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Biomedical subjects

D Hughes

Publications and source records attributed to D Hughes.

At least 109 records · Page 6Linked to original sources
PubMed1998

Community health monitoring: taking the pulse of America's children.

OBJECTIVE: To describe the development, content, enablers/barriers, and impact of child health reports in nine communities participating in the Robert Wood Johnson Foundation funded Child Health Initiative (1991-1996). METHODS: A qualitative, prospective, multiyear, longitudinal evaluation using a multiple case-study methodology. Three waves of structured in-person and telephone interviews of the project staff, community leaders, and key participants tracked the development of child health reports in all nine communities. A mailed survey of project directors was administered to assess accomplishments at the completion of the project. Content analysis of each community health report was conducted using different conceptual frameworks for health measurement and reporting. RESULTS: All communities succeeded in creating a report that contained a broad set of outcome indicators reflecting children's health and well-being. The process of creating these reports, their content, level of analysis, presentation formats, and dissemination varied across sites based on available resources, data and analysis capacity, and other political considerations. While commonly accepted outcome measures were used in most reports (e.g., infant mortality, teen births, immunization rates), process indicators, important for quality monitoring and community health improvement, were notably lacking. In each community the reports were credited with providing a more comprehensive and integrated view of the health needs of children. CONCLUSIONS: Additional conceptual and technical work is needed to improve the ability of community health reports to capture key indicators of interest. Community reports can serve an important role in building the consensus needed to create program and policy changes. Community reports may have additional utility in monitoring the impact of health systems change on population health. Community reports can also facilitate a shared learning process for the participants and the community, and can be a useful tool to advance a children's health policy agenda.

Child↗
PubMed1998

Comparison of the traditional paper visual analogue scale questionnaire with an Apple Newton electronic appetite rating system (EARS) in free living subjects feeding ad libitum.

OBJECTIVE: Assessing the value of a newly developed electronic visual analogue scale questionnaire (Apple Newton Message Pad) with the traditional paper method for appetite rating. DESIGN: In a random, crossover design, subjects completed both electronic and paper questionnaires to compare results obtained by the two methods; individual methods were completed consecutively to assess test-retest reliability; preference was established using a questionnaire. SETTING/SUBJECTS: Healthy, free-living adults were studied for comparison of methods (n = 12), test-retest reliability (n = 8) and preference (n = 13). INTERVENTION: Visual analogue scales were completed each waking hour to assess appetite. Preference was assessed after both methods were completed. RESULTS: There was no significant difference in the hourly results obtained by the paper and electronic methods for 'desire to eat', 'how much can you eat now', 'urge to eat' and 'preoccupation with thoughts of food'. Small differences in 'hunger' and 'fullness' ratings were noted (approximately 5% mean difference between methods, P < 0.05), but patterns of change and sensitivity for these and all other parameters remained similar for both methods across the visual analogue scale. Test-retest reliability demonstrated was similar for both methods. Seven (54%) subjects preferred to use the paper questionnaire, five (38%) the electronic method and one (8%) had no preference. CONCLUSIONS: The electronic Apple Newton questionnaire is as sensitive and reliable as the paper method, has the advantage that it automatically records the time of data acquisition and data collection and processing are more efficient for the researcher. The two methods should not be used interchangeably.

Adult↗
PubMed1998

The direct costs to the NHS of discontinuing and switching prescriptions for hypertension.

There is much evidence to suggest that the treatment of hypertension reduces the risk of cardiovascular diseases and that it is cost-effective in most patients. However, the effectiveness of treatment relies on compliance and maintenance of treatment. Each pharmacological agent differs in terms of side effects. The existence of side effects can result in poor compliance and switching between treatments. A number of studies have reported high discontinuation rates for anti-hypertensive therapies. This potentially imposes costs on the health service. The aim of this study is to use the MEDIPLUS data set to consider the cost arising from switching and discontinuation of therapy. The analysis will assess the resource costs in terms of extra GP visits and hospitalisations arising from individuals switching and discontinuing treatments. The total costs of hypertension were estimated to be around 76.5 m pound sterling per annum, of which 26.9 m pound sterling can be attributed to patients who switch or discontinue therapy.

Adult↗
PubMed1998

Evaluation of remifentanil for control of haemodynamic response to tracheal intubation.

We have studied the effect of three bolus doses of remifentanil on the haemodynamic response to laryngoscopy and tracheal intubation. Using a double-blind design, 80 ASA 1 or 2 patients presenting for elective surgery received saline placebo or remifentanil 0.25, 0.5 or 1.0 microgram.kg-1 by random allocation. Anaesthesia was induced with thiopentone 5-7 mg.kg-1 and followed immediately by the study medication given as a bolus over 30s. Muscle relaxation was provided with rocuronium 0.75 mg.kg-1. The patients' tracheas were intubated under direct laryngoscopy 1 min later. Noninvasive arterial blood pressure and heart rate were recorded immediately before induction of anaesthesia and then at intervals until 5 min after tracheal intubation. There was a significant increase in heart rate (p < 0.01) and systolic arterial pressure (p < 0.01) in all groups after tracheal intubation. However, this was short-lived and of a smaller magnitude in the remifentanil 1 microgram.kg-1 group in which the increase was significantly lower than in the control group (p < 0.01).

Adolescent↗
PubMed1998

Using bioscience knowledge in nursing: actions, interactions and reactions.

This paper draws on empirical data from a study undertaken to explore the outcomes of the applied physiology component of a post-registration diploma in nursing (DN). Most students completing the DN were utilizing their new bioscience knowledge in clinical practice, and reported increased participation in interprofessional discussions and team decisions. Respondents found themselves better able to monitor and evaluate doctors' decisions and this led to friction with some medical colleagues. However, the strongest resistance came from senior nurses, very few of whom had completed advanced nursing courses in bioscience and who were generally unwilling to allow respondents to develop new roles. General managers were also perceived as a major barrier to change. There is little evidence of tangible benefits to the nurses themselves: most saw the DN qualification as a way of protecting their status as professional nurses in the face of managerially driven organizational change, rather than as a route to occupational advancement.

Adult↗
PubMed1998

Fire.

Explore the source record for details and available documents.

Disaster Planning↗
PubMed1997

Concentration of ionized calcium in plasma from cats with urethral obstruction.

OBJECTIVE: To measure ionized calcium concentration in plasma from cats with urethral obstruction and to correlate these values with results of clinical biochemical analyses and physical examinations. DESIGN: Prospective study. ANIMALS: 24 male cats. PROCEDURE: Blood samples were obtained from each cat on admission, and PCV, pH, and concentrations of ionized calcium, total calcium, glucose, total solids, sodium, potassium, BUN, creatinine, chloride, magnesium, albumin, and phosphorus were determined. Mentation, tissue perfusion, and ECG recordings were also assessed. RESULTS: 18 (75%) cats had low ionized calcium concentrations (reference range, 2.4 to 2.8 mEq/L). Hypocalcemia was considered mild (2.0 to 2.36 mEq/L) in 9 (37.5%) cats, moderate (1.6 to 1.98 mEq/L) in 6 (25%), and severe (< 1.6 mEq/L) in 3 (12.5%). Significant positive correlations were found between ionized calcium concentration and heart rate, pH, and concentrations of sodium, chloride, and total calcium. Significant negative correlations were found between ionized calcium concentration and concentrations of potassium, BUN, creatinine, and phosphorus. CLINICAL IMPLICATIONS: Most cats with urethral obstruction had a low concentration of ionized calcium. This may contribute to cardiac electrical and mechanical dysfunction in some severely affected cats. Although effects of i.v. administration of calcium were not evaluated, results of this study strengthen the rationale for its use in cats with urethral obstruction.

Animals↗
PubMed1997

The macrophage scavenger receptor type A is expressed by activated macrophages and protects the host against lethal endotoxic shock.

During gram-negative bacterial infections, lipopolysaccharide (LPS) stimulates primed macrophages (Mphi) to release inflammatory mediators such as tumor necrosis factor (TNF)-alpha, which can cause hypotension, organ failure, and often death. Several different receptors on Mphi have been shown to bind LPS, including the type A scavenger receptor (SR-A). This receptor is able to bind a broad range of polyanionic ligands such as modified lipoproteins and lipoteichoic acid of gram-positive bacteria, which suggests that SR-A plays a role in host defense. In this study, we used mice lacking the SR-A (SRKO) to investigate the role of SR-A in acquired immunity using a viable bacillus Calmette Guérin (BCG) infection model. We show that activated Mphi express SR-A and that this molecule is functional in assays of adhesion and endocytic uptake. After BCG infection, SRKO mice are able to recruit Mphi to sites of granuloma formation where they become activated and restrict BCG replication. However, infected mice lacking the SR-A are more susceptible to endotoxic shock and produce more TNF-alpha and interleukin-6 in response to LPS. In addition, we show that an antibody which blocks TNF-alpha activity reduces LPS-induced mortality in these mice. Thus SR-A, expressed by activated Mphi, plays a protective role in host defense by scavenging LPS as well as by reducing the release by activated Mphi of proinflammatory cytokines. Modulation of SR-A may provide a novel therapeutic approach to control endotoxic shock.

Animals↗
PubMed1997

Explaining oropharyngeal dysphagia after unilateral hemispheric stroke.

BACKGROUND: Oropharyngeal dysphagia occurs in up to a third of patients presenting with a unilateral hemiplegic stroke, yet its neurophysiological basis remains unknown. To explore the relation between cortical motor function of swallowing and oropharyngeal dysphagia, mylohyoid, pharyngeal, and thenar electromyographic responses to stimulation of affected and unaffected hemispheres were recorded in dysphagic and non-dysphagic patients. METHODS: The 20 patients studied had unilateral hemispheric stroke confirmed by computed tomography. Eight of them had associated swallowing difficulties. Electromyographic responses were recorded after suprathreshold transcranial magneto-electric stimulation of affected and unaffected hemispheres with a figure-of-eight coil. FINDINGS: Stimulation of the unaffected hemisphere evoked smaller pharyngeal responses in dysphagic patients than in non-dysphagic patients (mean 64 microV, median 48, interquartile range 44-86 vs 118 microV, 81, 73-150) (p < 0.02). With stimulation of the affected hemisphere, the pharyngeal responses were smaller than for the unaffected hemisphere but similar between the two patient groups (26 microV, 0, 0-48 vs 54 microV, 0, 0-80). Dysphagic and non-dysphagic patients showed similar mylohyoid and thenar responses to stimulation of the unaffected hemisphere as well as to stimulation of the affected hemisphere-unaffected mylohyoid (269 microV, 239, 89-372 vs 239 microV, 163, 133-307), thenar (572 microV, 463, 175-638 vs 638 microV, 485, 381-764); affected mylohyoid (60 microV, 41, 0-129 vs 96 microV, 0, 0-195); thenar (259 microV, 258, 0-538 vs 451 microV, 206, 8-717). INTERPRETATION: The findings indicate that dysphagia after unilateral hemispheric stroke is related to the magnitude of pharyngeal motor representation in the unaffected hemisphere.

Adult↗
PubMed1997

Does the term carcinogen send the wrong message?

The term carcinogen has been used by scientists and health regulatory officials for decades. During the last 20 years there have been attempts to redefine the term to make it more rigorous. But, as predicted two decades ago by a benchmark-setting subcommittee of the National Cancer Advisory Board, advances in scientific understanding have brought about dramatic changes in the way we are able to view the term carcinogen. These changes, their scientific bases and their effect on defining the term carcinogen are described. An alternative to the use of the term carcinogen is suggested by the recently proposed US Environmental Agency's guidelines for cancer risk assessment which appear to be in accord with current scientific understanding and the importance of considering the factors affecting the term carcinogen. The guidelines set forth four questions, the answers to which could, in our judgment, replace the need to define or use the term carcinogen which, in light of new scientific knowledge, has become more misleading than useful.

Animals↗
PubMed1997

Prevention of normally occurring and deafferentation-induced neuronal death in chick brainstem auditory neurons by periodic blockade of AMPA/kainate receptors.

The role of glutamate receptors in regulating programmed neuronal death and deafferentation-induced neuronal death in the brainstem auditory nuclei was studied by in ovo drug administration to chick embryos. The nucleus laminaris (NL) undergoes programmed developmental cell death of 19% between embryonic day 9 (E9) and E17. The AMPA/kainate receptor antagonist CNQX, when administered at doses of 200-300 microg/d from E8 to E15, prevented programmed neuronal death in NL through at least posthatching day 8, without producing anatomical or behavioral abnormalities. 3-((RS)-2-Carboxypiperazin-4-yl)-propyl-1-phos-phonic acid, an antagonist of NMDA receptors, had no effect on normal cell death in the NL. CNQX, given from E8 to E15 or only from E8 to E10, also blocked the 33% neuronal loss in the nucleus magnocellularis (NM) that follows surgical destruction of the otocyst on E3, a procedure that deafferents NM neurons by preventing formation of the cochlear nerve. Treatment either with CNQX or the more highly selective NBQX from E8 to E10, before the onset of synaptic transmission in NM and NL, was also effective in preventing normal neuronal death in NL. Analysis of the effects of CNQX or NBQX on spontaneous embryonic motility at E10 showed that the doses effective in preventing neuronal death suppressed motility for <8 hr. We conclude that periodic blockade of AMPA/kainate receptors can protect CNS neurons against subsequent programmed cell death or deafferentation-induced death.

6-Cyano-7-nitroquinoxaline-2,3-dione↗
PubMed1997

Patterns of graft infiltration and cytokine gene expression during the first 10 days of kidney transplantation.

Understanding of the events preceding acute cellular rejection of kidney transplants would be useful in the development of immunosuppressive strategies to prevent rejection. Information about these events in humans has been scarce, because of the lack of early, serial, biopsy samples. We took daily fine needle aspirates from kidney allografts for the first 10 days after transplant. Samples were analyzed by morphological cytology of graft-infiltrating cells, and reverse transcriptase-polymerase chain reaction for detection of interleukin (IL)-2, IL-4, IL-6, IL-10, and gamma-interferon gene expression. During the first 4 days, all of the grafts developed a low-grade monocyte-rich mononuclear cell infiltrate, accompanied by IL-10 gene expression. Thereafter, the infiltrates either remained stable or intensified. Of the 13 grafts with dense infiltrates, seven developed graft dysfunction. The remaining six did not, despite significant interstitial infiltrates. Both rejecting and nonrejecting dense infiltrates were associated with a biphasic pattern of IL-2 and gamma-interferon gene expression, preceding and accompanying lymphocytic graft infiltration. Grafts that did not develop dense infiltrates had no detectable IL-2 or gamma-interferon gene expression and did not suffer cellular rejection during the study period. The development of both rejecting and nonrejecting infiltrates was strongly associated with DR mismatches between donor and recipient. IL-2 and gamma-interferon gene expression are necessary, but not sufficient, for the development of acute cellular rejection in the first 10 days of kidney transplantation, and are more closely associated with the period leading up to rejection than with the period of graft dysfunction.

Acute Disease↗
PubMed1997

"Ruling in" and "ruling out": two approaches to the micro-rationing of health care.

Much of the implicit rationing said to characterise British health care occurs as doctors decide what resources to allocate to individual patients. This paper examines this process using data from case studies of selection of patients for cardiac surgery and admission to a specialist neurological rehabilitation centre. The analysis focuses on cardiac catheterisation conferences in which cardiologists present surgical candidates to a cardiac surgeon, and neuro-rehabilitation admissions conferences in which a multidisciplinary team assess the suitability of head injury and stroke patients referred by hospital doctors. For much of the time participants in both settings discuss patients within a clinical discourse that relies on technical assessments of coronary anatomy, ADL scores and the like. However, there are many examples where the discourse "frame" shifts to address patient characteristics of a social or moral nature. Information of this kind tends to be deployed in two ways: it can be used to signal the patient's unsuitability, usually on the basis that past behaviour implies poor prognosis ("ruling out"), or it can be used to suggest that a patient is especially deserving of help ("ruling in"). Analysis of the data suggests that "ruling out" is more salient within the cardiac catheterisation conferences, and "ruling in" within the neuro-rehabilitation admissions conferences. The authors suggest that this reflects differences in the work organisation of the two specialties, including the division of labour, the organisation of waiting lists as a queue or a pool, and the putative significance of patient agency in the genesis of disease and recovery.

Adult↗
PubMed1997

African American women in the workplace: relationships between job conditions, racial bias at work, and perceived job quality.

Although studies have described work processes among employed African American women, few have examined the influence of these processes on job outcomes. This study examined relationships between African American women's exposure to a range of occupational stressors, including two types of racial bias--institutional discrimination and interpersonal prejudice--and their evaluations of job quality. Findings indicated that institutional discrimination and interpersonal prejudice were more important predictors of job quality among these women than were other occupational stressors such as low task variety and decision authority, heavy workloads, and poor supervision. Racial bias in the workplace was most likely to be reported by workers in predominantly white work settings. In addition, Black women who worked in service, semiskilled, and unskilled occupations reported significantly more institutional discrimination, but not more interpersonal prejudice, than did women in professional, managerial, and technical occupations or those in sales and clerical occupations.

Adult↗
PubMed1997

A review of the economic analysis of obesity.

There are indications that the treatment costs arising from obesity are significant. However, the cost-of-illness studies undertaken to data also highlight two other important points. First, the cost of treatment in sensitive to the body mass index (BMI) cut-off used. Given that there is no definitive definition of obesity as based on BMI, a range of costs reflecting differing BMI cut-offs may be more appropriate than the use of a single figure. Second, the costs are, not surprisingly, also sensitive to the defined associated diseases. Again there is little agreement on these and also little information on the relative risks of attributable diseases arising from obesity. The calculations of the cost-of-illness arising from the treatment of obesity, and its associated conditions must, therefore, remain indicative rather than authoritative.

Cost Control↗
PubMed1997

Cost-effectiveness of different ACE inhibitor treatment scenarios post-myocardial infarction.

AIMS: To assess the cost-effectiveness of three different treatment strategies for the use of ACE inhibitors after myocardial infarction. These were (a) a high risk (AIRE type) strategy, (b) an intermediate risk (SAVE type) strategy, and (c) initial, short-term treatment of all patients followed by long-term treatment according to (a) or (b). METHODS AND RESULTS: Incremental costs per life year gained were calculated for each of the above scenarios. The most optimistic cost per life year gained over 10 years, for (a) was L1752 and for (b) was L2962. Strategy (c) increased the cost per life year gained of (a) to L2017 and (b) to L3110. The incremental cost-effectiveness ratio was found to be very sensitive to drug cost. CONCLUSIONS: If a low cost ACE inhibitor is used, initial treatment of relatively unselected patients followed by long-term treatment of those at high and medium risk maximizes benefit at an acceptable cost. Use of an ACE inhibitor after myocardial infarction is very cost-effective by comparison with many other treatments.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1997

Late-onset preemptive analgesia associated with preincisional large-dose alfentanil.

UNLABELLED: Few studies using systemic opioids have been adequately designed to demonstrate a preemptive effect. We investigated the preemptive effect of intraoperative large-dose intravenous (I.V.) opioids over a 72-h period after lower abdominal surgery. Thirty-eight ASA physical status I or II patients undergoing abdominal hysterectomy were studied in a prospective, randomized, double-blind design. Group PRE received alfentanil 70 microg/kg over 10 min before surgical incision; Group POST received alfentanil 70 microg/kg over 10 min after incision. Patients received no other intraoperative opioid. Pain was treated in the recovery room with 2-mg I.V. boluses of morphine and was subsequently managed via patient-controlled analgesia (PCA) using morphine sulfate. Visual analog scale pain scores at rest (VAS-R) and on movement (VAS-M) and PCA morphine consumption were recorded for 72 hours. VAS-M and VAS-R scores did not differ at any point, and morphine consumption was similar in both groups over the initial 48 h. Group PRE used significantly less morphine from 48 to 72 h postoperatively (P < 0.02). We conclude that presurgical incisional (i.e., compared with postincisional) large-dose opioid exposure results in a modest, late decrease in postoperative morphine consumption, with no clinical impact on early postoperative pain. Timing of the observed reduction coincides with maximal output of substances implicated in experimental hyperalgesia. IMPLICATIONS: When given before surgical incision, alfentanil, a short-acting narcotic, was associated with a reduction in morphine requirements 48-72 h after surgery. Brief interventions may have a delayed and sustained impact on pain perception, possibly by reducing mechanisms of sensitization.

Adult↗