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Biomedical subjects

E Collins

Publications and source records attributed to E Collins.

At least 37 records · Page 2Linked to original sources
PubMed1997

Transmission of hepatitis C virus to infants of human immunodeficiency virus-negative intravenous drug-using mothers: rate of infection and assessment of risk factors for transmission.

The risk of perinatal transmission of hepatitis C virus (HCV) from a cohort of 95 human immunodeficiency virus (HIV)-negative intravenous drug users (IVDU) is described, 89 of whom were positive for antibodies to HCV (anti-HCV). Infection, defined as the presence of HCV RNA in a serum sample collected from an infant at any time during follow-up, was detected in six of 63 (9.5%) infants born to HCV antibody-positive viraemic mothers. No mother who was HCV RNA negative at delivery transmitted HCV to her infant. Hepatitis C virus antibodies became undetectable in uninfected infants by 15 months, but persisted in all HCV-infected infants throughout follow-up. An abnormal alanine aminotransferase (ALT) level was observed on at least one occasion in all HCV-infected infants and in six occasions in uninfected infants. Two of the six HCV-infected infants became HCV RNA negative during follow-up by 27 and 29 months. Both of these infants had a large ALT elevation (mean peak ALT 398U l-1) at around 12 months of age. Analysis of a range of potential risk factors revealed that maternal HCV RNA load was important in predicting transmission, but suggested that other factors play a role in perinatal transmission from mother to child. No difference was found between mothers who transmitted HCV to their infants and those who did not for HCV genotype, duration of drug use, duration of methadone use, methadone dose, history of alcohol abuse, past hepatitis B virus (HBV) infection, mode of delivery, maternal and gestational age, birth weight and incidence of breast-feeding. Mothers who transmitted HCV to their infants had a longer duration between membrane rupture and delivery than the mothers who did not transmit (P = 0.03). HCV RNA was not detected in breast milk and colostrum samples from 38 viraemic mothers, including two who transmitted HCV to their infant.

Alanine Transaminase↗
PubMed1997

Management of depression in the elderly by general practitioners: referral for psychological treatments.

This study investigates referrals for psychological therapies in general practitioners (GPs) from five catchment areas. The results show that 93 per cent of GPs would consider referring elderly patients for psychological help but only 44 per cent had done so and one in three GPs were unfamiliar with the psychological therapies available. When GPs were asked to select a psychological treatment for depression, 60 per cent chose counselling compared to 21 per cent who chose cognitive-behavioural therapy (CBT). Female GPs particularly favoured counselling. Experience in psychiatry was associated with selection of CBT. The results show that GP training and further education should emphasize psychological therapies. This should make referrals more appropriate and improve patient care.

Aged↗
PubMed1996

The social dysfunction index (SDI) for patients with schizophrenia and related disorders.

The social dysfunction index (SDI) is a new measure designed to assess social dysfunction in schizophrenia and other severe mental illnesses. It is intended to serve clinical and research purposes. Raters can be readily trained and there is low respondent burden with its use. Good psychometric properties were identified in three studies (sample sizes 33, 67 and 113). The SDI assesses a wide and comprehensive range of social functioning. It includes objective assessment of dysfunction and subjective client assessment of satisfaction with functioning. It produces a summary score, a satisfaction score and a score for each of the nine components of social functioning assessed. Internal consistency is good (alpha = 0.80). Inter-rater reliability is high (r = 0.96). Use of the component scores was confirmed by factor analysis. There is modest correlation with other measures of social functioning. Evidence of construct validity is demonstrated by findings of differences in social dysfunction between subjects who lived independently vs. those who lived in boarding homes; differences between subjects who were unemployed vs. subjects who were employed; and independence of social functioning from both age and education.

Adult↗
PubMed1996

Evaluation of a cognitive-behavioural intervention for pregnant injecting drug users at risk of HIV infection.

Pregnant injecting drug users were randomly assigned to: (i) individually receive a six-session cognitive-behavioural intervention in addition to their usual methadone maintenance treatment (intervention condition (I) (n = 40)); or (ii) their usual methadone maintenance treatment only (control condition (C) (n = 40)). There was no change in drug use per se in either group after the intervention. However, at 9-month follow-up the I group had significantly reduced some HIV risk-taking behaviours (in particular injecting risk behaviours). The I group reduced the needle risk associated both with "typical" use (drug use in the month before interview) and "binge" use (drug use in the month nominated as the heaviest month of drug use in the previous 6 months). The intervention had no effect on sexual risk behaviours. The finding of reduced injecting risk behaviour following the six-session intervention suggests that such an intervention may be of benefit for individuals persisting with injecting risk behaviours despite methadone maintenance treatment and the availability of sterile injection equipment.

Adult↗
PubMed1996

Ethical considerations in treating oncology patients in the intensive care unit.

The care of oncology patients within an intensive care unit (ICU) setting poses an added dimension of ethical concerns faced by practitioners. This article reviews/highlights some of the issues confronting ICU staff when caring for an oncology patient. The issues addressed include: access/admission of the oncology patient to the ICU, advance directives, and the withdrawal of life-sustaining treatments.

Advance Directives↗
PubMed1996

Semiextended position of intramedullary nailing of the proximal tibia.

Over a 24 month period, 30 patients with proximal tibia fractures who were reviewed consecutively were treated by nonreamed, statically locked, intramedullary nailing. There were 16 open, 13 segmental, and 7 comminuted fractures (Winquist III, IV). The average distance from the fracture to the proximal locking screws was 24 mm (range, 0-65 mm). All procedures were performed while the patient's affected leg was on a radiolucent table without traction. The last 25 fractures were nailed using a partial (2/3) medial parapatellar incision while the leg was semiextended. This approach allowed the patella to be subluxed laterally availing the trochlear groove for use as a conduit for nail placement. Using only 15 degrees knee flexion eliminated the extension force of the quadriceps on the proximal fragment, which otherwise would have tended to cause anterior angulation at the fracture site. In the first 5 patients, the average anterior angulation was 8 degrees (range, 5 degrees-15 degrees). Of the 25 patients who were treated while in the semiextended position, none had more than 5 degrees anterior angulation and 19 had no anterior angulation. Fractures of 3 of the 25 patients had greater than 5 degrees angulation in the coronal plane, 2 of which were nailed in the semiextended position. This technique greatly facilitates intramedullary nailing of proximal tibia fractures.

Adolescent↗
PubMed1996

Lead extraction in young patients with and without congenital heart disease using the subclavian approach.

Pacemaker lead removal using interlocking stylets and dilator sheaths has greatly reduced the need for major surgical intervention when lead extraction is required. Previous reports have shown the utility of this method in older patients, most of whom have anatomically normal hearts. The purpose of this study is to report the results of this technique in young patients with and without congenital heart disease. There were 13 patients (M:F = 7:6) aged 9-26 years (median 13). Congenital heart disease was present in 8 of 13 patients. A total of 17 leads required removal; they had been implanted for 54 +/- 24 months (range 19-94). Leads were removed from the left subclavian vein (13) or right subclavian vein (4) only. Seventeen of 18 leads were completely removed and one partially retained in the left subclavian vein. New leads were implanted from the same vein in 11 of 13 patients. Interlocking stylets and metal or flexible dilator sheaths were used in all cases except two. There was one surgical complication: a late wound dehiscence, which was easily managed. No patient required a transfusion, and there was no structural damage noted in any patient on the postoperative echocardiogram. We conclude that lead removal using interlocking stylets and dilator sheaths from the subclavian approach is an effective technique that can be used in young patients, including those with congenital heart disease.

Adolescent↗
PubMed1996

Care of central venous catheters for total parenteral nutrition.

This report summarizes data obtained via a mailed questionnaire from 129 Department of Veterans Affairs (VA) hospitals regarding current practices in the care of central venous catheters (CVCs) used for total parenteral nutrition (TPN). The size of VA hospitals' acute medical-surgical beds ranged from 14 to 1320 (median 168) beds. Over 6000 patients annually received CVCs for TPN. Hospitals reported using triple-lumen catheters most frequently as their CVC for TPN (80.3%). A povidone-iodine scrub was used to prepare the skin for CVC insertion by 72.6% of reporting hospitals. Sixty percent of hospitals used transparent polyurethane dressings. Care of CVCs varied among hospitals. Catheter-related infection and sepsis rates were within the national average, although < 50% of responding hospitals provided data on these outcomes. The results of this survey point to the need for a national standardized database relative to patients receiving TPN via a CVC.

Bandages↗
PubMed1995

Changing nurses' pain assessment practice: a collaborative research utilization approach.

It is not uncommon for a decade to pass between the time a research problem is identified and the time that research-based solutions are translated into standards for care. This quasi-experimental study demonstrated the effectiveness of a collaborative research utilization model directed towards the transfer of specific research-based knowledge (pain assessment) into practice for the purpose of helping to solve pain management problems. At the same time, nurses who participated in the model significantly improved their competency in research utilization and their attitudes towards research when compared to a control group who did not participate in the model.

Attitude of Health Personnel↗
PubMed1995

Management of depression in the elderly by general practitioners: II. Attitudes to ageing and factors affecting practice.

Although general practitioners (GPs) may be able to identify depression in elderly patients many patients do remain untreated. It is possible that negative attitudes could influence treatment. This study aims to investigate GPs' attitudes towards depression in the elderly. A national questionnaire study on the management of depression in the elderly was carried out. It enquired about attitudes towards treatment and diagnosis of depression and ageing and depression. Most GPs were confident about treating depression but agreed that it was difficult to treat and said that they would benefit from more information and training. A small proportion of the sample agreed that depression was a natural consequence of ageing and that most people when elderly get depressed. Older GPs were more likely to see depression as more difficult to treat and stopped medication sooner after recovery. Female GPs felt less confident in management and expressed more interest in further training although this did not appear to reflect the quality of care. In general GPs did not have negative views about depression and ageing; they did, however, identify a need for more training in the management of depression in the elderly.

Adult↗
PubMed1995

Management of depression in the elderly by general practitioners: I. Use of antidepressants.

Depression is a common problem in the elderly but studies have suggested that it is often inadequately treated by general practitioners (GPs). This study aims to investigate how GPs manage depression in the elderly. A national questionnaire study on the management of depression in the elderly was carried out. Case vignettes were used to investigate how GPs manage depression and what influenced their decision making process. Each case vignette had a factor complicating the use of the older tricyclics. The questionnaire was completed by 407 out of 667 GPs (61%). Many GPs chose the newer antidepressants but a substantial proportion preferred the older tricyclics. Many GPs selected subtherapeutic doses, particularly of the older tricyclics. Few GPs said they maintained patients on antidepressants for more than 3 months after recovery and only 1 in 12 continued antidepressants for over 6 months. If these results reflect GPs practice there is a danger that many patients will be inadequately treated and also at risk of relapse because of their antidepressants being stopped too soon after recovery.

Adult↗
PubMed1993

The proto-oncogene c-myb mediates an intracellular calcium rise during the late G1 phase of the cell cycle.

The intracellular concentration of ionized calcium is involved in regulating mitosis. However, little is known about intracellular levels of calcium during G1. We have demonstrated in vascular smooth muscle cells a mid-G1 decrease in ionized calcium concentration followed by a 2-fold rise at the G1/S interface (44 nM +/- 0.6 nM versus 98 nM +/- 1.1 nM, p < 0.01). The elevation of intracellular calcium is preceded by an increase in c-myb mRNA levels and is abolished with antisense but not missense c-myb oligonucleotides. Furthermore, cells stably transfected with c-myb show a similar 2-fold augmentation in intracellular calcium concentrations, as compared with untransfected cells, which is also abolished by antisense c-myb oligonucleotides. The c-myb-induced rise in intracellular calcium is dependent upon the presence of extracellular calcium and is not suppressed by L type calcium channel blockers. We conclude that c-myb induces an elevation in intracellular calcium levels of vascular smooth muscle cells at the G1/S interface which provides a novel role for this proto-oncogene as well as a potentially important control point for cell cycle regulation.

Animals↗
PubMed1993

Cervical conization with frozen section before planned hysterectomy.

OBJECTIVE: To report our institutional experience with the accuracy and usefulness of cervical conization with frozen section before planned hysterectomy. METHODS: One hundred fifty-nine patients who planned to have hysterectomies for or with a concomitant diagnosis of cervical intraepithelial neoplasia (CIN) underwent preliminary cone biopsies with frozen section. The frozen and permanent pathologic diagnoses were compared retrospectively. Detailed analysis was directed at the indications for cone biopsy and the patients who were found to have invasive cancer. RESULTS: Among 108 patients with negative specimens or CIN, the frozen section was accurate within one degree of CIN in 106. Cone biopsy for a positive endocervical curettage, unsatisfactory colposcopy, or discrepant cytology did not contribute to the diagnosis of invasive cancer but did lead to an ultimate diagnosis of CIN III. One of 12 women with a frozen-section diagnosis of microinvasion had deeper invasion on permanent sections. CONCLUSIONS: Frozen-section evaluation of a cone biopsy carries a degree of accuracy that enables the surgeon to make an immediate decision about definitive therapy. Exact indications, use during pregnancy, and accuracy for the diagnosis of microinvasion require further study.

Adult↗
PubMed1991

Peritoneal closure or non-closure at cesarean.

The value of peritoneal closure at the time of cesarean birth was evaluated prospectively. Two hundred forty-eight women undergoing low transverse cesarean through a Pfannenstiel skin incision were assigned to one of two groups: peritoneum open (N = 127) or peritoneum closed (N = 121). The mean (+/- SEM) surgical time in the open group (48.1 +/- 1.2 minutes) was significantly less than for the closed group (53.2 +/- 1.4 minutes) (P less than .005). There were no postoperative differences between the groups in the incidence of wound infection, dehiscence, endometritis, ileus, and length of hospital stay. Our study suggests that leaving the parietal peritoneum unsutured is an acceptable way to manage patients at cesarean delivery.

Adult↗
PubMed1990

A three-dimensional system for long-term culture of human colorectal adenomas.

Studies of the adenoma-carcinoma sequence in the colon and rectum have been limited by the paucity of experimental models of adenoma growth and progression. Progress recently was reported in the development of monolayer culture systems. The principal objective of this study was to develop a primary culture system for colorectal adenomas that would simulate three-dimensional in vivo growth. We used a calcium alginate encapsulation technique that was previously described for established tumor cell lines. Briefly, fresh resected specimens were washed, minced into small multicellular particles called microadenomas, and encapsulated in 1% calcium alginate pellets. The pellets were maintained in minimum essential medium containing 10% fetal bovine serum at 37 degrees C in humidified atmosphere of 95% air, 5% CO2. Ten of eleven adenomas, including six tubular, three tubulovillous, and one villous have been successfully cultured for 34 to 162 days. Cell viability was confirmed histologically by light and electron microscopy. The cells were characterized as epithelial by morphologic features and ultrastructural studies, which showed a high degree of cellular differentiation, including villous brush borders and many desmosomes. Both tubular and villuslike structures have been observed in vitro, correlating in some cases with the histology of the parent adenoma. Measurements of proliferative activity by [3H]thymidine autoradiography or immunohistochemical staining with the monoclonal antibody Ki-67 demonstrated growth fractions of 9% to 25%. A simple, highly efficient primary culture system was developed for the long-term maintenance of adenomas that promotes three-dimensional growth patterns and growth rates analogous to those seen in vivo. This model provides an opportunity to develop an experimental system for longitudinal studies of pathologic and molecular parameters in adenoma progression to carcinoma.

Adenoma↗
PubMed1989

Perinatal cocaine intoxication.

This report describes a case in which cocaine abuse during pregnancy was related temporally to abruptio placentae, preterm labour and to rapid delivery. The neonate developed respiratory distress with features of persistent pulmonary hypertension of the newborn and also signs of neurological dysfunction. He was managed by supportive therapy and has been followed-up to nine months of age. Perinatal cocaine intoxication, either directly or indirectly, is discussed as a cause of his cardiorespiratory and neurological maladaptation. As cocaine abuse appears to be an escalating problem in Australia, increased public awareness of the dangers of both acute and long-term abuse of the drug is seen as a priority in preventive care.

Adult↗