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Biomedical subjects

D M Anthony

Publications and source records attributed to D M Anthony.

9 recordsLinked to original sources
PubMed2003

Fibrin sealant use for minimising peri-operative allogeneic blood transfusion.

BACKGROUND: Fibrin sealants have gained increasing popularity as interventions to improve peri-operative (intra/post-operative) haemostasis and diminish the need for allogeneic red cell transfusion (blood from an unrelated donor). OBJECTIVES: To examine the efficacy of fibrin sealants in reducing peri-operative blood loss and allogeneic red blood cell (RBC) transfusion. SEARCH STRATEGY: Studies were identified by: searches of MEDLINE, EMBASE, Current Contents, the Cochrane Library (July 2002), manufacturer web sites (to July 2002), and bibliographies of published articles. SELECTION CRITERIA: Controlled trials in which adult patients, scheduled for elective surgery, were randomised to fibrin sealant treatment or to a control group who did not receive fibrin sealant treatment. Trials were eligible if they reported data on the number of patients exposed to allogeneic red cell transfusion, the volume of blood transfused, or blood loss (assessed objectively). DATA COLLECTION AND ANALYSIS: Primary outcomes measured were: the number of patients exposed to allogeneic red cells, the amount of blood transfused, and blood loss. Other outcomes measured were: re-operation due to bleeding, infection, mortality, and length of hospital stay. Treatment effects were pooled using a random effects model. MAIN RESULTS: Seven trials, including a total of 388 patients, reported data on peri-operative exposure to allogeneic RBC transfusion. Fibrin sealant treatment, on average, reduced the rate of exposure to allogeneic red cell transfusion by a relative 54% (relative risk [RR] = 0.46: 95%CI = 0.32 to 0.68). Eight trials, including a total of 442 patients, provided data for post-operative blood loss. Fibrin sealant treatment reduced blood loss on average by around 134 per patient (95%CI = 51 to 217 ). However the trials reviewed were small and of poor methodological quality (91% unblinded). REVIEWER'S CONCLUSIONS: Overall the results suggest that fibrin sealants are efficacious in reducing both post-operative blood loss and peri-operative exposure to allogeneic RBC transfusion. However, due to the lack of blinding, transfusion practices may have been influenced by knowledge of the patient's treatment status. This raises concerns about the use of blood transfusion practice as an outcome variable in trials of fibrin sealant. In the case of blood loss, the results must be interpreted with caution, in view of the statistically significant heterogeneity in treatment effect observed. Large, methodologically rigorous, randomised controlled trials of fibrin sealants are needed.

Adult↗
PubMed2003

Platelet-rich-plasmapheresis for minimising peri-operative allogeneic blood transfusion.

BACKGROUND: Concerns regarding the safety of transfused blood have generated considerable enthusiasm for the use of technologies intended to reduce the use of allogeneic blood (blood from an unrelated donor). Platelet-rich plasmapheresis (PRP) offers an alternative approach to blood conservation. OBJECTIVES: To examine the evidence for the efficacy of PRP in reducing peri-operative allogeneic red blood cell (RBC) transfusion, and the evidence for any effect on clinical outcomes such as mortality and re-operation rates. SEARCH STRATEGY: Studies were identified by: computer searches of MEDLINE, EMBASE, Current Contents, and the Cochrane Library (to June 2001). These searches were supplemented by checking the reference lists of published articles, reports, and reviews. SELECTION CRITERIA: Controlled parallel group trials in which adult patients, scheduled for non-urgent surgery, were randomised to PRP, or to a control group who did not receive the intervention. DATA COLLECTION AND ANALYSIS: Main outcomes measured were: the number of patients receiving an allogeneic RBC transfusion, and the amount of RBC transfused. Trial quality was assessed using criteria proposed by Schulz et al. (Schulz 1995) and Jadad et al. (Jadad 1996). MAIN RESULTS: Nineteen trials of PRP were identified that reported data for the number of patients exposed to allogeneic RBC transfusion. These trials evaluated a total of 1452 patients. The pooled relative risk (RR) of exposure to allogeneic blood transfusion in those patients randomised to PRP was 0.71 (95%CI: 0.56, 0.90), equating to a relative risk reduction (RRR) of 29%; the average absolute risk reduction (ARR) was 19% (RD = -0.19: 95%CI: -0.29, -0.09). On average, PRP did not significantly reduce the total volume of RBC transfused (weighted mean difference [WMD] = -0.69: 95%CI: -1.93, 0.56 units). Substantial statistical heterogeneity was observed (p < 0.001). Trials provided inadequate data regarding the impact of PRP on morbidity, mortality, and hospital length of stay. The majority of trials were small and of poor methodological quality. REVIEWER'S CONCLUSIONS: Although the results suggest that PRP is effective in reducing allogeneic RBC transfusion in adult patients undergoing elective surgery, there was considerable heterogeneity in treatment effects and the trials were of poor methodological quality. As the majority of trials were unblinded, transfusion practices may have been influenced by knowledge of the patient's allocation status, potentially exaggerating the true magnitude of the beneficial effect of PRP. The available studies provided inadequate data for firm conclusions to be drawn regarding the impact of PRP on clinically important endpoints.

Adult↗
PubMed2002

Systematic review of the use of fibrin sealant to minimize perioperative allogeneic blood transfusion.

BACKGROUND: Fibrin sealants have become popular in improving perioperative haemostasis and reducing the need for allogeneic red cell transfusion. METHODS: A systematic review of randomized controlled trials was conducted to examine the efficacy of fibrin sealants in reducing perioperative blood loss and allogeneic red blood cell transfusion. Studies were identified by computer searches of Medline, Embase, Current Contents, the Cochrane Library, manufacturer websites (to January 2001), and bibliographic searches of published articles. Trials were eligible for inclusion if they involved adult elective surgery and reported quantitative data on blood loss, the proportion of patients exposed to allogeneic red cell transfusion and/or the volume of blood transfused. RESULTS: Twelve trials met the criteria for inclusion. Fibrin sealants reduced the rate of allogeneic blood transfusion (relative risk 0.40 (95 per cent confidence interval (c.i.) 0.26 to 0.61); five trials with 275 subjects) and reduced blood loss (weighted mean difference--151.68 (95 per cent c.i. - 251.91 to - 51.46) ml; seven trials with 391 subjects). Generally, the trials were small and of poor methodological quality. CONCLUSION: Overall the results suggest that fibrin sealants are efficacious. Owing to lack of blinding, transfusion practices may have been influenced by knowledge of the patient's treatment status. This raises concern about blood transfusion practice as a response variable. Large methodologically rigorous trials of fibrin sealants with clinical outcomes are needed.

Blood Loss, Surgical↗
PubMed1998

Nursing e-journals: are current models using the web's potential?

As the number of nursing and health-related electronic journals (e-journals) available on the World Wide Web increases, we are seeing an increasing diversity of models. A taxonomy of current nursing e-journal models is presented, together with brief discussion of some of the issues pertinent to the development of e-journals, and that currently appear to constrain the electronic publication of high quality content. We describe in detail the model and usage of one particular e-journal, Nursing Standard Online. We conclude by advocating the development of innovative and increasingly interactive nursing e-journals as the way forward, discussing one particular model which holds promise. We believe it likely that nursing e-journals using current models will need to be specialist rather than generalist if they are to attract a larger audience.

Humans↗
PubMed1997

BTS 67 582 stimulates insulin secretion from perifused rat pancreatic islets.

The novel antidiabetic agent BTS 67 582 (1,1-dimethyl-2-[2-(4-morpholinophenyl)]guanidine monofumarate) demonstrated a concentration-dependent stimulation of insulin release in perifused rat pancreatic islets. EC50 values of 7.7 microM and 6.3 microM were obtained for BTS 67 582 in the presence of 8 mM glucose, after islets were pre-equilibrated with 4 and 8 mM glucose respectively. In contrast, there was little or no stimulation of insulin release at substimulatory (4 mM) or maximal stimulatory (15 mM) glucose concentrations. The plasma EC50 value for the glucose lowering effect of BTS 67 582 in fasted normal rats was 3.9 microM indicating a similar potency in vivo. In islets, BTS 67 582 completely antagonised (EC50 value of 13.2 microM) the actions of the selective ATP-dependent K+ channel opener diazoxide indicating K+ channel blocking activity. BTS 67 582 only weakly reversed the alpha2-adrenoceptor mediated inhibition of insulin release in islets (EC50 of 83 microM). BTS 67 582, like other imidazoline/guanidine insulin releasing agents, appears to promote insulin release via an effect on the islet ATP-dependent K+ channel which is not mediated by binding to the sulphonylurea receptor.

Animals↗
PubMed1997

Evaluation of BTS 67 582, a novel antidiabetic agent, in normal and diabetic rats.

1. The effect of BTS 67 582, a novel antidiabetic agent, has been evaluated on plasma glucose and plasma insulin in normal and streptozotocin-induced diabetic rats. 2. BTS 67 582 (3 to 300 mg kg-1, p.o.) caused a dose- and time-dependent reduction in plasma glucose and an increase in plasma insulin in both fasted and glucose-loaded normal rats. The ED50 for the glucose lowering effect of BTS 67 582 in fasted rats was 37.6, 18.4 and 18.5 mg kg-1 at 1, 2 and 4 h after administration respectively. 3. In streptozotocin-induced (50 mg kg-1, i.v.) diabetic rats, BTS 67 582 (37-147 mg kg-1, p.o.) caused significant reductions of plasma glucose following a glucose load, whereas glibenclamide (100 mg kg-1, p.o.) was ineffective. BTS 67 582 significantly increased plasma insulin compared to controls whereas glibenclamide did not. 4. BTS 67 582 did not displace [3H]-glibenclamide from its binding sites in rat brain, guinea-pig ventricle or the HIT-T15 insulinoma beta-cell line. BTS 67 582 does not therefore appear to modulate its action via an effect on the 'sulphonylurea' receptor. 5. In fasted rats, the glucose lowering effect of BTS 67 582 (100 mg kg-1 p.o.) and glibenclamide (1 mg kg-1, p.o.) were antagonized by diazoxide (30 mg kg-1, i.p.). In addition BTS 67 582, like glibenclamide, caused a dose-dependent rightward shift of cromakalim-induced relaxation of noradrenaline precontracted rat aortic strips, suggesting the involvement of KATP channels. 6. In summary, BTS 67 582 produces a blood glucose-lowering effect in normal and streptozotocin-induced diabetic rats associated with increased insulin concentrations. This effect appears to be due to a blockade of ATP-sensitive potassium channel activity via a different binding site to that of glibenclamide.

Animals↗
PubMed1997

The value of computer networks in nursing.

A number of computerised and networked clinical and administrative systems are currently being used in the NHS. Networks can be confined to a single area or may be part of a wide area network, such as the NHSNet. Computer networks used by nurses must address clinical needs and be relevant to patient care.

Computer Communication Networks↗
PubMedDate not supplied

Current and future models for nursing e-journals: making the most of the Web's potential.

We are presently witnessing an increasing number of nursing, medical and health-related electronic journals (e-journals) being made available on the World Wide Web, a minority of which are specifically devoted to informatics. We would expect, given the potential of interacting multimedia and computer-mediated communications (i.e. telematics), to also see an increasing diversity of models, but this is not currently the case. Following a brief discussion of some of the issues relevant to electronic publications, the authors present a taxonomy of current nursing e-journal models, including discussion of some examples from around the world that fall into categories within this taxonomy. We describe the model and levels of usage of one particular e-journal, Nursing Standard Online. Some of the issues presented may account for the current relative paucity of high quality content and innovative models in the development of Web-based e-journals for nurses and other health professionals. We believe it likely that nursing e-journals using current models will need to be specialist rather than generalist if they are to attract a larger audience. In concluding our paper, we advocate the development of innovative and increasingly interactive nursing e-journals as the way forward, discussing one particular model which holds promise.

Classification↗