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Biomedical subjects

I Brown

Publications and source records attributed to I Brown.

At least 55 records · Page 3Linked to original sources
PubMed1996

Long-term results of transtrochanteric rotational osteotomy for femoral head osteonecrosis.

Twenty transtrochanteric rotational osteotomies were performed in 19 patients with osteonecrosis of the femoral head (average age 32 years; range 19-55 years). There were 17 hips at Ficat stage III and three at stage IV. The average head rotation achieved was 70 degrees (range 55 degrees-95 degrees) Fourteen hips were converted to a total hip arthroplasty after an average period of 5.6 years (range 1.5-12.7 years). Five hips have maintained a good clinical result and normal function for an average period of 11.3 years (range 9.2-13.5 years). One patient with an ankylosed hip was lost to follow-up at 3.5 years. All hips with incomplete rotation of the necrotic fragment out of the weight-bearing area were revised to total hip arthroplasties. All unrevised hips had radiographic evidence of mild to moderate osteoarthritis. Total hip arthroplasty was deferred for a modest period in most patients, and conversion was performed without difficulty. However, we no longer advocate transtrochanteric rotational osteotomy because of unpredictable results and technical difficulties, especially with large lesions.

Adult↗
PubMed1996

The Quality of Life Profile--Adolescent Version: background, description, and initial validation.

PURPOSE: Emerging concepts of adolescent health were considered within a broadened quality of life perspective. Instrumentation examining quality of life-the extent to which a person enjoys the important possibilities of his/her life-in three broad domains of adolescent functioning: being, belonging, and becoming, was developed and validated. METHODS: The 54-item Quality of Life Profile: Adolescent Version (QOLPAV) asks adolescents to rate items for importance and satisfaction. The QOLPAV was administered, together with a range of other measures of adolescent functioning, to 160 Canadian adolescents. RESULTS: QOLPAV scores were reliable and correlated with measures of adolescent personality, self-reported health status, and tobacco and alcohol use. CONCLUSIONS: With further validation, the QOLPAV could be used to assess current states of coping and functioning, identify adolescents' service needs, develop health enhancing environments, and assess the effects of illness and treatments.

Adolescent↗
PubMed1996

Deliberate self harm and the Probation Service; an overlooked public health problem?

Reducing the suicide rate is one of chief targets of Health of the nation, although consideration scepticism has been expressed about whether or not this can be achieved. We have reported that nearly a third of those supervised by the West Yorkshire Probation Service had a history of deliberate self harm (DSH). Comparing the known risk factors for DSH and suicide with the composition of those supervised by the Probation Service suggests this is a high-risk group that has not traditionally been well served by mental health services.

Attitude to Health↗
PubMed1996

Unplanned readmissions of elderly patients.

OBJECTIVE: This study was undertaken to determine the prevalence of unplanned readmissions in Geriatric Medicine in Aberdeen and to examine their nature in order to establish how many of them were avoidable. DESIGN: Patients living within Aberdeen who were discharged from Care of the Elderly Assessment Wards in one hospital between 1 August 1994 and 31 January 1995 were identified. Any subsequent unplanned readmissions of this population to any local hospital within 28 days were identified and formed the study's sample. Subsequent comparison with the non-readmitted population yielded readmission rates. The nature of each episode was investigated by obtaining a wide range of data (e.g. from medical and nursing notes) soon after readmission and by the audit team subsequently identifying principal and associated causative factors. A questionnaire was also sent to the discharging consultant and the patient's GP seeking opinions on whether readmission was avoidable and these were weighted equally with the audit team's opinion in order to establish avoidability. SETTING: The patients were all discharged from the nine Care of the Elderly Assessment wards at Woodend Hospital in Aberdeen and readmitted to any NHS hospital within Aberdeen. SUBJECTS: The subjects were patients living within Aberdeen who satisfied the above criteria. RESULTS: There were 109 episodes of readmission resulting from 713 discharges, making a readmission rate of 15.3%. The readmitted population was elderly with multiple medical problems; 50% lived alone. In 87% of cases the principal causative factor in readmission was medical, most commonly involving relapse of illness. The remaining 13% were 'social' in nature. Response rates to the questionnaire by GP's and Consultants were excellent (96% and 99% respectively) and 34 cases emerged where either party, or both, thought readmission to be avoidable. These cases were subject to further review by the audit team and in this way 16 of the 34 cases were judged to be avoidable. The main area for improvement was considered to be pre-discharge assessment of home circumstances. CONCLUSION: The majority of unplanned readmissions were medical in nature and unavoidable. The use of rates of unplanned readmission as a measure of clinical outcome in care of the elderly is unsatisfactory as they do not accurately reflect the quality of in-patient care.

Aged↗
PubMed1995

Food processing and maize variety affects amounts of starch escaping digestion in the small intestine.

Two meals which differed greatly in resistant starch (RS) concentration, but otherwise had similar macronutrient composition (including nonstarch polysaccharides), were fed for breakfast to five subjects with ileostomies. The high-RS meal included bread made from high-amylose maize, uncooked green banana flour, and coarsely ground uncooked wheat. The low-RS meal contained bread made from low-amylose maize, cooked green banana flour, and cooked wheat. The effluent produced over 14 h was analyzed for the total amount of starch escaping digestion. In the low-RS meal 51.8 +/- 6.2 g (mean +/- SD) starch was consumed and 2.4 +/- 0.6 g recovered in the effluent, while for the high-RS meal a total of 52.7 +/- 8.8 g starch was fed and 19.9 +/- 5.2 g recovered in the effluent. The ileostomy results provided additional validation of an in vitro resistant starch assay. Scanning electron micrographs of effluent from one subject who consumed the high-amylose bread revealed that many intact starch granules escaped digestion in the small intestine.

Adult↗
PubMed1995

Frailty: constructing a common meaning, definition, and conceptual framework.

The term frailty has been used for many years, both in everyday and academic language. It is a term that appears, on the surface, to be simple enough in its meaning, yet it has been used in a variety of ways to describe both people and a condition that applies to people. Moreover, little conceptual thought has gone into the nature of frailty and the factors that might affect it. This paper presents a definition of frailty: frailty occurs when there is diminished ability to carry out the important practical and social activities of daily living. It also presents a conceptualization of frailty that specifies its basic components, the categories of factors that contribute to it, and its relationship to closely related concepts.

Activities of Daily Living↗
PubMed1994

The development of a [211At]-astatinated endoradiotherapeutic drug: Part II. Therapeutic results for transplanted adenocarcinoma of the rectum in mice and associated studies.

PURPOSE: 6-[211At]-astato-MNDP is of a class of a high linear energy transfer endoradiotherapeutic drug, which selectively targets to an onco-APase isoenzyme expressed by certain epithelial and germ cell tumors. The therapeutic efficacy and acute toxicity of its endogenous alpha-particle emissions have been studied in a murine tumor model. METHODS AND MATERIALS: 211At was produced by the 207Bi(alpha,2n)211 At cyclotron-based nuclear reaction. High specific activity 6-[211At]-astato-MNDP was rapidly synthesized by in vacuo thermal heterogeneous isotopic exchange. The therapeutic potential of 6-[211At]-astato-MNDP and 211At- was determined in mice bearing a transplanted CMT-93 rectal carcinoma which exhibited onco-APase activity. RESULTS: Significant therapeutic effects due to targeted alpha-particle emissions have been confirmed for the activity dose range, 10-750 kBq 6-[211At]-astato-MNDP. A therapeutic window has been identified, whereby cure rates of approximately 45-65% were achieved following administration of 55-300 kBq 6-[211At]-astato-MNDP. Estimated tumor absorbed radiation doses were not inconsistent with clinical response. Irreversible hematoxicity or stigmata of acute radiation damage in other critical normal tissues were not encountered. Nonspecifically internalized 211At- exerted no therapeutic effect. CONCLUSION: Therapeutic results for 6-[211At]-astato-MNDP have confirmed the profound in vivo cytotoxicity of its targeted alpha-radiations in the CMT-93 tumor. Acute normal tissue toxicity was acceptable. A rationale for optimal fractionation of targeted 6-[211At]-astato-MNDP endoradiotherapy is discussed, and its putative role in the possible individualized management of certain human tumors has been proposed.

Adenocarcinoma↗
PubMed1994

Community and participation for general practice: perceptions of general practitioners and community nurses.

A central theme of health policy has concerned the public's participation in primary health care services, both as individual consumers and collectively as communities. In the U.K. primary care increasingly centres on general practice. This paper reports an exploratory study undertaken with practice teams in inner city Sheffield about community participation. The study design was influenced by a grounded theory approach to data collection and analysis. The main data collected was from interviews of 23 general practitioners, 20 practice nurses, 11 health visitors and 7 district nurses. Concepts of community and participation were explored by interview with these primary care workers. Typologies of community and participation for general practice are presented in the findings, along with associated strategic positions and political tensions. The discussion highlights a number of tensions and issues concerning community participation when primary care is organized around general practice.

Attitude of Health Personnel↗
PubMed1994

Aortic compliance measured by non-invasive Doppler ultrasound: application of a personal computer based MkII system and its repeatability.

A non-invasive pulse-wave-velocity Doppler ultrasound technique for the assessment of aortic compliance is described. A computational approach for correcting for the effect of non-chronic changes in blood pressure is considered and applied to compliance measurements performed on an age-select cohort of 70 normotensive, normal healthy volunteers. In order to permit the wider availability of the pulse-wave-velocity Doppler ultrasound technique, the authors have developed a MkII system based on a standard 80486/33 MHz IBM compatible WINDOWS based personal computer; real-time spectral analysis being achieved using a relatively inexpensive but fast analogue to digital signal processing card. An overview of the new apparatus is provided and verification work to compare the repeatability of the MkI and MkII systems is described. Medical disorders such as atherosclerosis, diabetes mellitus, familial hypercholesterolaemia, growth hormone deficiency, and Ehlers-Danlos and Marfan's syndromes have all been shown to affect arterial wall compliance. We suggest that the in vivo clinical measurement of blood pressure corrected aortic distensibility using the MkII system may be a useful, reproducible, non-invasive tool for assessing such patients' susceptibility to atheromatous arterial disease as well as for monitoring their response to therapeutic interventions. Measurements in the aorta may be especially pertinent since the natural history of fatty streaks there tends to parallel that in the coronary vasculature thereby potentially affording a convenient surrogate estimate of coronary heart disease.

Aorta↗
PubMed1994

A stapling instrument for placement of right atrial pursestrings.

The right atrial pursestring was placed in 12 patients undergoing cardiac operations utilizing a commercially available stapling instrument. Our initial experience indicates that this device can be used for rapid, simple, and safe application of the right atrial pursestring.

Coronary Artery Bypass↗
PubMed1994

EB9, a new antibody for the detection of trophozoites of Pneumocystis carinii in bronchoalveolar lavage specimens in AIDS.

AIM: To prepare a monoclonal antibody (EB9) against the trophozoite form of Pneumocystis carinii and to test its efficacy for detecting infection with this organism. METHOD: The sensitivity and specificity of the EB9 antibody were assessed by comparing it with other conventional stains (Papanicolaou, Giemsa and Grocott) and 3F6 antibody in 33 bronchoalveolar lavage specimens from HIV positive patients suspected of having P carinii pneumonia. RESULTS: P carinii infection was detected in 15 of 33 patients. In 14 cases the organism was detected by two or more of the staining methods used; however, EB9 failed to detect infection in two cases which were positive by other staining techniques. In one case P carinii infection was detected by EB9 only. CONCLUSION: The results of this study suggest that P carinii infection in the lung may occur in two forms: the cyst form and the trophozoite form, which may explain the observed variation in response to treatment.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Perception of humor in cartoon riddles by adults with intellectual disability.

Young adults with intellectual disability, 15 with IQs of 55 to 75 and 15 with IQs of 40 to 54, rated 12 cartoon riddles of six levels of difficulty. Mirth and comprehension were also scored. Analyses indicated that participants considered the jokes funny but there was a strong tendency to respond to the visual aspects of the jokes rather than to the auditory aspects.

Adult↗
PubMed1994

Defining our terms: community development and public health.

The HVA's community development interest group was launched to provide a forum for health visitors working, or wishing to develop their work, in this specialist area of practice. Ian Brown reflects on the discussions and issues raised at a study day organised by the group in March this year.

Community Health Nursing↗