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Biomedical subjects

E Jackson

Publications and source records attributed to E Jackson.

At least 19 recordsLinked to original sources
PubMed2006

A small scale survey of ivermectin resistance in sheep nematodes using the faecal egg count reduction test on samples collected from Scottish sheep.

Thirty-eight sheep flocks, predominantly from the south/central Scotland, were examined using a faecal egg count reduction test (FECRT) for the presence of ivermectin (IVM) resistant nematodes. Efficacies of less than 95%, 14-17 days post-treatment, were identified in 6 of 17 naturally grazing flocks where pre-treatment faecal egg counts were in excess of 150 eggs per gram. Efficacies on these IVM resistant farms ranged from 66 to 92%. One other suspected cases of IVM resistance was also identified in returned material. The larvae detected in post-treatment coprocultures from resistant flocks were from the genera Teladorsagia (4 from 6) and Trichostrongylus (2 from 6).

Animals↗
PubMed2005

Further characterisation of a triple resistant field isolate of Teladorsagia from a Scottish lowland sheep farm.

Anthelmintic efficacies against juvenile developing populations of Teladorsagia species that were known to be resistant to anthelmintics from all three broad spectrum families were examined using a controlled efficacy test. Fenbendazole (FBZ), levamisole (LEV), ivermectin (IVM), combinations of these anthelmintics and moxidectin (MOX) were assessed in parasite naïve lambs artificially infected with 8,000 third stage larvae (Tci5) and treated orally 8-day post-infection with the compounds at the manufacturers recommended dose rates, FBZ, 5 mg/kg body weight (BW); LEV, 7.5 mg/kg BW; IVM, 0.2 mg/kg BW; MOX (0.2 mg/kg BW). The lambs were slaughtered 14-day post-treatment. The arithmetic mean worm burden reductions resulting from oral treatments with FBZ; IVM; LEV; FBZ+IVM; FBZ+LEV; FBZ, LEV+IVM or MOX were 36%, 82%, 38%, 86%, 60%, 88% and 97%, respectively. The results illustrate that combination treatments showed improved efficacies against the juvenile population compared to individually administered treatments but that these improvements were not wholly effective. Moxidectin was the only treatment that was over 95% effective, though caution should be noted when advising the use of MOX prophylactically since 3% of the infection still survived this treatment. Treatments directed at juvenile stages of Tci5 were less effective, with the exception of IVM, compared to a similar trial using Tci5 where the same treatments were directed against a predominantly adult population. No interaction was detected comparing the timings of treatments and its effectiveness with the exception of IVM (two-way ANOVA, p < 0.05). These findings suggest that, on the whole, the selection processes for anthelmintic resistance (AR) may occur at an early stage of development within the parasites, having severe implications for the early detection of AR.

Abomasum↗
PubMed2005

Impact of the European Working Time Directive on the training of paediatric anaesthetists.

The European Working Time Directive and the New Deal have decreased the number of hours worked by anaesthetic trainees. We implemented the Working Time Directive in May 2004 and evaluated the effect of its implementation on training. During two 6-month periods, one before and one after the change, we determined the number of operating lists undertaken by each Specialist Registrar in Anaesthesia. After implementation of the Working Time Directive, the mean number of lists performed by Specialist Registrars decreased from 24 to 21 lists per registrar per month, a 13% decrease. Exposure to subspecialty lists was the same in both periods, but this was at the expense of general lists and those in remote locations. We conclude that the Working Time Directive has had a measurable impact on the training of paediatric anaesthetists, but that the significance of this change for clinical practice has not yet been measured.

Anesthesiology↗
PubMed2004

Characterisation of two triple resistant field isolates of Teladorsagia from Scottish lowland sheep farms.

The anthelmintic resistance status of two field isolates derived from farms (farm A and B) located near Edinburgh were examined using both controlled efficacy tests (CET) and faecal egg count reduction tests (FECRT). Efficacies against fenbendazole (FBZ), levamisole (LEV) and ivermectin (IVM) and, for one isolate, against combinations of these anthelmintics and moxidectin were determined in naïve lambs, artificially infected with the isolates and treated with the compounds at the manufacturers recommended dose rates. (FBZ, 5mg/kg bodyweight (BW); LEV, 7.5mg/kg BW; IVM, 0.2mg/kg BW; Moxidectin (MOX) 0.2mg/kg BW). In both field isolates, the predominant species found pre-treatment and the only species found post-treatment was Teladorsagia circumcincta. Resistance to FBZ, LEV and IVM was confirmed in CET and FECRT on farm A and to the latter two compounds on farm B, which had a history of benzimidazole resistance and where TBZ resistance was also demonstrated using an egg hatch assay (EHA). For the farm A isolate CET efficacies against FBZ; IVM; LEV; FBZ + IVM; FBZ + LEV; FBZ, LEV + IVM and MOX were 59, 60, 88, 94,93, 92 and 98%, respectively. The CET efficacies for the farm B isolate were 51% and 72% for LEV and IVM, respectively.

Abomasum↗
PubMed2004

Treating asthma by the guidelines: developing a medication management information system for use in primary care.

The aim of this study was to develop, implement, and assess an automated asthma medication management information system (MMIS) that provides patient-specific evaluative guidance based on 1997 NAEPP clinical consensus guidelines. MMIS was developed and implemented in primary care settings within a pediatric asthma disease management program. MMIS infrastructure featured a centralized database with Internet access. MMIS collects detailed patient asthma medication data, evaluates pharmacotherapy relative to practitioner-reported disease severity, symptom control and model of guideline-recommended severity-appropriate medications and produces a patient-specific "curbside consult" feedback report. A system algorithm translates actual detailed medication data into actual severity-specific medication-class combinations. A table-driven computer program compares actual medication-class combinations to a guideline-based medication-class combinations model. Methodology determines whether the patient was prescribed a "severity-appropriate" amount or an amount "more" or "less" medication than indicated for patient's reported severity. Feedback messages comment on comparison. Missing data, unrecognized amounts of controller medication or unrecognized medication combinations create error cases. Post hoc review analyzed error cases to determine prevalence of non-guideline medicating practices among these practitioners. Proportion of valid and error cases across two clinical visits before and after post hoc clinical review were measured, as well as proportion of severity-appropriate, out-of-severity and non-guideline medications. MMIS produced a valid feedback report for 83% of patient visits. Missing data accounted for 60% of error cases. Practitioners used severity-appropriate medications for 60% of cases. When non-severity-appropriate medications were used they tended to be "too much" rather than "too little" (22%, 5%), suggesting appropriate use of guideline-recommended "step down" therapy by these practitioners.

Anti-Asthmatic Agents↗
PubMed2003

A comparison of larval development and mucosal mast cell responses in worm-naïve goat yearlings, kids and lambs undergoing primary and secondary challenge with Teladorsagia circumcincta.

Larval development, mucosal mast cell (MMC) and eosinophil responses in worm-nai;ve lambs, yearling goats and goat kids were compared using two different experimental challenge regimes involving oral administration of infective Teladorsagia circumcincta L(3). Experimental challenge regimes enabled primary and secondary immune responses in the two species to be compared. Goats carried higher worm burdens than lambs and there were significant differences in the stages of development attained by the larval challenge that established in the two species. Possible physiological reasons for these differences are discussed. There were also differences in the establishment and development of larvae in individual yearlings which may indicate the development of a weak age-related immune response. Quantitative analysis of MMC and globule leukocyte (GL) recruitment and functional activity in the form of mast cell-specific proteinase (MCP) production demonstrated differences between the species with goat tissues containing significantly higher numbers of GL and lower concentrations of MCP than the lambs. Quantitative analysis of blood and tissue eosinophil responses failed to demonstrate any significant differences in either species under the two challenge regimes.

Aging↗
PubMed2003

Cytomegalovirus infection and thrombosis: a causative association?

Venous thrombosis is a well-organised complication of hospitalisation and has often been reported in the context of HIV infection. Less frequently cytomegalovirus (CMV) has been implicated in the development of thrombosis, although usually in the context of immunosuppression. We report the case of a young, immunocompetent individual who developed pulmonary emboli as a complication of CMV infection and describe the three proposed mechanisms by which this is thought to occur. The probable mechanism in our patient is discussed.

Adult↗
PubMed2002

The use of surgical facemasks during cataract surgery: is it necessary?

AIM: To assess whether facemask utilisation by the surgeon during cataract surgery has any effect on the bacterial load falling onto the operative site. METHOD: Prospective randomised masked study. Consent was obtained from 221 patients. Cases were randomised to wearing a new mask or not wearing any mask throughout the procedure. Blood agar settle plates were placed adjacent to the patient's head in the operative field. Duration of procedure was noted. Plates were incubated and read at 48 hours. Colony forming bacteria were counted and identified. RESULTS: There were significantly fewer organisms cultured when the surgeon used a facemask (p=0.0006). The majority of organisms were Staphylococcus epidermidis, Bacillus spp, and Diphtheroid spp; however Staphylococcus aureus and Pseudomonas aeruginosa were cultured on several occasions. There were no cases of infective complication. CONCLUSIONS: The main purpose of an operating mask is to prevent bacteria falling on to the operative site from the surgeon's oropharynx or nasopharynx with the concomitant theoretical risk of infective complication. Operating masks were shown to have a significant effect on the volume of bacterial organisms falling to the operative site; however, whether this is clinically significant is unknown.

Bacterial Infections↗
PubMed2002

The role of the transjugular intrahepatic portosystemic stent shunt (TIPSS) in the management of bleeding gastric varices: clinical and haemodynamic correlations.

BACKGROUND: The transjugular intrahepatic portosystemic stent shunt (TIPSS) is effective in the management of both oesophageal and gastric variceal bleeding. Although it has been reported that gastric varices can bleed at pressures of < or = 12 mm Hg, this phenomenon has been little studied in the clinical setting. AIMS: To assess the efficacy of TIPSS on rebleeding and mortality following gastric and oesophageal variceal bleeding, and the importance of portal pressure in both groups. METHODS: Forty eligible patients who had bled from gastric varices and 232 from oesophageal varices were studied. Patients were also subdivided into those whose portal pressure gradients (PPG) prior to TIPSS were < or = 12 mm Hg (group 1) and >12 mm Hg (group 2). RESULTS: There was no difference in Child-Pugh score, age, sex, or alcohol related disease between patients bleeding from gastric or oesophageal varices. Patients who bled from gastric varices had a lower PPG pre-TIPSS (15.8 (0.8) v 21.44 (0.4) mm Hg; p<0.001). There was no difference in the rebleeding rate (20.0% v 14.7%; NS). There was a significant difference (p<0.05) in favour of the gastric varices group in the one year mortality (30.7% v 38.7%) and five year mortality (49.5% v 74.9%), particularly in those patients in group 2. Gastric variceal bleeding accounted for significantly more cases in group 1 than in group 2 (36.8% v 10.2%; p<0.001). Most patients in group 2 who rebled had a PPG post-TIPSS of >7 mm Hg. CONCLUSIONS: TIPSS is equally effective in the prevention of rebleeding following gastric and oesophageal variceal bleeding. A significant proportion of gastric varices bleed at a PPG < or = 12 mm Hg. The improved mortality in patients with gastric variceal bleeding is seen only in those that bleed at a PPG >12 mm Hg, and warrants further study.

Chi-Square Distribution↗
PubMed2001

Fishhook removal.

Fishing is a common recreational sport. While serious injuries are uncommon, penetrating tissue trauma involving fishhooks frequently occurs. Most of these injuries are minor and can be treated in the office without difficulty. All fishhook injuries require careful evaluation of surrounding tissue before attempting removal. Ocular involvement should prompt immediate referral to an ophthalmologist. The four most common techniques of fishhook removal and injury management are described in this article. The choice of the method for fishhook removal depends on the type of fishhook embedded, the location of the injury and the depth of tissue penetration. Occasionally, more than one removal technique may be required for removal of the fishhook. The retrograde technique is the simplest but least successful removal method, while the traditional advance and cut method is most effective for removing fishhooks that are embedded close to the skin surface. The advance and cut technique is almost always successful, even for removal of large fishhooks. The string-yank method can be used in the field and can often be performed without anesthesia. Wound care following successful removal involves extraction of foreign bodies from the wound and the application of a simple dressing. Prophylactic antibiotics are generally not indicated. Tetanus status should be assessed and toxoid administered if needed.

Animals↗
PubMed2001

Pig-tailed macaques infected with human immunodeficiency virus (HIV) type 2GB122 or simian/HIV89.6p express virus in semen during primary infection: new model for genital tract shedding and transmission.

Characterizing human immunodeficiency virus (HIV) expression in semen during primary infection remains essential to understanding the risk of sexual transmission. This investigation represents the first systematic evaluation of male genital tract shedding to use a nonhuman primate model, including the impact of exposure route and viral virulence. Male macaques were inoculated with either a chronic disease-causing virus (HIV-2(GB122); n=4 intravenous; n=4 intrarectal) or an acutely pathogenic simian/HIV strain (SHIV(89.6P); n=2 intravenous). All macaques were systemically infected, and seminal plasma virion-associated RNA (vRNA) levels were approximately 10-fold lower than those in blood. In HIV-2(GB122) infection, seminal virus was delayed by 1-2 weeks compared with that in blood. Intrarectal inoculation resulted in a shorter duration of seminal vRNA expression and intermittent seminal cell provirus. No delays, higher peaks ( approximately 50-fold), or longer durations in seminal virus expression were noted for SHIV(89.6P) infection. This novel model definitively establishes that virus dissemination results in early peak seminal levels and provides a basis for evaluating interventions targeting male genital tract expression.

Animals↗
PubMed2001

Interstitial nephritis, hepatic failure, and systemic eosinophilia after minocycline treatment.

This report describes a 15-year-old white boy who presented with fever, back pain, a disseminated exanthematous rash, renal failure, and hepatopathy 3 weeks after the initiation of oral minocycline therapy for facial acne. Marked peripheral and urine eosinophilia were noted. A bone marrow aspiration showed more than 50% eosinophils without any evidence of malignancy, and a simultaneous kidney biopsy showed acute interstitial nephritis (AIN). The patient's symptoms and laboratory findings improved after high-dose steroid therapy was initiated, worsened when it was withheld, and improved again after it was reinitiated in view of the biopsy findings. The patient recovered completely, and steroids were tapered to discontinuation over 3 months. Over a year later, the patient's peripheral blood mononuclear cells (PBMCs) were cultured for 2 weeks in the presence or absence of minocycline ex vivo, and minocycline was found to induce the emergence of CD4(+) cells after 1 week in culture. In conclusion, this article shows for the first time several new aspects of minocycline-induced morbidity: renal and hepatic failure can occur together, and AIN and elevated blood eosinophil counts can be accompanied by marked bone marrow eosinophilia, suggesting a systemic allergic response as the underlying pathomechanism. Furthermore, the initial phase of such a response appears to involve CD4(+) T cells detectable ex vivo. Lastly, high-dose treatment with corticosteroids appears to be beneficial in this setting.

Acne Vulgaris↗
PubMed2001

Come talk with me: improving communication between nursing assistants and nursing home residents during care routines.

PURPOSE: We examined the effects of communication skills training and the use of memory books by certified nursing assistants (CNAs) on verbal interactions between CNAs (n = 64) and nursing home residents (n = 67) during care routines. DESIGN AND METHODS: CNAs were taught to use communication skills and memory books during their interactions with residents with moderate cognitive impairments and intact communication abilities. A staff motivational system was used to encourage performance and maintenance of these skills. Formal measures of treatment implementation were included. RESULTS: Results were compared with those for participants on no-treatment control units. Trained CNAs talked more, used positive statements more frequently, and tended to increase the number of specific instructions given to residents. Changes in staff behavior did not result in an increase in total time giving care to residents. Maintenance of CNA behavior change was found 2 months after research staff exited the facility. Although an increase was found in positive verbal interactions between CNAs and residents on intervention units, other changes in resident communication were absent. IMPLICATIONS: Nursing staff can be trained to improve and maintain communication skills during care without increasing the amount of time delivering care. The methodological advantages of including measures to assess treatment implementation are discussed.

Activities of Daily Living↗
PubMed2001

An audit of the ophthalmic division of the accident and emergency department of the Royal Victoria Eye and Ear Hospital, Dublin.

The objective was to study the patterns of emergency department visits and to make recommendations on ways of improving the service. Patients' demographic data, diagnoses, source of referral and follow-up were entered onto a database. Three thousand seven hundred consecutive patients' visits over a six-week period were entered. The average daily attendance ranged between 80-100 people. 54% of patients were self-referrals. 20% had a previous visit to the hospital. 17% were referred from a GP, 5% from another hospital and 3% from opticians. Superficial injury to the eye and ocular adnexae was the most common diagnostic category. 56% of patients were discharged at the first visit. 23% returned for review to casualty. 14% were referred to OPD, 3% directly to a consultant for review and 1% were admitted to hospital. Waiting times for consultation for patients was highly variable ranging from thirty minutes to five hours, mean two hours. The department provides a service far in excess of its defined function. Non urgent problems accounted for as much as 60-70% of all emergency department visits. Improvement of ophthalmic training of GPs, introduction of an ophthalmic triage system and expansion of outpatient services is recommended so that casualty remains a genuine emergency service and not a primary care service with uncontrollable numbers and unacceptable waiting times for patients.

Emergency Service, Hospital↗
PubMed2000

Colorectal cancer prevention in ulcerative colitis: a case-control study.

BACKGROUND: The risk of colorectal cancer (CRC) in ulcerative colitis (UC) increases with extent and duration of disease. Identifying other risk factors would allow targeting of sub-groups at greatest risk, enabling more cost-effective surveillance. METHODS: We conducted a case-control study comparing 102 cases of CRC in UC with matched controls. Odds ratios (OR) for cancer risk were estimated by conditional logistic regression. A multivariate model assessed the contribution of individual variables. RESULTS: Regular 5-aminosalicylic acid (5-ASA) therapy reduces cancer risk by 75% (OR 0.25, 95% CI: 0.13-0.48, P < 0.00001). Adjusting for other variables, taking mesalazine regularly reduces risk by 81% (OR 0.19, 95% CI: 0.06-0.61, P=0.006) and visiting a hospital doctor more than twice a year also reduces risk (OR 0.16, 95% CI: 0.04-0.60, P=0.007). Considering variables independently, having a family history of sporadic CRC in any relative increases risk fivefold (OR 5.0, 95% CI: 1.10-22.82, P < 0.04). CONCLUSIONS: CRC risk among UC patients can be reduced by regular therapy with 5-ASA medication. Colonoscopic surveillance may be best targeted on those unable to take 5-ASAs (e.g. due to allergy) and those with a positive family history of CRC.

Adolescent↗