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Biomedical subjects

D Evans

Publications and source records attributed to D Evans.

At least 163 records · Page 9Linked to original sources
PubMed1996

National Asthma Education and Prevention Program working group report on the quality of asthma care.

The quality of asthma care is the second topic of the National Asthma Education and Prevention Program Task Force Report on the Cost Effectiveness, Quality of Care, and Financing of Asthma Care. This working group recommended an asthma continuous quality improvement model as an appropriate framework for examining the quality of asthma care. This model can be implemented by various organizations and providers of care in a variety of settings. The framework consists of four steps: (1) define the opportunity for improvement, (2) set the asthma quality improvement goals (outcomes), (3) characterize the process of care, and (4) begin the improvement cycle. Several case studies are presented to illustrate the use of this model in various settings, including managed care facilities, emergency departments, teaching hospitals, physician's offices, schools, workplaces, and communities. In addition, the appendix provides an overview of asthma outcome measures in the framework of patient-centered versus organizationally based perspectives.

Asthma↗
PubMed1996

Serologic responses of Brucella abortus strain 19 calfhood-vaccinated cattle following adult vaccination with strain RB51.

This study was designed to determine if Brucella abortus strain RB51, which expresses small amounts of the lipopolysaccharide O side chain, would cause positive responses on brucellosis serologic surveillance tests when given to adult cattle that were vaccinated as calves with B. abortus strain 19. Cattle vaccinated as adults with strain RB51 that had been vaccinated as calves with strain 19 (n = 40) had significantly greater antibody titers (P < 0.05) against strain RB51 at 4 and 8 weeks postvaccination in the dot blot assay than did animals (n = 10) not vaccinated with strain RB51. When evaluated using the card or buffered acid plate agglutination presumptive tests, 7 strain RB51 vaccinates tested positive at either 4 or 8 weeks following vaccination as compared with 4 cattle in the control group that were not vaccinated with strain RB51. One strain RB51 vaccinate was scored as suspect on the standard tube agglutination (STA) test at 8 weeks following vaccination. Remaining samples from strain RB51 vaccinates tested negative on the STA, complement fixation (CF), rivanol, and particle concentration fluorescence immunoassay (PCFIA) confirmatory tests. Samples from 2 control cattle were PCFIA positive at time 0; 1 of these animals was CF positive throughout the study. This study suggests that use of strain RB51 in cattle vaccinated with strain 19 as calves will not cause positive responses on confirmatory tests and will not impair brucellosis serologic surveillance efforts.

Animals↗
PubMed1996

Factors associated with emergency department visits by children with asthma: implications for health education.

OBJECTIVES: This study investigated the relationship between psychosocial and behavioral factors and the frequency of emergency department visits for childhood asthma. METHODS: Data obtained from a survey of parents of 445 children who were being treated for asthma in the emergency room of a large urban hospital were examined. RESULTS: Factors associated with high emergency department use included the child's being of younger age, a greater number of days with symptoms of asthma, a higher number of asthma medicines prescribed, a prior hospitalization for asthma, a lower level of parental confidence in the efficacy of medicines, and a failure to use a criterion for deciding to seek emergency care. CONCLUSIONS: Younger children with asthma and children with previous hospitalization for asthma are at high risk for using emergency care. Families who use the emergency department frequently need to be further educated in the inflammatory nature of the disease, in the efficacy of proper use of medicine, in the need for ongoing care, and in criteria to distinguish those symptoms that can be handled at home from those requiring emergency care.

Age Factors↗
PubMed1996

Protective effect of gluten-free diet against development of lymphoma in dermatitis herpetiformis.

A retrospective study of 487 patients with dermatitis herpetiformis showed that lymphoma developed in eight patients, the expected incidence being 0.21 (standardized registration ratio 3810). All lymphomas occurred in patients whose dermatitis herpetiformis had been controlled without a gluten-free diet (GFD) or in those who had been treated with a GFD for less than 5 years. The results are suggestive of a protective role for a GFD against lymphoma in dermatitis herpetiformis and give further support for advising patients to adhere to a strict GFD for life.

Adult↗
PubMed1996

A stakeholder analysis of developments at the primary and secondary care interface.

BACKGROUND: The interface between primary and secondary care has become a major focus of health policy debate, but the differing perspectives of stakeholders on recent developments in policy and practice have seldom been researched. AIM: To examine stakeholder perspectives on the extent of developments at the primary and secondary care interface, and the barriers and opportunities for future development. METHOD: This qualitative study was based on semi-structured interviews with a purposive sample of 27 primary and secondary care stakeholders in Southampton and South West Hampshire in 1994. Respondents were asked to identify developments in seven areas: direct access, consultant outreach, shifted services, substituted services, shared care, workload shifts and communication. RESULTS: Key issues were identified relating to the cultures of primary and secondary care, communication and work-load. Most respondents described an important shift in power from consultants to GPs. Although respondents identified several useful developments at the interface, including improvements in communication and increased direct access facilities, there were relatively few reports of shifts in resources and services to primary care. Respondents identified important continuing barriers to change, including the attitudes of consultants and the individualistic culture of GPs. CONCLUSION: Policies to "shift the balance' and to further "a primary care-led NHS (National Health Service)' need to address the cultural and political factors which respondents identified as barriers to primary care development.

Attitude of Health Personnel↗
PubMed1995

Expression of immediate early genes in rat gastric myenteric neurones: a physiological response to feeding.

1. Expression of the immediate early genes c-fos, c-jun and c-myc in rat stomach in response to feeding and gastric distension was examined by Northern blot analysis and in situ hybridization. 2. Refeeding of fasted rats induced a transient increase in c-fos mRNA abundance in gastric corpus and antrum that was sixfold within 15 min and declined within 4 h. The response was not mediated by gastrinergic or muscarinic cholinergic mechanisms; it was reduced but not abolished by hexamethonium. No changes in expression of c-jun, c-myc or the constitutively expressed protein glyceraldehyde-3-phosphate dehydrogenase (GAPDH) were observed. 3. In conscious rats prepared with a gastric fistula, gastric distension with nutritive and non-nutritive solutions at a physiological pressure for 30 min induced expression of c-fos, c-jun and c-myc, but not GAPDH. 4. Messenger RNA encoding c-fos was localized by in situ hybridization to gastric myenteric neurones of animals that underwent gastric distension, but not of undistended controls. 5. The results suggest that expression of c-fos in gastric myenteric neurones is an early response to the physiological stretching of the stomach wall that accompanies feeding. With supraphysiological distension, other immediate early genes may be recruited.

Animals↗
PubMed1995

Desirable characteristics of a schistosomiasis vaccine: some implications of a cost-effectiveness analysis.

This paper investigates some of the characteristics which a vaccine for schistosomiasis would require to be more cost-effective than chemotherapy. The impact of a variety of possible vaccination scenarios are assessed in terms of the discounted years of heavy infection prevented in children, and the cost-effectiveness of these approaches are compared with annual mass treatment. The analyses demonstrate that the three critical parameters determining whether a vaccine would ever be more cost-effective than mass chemotherapy are price, duration of protection and efficacy. If the vaccine had sufficient duration of protection to be delivered through the regular childhood immunization programmes (EPI), it could be more cost-effective than annual chemotherapy. The necessary condition is that adding the vaccine to EPI must not cost more than $4.30 per person in excess of one round of chemotherapy. For a shorter duration of vaccine protection, the schistosomiasis vaccine could not exceed the cost (including delivery costs) of one round of annual chemotherapy by more than approximately $3.50.

Adolescent↗
PubMed1995

The effects of recombinant human hemoglobin on esophageal motor functions in humans.

BACKGROUND & AIMS: Nitric oxide controls lower esophageal sphincter (LES) relaxation and esophageal peristalsis in opossums, but its role in the control of esophageal motility in humans is not defined. Hemoglobin inactivates NO by binding it. Recombinant human hemoglobin (rHb1.1) was used to test the hypothesis that NO mediates esophageal motor functions in humans. METHODS: rHb1.1 or human serum albumin was administered intravenously to fasting male volunteers. Esophageal manometric studies were performed before, during, and up to 6 hours after the infusion. RESULTS: rHb1.1 increased the velocities of peristaltic contractions to produce simultaneous contractions in 6 of 9 subjects. It increased the amplitude and duration of contractile waves in the esophagus. There was no consistent effect on the resting tone of the LES, but LES relaxation was inhibited. Spontaneous, simultaneous high-pressure contractions occurred in 8 of 9 subjects. Lower retrosternal chest pain during swallowing was observed in 4 subjects. CONCLUSIONS: rHb1.1 interfered with esophageal peristalsis and LES relaxation. It precipitated esophageal spasm in some subjects. These data support the hypothesis that the timing of smooth muscle esophageal peristalsis and LES relaxation are mediated by NO. They suggest that some disorders of esophageal motor function may result from defects in NO neuromuscular communication.

Adult↗
PubMed1995

RET proto-oncogene mutations in multiple endocrine neoplasia type 2 and medullary thyroid carcinoma.

The identification of RET proto-oncogene mutations in patients with MEN2 2 years ago was a watershed event in the management of this genetic cancer syndrome. The identification of a finite number of mutations that together causes more than 95% of hereditary and 15-25% of sporadic MTC has made it possible to develop simple and definitive tests to screen individuals at risk for this tumour syndrome. The impact of this technology is enormous. It is now possible to reassure 50% of family members at risk that they, and their children, do not have to worry about developing MTC. In the other 50% who are gene carriers, it is now possible to approach clinical management with greater certainty and plot strategies that are likely to result in a greater percentage of curative therapy. It seems likely that this technology will also have an impact on the management of sporadic MTC, although it is still too early to define a specific role for mutational analysis in these patients, except to exclude hereditary disease. The identification of specific mutations causative for MTC makes it possible to conceive future strategies for the treatment or prevention of MTC and to further extend the impact of these exciting findings.

Carcinoma, Medullary↗
PubMed1995

Brain death: the family in crisis.

Brain death has created a new class of dead people that does not conform to society's expectations of normal death and dying. Brain death also causes intense emotions and great stress for the family and friends of the person concerned. Nurses play a major role in helping the family through this distressing time by maintaining high standards of nursing care. Major components of this care include effective communication and caring that supports the family. While these families have a variety of special needs, it is the nurses' constant bedside presence that provides many opportunities to have a positive influence on family members' ability to cope with the tragedy and begin the healing process.

Adaptation, Psychological↗
PubMed1995

Differentiation between human and animal strains of Cryptosporidium parvum using isoenzyme typing.

Isoenzyme typing was used to study a number of oocyst isolates of Cryptosporidium parvum from different geographical locations and of human or animal origin. All isolates showed identical enzyme motility when glucose phosphate isomerase (GPI; 23 isolates tested) or lactate dehydrogenases (LDH; 20 isolates tested) was assayed. However, two isoenzyme forms were observed with phosphoglucomutase (PGM; 9 animal isolates showed one form, while 8/9 human isolates showed a second form) and hexokinase (HK; 4 human isolates showed one form and 6 animal isolates showed a second form). Thus, PGM and HK each exhibit 2 isoenzymes corresponding to 2 parasite populations associated with separate hosts. The data from this study, plus supportive evidence obtained by different methods and by independent researchers, lend support to the hypothesis that separate cycles of transmission of C. parvum may exist within human and animal hosts.

Animals↗
PubMed1995

Phase I study of accelerated FEC with granulocyte colony-stimulating factor (Lenograstim) support.

With the aim of increasing the dose intensity of chemotherapy in breast cancer, 14 patients with stage II-IV breast cancer were treated with FEC chemotherapy at 2 week intervals together with granulocyte colony-stimulating factor (G-CSF) 5 micrograms kg-1 s.c. on days 2-14. Five of six patients completed six courses of 5-fluorouracil 600 mg m-2, epirubicin 60 mg m-2 and cylcophosphamide 600 mg m-2 within 11 weeks. Eight patients were treated with 5-fluorouracil 700 mg m-2, epirubicin 70 mg m-2 and cyclophosphamide 700 mg m-2 and four had dose-limiting toxicity with sepsis, thrombocytopenia or mucositis. All patients who received G-CSF had satisfactory neutrophil counts by day 15 of each course. Cumulative anaemia and thrombocytopenia were observed, but treatment at the first dose was tolerable. Seven of eight patients with measurable disease had partial responses. This regimen permits a 50% increase in dose intensity compared with conventional treatment at 3 week intervals and warrants further evaluation.

Adolescent↗
PubMed1995

A set of polymorphic DNA microsatellites useful in swamp and river buffalo (Bubalus bubalis).

DNA microsatellites have found widespread application in gene mapping, pedigree determination and population genetics. In closely related species such as bovids, heterologous polymerase chain reaction (PCR) primers may in some cases be used, bypassing the need to isolate and characterize microsatellite-containing sequences and design PCR primers. We report on the ability of a set of eighty bovine derived DNA microsatellite primers to amplify sequences in the two types (swamp and river) of water buffalo (Bubalus bubalis). Number of alleles and per cent heterozygosities in a large number of animals were determined on a subset of microsatellite loci selected on the robustness of the primers. These loci will form the basis of a set of polymorphic DNA markers for use in water buffalo.

Alleles↗
PubMed1995

Difficulty with holding urine among older persons in a geographically defined community: prevalence and correlates.

OBJECTIVE: The goal of this study was to estimate the prevalence and correlates of difficulty holding urine among a population of community-dwelling older people. DESIGN: Population-based cross-sectional study. SUBJECTS: A population census identified all residents aged 65 years and older residing in East Boston, Massachusetts, in 1982. MEASURES: Data collected via in-home interviews were used to estimate the prevalence of difficulty holding urine and to provide information regarding potential correlates of urinary difficulty. RESULTS: Of the 3809 study participants (85% response rate), 28% reported having "difficulty holding urine until they can get to a toilet" at least some of the time, and 8% reported difficulty "most" or "all of the time." Difficulty was associated with age and sex; 44% of women and 34% of men reported some difficulty (P < .001), and 9% of women and 6% of men (P < .001) reported difficulty most or all of the time. For respondents aged 65 to 74 years, 40% reported some difficulty, compared with 47% of those aged 85 and older (Ptrend < .001); difficulty most or all of the time was reported by 6% of those aged 65 to 74 and 12% of those aged 85 and older (Ptrend < .001). Difficulty holding urine was associated with important health and functional measures including depression, stroke, chronic cough, night awakening, fecal incontinence, problems with activities of daily living, decreased frequency and ease in getting out of the house, and poor self-perception of health. CONCLUSIONS: Difficulty holding urine is a prevalent condition among older people living in the community and is associated highly with a number of health conditions and functional problems.

Aged↗