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Biomedical subjects

D A Alexander

Publications and source records attributed to D A Alexander.

At least 37 records · Page 2Linked to original sources

The ion coupling and organic substrate specificities of osmoregulatory transporter ProP in Escherichia coli.

Transporter ProP of Escherichia coli, a member of the major facilitator superfamily, mediates osmoprotective proline or glycine betaine accumulation by bacteria exposed to high osmolality environments. Morpholinopropane sulfonic acid, a common constituent of microbiological media, accumulates in osmoadapting E. coli cells but it is not osmoprotective and it did not influence proP transcription or ProP activity. The apparent K(m) for proline uptake via ProP increased with decreasing pH in the range 7.5-4. ProP-dependent proline uptake by de-energized bacteria was associated with alkalinization of the external medium. Thus ProP mediates cotransport of H(+) and zwitterionic proline and a transporter functional group with a pK(a) of 5-6 is implicated in catalysis. Exogenous proline or glycine betaine elicits K(+) release from osmoadapting E. coli cells and ProP activity is stimulated by exogenous K(+). However, uptake of proline or glycine betaine stimulated K(+) efflux from K(+)-loaded bacteria which expressed either ProP or alternative, osmoregulatory transporter ProU. This indicated that ProP was unlikely to mediate K(+) efflux. Zwitterions ectoine, pipecolate, proline betaine, N,N-dimethylglycine, carnitine and 1-carboxymethylpyridinium were identified as alternative ProP substrates. Choline, a cation and a structural analogue of glycine betaine, was a low affinity inhibitor but not a substrate of ProP.

Bacterial Proteins↗

A pragmatic randomised comparison of transcervical resection of the endometrium with endometrial laser ablation for the treatment of menorrhagia.

OBJECTIVE: To compare endometrial laser ablation (ELA) with transcervical resection of the endometrium (TCRE) in the treatment of menorrhagia. DESIGN: Randomised controlled trial. SETTING: Gynaecology department of a large teaching hospital. PARTICIPANTS: Women with menorrhagia due to dysfunctional uterine bleeding (n = 372) were randomly allocated to ELA (n = 188) or TCRE (n = 184). MAIN OUTCOME MEASURES: Operative complications, post-operative recovery, relief of menstrual and other symptoms, need for further surgical treatment, satisfaction with treatment after 6 and 12 months, and differential resource use. RESULTS: TCRE was significantly quicker, with lower rates of fluid overload. Perioperative morbidity was low and similar in both groups. Outcome at 12 months was also similar: 72 women (45%) had either amenorrhoea or brown discharge in the ELA group compared with 71 (49%) in the TCRE group; 79 (49%) versus 68 (46%) had lighter periods. Thirty (16%) versus 36 (20%) had received further surgical treatment: 9 (5%) compared with 25 (14%) had had a hysterectomy and 21 (11%) versus 11 (6%) had received repeat ablation. Anxiety and depression, dysmenorrhoea and pre-menstrual symptoms were improved by both procedures and bladder symptoms were affected by neither. At 12 months 148 (90%) women in the ELA group and 140 (91%) women in the TCRE group were satisfied with their treatment. The estimated additional cost of ELA was Pound 145 per procedure. CONCLUSIONS: At one year there was no clear difference in clinical outcome between ELA and TCRE. Both procedures were associated with low morbidity. ELA was the more costly procedure. Despite the need for further surgery for about one in six women, satisfaction rates were high following both ELA and TCRE.

Adult↗

Randomised trial comparing hysterectomy with endometrial ablation for dysfunctional uterine bleeding: psychiatric and psychosocial aspects.

OBJECTIVE: To compare in psychiatric and psychosocial terms the outcome of hysterectomy and endometrial ablation for the treatment of dysfunctional uterine bleeding. DESIGN: Prospective randomised controlled trial. SETTING--Obstetrics and gynaecology department of a large teaching hospital. SUBJECTS: 204 women with dysfunctional bleeding for whom hysterectomy would have been the preferred treatment were recruited over 24 months and randomly allocated to hysterectomy (99 women) or to hysteroscopic surgery (transcervical resection (52 women) or laser ablation (53 women). MAIN OUTCOME MEASURES: Mental state, martial relationship, psychosocial and sexual adjustment in assessments conducted before the operation and one month, six months, and 12 months later. RESULTS: Both treatments significantly reduced the anxiety and depression present before the operation, and there were no differences in mental health between the groups at 12 months. Hysterectomy did not lead to postoperative psychiatric illness. Sexual interest after the operation did not vary with treatment. Overall, 46 out of 185 (25%) women reported a loss sexual interest and 50 out of 185 (27%) reported increased sexual interest. Marital relationships were unaffected by surgery. Personality and duration of dysfunctional uterine bleeding played no significant part in determining outcome. CONCLUSIONS: Hysteroscopic surgery and hysterectomy have a similar effect on psychiatric and psychosocial outcomes. There is no evidence that hysterectomy leads to postoperative psychiatric illness.

Adaptation, Psychological↗

Randomised trial of hysterectomy, endometrial laser ablation, and transcervical endometrial resection for dysfunctional uterine bleeding.

OBJECTIVE: To evaluate the effectiveness and safety of endometrial laser ablation and transcervical resection of the endometrium compared with hysterectomy in the surgical treatment of women with dysfunctional uterine bleeding. DESIGN: Prospective randomised controlled trial. SETTING: Gynaecology department of a large teaching hospital. SUBJECTS: 204 women who would otherwise have been undergoing hysterectomy for menorrhagia were recruited between August 1990 and March 1992 and randomly allocated to hysterectomy (n = 99) or conservative (hysteroscopic) surgery (transcervical resection (n = 52) and laser ablation (n = 53)). MAIN OUTCOME MEASURES: Operative complications, postoperative recovery, relief of menstrual and other symptoms, patient satisfaction with treatment after six and 12 months. RESULTS: Women treated by hysteroscopic surgery had less early morbidity and a significantly shorter recovery period than those treated by hysterectomy (median time to full recovery 2-4 weeks v 2-3 months, P < 0.001). Twelve months later 17 women in the hysteroscopy group had had a hysterectomy, 11 for continuing symptoms; 11 women had had a repeat hysteroscopic procedure; 45 were amenorrhoeic or had only a brown discharge; and 35 had light periods. Dysmenorrhoea and premenstrual symptoms improved in most women in both groups. After 12 months 89% (79/89) in the hysterectomy group and 78% (75/96) in the hysteroscopy group were very satisfied with the effect of surgery (P < 0.05); 95% (85/89) and 90% (86/96) thought that there had been an acceptable improvement in symptoms, and 72% (64/89) and 71% (68/96) would recommend the same operation to others. CONCLUSIONS: Hysteroscopic endometrial ablation was superior to hysterectomy in terms of operative complications and postoperative recovery. Satisfaction after hysterectomy was significantly higher, but between 70% and 90% of the women were satisfied with the outcome of hysteroscopic surgery. Hysteroscopic surgery can be recommended as an alternative to hysterectomy for dysfunctional uterine bleeding.

Endometrium↗

Burn victims after a major disaster: reactions of patients and their care-givers.

There have been considerable advances in the physical management of burns, and there is a greater awareness of their psychological impact. However, much less attention has been given to the staff who have to deal with burn victims. Disasters are critical incidents which offer a magnified opportunity to appreciate with what care-givers have to cope and how they do so. This paper identifies how complex are the psychological and emotional reactions associated with burn care, and it advocates that more should be done, by means of debriefing, to cater for the needs of staff after critical incidents.

Accidents, Occupational↗

Premature termination of psychiatric contact.

Failure to complete psychiatric treatment is an extensive and wasteful problem. This retrospective case note study of 252 patients, suffering from a neurotic disorder, investigated which clinical and sociodemographic factors were associated with premature termination of psychiatric treatment. It was found that a history of deliberate self harm was strongly linked with the patients discontinuing their treatment. Other clinical factors, viz, diagnosis, duration of illness, a history of alcohol abuse and a family history of psychiatric illness were not however associated with premature termination of treatment. Older patients and those who were married were least likely to end treatment in this fashion, but sex of the patient, employment status, and distance from the hospital had no such link. Belonging to socioeconomic group 5 was significantly associated with premature termination although no other associations with social groupings were found.

Adult↗

Domiciliary care: a comparison of the views of terminally ill patients and their family caregivers.

This study compares terminally ill patients and their family caregivers in terms of the physical and emotional status of the patients, the adequacy of the support provided for the patients and where the patients would be most appropriately placed during the last stage of their lives. Patients and caregivers shared similar views about the latter, but there was a lack of concordance between them regarding the patients' physical and emotional state. Patients generally reported a much more favourable view of their outlook and emotional state than did their caregivers. Caregivers may need help to review their assumptions about the patients' emotional welfare, and caution should be used in accepting caregivers' views about how patients are coping emotionally.

Adult↗

Staff support groups: do they support and are they even groups?

This article emphasizes the need to adopt a rigorous approach to the establishment of staff support groups. They are too important to be allowed to materialize without careful consideration of their aims, methods and composition. As a method of combating work-related stress they have a role to play, but it cannot be assumed that they will fulfil this role without serious attention being paid to these matters. There are good reasons for suspecting that improperly run support groups might have a harmful as well as a positive effect. As with all forms of help, the 'therapeutic' ingredients of support groups have to be identified and developed to ensure they fulfil their potential.

Female↗

Stress among police body handlers. A long-term follow-up.

Thirty-five police officers were followed up three years after they had been first assessed following their involvement in the retrieval and identification of human remains after a major disaster. Most of these officers were free from signs of psychiatric morbidity. Organisational and managerial practices appear to be powerful antidotes to adverse post-traumatic reactions. In this study the use of a longitudinal design, with a pre-disaster baseline and a control group, suggests that these are robust findings.

Adaptation, Psychological↗

Perceptions of drinking problems among undergraduate students in the United States and Scotland.

This study compares the perceptions of problem drinking and preferred explanations for problem drinking held by 440 undergraduate students in the United States and 185 in Scotland. Respondents' drinking habits influenced perceptions of drinking problems in both nations. The Scottish sample, with drinking habits statistically controlled, was less likely to perceive drinking problems than the United States sample and was less likely to endorse a physiological explanation for drinking problems. The importance of different perceptions in influencing decisions to seek help is discussed.

Adult↗

Reactions of police officers to body-handling after a major disaster. A before-and-after comparison.

This study reports the results of an unusual opportunity to follow up a group of police officers who were involved in body-handling duties following the Piper Alpha disaster, and for whom there were available data from pre-disaster assessments. In addition, after these duties, the officers were compared with a matched control group of officers who had not been involved in such work. The comparisons failed to demonstrate high levels of post-traumatic distress or psychiatric morbidity. The results are interpreted in terms of issues such as the officers' own coping strategies, and major organisational and managerial factors.

Absenteeism↗

Relationship between personality and premenstrual symptoms: a study in five general practices.

A large representative sample of women of child bearing age in five urban practices were asked to complete two measures to record premenstrual changes in their health. The first method was a daily health record which sought to disguise the fact that the focus of the study was premenstrual changes while the second method was a conventional, retrospective checklist. In addition, the women completed a personality inventory which allowed them to be allocated to one of two personality subtypes according to level of neuroticism--neurotic or stable. The results suggest that women in the neurotic subgroup are, in general, more likely to report premenstrual changes than stable women and particularly so on the retrospective checklist rather than the daily record of health changes. It was also shown that women in the stable subgroup were less likely to be inconsistent reporters of symptoms on the two questionnaires than neurotic women. Better understanding of the variable nature of the premenstrual syndrome may demand that more attention is paid to the method of collection of data and to how this interacts with the woman's basic personality. In particular, for research purposes, the traditional method of a retrospective checklist introduces an unacceptable level of response bias in favour of the identification of women with high neuroticism scores, and underrepresents more stable women who suffer from premenstrual complaints. Previous treatment trials which have used this method may therefore be invalid and their conclusions should be reappraised.

Adult↗

Changes in attitudes towards psychiatry among medical students: correlation of attitude shift with academic performance.

This study investigates the changes in attitudes to psychiatry and level of psychiatric knowledge among medical students before and after formal teaching on psychiatry. Teaching led to the development of more favourable attitudes (particularly among women) towards psychiatry, but doubt remained after teaching about the 'scientific' status of the discipline. Initial attitudes did not relate to academic performance but, those developed after teaching showed a significant positive correlation with it.

Attitude of Health Personnel↗

To which neurotic patients do psychiatrists prescribe medication?

Of 318 newly referred neurotic patients, 43% were prescribed medication by their psychiatrist. Medication was more likely to be prescribed to patients who are older, who are married, who have lengthy illnesses and who do not have a history of deliberate self-harm. These findings are discussed in the context of current debate about optimal treatment methods for patients with neurotic disorders.

Adult↗

'Stressors' and difficulties in dealing with the terminal patient.

This study investigated by means of questionnaires and semi-structured interviews some of the major sources of stress for palliative care nurses and how they deal with these. The nurses' replies were related to a general measure of health. Irrespective of their shifts, duties, and training, the nurses in two units specializing in palliative care shared very similar views. The most potent influence on the nurses' attitude to death was their own experience with dying patients. The nurses found it particularly stressful to deal with patients who suffer intractable pain, with those patients who have young children, and with those patients who are afraid to die. In addition, dealing with psychiatric symptoms and with relatives are major sources of stress. Generally, it was found that those symptoms and situations which left nurses feeling helpless and useless were the most stressful. The implications of these findings for nurse training and education are discussed.

Humans↗