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Biomedical subjects

D Magee

Publications and source records attributed to D Magee.

At least 19 recordsLinked to original sources
PubMed2006

Liquid-based cytology improves productivity in cervical cytology screening.

OBJECTIVES: The ThinPrep test was introduced into our institution on a phased basis over 3 years between January 2002 and December 2004. This study set out to assess its effect on productivity (as measured by output of cases per medical scientist per day) during the changeover period. Numbers of high and low-grade lesions and of unsatisfactory slides were also monitored. METHODS: The percentage conversion from conventional preparation to liquid-based cytology (LBC) and output of cases per medical scientist per day were calculated from our database at 6-month intervals. The average backlog, average number of cases received per month and percentage of unsatisfactory and abnormal cases were calculated similarly. RESULTS: Over the study period 92 084 cases were received. The percentage of cases using ThinPrep increased: from 9% in January 2002 to 73% in December 2004. During the study there was an increase in output from 17.0 to 22.3 cases per medical scientist per day, representing a 31% improvement at 73% conversion. Numbers of unsatisfactory cases decreased substantially and the numbers of low and high-grade diagnoses were relatively constant. CONCLUSIONS: The change to ThinPrep has improved productivity and decreased the number of unsatisfactory cases. There was no adverse effect on quality during the changeover.

Carcinoma↗
PubMed2006

A comparison of the head and cervical posture between the self-balanced position and the Frankfurt method.

Head and cervical posture evaluation has been a concern for many years, not only because of the purported relationship that exists between head and cervical posture in the presence of temporomandibular disorders, neck pain and headache, but also because of the biomechanical relationship between the head and cervical spine and dentofacial structures. Many methods have been suggested in an attempt to establish the best way to evaluate the position of the head using teleradiographs and cephalometric analysis. However, there is still no agreement as to which procedure is the best. The objective of this study was to evaluate the differences that exist between craniocervical measurements in lateral teleradiographs when comparing the position of the head in the self-balanced position to the position of the head using the Frankfurt method (Frankfurt plane parallel to the floor). Sixty-eight subjects who sought dental treatment in community health centres in Talca, Chile participated in this study. Rocabado analysis was used to measure the craniocervical variables. The Cobb analysis was used to measure cervical lordosis. A paired student t-test was used to evaluate the differences between both procedures, using an alpha of 0.05 and a power of 0.90. The use of the cephalostat changed only the craniocervical angle (P < 0.001). However, this change was minimal. No changes related to gender and age were found. More studies are needed to determine the variation between different procedures and to define a good procedure for evaluating head posture.

Adolescent↗
PubMed2005

The number of dyskaryotic cells on an initial ThinPrep cervical sample showing mild dyskaryosis has predictive value.

OBJECTIVES: Recent National Health Service Cervical Screening Programme (NHSCSP) guidelines suggest referral for colposcopy following an initial result of mild dyskaryosis. The aim of this study was to investigate if the number of dyskaryotic cells counted on an initial ThinPrep cervical sample showing mild dyskaryosis has predictive value. METHODS: Cases of mild dyskaryosis on ThinPrep cervical samples from 2002 were retrieved from the cytology department records of St Luke's Hospital. A total of 123 sequential cases with a first-time result of mild dyskaryosis on ThinPrep slides with follow-up cytology available in the same institution were identified. While blinded to outcome, the number of dyskaryotic cells was counted in each case. Follow-up colposcopy/histology information was retrieved where indicated. The number of dyskaryotic cells counted on each slide was collated with outcome data. RESULTS: Of the 123 cases, six women were lost to follow-up. Seventy-three had a negative outcome, 27 had a low-grade outcome and 17 had a high-grade outcome. Only one of 17 high-grade outcome cases had < or = 15 dyskaryotic cells on the initial slide. The distribution of women with a negative/low-grade outcome and those with a high-grade outcome with >15 and < or = 15 dyskaryotic cells on the initial slide was tested using a chi-square test (P = 0.008). The negative predictive value for a high-grade outcome when < or = 15 dyskaryotic cells were present on the initial slide was 97.7%. CONCLUSION: The number of dyskaryotic cells on ThinPrep slides showing mild cervical dyskaryosis has predictive value. The number of dyskaryotic cells may be used to select women suitable for cytological rather than colposcopic follow-up.

Cell Nucleus↗
PubMed2004

Clinicopathological significance of Borderline Nuclear Change - High Grade Dyskaryosis Not Excluded.

During a recent discussion on classification of cervical cytology, the introduction of a 'Borderline Nuclear Change - High Grade Dyskaryosis Not Excluded' (BNCH) category was proposed. BNCH cases diagnosed prospectively were retrieved from laboratory records. Questionnaires were sent to referring practitioners regarding clinicopathological outcome. Cytopathological features resulting in the BNCH classification were recorded on slide review. A total of 103 reports on conventional cervical smears diagnosed as BNCH from 1999 to 2002 were retrieved, comprising 0.096% of 107 634 smears. Of 86/103 cases with clinical follow-up, CIN2 or worse was present in 30 (35%); 15 (17%) showed a borderline/low-grade abnormality and 41 (48%) were negative. No individual cytopathological feature was predictive of high-grade disease on follow-up. The yield of high-grade abnormalities on follow-up of BNCH supports the introduction of this terminology.

Artifacts↗
PubMed1999

Endoscopic removal of an esophageal fibrovascular polyp.

Fibrovascular polyps are intraluminal pedunculated esophageal polyps, which can produce devastating consequences if untreated. Therapy for these lesions is traditionally surgical, with esophagotomy. The present report describes a case of endoscopic removal of a fibrovascular polyp, alleviating the need for hospitalization or further interventions. The natural history, clinical presentation, diagnostic evaluation, and therapies are reviewed.

Electrocoagulation↗
PubMed1997

An ELISA for measuring tumour necrosis factor alpha in rat plasma.

Tumour necrosis factor (TNF) is a cytokine with multiple biological activities which plays a pivotal role in the response of the body to infection. TNF is secreted in the the monomeric form and associates to yield a biologically active oligomeric molecule. Bioactive TNF can be measured in plasma using cytotoxic assays which employ the murine cell-lines L929 or WEHI 164 clone 13. However, it has become clear that inactive TNF also circulates in vivo, which is not detected by bioassay. These inactive forms may play an important role in the regulation of TNF activity. The rat is often used as a model for the study of acute infection and its systemic effects. Our aim was to develop an ELISA for rat TNF which would provide a convenient and cost effective method of assay. The assay employs two commercially available antibodies raised against recombinant murine TNF (rMuTNF) which exhibit cross-reactivity with rat TNF. The lower limit of detection for this assay was determined to be 39.0 pg/ml rMuTNF. The inter and intra-assay coefficients of variation were < 12.0%. Specificity of the assay was shown by the high degree of parallelism obtained between rMuTNF and commercially available rRatTNF. The assay described measures rat TNF in both plasma and tissue culture supernatant. The measurement of plasma concentrations of TNF using both the ELISA and bioassay may help elucidate more fully the biological importance of TNF.

Animals↗
PubMed1996

Development of a clinical tool and patient questionnaire for evaluation of patellofemoral pain syndrome patients.

OBJECTIVE: To develop an evaluation tool for patellofemoral pain syndrome (PFPS) patients. DESIGN: Exploratory, descriptive content validation study. PARTICIPANTS: Convenience sample, three groups of clinicians: 15 sports physical therapists, 9 sports medicine physicians, and 10 physical therapists and physicians with limited experience with PFPS. Selection based on specialization qualifications and experience with PFPS patients. DESCRIPTION OF TESTS: Content validation questionnaire to determine importance of clinical outcomes in determining change in PFPS patients. Using 10-cm visual analogue scales, reviewers rated the importance of five domains and rated the importance of twenty-one clinical tests; using a categorical scale, determined appropriateness and clarity of potential patient questionnaire items. MAIN RESULTS: Correlation values indicated significant correlation (p < 0.01) between pain and functional limitations (r = 0.068) and activity and functional limitations (r = 0.67), indicating that functional limitation may not be a unique component, but is integrated with pain and activity. A set of five pain questions, twelve function questions and six activity questions was developed. No statistical differences (p < 0.05) between the three groups of clinicians for the majority of clinical tests. Statistical differences (p < 0.05) between the three groups for rating of importance of flexibility of hip flexor and flexibility of gastrocnemius-soleus muscle groups, knee swelling, and radiographs. Good internal consistency among the 21 clinical tests (Cronbach's alpha = 0.84). The five top rated tests considering mean score values and standard deviations: lower extremity alignment, patellar orientation, patellar mobility, and flexibility of rectus femoris and tensor fasciae latae muscle groups. CONCLUSIONS: The results provide evidence of content validity for the components of PFPS evaluation investigated. The findings provide a basis of design of an evaluation tool for PFPS patients consisting of patient self-report questionnaire items and clinical tests.

Adult↗
PubMed1996

Reliability of performance-based clinical skill assessment of emergency medicine residents.

OBJECTIVE: To test the overall reliability of a performance-based clinical skill assessment for entering emergency medicine (EM) residents. Also, to investigate the reliability of separate reporting of diagnostic and management scores for a standardized patient case, subjective scoring of patient notes, and interstation exercise scores. METHODS: Thirty-four first-year EM residents were tested using a 10-station standardized patient (SP) examination. Following each 10-minute encounter, the residents completed a patient note that included differential diagnosis and management. The residents also were asked to read an ECG or chest x-ray (CXR) associated with each case. History, physical examination, and interpersonal skills were scored by the SPs. The patient note, CXR, and ECG readings were scored by faculty emergency physicians. Intercase reliability was determined for the residents. RESULTS: Global score reliability, Cronbach's alpha = 0.85. Reliabilities for the other components were: history, 0.77; physical examination, 0.83; and interpersonal skills, 0.80. Differential diagnosis and management reliabilities were 0.61 and 0.66, respectively. Subjective scoring of the patient note resulted in acceptable reliability for legibility (0.80), history completeness (0.80), and history organization (0.81). Physical examination completeness and organization reliabilities were 0.74 and 0.73. For ECG and CXR readings, alpha = 0.74 and 0.34, respectively. CONCLUSIONS: SPs can be used to reliably assess bedside clinical skills of EM residents. While component reliability levels are slightly lower than the global clinical skill reliability coefficient, they are still high enough to use for identification of individual strengths and weaknesses.

Clinical Competence↗
PubMed1995

Analysis of outcome measures used in the study of patellofemoral pain syndrome.

Validation of evaluation methods is necessary in order to appropriately monitor Patellofemoral Pain Syndrome (PFPS) patients and to determine the effectiveness of treatment and prevention programs. The goal of this study was to investigate the psychometric properties of five evaluation methods: a functional index questionnaire (FIQ), visual analogue scales (VAS) for pain, a patellofemoral function scale (PFS), a step test and a subjective report of functional limitations. Measurements for each of the six components were taken on 56 PFPS patients participating in a randomized clinical trial, prior to and at one month following treatment. Modest test-retest reliability for the FIQ, VAS and step test were found. High internal consistency for the FIQ and modest internal consistency for the PFS were demonstrated. The VAS and FIQ were found to be good discriminators for measuring clinical change, while the step test was found to be reliable but poor at detecting clinical change. The PFS, which combines a number of evaluation areas into an index, demonstrated potential to detect clinical change, however, conclusions are limited as reliability testing was not performed.

Activities of Daily Living↗
PubMed1994

Dual-energy x-ray absorptiometry of raloxifene effects on the lumbar vertebrae and femora of ovariectomized rats.

A new potential therapeutic agent for postmenopausal osteoporosis, raloxifene, previously known as keoxifene, was evaluated by x-ray densitometry and more traditional techniques in quantitating the short-term (4-5 weeks) effects of ovariectomy on bones from 6-month-old rats. A Hologic QDR 1000/W and, to a limited extent, a Lunar DPXL, was used to quantitate ovariectomy, estrogen replacement, and raloxifene effects on vertebrae, femora, and tibiae. Both instruments performed well with precisions of 1.6% (Hologic) and 0.9% (Lunar) for anesthetized rats, which improved to 0.4% (Hologic) and 0.5% (Lunar) when the same rats were frozen. The lumbar vertebrae L1-4 showed a 12% decrease in bone mineral density 4 weeks after ovariectomy, compared with a 9% decrease for femora. Tibiae were also examined, but edge-detection problems prevented reproducible analysis of this site in vivo. The decrease in bone mineral density postovariectomy, especially for femora, was found to include both an increase in the projected area and a slight but not significant decrease in the bone mineral content of L1-4 and femora. These changes in density parameters of femora were supported by a decrease in dry weight and volume and a marginal increase in the second moment of inertia I for the identical femora examined ex vivo. Examination of individual lumbar vertebrae L1-5 suggested that the bone mineral density of L3 changes most dramatically in response to ovariectomy, but present techniques lack the spatial resolution and precision to quantitate bone changes reliably in individual vertebrae. 17 beta-Estradiol administered at 100 micrograms/kg/day subcutaneously inhibited ovariectomy effects on L1-4 bone mineral density, femoral moment of inertia, dry weight, and volume and to a lesser extent, femoral bone mineral density. A nonsteroidal compound, raloxifene HCl, at 1 mg/kg/day per os, had bone effects and effects on body weight that were largely indistinguishable from those of 17 beta-estradiol; however, raloxifene did not produce the uterotrophic effects observed with estrogen. The half-maximal efficacious dose of raloxifene on L1-4 bone mineral density was between 0.1 and 1.0 mg/kg/day per os. These data show that dual-energy x-ray absorptiometry compares favorably with traditional methods in quantitating bone changes caused by ovariectomy in small rodents, that L1-4 is a more sensitive region than whole femora in evaluating the effect of estrogen deficiency on bone loss, and the raloxifene may have promise as a treatment for conditions characterized by excessive bone loss after ovariectomy.

Absorptiometry, Photon↗
PubMed1994

The effects of raloxifene on tibia histomorphometry in ovariectomized rats.

Tissue-specific estrogen agonists may be useful in protecting against osteoporosis and the increased risk of coronary heart disease in postmenopausal women with minimal undesired effects on reproductive tissues. The actions of the mixed estrogen agonist/antagonist raloxifene on selected estrogen target tissues were determined in ovariectomized (OVX) rats immediately postovariectomy. Five groups of 75-day-old Sprague-Dawley rats were studied; baseline controls, sham-operated controls, OVX controls, OVX animals treated with estrogen (0.1 mg 17 alpha-ethynyl estradiol/kg.day), and OVX animals treated with raloxifene (3 mg/kg.day). Fluorochrome labels were given on days 1, 28, and 34. The baseline controls were killed on day 2, and the remaining groups on day 35. Ovariectomy increased tibial longitudinal growth rate as well as measurements related to radial growth and cancellous bone turnover. Ovariectomy decreased cancellous bone area and uterine weight, and increased serum cholesterol, bone elongation, and radial bone growth. Estrogen treatment prevented these changes in OVX rats. Raloxifene prevented cancellous osteopenia as well as the changes in radial bone growth, bone resorption, and blood cholesterol, but was less effective in reducing cancellous bone formation and did not prevent uterine atrophy. These findings suggest that raloxifene is a target-specific, mixed estrogen agonist/antagonist. At the concentration studied, raloxifene had potent estrogenic activity on bone resorption and serum cholesterol, a lesser effect on bone formation, and minimal activity on uterine wet weight.

Aging↗
PubMed1985

Requirements for restitution of the surface epithelium of frog stomach after mucosal injury.

In frog fundic mucosae mounted in Ussing chambers, exposure to luminal 1 M NaCl for 10 min caused a sharp immediate decrease in potential difference, resistance, short circuit current, and acid secretion, but within 4-6 h these readings had returned toward control values. After initial severe destruction of surface epithelial cells, gradual morphologic restitution occurred within 4-6 h. A Ca2+-free nutrient solution and 4 mM ethylenediaminetetraacetic acid administered after injury prevented both physiologic and morphologic restitution. A Ca2+-free nutrient solution administered alone after injury prevented physiologic recovery, but although narrow gaps and lack of tight junctions were found between some cells, there was near-complete epithelial cell coverage. The addition of 2 mM Ca2+ to these tissues 3 h after injury effected rapid recovery of electrophysiologic parameters and a complete closure of the intercellular spaces. Cytochalasin B (3 X 10(-3) M nutrient) prevented physiologic recovery and mucosal restitution. Neither cycloheximide nor colchicine had any effect on the normal process of restitution. Autoradiography of [3H]thymidine incorporation showed no increase in labeling within 4 h of hyperosmolar injury. We conclude that adequate Ca2+ is required for complete restitution of gastric mucosa after hyperosmolar injury, and that restitution occurs by migration of persisting viable gastric pit cells.

Animals↗