Biomedical subjects

C Roberts

Publications and source records attributed to C Roberts.

At least 37 records · Page 2Linked to original sources

PubMed2004

CD94 expression and natural killer cell activity after acute exercise.

This study examined the effects of acute exercise on natural killer (NK) cell numbers, their expression of CD94 and cytotoxic capacity in triathletes over a 10-week training period. Nine highly trained male triathletes (age 25.9+/-4.1 yrs, VO2max 5.14+/-0.33 L.min(-1)) attended the laboratory on weeks 0, 2, 5 and 10 for incremental submaximal and maximal cycle ergometry. Peripheral blood was analysed for white blood cell counts, lymphocyte phenotype and cytolytic activity (51Cr release from K562 cells). Maximum oxygen consumption increased from week 2 (5.14+/-0.33 L.min(-1)) to week 10 (5.28+/-0.32 L.min(-1)). Resting NK cell numbers and their expression of CD94 were not altered over the 10-week study period. Natural killer cells expressing CD94+ were not differentially recruited into the circulation and cytolytic activity of exercise-recruited NKs did not differ from those present at rest. There was longitudinal stability (over the 10 weeks of the study) in CD94 expression on NK cells, exercise recruitment of CD94+ NK cells and cytolytic capacity of NK cells. The distribution and functional activity of NK cells are not markedly influenced by 10 weeks of training in competitive triathletes. Natural killer cytotoxic activity after exercise reflects numbers of NK cells and not a changed activation state of these cells per se.

Adaptation, Physiological↗

PubMed2004

Player movement patterns and game activities in the Australian Football League.

In the Australian Football League (AFL), specific game movements and activities have not been studied since the 1970s and 1980s and the game is now much faster than it was 20-30 years ago. Using lapsed-time video analysis, AFL players from five different positions (full forward/full back, centre half forward/centre half back, small forward/small back, mid fielders and ruckmen) had their movement patterns (stand, walk, jog, fast-run, sprint, change of direction) and game activities (possessions, ruck duels, ground ball contests, shepherds, spoils, bumps and tackles) recorded in two games each in the 2000 season. A descriptive analysis of the results was undertaken. The main findings were: full forward/full back were most different from the other positions, as they were seen to stand more and jog and fast-run less: ruckmen and midfielders were involved in more game activities than the other positions; for all positions, there were more than 150 high intensity movements (fast-run plus sprint) in the game, but these accounted for only 4-6% of total movement time: virtually all of the high intensity movements lasted for <6 secs; more than half of all sprints involved at least one change of direction, mostly within the 0-90 degrees arc (left or right) and all ground ball contests took <6 secs, with midfielders having 2-3 times as many as the other positions. Improvements in specific pre-season and in-season training practices for different positions should be possible after careful interpretation of these findings.

Australia↗

PubMed2004

Comparison of training activities and game demands in the Australian Football League.

his paper serves as a companion to our recent study of the movement patterns and game activities of players (from five different positions) during matches in the 2000 Australian Football League season. Using lapsed-time video analysis, the same individual players (n= 11) as filmed in matches were also monitored during 21 in-season, main training sessions conducted by their clubs in order to assess the degree to which training activities matched game demands. In general, the training sessions did not involve physical pressure; therefore there were very few contested marks and ground balls or tackles, shepherds and spoils, thereby not matching these game demands. Players typically had more possessions (kicks and handballs) at training than in games. They also spent a greater percentage of total time standing and less time walking at training than in games. Fast-running and sprinting efforts at training were almost all for durations of <6 secs, which matched game demands, as did changes of direction when sprinting, which were almost all in a 0-90 degrees arc. However, across all players filmed, high intensity (fast-running and sprinting) movements were not performed as frequently at training (one every 76 secs) as in games (one every 51 secs). Therefore, while some game demands were adequately replicated at training, others were not closely simulated, suggesting that, after careful interpretation of these results, some improvements in training practices could be made.

Australia↗

PubMed2004

Clinical pathway for the evaluation of postmenopausal bleeding with an emphasis on endometrial cancer detection.

Postmenopausal bleeding (PMB) accounts for about 5% of all office gynaecology visits. The causes of PMB are varied. Many women with endometrial cancer present with this symptom. Although many investigations are described, the most appropriate approach is often unclear. In a patient with no obvious local cause, the emphasis should be on uterine and adnexal evaluation. Based on a literature review, the evidence favours a conservative approach if the endometrial thickness (ET) is < 4mm, unless there are risk factors. All patients with ET 4 mm should have outpatient endometrial sampling. If this is unsuccessful, then outpatient hysteroscopy with directed biopsy or inpatient hysteroscopy is favoured. The role of ancillary investigations are described.

Biopsy↗

PubMed2004

Vitamin A for acute respiratory infection in developing countries: a meta-analysis.

AIM: To determine the efficacy of intervention with high-dose vitamin A as an adjunct to standard treatment on outcome in acute lower respiratory tract infection in children in developing countries. METHODS: A systematic review of double-blinded, randomized, controlled intervention studies of high-dose vitamin A or placebo in children aged between 1 mo and 6 y presenting with acute non-measles lower respiratory tract infection. RESULTS: Five studies fulfilling the criteria were identified and included a total of 2177 children (1067 intervention, 1110 control). The main outcome measures were time to normalization of fever, respiratory rate and oxygen dependence, time to discharge, and mortality. On meta-analysis, there were no significant differences in any of the recovery measures or mortality between the intervention and control groups. Pooled results for recovery times are given showing difference in days to recovery days and 95% confidence intervals. Positive summary measures indicate faster recovery in the vitamin A group and negative in the placebo: fever: 0.03 (-0.10 to 0.17); oxygen requirement: -0.08 (-0.31 to 0.16); raised respiratory rate: -0.09 (-0.38 to 0.19); hospital stay: -0.06 (-0.52 to 0.40). Mortality was below 2% in both groups, with a non-significantly higher risk in the intervention group (odds ratio 1.16, 95% CI: 0.61-2.21). CONCLUSION: There is no evidence from this meta-analysis that intervention with high-dose vitamin A improves recovery from pneumonia in children in developing countries aged from 1 mo to 6 y.

Acute Disease↗

PubMed2004

A randomised controlled trial to assess the effectiveness and cost of a patient orientated self management approach to chronic inflammatory bowel disease.

OBJECTIVES: We developed a patient centred approach to chronic disease self management by providing information designed to promote patient choice. We then conducted a randomised controlled trial of the approach in inflammatory bowel disease (IBD) to assess whether it could alter clinical outcome and affect health service use. DESIGN: A multicentre cluster randomised controlled trial. SETTING: The trial was conducted in the outpatient departments of 19 hospitals with randomisation by treatment centre, 10 control sites, and nine intervention sites. For patients at intervention sites, an individual self management plan was negotiated and written information provided. PARTICIPANTS: A total of 700 patients with established inflammatory bowel disease were recruited. MAIN OUTCOME MEASURES: Main outcome measures recorded at one year were: quality of life, health service resource use, and patient satisfaction. Secondary outcomes included measures of enablement-confidence to cope with the condition. RESULTS: One year following the intervention, self managing patients had made fewer hospital visits (difference -1.04 (95% confidence interval (CI) -1.43 to -0.65); p<0.001) without increase in the number of primary care visits, and quality of life was maintained without evidence of anxiety about the programme. The two groups were similar with respect to satisfaction with consultations. Immediately after the initial consultation, those who had undergone self management training reported greater confidence in being able to cope with their condition (difference 0.90 (95% CI 0.12-1.68); p<0.03). CONCLUSIONS: Adoption of this approach for the management of chronic disease such as IBD in the NHS and other managed health care organisations would considerably reduce health provision costs and benefit disease control.

Adaptation, Psychological↗

PubMed2004

Anatomical distribution of colorectal cancer over a 10 year period in a district general hospital: is there a true "rightward shift"?

INTRODUCTION: Recent studies of patients with colorectal cancer have suggested a shift towards the proximal colon and an increase in the incidence of right sided colon cancer. This study aimed to determine the anatomical distribution of colorectal cancer over a 10 year period in a district general hospital. METHODS: Records of patients diagnosed with primary colorectal cancer from 1993 to 2002 were reviewed for demographic data, histology subtype, and anatomical location of the tumour. Tumours located at and proximal to the splenic flexure were defined as right sided cancer and tumours arising distal to the splenic flexure were defined as left sided cancer. RESULTS: A total of 763 patients were included in the study, of whom all had adenocarcinoma and 99% were white. Sixty nine percent of cancers were left sided and 31% were right sided. Although there was a 4% increase in the proportion of right sided cancers, there was no statistically significant increase using logistic regression analysis. Mann-Whitney U test revealed no significant difference in age at diagnosis between the right and left sided cancers. Although a higher proportion of females were diagnosed with right sided cancer compared with left sided cancer, this was not statistically significant. CONCLUSION: The anatomical distribution of colorectal cancer has been fairly stable at this hospital with no evidence of a shift towards the proximal colon. No differences were identified in the tumour distribution with respect to gender and age at diagnosis. Our findings support the initial application of flexible sigmoidoscopy for investigating patients with suspected colorectal malignancy and follow up colonoscopy for selected patients to exclude right sided pathology.

Adenocarcinoma↗

PubMed2004

Systematic assessments of need and care planning in severe mental illness: cluster randomised controlled trial.

BACKGROUND: Surveys have shown high levels of unmet need in representative samples of people with severe mental illness. Introducing standardised needs assessment into the care planning process might reduce these needs and improve outcome. AIMS: To determine whether feedback from a standardised assessment of need enhances the effectiveness of care planning and whether exposing care coordinators to feedback on some patients improves their care of other patients. METHOD: A single-blind, cluster randomised trial involving a within-cluster individually randomised arm: patients' needs were evaluated using the Cardinal Needs Schedule and the findings were fed back to their care coordinators under the care programme approach. A total of 304 patients were recruited from 72 care coordinators and 242 patients (79.6%) were reassessed at 12 months. RESULTS: The only significant effect of the intervention was on patient satisfaction. Patients cluster-randomised to receive feedback were more satisfied than controls, but patients individually randomised to receive feedback were not. CONCLUSIONS: Standardised needs assessment did not substantially enhance care planning in this trial. However, giving care coordinators some experience of feedback from a standardised assessment of need could improve satisfaction.

Adult↗

PubMed2003

AO or Schatzker? How reliable is classification of tibial plateau fractures?

INTRODUCTION: We compare the intra- and interobserver reproducibility of classifications of tibial plateau fractures most commonly used in our clinical practice. These were the AO and Schatzker classifications. PATIENTS AND METHODS: Agreement was measured using kappa coefficients on the data obtained from three observers reviewing 30 fractures and these values were interpreted according to Landis and Koch. RESULTS: It was found that both classifications were substantially reliable with regards to intraobserver reliability but that the Schatzker system was only fairly reliable and the AO classification moderately reliable with regards to interobserver reliability. Breaking down the AO classification, with regards to intraobserver reliability, the AO group was substantially reliable and the type excellently reliable. For interobserver reliability, the AO group was moderately reliable while the AO type was substantially reliable. CONCLUSION: For tibial plateau fractures seen on plain x-ray, the AO classification is more reliable between observers than the Schatzker classification.

Humans↗

PubMed2003

A national qualitative survey of community-based musculoskeletal services in the UK.

OBJECTIVE: To determine the characteristics of community-based musculoskeletal services provided by primary care organizations within the UK. METHODS: Members of five professional groups within UK primary care organizations (n=461) were sent a questionnaire. RESULTS: The response rate by organization was 71% (328/461). Respondents described 350 community-based musculoskeletal services, 233/328 (71%) organizations had one or more musculoskeletal services within their community. Five main forms of service provision were: a scanning service, a rehabilitation service, physiotherapy services, joint or soft tissue injections and the implementation of integrated care pathways. In 162 services, patients were assessed, reviewed or triaged, by a 'non-consultant' health-care professional (physiotherapist or general practitioner), at an intermediate level between primary and secondary care. The purpose of the service was described in 292/350 services, only 39/350 had clear evaluation strategies and 53/350 had consideration of individual training needs. CONCLUSIONS: There are a wide range of musculoskeletal services flourishing within the community sector, whose quality may be variable. Whilst there is good evidence to suggest systematic planning of these services, we are concerned about the lack of data to support their effectiveness in terms of clinical outcomes, monitoring of service delivery standards and ongoing professional development of service providers. Commissioners of such services must ensure they have taken account of the evidence base and met any identified needs of local populations. Services should have a clear purpose with an appropriate evaluation strategy, and well-defined dissemination mechanisms. An integrated educational strategy for staff within the service must be sensitive to issues relating to accreditation, appraisal and revalidation.

Community Health Services↗

PubMed2003

Day hospital versus admission for acute psychiatric disorders.

BACKGROUND: Inpatient treatment is an expensive way of caring for people with acute psychiatric disorders. It has been proposed that many of those currently treated as inpatients could be cared for in acute psychiatric day hospitals. OBJECTIVES: To assess the effects of day hospital versus inpatient care for people with acute psychiatric disorders. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register (Cochrane Library, issue 4, 2000), MEDLINE (January 1966 to December 2000), EMBASE (1980 to December 2000), CINAHL (1982 to December 2000), PsycLIT (1966 to December 2000), and the reference lists of articles. We approached trialists to identify unpublished studies. SELECTION CRITERIA: Randomised controlled trials of day hospital versus inpatient care, for people with acute psychiatric disorders. Studies were ineligible if a majority of participants were under 18 or over 65, or had a primary diagnosis of substance abuse or organic brain disorder. DATA COLLECTION AND ANALYSIS: Data were extracted independently by two reviewers and cross-checked. Relative risks and 95% confidence intervals (CI) were calculated for dichotomous data. Weighted or standardised means were calculated for continuous data. Day hospital trials tend to present similar outcomes in slightly different formats, making it difficult to synthesise data. Individual patient data were therefore sought so that outcomes could be reanalysed in a common format. MAIN RESULTS: Nine trials (involving 1568 people) met the inclusion criteria. Individual patient data were obtained for four trials (involving 594 people). Combined data suggested that, at the most pessimistic estimate, day hospital treatment was feasible for 23% (n=2268, CI 21 to 25) of those currently admitted to inpatient care. Individual patient data from three trials showed no difference in number of days in hospital between day hospital patients and controls (n=465, 3 RCTs, WMD -0.38 days/month CI -1.32 to 0.55). However, compared to controls, people randomised to day hospital care spent significantly more days in day hospital care (n=265, 3 RCTs, WMD 2.34 days/month CI 1.97 to 2.70) and significantly fewer days in inpatient care (n=265, 3 RCTs, WMD -2.75 days/month CI -3.63 to -1.87). There was no significant difference in readmission rates between day hospital patients and controls (n=667, 5 RCTs, RR 0.91 CI 0.72 to 1.15). For patients judged suitable for day hospital care, individual patient data from three trials showed a significant time-treatment interaction, indicating a more rapid improvement in mental state (n=407, Chi-squared 9.66, p=0.002), but not social functioning (n=295, Chi-squared 0.006, p=0.941) amongst patients treated in the day hospital. Four of five trials found that day hospital care was cheaper than inpatient care (with cost reductions ranging from 20.9 to 36.9%). REVIEWER'S CONCLUSIONS: Caring for people in acute day hospitals can achieve substantial reductions in the numbers of people needing inpatient care, whilst improving patient outcome.

Acute Disease↗

PubMed2003

Prevalence of Plasmodium falciparum pfcrt polymorphisms and in vitro chloroquine sensitivity in Senegal.

Mutations in pfcrt K76T are associated with chloroquine resistance in Plasmodium falciparum. Previous studies of K76T mutations in Senegal reported the association of T76 with in vitro-resistant isolates, but this mutation was also prevalent in chloroquine-sensitive isolates. This suggests involvement of additional genetic loci in modulating chloroquine resistance. Additional pfcrt polymorphisms at codons A220S, Q271E, N326S and R371I have been found in chloroquine-resistant isolates. We wanted to test if sequential acquisition of mutations at these codons leads to in vitro chloroquine resistance. Stepwise accumulation of mutations was not detected, rather there was almost complete linkage between the pfcrt K76T mutation and polymorphisms in these codons. Therefore these additional polymorphisms do not enhance the correlation between pfcrt T76 and chloroquine resistance in Senegal. These data suggest that in vitro chloroquine resistance requires the genetic background of the pfcrt K76T mutation and additional mutations in genetic loci outside the pfcrt gene.

Adolescent↗

PubMed2003

Surfactant-free, biodegradable nanoparticles for aerosol therapy based on the branched polyesters, DEAPA-PVAL-g-PLGA.

PURPOSE: This study describes the development of surfactant-free, biodegradable nanoparticle systems with varying physicochemical properties and their suitability for pulmonary application via nebulization. METHODS: Nanoparticle suspensions were formulated from the branched polyester, diethylaminopropyl amine-poly(vinyl alcohol)-grafted-poly(lactide-co-glycolide) (DEAPA-PVAL-g-PLGA) alone, as well as with increasing amounts of carboxymethyl cellulose (CMC). Particle size, zeta potential, turbidity, and morphology (atomic force microscopy) were characterized. Three formulations were chosen for further study: Cationic nanoparticles without CMC, cationic nanoparticles with CMC, and anionic nanoparticles with an excess of CMC. Nanoparticle degradation was characterized, as well as stability during nebulization. Nanoparticle-cell interactions were investigated and quantified using confocal laser scanning microscopy and fluorescence spectrometry. RESULTS: Nanoparticles ranged in size from 70-250 nm and displayed zeta potentials of +58.9 to -46.6 mV. Anionic nanoparticles showed the highest stability during nebulization. The degradation rate of each nanoparticle formulation decreased with increasing amounts of CMC. Cell association was highest among cationic nanoparticles (57% and 30%, respectively), although these were not internalized. Despite a lower rate of cell association (3%), anionic nanoparticles were internalized by A549 cells. CONCLUSIONS: Surfactant-free nanoparticles from DEAPA-PVAL-g-PLGA are versatile drug delivery systems; however, only the anionic formulations investigated were proven suitable for aerosol therapy.

Aerosols↗

PubMed2003

A pilot randomized trial in primary care to investigate and improve knowledge, awareness and self-management among South Asians with diabetes in Manchester.

AIMS: To investigate whether a secondary-primary care partnership education package could improve understanding of diabetes care among South Asians. METHODS: In a pilot randomized controlled trial, in the setting of eight general practices randomized to intervention or control, patients were invited to four or more rotating visits per year by one of a diabetes specialist nurse, dietician or chiropodist working with general practice staff. Participants were from lists of South Asian patients with known Type 2 diabetes in each (general) practice. RESULTS: Patients and practice scores at baseline and 1-year follow-up, from an interview using a questionnaire on knowledge, awareness and self-management of diabetes. Responses were developed into educational packages used during intervention. Of the 411 patients listed at baseline only 211 were traced for interview (refusal only 4%). Mean age was 55.4 years, age of diabetes onset 47.1 years. Fourteen percent were employed and 35% were able to communicate in English fluently. Only 118 could be traced and interviewed at 1 year, although there was no significant difference in demography between those who completed the study and those who did not. Despite a mean of four visits/patient, intervention had no impact on scores for diabetes knowledge, or awareness [score change 0.14, 95% confidence interval (CI) -0.20, 0.49] or self-management (-0.05, 95% CI -0.48, 0.39) between baseline and 1 year. CONCLUSIONS: This form of secondary/primary care support did not transfer information effectively, and we suspect similar problems would arise in other similar communities. Different methods of clinician/patient information exchange need to be developed for diabetes in this South Asian group.

Adult↗

PubMed2003

Corridor consultations and the medical microbiological record: is patient safety at risk?

The performance procedures of the General Medical Council are aimed at identifying seriously deficient performance in a doctor. The performance procedures require the medical record to be of a standard that enables the next doctor seeing the patient to give adequate care based on the available information. Setting standards for microbiological record keeping has proved difficult. Over one fifth of practising medical microbiologists (including virologists) in the UK (139 of 676) responded to a survey undertaken by the working group developing the performance procedures for microbiology, to identify current practice and to develop recommendations for agreement within the profession about the standards of the microbiological record. The cumulative frequency for the surveyed recording methods used indicated that at various times 65% (90 of 139) of respondents used a daybook, 62% (86 of 139) used the back of the clinical request card, 57% (79 of 139) used a computer record, and 22% (30 of 139) used an index card system to record microbiological advice, suggesting wide variability in relation to how medical microbiologists maintain clinical records.

Health Care Surveys↗

PubMed2003

Lessons from the implementation of a home telecare service.

We conducted a qualitative evaluation of the introduction of a telenursing service. The service used an analogue videophone linked with a physiological monitoring device, which allowed the transmission of data between the patient's home and the hospital. A researcher kept a detailed diary of day-to-day activity for the first year of the project. Computer software for qualitative data analysis was used to code the text and the analysis followed the principles of constant comparison. The diary entries documented how the commercially available equipment was adapted to suit the organization and content of the nurses' work. The nurses made a number of suggestions to improve the user-friendliness of the equipment. The technology, the existing home care service (the comparison arm of the study) and the randomized controlled trial itself all underwent continuous change. The traditional randomized control design of trial has limitations in this situation, and there is a need for more realistic trial designs.

Home Care Services↗

PubMed2003

A randomised controlled trial to assess the impact of a package comprising a patient-orientated, evidence-based self-help guidebook and patient-centred consultations on disease management and satisfaction in inflammatory bowel disease.

OBJECTIVES: To determine if a whole systems approach to self-management improves clinical outcomes and leads to cost-effective use of NHS services. DESIGN: Nineteen hospitals were randomised to 10 control sites and nine intervention sites. Consultants from intervention sites received training in patient-centred care before recruitment and introduced the intervention to eligible patients. Patients at the control sites were recruited and went on to have an ordinary consultation. Qualitative interviews were undertaken to obtain an in-depth understanding of patients' and consultants' experience of the intervention. SETTING: Follow-up outpatient clinics at 19 hospitals in the north-west of England. PARTICIPANTS: Seven hundred patients (297 at intervention sites and 403 at control sites) with established ulcerative colitis or Crohn's disease, aged 16 years and over, and able to write in English. INTERVENTIONS: Consultants were trained to provide a patient-centred approach to care. Guidebooks on ulcerative colitis and Crohn's disease were developed with patients prior to the study. Patients prepared a written self-management plan and self-referred to services based on a self-evaluation of their need for advice. MAIN OUTCOME MEASURES: Rates of hospital outpatient consultation, quality of life (QoL) and acceptability to patients. Health service resource use and assessed cost effectiveness using the EQ-5D. RESULTS: After 1 year, the intervention resulted in fewer hospital visits, without change in the number of primary care visits. Patients felt more able to cope with their condition. The intervention produced no reduction in QoL and did not raise anxiety. The intervention group reported fewer symptom relapses; 74% of patients in the intervention group indicated a preference to continue the system. Qualitative results showed the guidebook was effective but organisational limitations constrained patient-centred aspects of the intervention for some. Cost-effectiveness analyses favoured self-management over standard care. CONCLUSIONS: Further use of this method in chronic disease management seems likely to improve overall patient satisfaction and reduce health expenditure without evidence of adverse effect on disease control. Further attention needs to be given to self-referral and access arrangements and a re-distribution of control to patients through increased adherence to patient-centred norms on the part of consultants. Future research is recommended to evaluate the operating systems within secondary and primary care that would allow self-managers to self-refer and to keep them informed of new treatments, also to explore models for training health professionals in self-care methods, to study long-term effects of self-management in chronic disease and to transfer this approach to other chronic conditions.

Adolescent↗

PubMed2002

Austin-Moore hemiarthroplasty for failed osteosynthesis of intracapsular proximal femoral fractures.

We studied the outcome of 100 uncemented Austin-Moore hemiarthroplasties used as a revision procedure for failed osteosynthesis of intracapsular femoral fractures. This group was compared with 730 patients in whom an uncemented Austin-Moore prosthesis had been used as the primary treatment for an intracapsular femoral fracture. The results indicate that the study group had more pain at 1-year post-fracture. There were also significantly more revision procedures in those who had the arthroplasty performed as a salvage procedure. In general, the results of uncemented Austin-Moore hemiarthroplasty used as a revision procedure for failed osteosynthesis are inferior to that for primary hemiarthroplasty. We would advocate that for any case in which there are signs of acetabular damage a total hip replacement might be a better procedure. For the remainder, an alternative arthroplasty should be considered with an uncemented Austin-Moore prosthesis reserved for only the very frail.

Aged↗