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C Smith

Publications and source records attributed to C Smith.

At least 451 records · Page 25Linked to original sources
PubMed1995

Sequential urinalysis improves evaluation of fetal renal function in obstructive uropathy.

OBJECTIVES: The purpose of our study was to determine whether sequential vesicocenteses improve the evaluation of renal damage, compared with single urine sampling in obstructive uropathy. STUDY DESIGN: A total of 29 fetuses with complete obstructive uropathy underwent a minimum of three sequential complete vesicocenteses at 48- to 72-hour intervals. First and last urine values were analyzed for multiple parameters. The ability of first versus last urine values to detect the presence of renal damage was compared according to postnatal or fetal autopsy information. RESULTS: Fetuses with minimal renal damage had patterns of decreasing hypertonicity and last urine values below cutoff thresholds indicative of favorable prognosis. Fetuses with significant renal damage had higher initial values and patterns of increasing hypertonicity. For five of six parameters, last urine samples were more predictive of renal damage than first urine samples. CONCLUSION: Last urine values together with pattern-of-change trend analysis after serial vesicocenteses improve diagnostic precision in fetuses with complete obstructive uropathy.

Electrolytes↗
PubMed1995

Effectiveness of the non-spermicidal fit-free diaphragm.

Standard instructions for diaphragm use call for an individually sized latex diaphragm, used in conjunction with spermicide jelly. However, some investigators have reported that the diaphragm can be effective without a spermicide. A non-randomized trial designed to measure the contraceptive effectiveness of the diaphragm used without spermicide was conducted. A total of 110 self-selected women were enrolled to use a non-spermicide fit-free (60mm) diaphragm for a period of one year. They were advised to wear the diaphragm continuously, removing it once each day for washing but not within six hours after intercourse. Product-related problems related to insertion, retention and removal were few at both the 6- and 12-month follow-up visits, most commonly odor. The 12-month life table accidental pregnancy rate during typical use was 24.1 per 100 women (29.5 per 100 women without female barrier experience and 17.9 per 100 women with barrier experience). Over 85% of the women who returned for follow-up visits reported using the diaphragm during every act of intercourse. Until better data refute the traditional recommendations, users should be advised to add spermicide to fitted latex diaphragms.

Adult↗
PubMed1995

An empirical map of critical loads of acidity for soils in Great Britain.

The method used to produce a critical load map of acidity for soils in Great Britain is described. Critical loads were assigned to the dominant soil in each 1 km grid square of the UK national grid. Mineral soils were assigned a critical load based on mineralogy and chemistry, using approaches appropriate to UK conditions. Critical loads for peat soils are based primarily on a maximum acceptable reduction of peat pH, and results from laboratory equilibration studies. The map shows that soils with small critical loads (<0.5 kmol(c) ha(-1) year(-1)) i.e. highly sensitive to acidic deposition, dominate in the north and west of Britain; the south and east are dominated by soils with large critical loads, with small areas of more sensitive soils associated with sandy soil-forming materials. A modified critical load map illustrates the potential impact of agricultural liming on soil critical loads.

Journal Article↗
PubMed1995

The aetiology of severe community-acquired pneumonia and its impact on initial, empiric, antimicrobial chemotherapy.

Of 259 patients admitted to an intensive care unit with severe acute community-acquired pneumonia, 173 had primary infections and 86 had secondary infections. The commonest organism isolated in each group was Streptococcus pneumoniae (51.3 and 36.6% of known isolates in each group respectively). Klebsiella pneumoniae was the next most common isolate (31.9 and 29.3% respectively). A variety of other Gram-negative organisms and Staphylococcus aureus accounted for most of the remaining pathogens. Based on retrospective analysis of data, there appeared to be no difference in the alcohol consumption of patients with infection due to S. pneumoniae and K. pneumoniae. The overall mortality rate for the primary infections was 47.4%, with 68.4% of these infections due to K. pneumoniae and 33.9% due to the pneumococcus (P < 0.002). Among the secondary infections, the overall mortality rate was 40.8% (not significantly different to that of primary infections) with 45.5% due to K. pneumoniae and 23.1% due to the pneumococcus (not significantly different on statistical analysis, probably due to low patient numbers). Our investigation confirms that severe community-acquired pneumonia due to K. pneumoniae is extremely common, even in patients without obvious risk factors for Gram-negative colonization. This organism is contributing to the high mortality rate seen in our intensive care unit among patients with pneumonia, and our empiric therapy for such cases routinely includes a combination of agents active against this organism (e.g. a cephalosporin and an aminoglycoside).

Acute Disease↗
PubMed1995

Influence of hypercortisolemia on soluble tumor necrosis factor receptor II and interleukin-1 receptor antagonist responses to endotoxin in human beings.

BACKGROUND: We have previously reported that the antecedent administration of glucocorticoids altered both the hormonal and proinflammatory cytokine responses to lipopolysaccharide (LPS) when administered to human volunteers. In that study, subjects with vastly exaggerated levels of tumor necrosis factor (TNF) and interleukin (IL)-6 12 and 144 hours after cortisol infusion exhibited hemodynamic and hormonal responses no different from those of untreated subjects after endotoxin. The current study examined levels of the antiinflammatory cytokines interleukin-1 receptor antagonist (IL-1ra) and soluble receptors to tumor necrosis factor (sTNF-R) in the same setting of the previous report. METHODS: Hydrocortisone succinate was infused into healthy volunteers. LPS was then injected immediately or was delayed by 6, 12, or 144 hours (C, C-6, C-12, and C-144, respectively). Subjects receiving LPS alone served as controls. Plasma was analyzed to determine levels of TNF, sTNF-R and IL-1ra by enzyme-linked immunosorbent assay before administration of LPS and at 30-minute intervals after administration of LPS for 6 hours. RESULTS: Levels of sTNF-R increased after LPS administration in all groups (p < 0.05 versus baseline) with a significantly higher level recorded in the subjects having received hydrocortisone 144 hours before (C-144, p < 0.05 versus all other groups). TNF levels remained undetectable in association with immediate infusion of LPS (C) and the relatively short delay group (C6). This cytokine peaked 90 minutes after LPS in all other groups, with a significantly higher peak in the C-144 subjects when compared with controls. IL-1ra levels rose in all groups but to a lesser extent in the C group (p < 0.05). CONCLUSIONS: These data confirm that glucocorticoids influence the production of both sTNF-R and IL-1ra. The potential for an exaggerated response of sTNF-R exists for an extended period of time after exposure to glucocorticoids.

Adult↗
PubMed1995

Library audit: report of the process of undertaking the audit of library services of selected educational providers within the former Northern Region: July 1994.

With the current purchaser/provider split in the NHS the purchaser has a responsibility to evaluate the quality of services provided by the provider. In the past year the Northern and Yorkshire Regional Health Authority expressed an interest in auditing library services supplied from selected education providers. This article attempts to given an account of the experience and focuses on the background, the rationale, the process and the outcomes.

Education, Nursing↗
PubMed1995

Advanced nursing practice: new ideas and new perspectives.

The authors of this paper contend that advanced nursing practice differs substantially from other forms of nursing practice, such as expert and specialist practice. Additionally, they contend that the difference residues in the way that advanced nurse practitioners think about, see and experience clinical practice. Historically, nursing in Australia has been strongly influenced by events and ideas generated in North America. The authors argue this has led to the development of an emphasis on the nature, role and function of specialist and expert nursing practice to the detriment of ascertaining and fostering the notion and nature of advanced nursing practice. This influence of North American nursing has also significantly directed and influenced the way in which we use and understand the term 'advanced nursing practice', and further, that the way in which we use the term does not give full regard to the context of Australian nursing. The authors outline some of the key issues and ideas emerging in South Australia with respect to advanced nursing practice and in particular offer beginning theorizations into the different ways in which advanced nurse practitioners think, see and experience nursing practice.

Australia↗
PubMed1995

Two classes of cis sequences contribute to tissue-specific expression of a PAL2 promoter in transgenic tobacco.

Genes encoding phenylalanine ammonia-lyase (PAL) are expressed in a complex pattern during plant development and in response to light, pathogen ingress, mechanical damage and other stresses. Analysis of the promoter of the bean PAL2 gene in transgenic tobacco has shown that some regions responsible for developmental expression are functionally compensatory. The minimum sequence containing all cis sequences necessary for developmental patterns of expression is within -254 bp of the transcription start site. Footprinting and electrophoretic mobility shift assay studies of this region revealed potential cis sequences which coincided with the functional domains defined by small deletions and promoter fusions. Mutations in these potential cis sequences in the context of the minimal -254 bp promoter altered tissue-specific expression patterns, confirming the importance of these sequences for expression in vivo. A functional model for the promoter is presented which predicts that three AC-elements, which are possible Myb protein binding sites, together with a G-box, interact to direct the complex patterns of tissue-specific expression observed.

Base Sequence↗
PubMed1995

Measuring psychological well-being. The adapted General Well-Being Index in a primary care setting: a test of validity.

The measurement of health outcomes is central to the development of health services. Many acute and chronic illnesses and health interventions have implications for mental health. This study tests the validity of a 22 item measure of psychological well-being, the adapted general well-being index (AGWBI). A postal health survey, including the AGWBI, was sent to a 10% random sample of patients aged 16 or over drawn from the computerized list of one general practice. Two hundred and sixty-six respondents returned questionnaires (a response rate of 76%). The AGWBI was fully completed by 94% (249) of the respondents who returned their questionnaires. Only respondents who fully completed the AGWBI are included in the analysis. The AGWBI significantly discriminated people with a limiting long term illness, those reporting suffering from anxiety, depression or bad nerves, users of general practitioner services over the previous two weeks and respondents reporting taking anti-depressants, tranquillizers or sleeping tablets. It was also able to discriminate respondents with psychosocial difficulties in a small sub-sample who reported that they were in excellent health and did not have a limiting long term health problem or psychological illness. The results are broadly supportive of the validity of the AGWBI and suggest it may be appropriate for use in the evaluation of several developing areas of primary care. Further research is needed to test concurrent validity, responsiveness and to establish population norms.

Adolescent↗
PubMed1995

Levels of peptidoleukotriene E4 are elevated in active Crohn's disease.

Proinflammatory mediators, including leukotriene (LT) B4, are elevated in the intestinal mucosa in active chronic inflammatory bowel diseases (IBD). LTE4 is the major peptidoleukotriene metabolite and it is stable in urine. The aim of this study was to measure LTE4 levels in the urine of 27 children with Crohn's disease and 27 control subjects including 12 children with functional recurrent abdominal pain and 15 unaffected siblings of IBD patients. LTE4 levels were measured in urine using high-performance liquid chromatography separation and radioimmunoassay with specific antibody. The Pediatric Crohn's Disease Activity Index and physician global assessment were used to categorize patient groups. C-reactive protein, orosomucoid, and erythrocyte sedimentation rate were employed as laboratory markers of mucosal inflammation. Urinary LTE4 levels were elevated in the 13 children with active Crohn's disease (160.5 +/- 59.4 pg/ml; mean +/- SEM) compared with both levels in the 14 patients with inactive disease (67.1 +/- 18.1 pg/ml; p < 0.05) and controls (45.0 +/- 10.9 pg/ml; p < 0.05). We conclude that measurement of urinary LTE4 is a useful test for monitoring the activation of peptidoleukotrienes in patients with Crohn's disease. It provides a noninvasive, objective adjunct for assessment of disease activity and could be employed in future trials examining the role of the leukotriene inhibitors in the medical therapy of IBD.

Acute Disease↗
PubMed1995

Patient satisfaction: an indicator of quality in disablement services centres.

OBJECTIVES: To develop a patient satisfaction system for disablement services centres and to report on how the initial findings have been used in audit to improve their quality of care and services. DESIGN: Interview survey of randomly selected users attending in three centres: Birmingham (centre X), Oxford (centre Y), and Cambridge (centre Z) to establish core topics for developing a patient satisfaction questionnaire with incorporation into a computer patient satisfaction system (PATSAT) to enable collation of responses to the questionnaire. A pilot of the questionnaire was undertaken in the centres to assess the sensitivity of the questionnaire, which was subsequently used as part of clinical audit process during June 1991 and April 1992 in centre X and the patient satisfaction system used to monitor changes in routine practice. PATIENTS: 123 amputees in the development phase, selected by cluster sampling, and 1103 amputees in the pilot study. MAIN MEASURES: Satisfaction scores for components of the service. RESULTS: The questionnaire included 16 core topics contributing to quality of care and services, including comfort of limbs, appointments, interpersonal aspects of care, a system of support and counselling, and organisation. The pilot survey demonstrated high satisfaction scores for aspects of interpersonal care, organisation, and physical surroundings of the centres and lower satisfaction for counselling services, comfort of the limb and the number of alterations made before the limb was considered acceptable. During the audit in centre X these results prompted changes to care and services which produced significant improvements in satisfaction. CONCLUSIONS: The early results suggest that the questionnaire, coupled with PATSAT software system, enable users' views to be expressed, collated, and fed back to staff; the information provided has already prompted change, and the system is sufficiently sensitive to measure changes in satisfaction with the service.

Adolescent↗
PubMed1995

Health promotion in schools: policies and practices in Stockholm county, 1990.

A survey was undertaken of the policies and practices concerning organisation and implementation of health education and health promotion in schools in 151 of the total 213 Local Educational Areas (LEAs) in Stockholm county in 1990. Health education was included in the workplan of 49% of the responding LEAs, while 39% of respondents had a local action programme or guidelines for health education. Topic areas taught to all pupils and considered most important included alcohol, drug abuse, smoking, sex education, bullying, nutrition and physical exercise. Most senior level schools (55-83%) had written policies concerning pupils using alcohol, drugs or smoking in school, and 68% of LEAs had restrictions on staff smoking in school. Continuing health education was desired by 87% of the respondents. A written programme/plan regarding health education was identified as an important indicator of interest and commitment in health education and health policy issues by the local school.

Adolescent↗
PubMed1995

Chronic sinusitis.

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Chronic Disease↗