall necrosis and perforation. Massive delayed hemorrhage is reported as a complication of metallic esophageal endoprostheses but in the majority of cases there have been no post-mortem examinations. In this case the post-mortem examination demonstrated that the cause of death was not stent-related. We feel that this case report adds important information to the current literature regarding the delayed complications seen in patients with esophageal carcinoma who have been palliated with metallic stents.

Aged↗
PubMed2001

A critical appraisal of review articles on the effectiveness of conservative treatment for neck pain.

STUDY DESIGN: A criteria-based appraisal of review articles on neck pain. OBJECTIVES: To assess the methodologic quality, conclusions, and extent of concordance among reviews on the conservative treatment of neck disorders. SUMMARY OF BACKGROUND DATA: During the past decades there has been an increasing interest in summarizing and analyzing the available evidence on the effectiveness of conservative management of neck pain. Considering the growing number and quality of reviews, consumers may question which reviews to read and believe. METHODS: Computerized bibliographic databases were searched without language restriction. The reviews assessed had been published before January 1998, included neck pain and evaluated conservative therapies, and reported at least one controlled clinical trial. Identification, selection, and quality assessment were performed independently by two investigators. RESULTS: Of the 108 identified articles, 25 review articles were selected, of which 12 were systematic reviews. The reviews differed in their reporting of study population, interventions, and outcomes. Statistical pooling was performed in two high-quality systematic reviews, whereas in other reviews, the investigators explicitly decided not to pool data. The results of the current study show that the concordance among reviews varied. Regarding manipulation and traction, there is inconclusive evidence among reviews. Concordance regarding the effectiveness of other conservative interventions was absent. Many of the reviews displayed major methodologic flaws. CONCLUSIONS: Consumers should consider reports of reviews both carefully and critically, given the wide variety of review methodology, descriptive information, and final conclusions. There is a paucity of evidence from primary studies on neck pain. Therefore, more research is needed to allow systematic reviews to formulate stronger conclusions.

Databases, Bibliographic↗
PubMed2001

Major depressive and post-traumatic stress disorder comorbidity in female victims of intimate partner violence.

BACKGROUND & METHODS: Victims of intimate partner violence (IPV) often develop psychiatric disorders. We examined the extent and correlates of comorbidity between two of the disorders most frequently linked to trauma--major depressive disorder (MDD) and post-traumatic stress disorder (PTSD)--in a group of 44 women who were victims of IPV within the preceding 2 years. RESULTS: MDD (68.2%) and PTSD (50.0%) were highly prevalent on a lifetime basis in female victims of IPV. On a current basis, MDD (18.2%) and IPV-related PTSD (31.8%) were more frequently comorbid (42.9% of cases of current IPV-related PTSD also had MDD) than would be expected by chance (P<0.001). Most cases of current MDD occurred in persons who also had current IPV-related PTSD. Severity of depressive and PTSD symptoms were highly correlated (r=0.84). Although women with PTSD were significantly more disabled than women without PTSD, persons with comorbid PTSD and MDD were not significantly more disabled than those with PTSD alone. LIMITATIONS: Cross-sectional study; entry criteria for study may limit generalizability. CONCLUSIONS: PTSD and MDD symptoms are frequently seen in the aftermath of IPV, and often co-occur. The usefulness of the distinction between PTSD and MDD in this context remains to be determined, both in terms of diagnostic classification and prognostic implications.

Adaptation, Psychological↗
PubMed2001

"Being dealt with as a whole person." Care seeking and adherence: the benefits of culturally competent care.

The purpose of this study is to characterize the relationship between identity and health care experiences (including antiretroviral therapy utilization) among HIV-positive sexual minority males. This qualitative study used grounded theory with data collection occurring through focus groups and interviews. A questionnaire was used to complete a demographic profile. The study included 47 HIV positive participants from three minorities: gay men, bisexual men and transgendered persons, gender identifying as female and or living as women. Sessions elicited information on: (1) general experiences with health care, (2) experiences with HIV antiretroviral therapies and issues surrounding access, and (3) adherence to these therapies and identity in relation to health care. These textual data revealed three themes: (1) the importance of sexual identity and its social and cultural context, (2) the differences in the health concerns between the sexual minorities and (3) a wide spectrum of experiences with the health care system that provide information surrounding the access to and adequacy of health care. Successful health care providers are aware of different issues that may play a role in the provision of health care to these sexual minorities. Providers awareness of sexual and social identity and the related different cultural values, beliefs and custom enhance care seeking and therapeutic adherence. For sexual minorities, primary care remains the most important entry point into the health care system. Cultural competence of care providers can foster patient's care seeking and adherence to treatment.

Adult↗
PubMed2001

Differential coupling of the human P2Y(11) receptor to phospholipase C and adenylyl cyclase.

1. The human P2Y(11) (hP2Y(11)) receptor was stably expressed in two cell lines, 1321N1 human astrocytoma cells (1321N1-hP2Y(11)) and Chinese hamster ovary cells (CHO-hP2Y(11)), and its coupling to phospholipase C and adenylyl cyclase was assessed. 2. In 1321N1-hP2Y(11) cells, ATP promoted inositol phosphate (IP) accumulation with low microM potency (EC(50)=8.5+/-0.1 microM), whereas it was 15 fold less potent (130+/-10 microM) in evoking cyclic AMP production. 3. In CHO-hP2Y(11) cells, ATP promoted IP accumulation with slightly higher potency (EC(50)=3.6+/-1.3 microM) than in 1321N1-hP2Y(11) cells, but it was still 15 fold less potent in promoting cyclic AMP accumulation (EC(50)=62.4+/-15.6 microM) than for IP accumulation. Comparable differences in potencies for promoting the two second messenger responses were observed with other adenosine nucleotide analogues. 4. In 1321N1-hP2Y(11) and CHO-hP2Y(11) cells, down regulation of PKC by chronic treatment with phorbol ester decreased ATP-promoted cyclic AMP accumulation by 60--80% (P<0.001) with no change in its potency. Likewise, chelation of intracellular Ca(2+) decreased ATP-promoted cyclic AMP accumulation by approximately 45% in 1321N1-hP2Y(11) cells, whereas chelation had no effect on either the efficacy or potency of ATP in CHO-hP2Y(11) cells. 5. We conclude that coupling of hP2Y(11) receptors to adenylyl cyclase in these cell lines is much weaker than coupling to phospholipase C, and that activation of PKC and intracellular Ca(2+) mobilization as consequences of inositol lipid hydrolysis potentiates the capacity of ATP to increase cyclic AMP accumulation in both 1321N1-hP2Y(11) and CHO-hP2Y(11) cells.

Adenine Nucleotides↗
PubMed2001

Melanocortin 1 receptor (MC1R) gene variants are associated with an increased risk for cutaneous melanoma which is largely independent of skin type and hair color.

Individuals carrying melanocortin 1 receptor gene variants have an increased risk for the development of cutaneous melanoma. Melanocortin 1 receptor gene variants are also associated with other risk factors for melanoma such as fair skin and red hair. We evaluated the relationship of melanocortin 1 receptor gene variants, fair skin, red hair and the development of melanoma in 123 patients with cutaneous melanoma and 385 control subjects. To analyze the association between melanocortin 1 receptor gene variants and skin type or hair color we also made use of 453 patients with nonmelanoma skin cancer. We analyzed the coding sequence of the melanocortin 1 receptor gene region by single-stranded conformation polymorphism analysis, followed by DNA sequence analysis. Risk of melanoma dependent on the various melanocortin 1 receptor variant alleles was estimated by exposure odds ratios. The analyses of all different melanocortin 1 receptor gene variants combined, showed that the presence of melanocortin 1 receptor gene variants amounted to a higher melanoma risk, which, in stratified analyses, was independent of skin type and hair color. The odds ratios after adjusting for skin type were 3.6 (95% CI 1.7-7.2) for two variants and 2.7 (95% CI 1.5-5.1) for one variant, respectively. Compound heterozygotes and homozygotes for the Val60Leu, Val92Met, Arg142His, Arg151Cys, Arg160Trp, Arg163Gln, and His260Pro variants had odds ratios of about 4 to develop melanoma, whereas heterozygotes for these variants had half the risk. The presence of the melanocortin 1 receptor gene variant Asp84Glu appeared to impose the highest risk for cutaneous melanoma with odds ratios of 16.1 (95% CI 2.3-139.0) and 8.1 (95% CI 1.2-55.9) in compound heterozygotes and heterozygotes, respectively. The broad confidence intervals, when the different variants were analyzed separately, however, do not allow drawing definite conclusions about the magnitude of these risks. Of the more frequently occurring melanocortin 1 receptor variant alleles the Asp84Glu, Arg142His, Arg151Cys, Arg160Trp, His260Pro, and Asp294His variants were strongly associated with both fair skin and red hair. The Val60Leu, Val92Met, and Arg163Gln variant alleles, however, were only weakly or not associated with fair skin type and/or red hair, which further illustrates the finding that skin type, hair color, and melanoma are independent outcomes of the presence of melanocortin 1 receptor gene variants. We conclude that numerous melanocortin 1 receptor variants predispose to cutaneous melanoma and that possibly the Asp84Glu variant confers the highest risk. This predisposition is largely independent of skin type and hair color.

Adult↗
PubMed2001

Descriptive epidemiology of skin cancer on Aruba: 1980-1995.

BACKGROUND: An epidemiology unit was established in Aruba in 1994. The primary focus was the development of an infrastructure for both surveillance and health information data systems. This effort resulted in the first analysis of available skin cancer data. METHODS: A retrospective study of cancer and particularly skin cancer cases at the local histopathology laboratory for the period 1980-1995 was performed. All available records with a cancer diagnosis were evaluated. RESULTS: During the study period, an increase in age-adjusted rates for both men and women was observed for basal cell carcinomas and squamous cell carcinomas. No temporal trend was discerned for malignant melanoma or other skin cancers because the numbers of cases were small. Lesions were most often seen on the nose, face, and arm. Dermatologists provided the majority of skin cancer diagnoses and demonstrated the greatest diagnostic accuracy. CONCLUSIONS: The presence of a central histopathology laboratory may provide small island states, like Aruba, with important public health data. This first description of Aruba's skin cancer epidemiology provides information that may be utilized for future public health action.

Adult↗