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Biomedical subjects

D King

Publications and source records attributed to D King.

At least 73 records · Page 4Linked to original sources
PubMed2000

Method choice, intent, and gender in completed suicide.

Women who commit suicide use less violent methods, such as drugs and carbon monoxide poisoning, than do men, who more often use violent methods such as guns and hanging. Theories that attempt to explain this finding focus on gender differences in suicidal intent, socialization, emotions, interpersonal relationships, orientation and access to methods, and neurobiological factors. Data from a psychological autopsy study were used to test the theory that women who commit suicide use less violent means because they are less intent on dying. Although women were significantly less likely to use a violent method than men, there was no difference in the lethality of their suicidal intent.

Adult↗
PubMed1999

Meta-analysis of benzodiazepine use in the treatment of acute alcohol withdrawal.

OBJECTIVE: To analyse the evidence for the efficacy and potential harmful effects of benzodiazepines compared with other therapies in the treatment of acute alcohol withdrawal. DATA SOURCES: MEDLINE and the Cochrane Controlled Trials Registry were searched for English-language articles published from 1966 to December 1997 that described randomized controlled trials (RCTs) of benzodiazepines in the treatment of acute alcohol withdrawal. Key words included "benzodiazepines" (exploded) and "randomized controlled trial." Bibliographies of relevant articles were reviewed for additional RCTs, and manufacturers of benzodiazepines were asked to submit additional RCT reports not in the literature. STUDY SELECTION: Articles were considered for the meta-analysis if they were RCTs involving patients experiencing acute alcohol withdrawal and comparing a benzodiazepine available in Canada with placebo or an active control drug. Of the original 23 trials identified, 11 met these criteria, representing a total of 1286 patients. DATA EXTRACTION: Data were extracted regarding the participants, the setting, details of the intervention, the outcomes (including adverse effects) and the methodologic quality of the studies. DATA SYNTHESIS: The meta-analysis of benefit (therapeutic success within 2 days) showed that benzodiazepines were superior to placebo (common odds ratio [OR] 3.28, 95% confidence interval [CI] 1.30-8.28). Data on comparisons between benzodiazepines and other drugs, including beta-blockers, carbamazepine and clonidine, could not be pooled, but none of the alternative drugs was found to be clearly more beneficial than the benzodiazepines. The meta-analysis of harm revealed no significant difference between benzodiazepines and alternative drugs in terms of adverse events (common OR 0.67, 95% CI 0.34-1.32) or dropout rates (common OR 0.68, 95% CI 0.47-0.97). INTERPRETATION: Benzodiazepines should remain the drugs of choice for the treatment of acute alcohol withdrawal.

Acute Disease↗
PubMed1999

Diagnosis and management of acute alcohol withdrawal.

Alcohol abuse produces a considerable burden of illness in the Canadian population. The diagnosis of alcohol dependence and withdrawal can be difficult, particularly in the setting of covert intake or comorbidity. Two validated scales, the CAGE questionnaire to screen for alcohol abuse and dependence and the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scale to assess the severity of withdrawal, are valuable tools for clinicians to use on a regular basis. For the treatment of alcohol withdrawal, compelling anecdotal evidence supports the routine administration of thiamine, but not necessarily other vitamins. Phenytoin has not been shown to be superior to placebo for uncomplicated withdrawal seizures. Neuroleptics are not recommended for routine use. Sedation with benzodiazepines guided by the CIWA-Ar results is recommended. There is good evidence that the management of alcohol withdrawal can be improved with the routine use of the CIWA-Ar scale to assess severity, treatment with adequate doses of benzodiazepines and follow-up monitoring of patients in alcohol withdrawal.

Acute Disease↗
PubMed1999

Human growth hormone transgene expression increases the biomechanical structural properties of mouse vertebrae.

STUDY DESIGN: Caudal vertebrae were obtained from male and female mice from two transgenic lines expressing an erythroid-specific human growth hormone transgene construct, and gender-matched, age-matched, non-transgenic control mice. OBJECTIVE: To characterize the effect of human growth hormone transgene expression on the biomechanical structural properties of caudal vertebrae in compression. SUMMARY OF BACKGROUND DATA: An increase in trabecular and cortical bone deposition caused by erythroid-specific human growth hormone transgene expression was demonstrated previously. METHODS: Compression tests were performed on individual caudal vertebrae (Ca4, Ca5, Ca6) obtained from male and female mice from two transgenic lines (TG420 and TG450) and nontransgenic control mice. Two age groups were evaluated: 12 weeks old and 6 months old. The data were used to obtain axial stiffness, maximum load, and energy to failure. RESULTS: Vertebrae from male TG420 transgenic mice produced significantly larger values for maximum load, energy to failure, and axial stiffness at both 12 weeks and 6 months in comparison with their age-matched non-transgenic male controls. Vertebrae from female TG420 transgenic mice produced similar responses at 6 months. Vertebrae from male TG450 transgenic mice showed significant increases in maximum load and energy to failure at 6 months. In general, the biomechanical properties of vertebrae were significantly larger in the 6-month age group than in the 12-week age group, and this increase was significantly greater in the transgenic mice than in the gender-matched control mice during the same time span. This process was also influenced by transgenic genotype and gender. CONCLUSIONS: Erythroid-specific production of human growth hormone in transgenic mice resulted in significant increases in biomechanical properties of their caudal vertebrae in compression. The changes in the biomechanical properties were influenced by genotype, age, and gender.

Aging↗
PubMed1999

Novel size-independent modeling of the dilute solution conformation of the immunoglobulin IgG Fab' domain using SOLPRO and ELLIPS.

The proliferation of hydrodynamic modeling strategies to represent the shape of quasirigid macromolecules in solution has been hampered by ambiguities caused by size. Universal shape parameters, independent of size, developed originally for ellipsoid modeling, are now available for modeling using the bead-shell approximation via the algorithm SOLPRO. This paper validates such a "size-independent" bead-shell approach by comparison with the exact hydrodynamics of 1) an ellipsoid of revolution and 2) a general triaxial ellipsoid (semiaxial ratios a/b, b/c) based on a fit using the routine ELLIPSE (. J. Mol. Graph. 1:30-38) to the chimeric (human/mouse) IgG Fab' B72.3; a similar fit is obtained for other Fabs. Size-independent application of the bead-shell approximation yields errors of only approximately 1% in frictional ratio based shape functions and approximately 3% in the radius of gyration. With the viscosity increment, errors have been reduced to approximately 3%, representing a significant improvement on earlier procedures. Combination of the Perrin frictional ratio function with the experimentally measured sedimentation coefficient for the same Fab' from B72.3 yields an estimate for the molecular hydration of the Fab' fragment of approximately (0.43 +/- 0.07) g/g. This value is compared to values obtained in a similar way for deoxyhemoglobin (0.44) and ribonuclease (0.27). The application of SOLPRO to the shape analysis of more complex macromolecules is indicated, and we encourage such size-independent strategies. The utility of modern sedimentation data analysis software such as SVEDBERG, DCDT, LAMM, and MSTAR is also clearly demonstrated.

Algorithms↗
PubMed1999

An 'inherent' biodegradability test for oil products: description and results of an international ring test. CONCAWE Biodegradation Task Force.

Current test guidelines for assessing 'inherent' (potential) biodegradability were designed for water-soluble, organic compounds of low volatility and are unsuitable for most oil products. It was against this background, that CONCAWE (the oil companies' European organisation for environment, health and safety) formed a task force to develop a standard test protocol for assessing the 'inherent' biodegradability of oil products.

Biodegradation, Environmental↗
PubMed1999

Citizens and rationing: analysis of a European survey.

While many studies have reviewed the issues involved in rationing and priority setting within health care services, few studies have comprehensively analysed the views and attitudes of a significant stakeholder in the debate - the public. The aims of this paper are to discuss the issues involved in involving the public in rationing and priority setting decision-making; and to analyse data pertaining to citizen's attitudes towards rationing and priority setting. The data analysed were taken from the 1998 Eurobarometer Survey, with specific questions pertaining to rationing and priority setting asked in six countries within the European Union: Germany; France; Italy; the Netherlands; Britain and Sweden. The review of previous studies and the analysis of the Eurobarometer data, focus on issues relating to funding for health care; the need to set limits in health coverage; the role of stakeholders in setting priorities; and the use of age, and other factors, as a criteria for setting priorities.

Decision Making↗
PubMed1999

Public opinion and rationing in the United Kingdom.

In the United Kingdom and as in all other countries, health care professionals ration access to diagnosis and treatment. Throughout its history there has been a reluctance to acknowledge the existence, let alone the nature of rationing processes and public opinion about them. Several health policy reforms are discussed with reference to their approach to dealing with the scarcity of health care resources. Data taken form the 1998 Eurobarometer Survey are analysed to examine public opinion regarding rationing issues, such as funding for health care, the need to set limits in health coverage, the role of stakeholders in setting priorities, and the use of age, and other factors, as a criteria for setting priorities.

Health Care Rationing↗
PubMed1999

Metabolism in single rat brain slices measured by magnetic resonance spectroscopy.

Nuclear magnetic resonance spectroscopy (MRS) has been used to study brain biochemistry in superfused brain slice preparations for over a decade. However, unlike techniques that monitor electrical activity, ion fluxes, or the release of radio-labeled compounds in single brain slices, MRS studies have required samples composed of several slices and inherently poor anatomical specificity in order to achieve adequate signal-to-noise levels, spectral resolution, or, in the case of 1H MRS, a high degree of artifact-free water signal suppression. We report that gradient-enhanced 1H MRS techniques combined with a simple slice positioning and perfusion technique yield high-quality spectra from single 400 microns rat forebrain or neocortical-hippocampal slices within 15 min of data acquisition time. Spectra of comparable quality were obtained from samples with three neocortical or three hippocampal slices within the same time frame. The assessment of anaerobic energy metabolism in single slices by 1H MRS is also demonstrated. In addition to greater anatomical resolution in studies on brain slice biochemistry, single slice MRS also presents the possibility of correlating, within the same slice, 1H MRS-detectable metabolite levels with other physiological measurements commonly performed on single brain slices.

Adenosine Triphosphate↗
PubMed1999

Effect of the framing of questionnaire items regarding satisfaction with training on residents' responses.

PURPOSE: To determine whether framing questions positively or negatively influences residents' apparent satisfaction with their training. METHOD: In 1993-94, 276 residents at five Canadian internal medicine residency programs responded to 53 Likert-scale items designed to determine sources of the residents' satisfaction and stress. Two versions of the questionnaire were randomly distributed: one in which half the items were stated positively and the other half negatively, the other version in which the items were stated in the opposite way. RESULTS: The residents scored 43 of the 53 items higher when stated positively and scored ten higher when stated negatively (p < .0001). When analyzed using an analysis-of-variance model, the effect of positive versus negative framing was highly significant (F = 129.81, p < .0001). While the interaction between item and framing was also significant, the effect was much less strong (F = 5.56, p < .0001). On a scale where 1 represented the lowest possible level of satisfaction and 7 the highest, the mean score of the positively stated items was 4.1 and that of the negatively stated items, 3.8, an effect of 0.3. CONCLUSIONS: These results suggest a significant "response acquiescence bias." To minimize this bias, questionnaires assessing attitudes toward educational programs should include a mix of positively and negatively stated items.

Adult↗
PubMed1999

Should distal interlocking of tibial nails be performed from a medial or a lateral direction? anatomical and biomechanical considerations.

OBJECTIVE: To compare the relative risks of neurovascular injury from perforation during distal interlocking and the biomechanical stability of two approaches to distal interlocking of tibial nails. DESIGN: In vitro anatomical and biomechanical study. SETTING: All mechanical testing was performed in a servohydraulic test frame with a customized motion transducer. INTERVENTION: Tibial nails were interlocked distally with a medial-to-lateral (ML) or a lateral-to-medial (LM) approach. MAIN OUTCOME MEASURE: The distances from the nearest end of each distal locking screw to four neurovascular structures were measured manually with calipers, and two-dimensional motion under simulated stance load across the fracture site was recorded. RESULTS: There were greater distances from the posterior tibial neurovascular bundle and the superficial peroneal nerve with distal targeting from the LM direction compared with targeting from the ML direction. Biomechanically, the ML nail configuration demonstrated slightly greater resistance to bending than the LM configuration. CONCLUSIONS: Distal tibial interlocking from the LM direction appears to be safer than interlocking from the ML direction with regard to relative distances from the neurovascular structures. This small anatomical advantage must be considered in light of slightly greater resistance to bending of the ML interlocking configuration compared with the LM interlocking configuration.

Biomechanical Phenomena↗
PubMed1999

Development of a disease specific questionnaire to measure health related quality of life in patients with chronic liver disease.

BACKGROUND AND AIMS: To develop and assess a disease specific instrument for measuring health related quality of life (HRQL) in patients with chronic liver disease (CLD). METHODS: Based on responses from 60 patients with chronic liver disease, from 20 liver experts, and from a Medline search of the literature, items potentially affecting the HRQL of these patients were identified. A separate sample of 75 patients identified which items they found problematic and rated their importance. Results were explored using factor analysis; domains were chosen and items placed within domains. Redundant questions were eliminated and the final questionnaire was pretested in 10 patients. Using this instrument, HRQL was assessed in a further 133 patients with various types and stages of liver disease. RESULTS: Patients, experts, and the literature search identified 156 items of potential importance. Of these, 35 proved important to over 50% of 75 respondents in the item reduction sample. The factor analysis suggested six domains. After eliminating redundancies, the Chronic Liver Disease Questionnaire (CLDQ) included 29 items in the following domains: fatigue, activity, emotional function, abdominal symptoms, systemic symptoms, and worry. In pretesting, patients found the CLDQ clear and easy to complete in 10 minutes. In another 133 patients, the CLDQ showed a gradient between patients without cirrhosis, Child's A cirrhosis, and those with Child's B or C cirrhosis. CLDQ has evidence for moderate reliability at six months and seems to be responsive. CONCLUSION: The CLDQ is short, easy to administer, produces both a summary score and domain scores, and correlates with the severity of liver disease.

Analysis of Variance↗
PubMed1999

Funduscopy: a forgotten art?

Funduscopy is an integral part of the physical examination, especially in older patients in whom visual problems and systemic diseases affecting the fundi (e.g., diabetes mellitus) are more common. We have assessed the views of hospital doctors to funduscopy via a questionnaire survey, reviewed the case notes to see whether or not funduscopy is carried out on older patients, and assessed the views of older patients on vision via a questionnaire survey. Review of the case notes showed only three of 100 patients had had funduscopy. Most patients reported a visual problem on specific enquiry. Whilst most hospital doctors believed funduscopy was important, many felt they had insufficient training in this procedure and felt their skills could be improved. We conclude that older patients are missing out on routine funduscopy. Hospital doctors should be aware that not all patients complain of visual problems and specific enquiry should be made. The issue of training and encouragement to perform funduscopy needs to be addressed before funduscopy becomes a forgotten art.

Diabetic Retinopathy↗
PubMed1999

Evaluating the performance of academic medical education administrators.

Educators have devoted little attention to formal evaluation of educational administrative personnel. The authors surveyed the educational administrators working in McMaster University's Department of Medicine residency program and found they felt they were receiving little useful feedback. The authors also surveyed the colleagues, residents, and administrative staff with whom the administrators worked and found they felt they had inadequate input into the administrators' evaluation. In response to these results, a measurement instrument was developed based on existing job descriptions and feedback was obtained on administrators' performance from relevant individuals. After three yearly evaluations, administrators and evaluators acknowledged much broader input into evaluation but saw little evaluation-related improvement in performance. Of the administrators, 85% felt the process should continue as did 91% of the evaluators. An evaluation process may not alter perceived performance when it is already good but there may be other benefits to rigorous evaluation.

Attitude of Health Personnel↗
PubMed1999

Capture of human Fab fragments by expanded bed adsorption with a mixed mode adsorbent.

A novel group of mixed mode adsorbents has been developed for purification of monoclonal and polyclonal antibodies from a broad range of raw materials such as hybridoma cell culture, ascites fluid, animal sera, milk, whey and egg yolk. The aim of this study was to determine whether such mixed mode adsorbents were also useful for the recovery of recombinant proteins from microbial feedstocks. This paper describes the performance of one of these adsorbents for expanded bed capture of a human Fab fragment from recombinant E. Coli cell extracts. It is concluded that the mixed mode adsorbent binds the Fab fragment efficiently from crude extracts without any requirement for preconditioning the extract by for example de-salting or dilution. The capacity of the mixed mode adsorbent is approx. 12 mg Fab/ml matrix. The novel mixed mode adsorbent can be useful during production of highly purified Fab fragments as the first step in a purification scheme. In this respect the mixed mode adsorbent is advantageous over alternative commercially available ion-exchange materials which require pre-conditioning of cell extract for Fab' capture. Together with the concentration and clarification effect a significant enrichment of the Fab fragment is obtained in one single high yield operation.

Adsorption↗