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Biomedical subjects

I Russell

Publications and source records attributed to I Russell.

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

Developing a condition-specific measure of health for patients with dyspepsia and ulcer-related symptoms.

A patient-administered instrument for dyspepsia and symptoms suggestive of duodenal or gastric ulcer, based on the type of questions asked when taking a patient's history, was developed and tested using the following steps: literature reviews, devising the questions, testing the responses to the questions using factor analysis and internal consistency, assessing test-retest reliability, and validating the questionnaire by comparing patient responses to the SF-36 health survey questionnaire. The main sample consisted of 135 patients referred to an outpatient clinic with dyspepsia, and 152 patients in general practice who were not referred to a specialist. The final instrument produced a Cronbach's alpha of 0.72 and an intraclass correlation coefficient of 0.69. Patient scores on the dyspepsia questionnaire had small to moderate correlations with the SF-36 health survey, the largest correlation being with the SF-36 scale of pain. Patient scores were significantly related to general practitioner perceptions of symptom severity, family history of gastric ulcer disease, and whether the patient was referred. The questions asked in taking a clinical history from a patient with dyspepsia and other symptoms suggestive of ulcer disease can be used to construct a valid and reliable measure of the effect of dyspepsia on health.

Adult↗
PubMed1995

Developing clinically valid practice guidelines.

Valid guidelines, when appropriately disseminated and implemented, can lead to changes in clinical practice and improvements in patient outcome. Guidelines are more likely to be valid if they are developed using systematic reviews, national or regional guideline development groups (including representatives of key disciplines) and explicit links between recommendations and scientific evidence. This paper discusses the practical implications of adopting this approach for guideline development and the role of peer review guidelines as another element of the process to ensure validity. Considerable resources are required to develop evidence-linked guidelines, but this investment can be recouped by relatively small changes in the process or outcome of care. Good leadership and technical support are required for the successful development of clinically valid guidelines, which is dependent upon the small-group processes of guideline development panels and the translation of evidence into recommendations. Future guideline developers need to gain expertise in these areas. Research priorities are identified.

Consensus Statements as Topic↗
PubMed1995

Yeast Nop3p has structural and functional similarities to mammalian pre-mRNA binding proteins.

Indirect immunofluorescence shows the yeast protein Nop3p/Np13p/Mts1p to be localized both in the nucleoplasm and the nucleolus. Here we show that Nop3p can be efficiently UV cross-linked in vivo to poly(A)+ RNA. In higher eukaryotes it would therefore be classed as a heterogeneous nuclear ribonucleoprotein (hnRNP) component. As judged by immunofluorescence and in situ hybridization, a temperature-sensitive allele of nop3 leads to the accumulation of poly(A)+ RNA in the nucleus at non-permissive temperature. The sequence of Nop3p shows homology to the larger members of the SR protein family of splicing factors, particularly in the RRMH domain. We have, however, detected no splicing defects in strains genetically depleted to Nop3p or carrying a temperature-sensitive allele.

Cell Compartmentation↗
PubMed1995

Adjuvant treatment of high-risk breast cancer using multicycle high-dose chemotherapy and filgrastim-mobilized peripheral blood progenitor cells.

Women with primary breast cancer associated with extensive axillary node involvement or large primary tumors have a very poor prognosis despite treatment with standard-dose adjuvant chemotherapy. In an attempt to improve the outlook of these patients, we investigated the safety and feasibility of delivering three cycles of high-dose epirubicin and cyclophosphamide supported with filgrastim-mobilized peripheral blood progenitor cells (PBPC). Fifteen previously untreated women, median age 50 (range, 30-58) years, with poor prognosis early stage breast cancer received filgrastim (12 microgram/kg daily for 6 days) prior to chemotherapy to mobilize progenitor cells. Patients were then given three cycles of epirubicin (200 mg/m2) and cyclophosphamide (4 g/m2) at planned 28-day intervals, each followed by infusion of one third of the PBPC collected and daily administration of filgrastim (5 microgram/kg s.c.). Three leukaphereses collected a median of 114.9 (range, 22.7-273.5) x 10(4) granulocyte-macrophage-colony-forming cells/kg body weight. Hemopoietic recovery was rapid after each cycle, and there was no correlation between the rate of recovery and the number of granulocyte-macrophage-colony-forming cells infused. There was a small but significant progressive delay in recovery from hematological and nonhematological toxicities across the three cycles. Left ventricular ejection fraction fell to below 50% in eight (53%) patients, but none developed congestive cardiac failure. Two patients did not complete three cycles because of insufficient PBPC for a third cycle (n = 1) and 2-mercaptoethane sodium sulfonate- related drug reaction during the second cycle (n = 1). There were no deaths during the study or during the follow-up period (median, 70 weeks; range, 50-85 weeks), and no late toxicities occurred. Therefore, we concluded that the delivery of multiple cycles of nonmyeloablative, dose-intensive chemotherapy supported by PBPC and filgrastim is safe, and may be widely applicable to a variety of common chemosensitive cancers with a poor prognosis. The efficacy of three cycles of high-dose epirubicin and cyclophosphamide is to be compared with standard-dose chemotherapy in a randomized trial in patients with high-risk, operable stage II and III breast cancer.

Adolescent↗
PubMed1994

Tuned phasic and tonic motile responses of isolated outer hair cells to direct mechanical stimulation of the cell body.

Guinea pig outer hair cells (OHCs) isolated from the two apical turns of the cochlea and firmly attached to a suction pipette, were subjected to the stimulus of the near-field (particle) displacements of a calibrated oscillating fluid jet aimed at the lateral cell walls. The longitudinal length changes of the OHCs in response to stimulation, in a direction orthogonal to that of the fluid jet, were recorded by a photodiode array. The response had two components; a phasic length change which followed the frequency of the particle displacement of the jet cycle by cycle, and a tonic length change which took several milliseconds to develop depending on the magnitude of the mechanical stimulus. When the hair cell changed length the lateral walls of the OHC moved in antiphase, moving apart during shortening and together during lengthening. With increased stimulus level the phasic response grew in proportion to the stimulus magnitude and began to saturate at the highest stimulus levels, while the tonic response grew in proportion to the square of the stimulus magnitude. Both the direction of the tonic length change and the phase of the phasic component could alter with the level of stimulation. Isolevel and isoresponse-frequency functions of both the tonic and phasic length changes revealed that both response types were tuned to similar resonant frequencies (RF) between 150 and 2500 Hz. The phase of the phasic length change began to lag at frequencies just below the RF, lagged by about 90 degrees at the RF and lagged by a further 90 degrees at frequencies above RF. The frequency response properties of the OHCs closely corresponded to those of a damped, forced, mechanical resonance. The tonic response disappeared and the phasic response was reduced at low-levels as a consequence of intense mechanical stimulation and with time.

Acoustic Stimulation↗
PubMed1994

The effect of allowing clinical discretion in ordering biochemical tests. Evaluation by complementary methods.

We describe the effects on costs, working patterns, and clinical behavior of installing a DAX "discretionary" biochemistry analyzer. Use of the new analyzer encouraged doctors to be more specific in requesting biochemical tests, which substantially reduced the number of tests requested and slightly reduced overall costs. Doctors preferred being able to order tests in this more specific way.

Autoanalysis↗
PubMed1994

Analysis of cerbB2 expression using a panel of 6 commercially available antibodies.

Results are presented of a study comparing cerbB2 (neu or Her2) expression as assessed immunohistochemically in breast neoplasia using a panel of 6 commercially available antibodies. The antibodies were examined utilizing conventional formalin fixed paraffin embedded tissue, and compared with molecular analysis of gene amplification. The aim was to determine the practical utility of each antibody, assessing ease of use, specific and non-specific staining characteristics, and expense, thus allowing a specific recommendation as to antibody of choice for immunohistochemical assessment of cerbB2 expression. Reassuringly, amongst the 38 breast lesions (36 carcinomas, 2 fibroadenomas) subjected to immunohistochemically (IHC) with the panel of 6 antibodies (Ab), no gross discrepancy of staining pattern was seen. Of the 38 cases, 10 were positive (26%), where at least one Ab demonstrated clear cytoplasmic membrane staining. Of a total of 45 breast lesions (43 carcinomas, 2 fibroadenomas), including all those examined by IHC, the total number of cases showing cerbB2 amplification by DNA analysis was 14 (31%). Using the DNA amplification as a base line for comparison, one Ab (No. 4) was found to stain 6 of the 14 cases of breast carcinoma that were assessed as showing amplification at the DNA level. Four Abs (1,3,5,6) stained 5 of these cases. However, Abs 3,4 and 6 displayed artefactual cytoplasmic staining (in the absence of membrane staining) that precluded the practical use of these reagents. Therefore, based on additional considerations of cost and ease of use, Ab No. 1 was finally chosen for recommendation from the 6 Ab panel.

Adult↗
PubMed1994

Psychological responses following medical abortion (using mifepristone and gemeprost) and surgical vacuum aspiration. A patient-centered, partially randomised prospective study.

BACKGROUND: A substantial body of objective data now exists to support the consensus view that induced abortion results in a low incidence of psychiatric morbidity. However, these data do not include more recent advances in abortion technology. Medical abortion entails a participatory role on the part of the woman, who may perceive more pain or see products of conception. The physical and psychological events experienced by women undergoing this procedure may lead to differences in psychopathology. METHODS: 363 women undergoing legal induced abortion up to 63 days gestation were allocated by a prospective partially randomised design to undergo medical abortion (using mifepristone 600 mg followed 48 h later by gemeprost 1 mg vaginal pessary) or vacuum aspiration performed under general anesthesia. This study design allowed women with a preference for a particular method to undergo that method; women without preferences were allocated at random. Women completed sensitive and reliable psychometric instruments (the Hospital Anxiety and Depression Scale and a semantic differential rating scale designed to measure self-esteem) prior to abortion and 16 days later. RESULTS: There were no significant differences between women allocated at random to medical abortion or vacuum aspiration in post-abortal anxiety, depression or low self-esteem. Women with high levels of mood disturbance prior to abortion, who were smokers or who had medical complications following abortion were at highest risk of post-abortal mood disorder. CONCLUSIONS: Medical abortion is a psychologically safe as surgical vacuum aspiration. The quantitative findings of the study support the consensus view that abortion is associated with high incidence of psychological benefit, whichever method is used.

Abortifacient Agents, Nonsteroidal↗
PubMed1994

Case mix and content of trainee consultations: findings from the north of England study of standards and performance in general practice.

BACKGROUND: Previous studies have examined the differences in the work of trainees and trainers. However, they have not investigated how many of these differences are due to differences in the case mix seen by trainees. AIM: A study was undertaken to investigate the effect of case mix on the content of consultations with trainee general practitioners. METHOD: Details of surgery consultations with 207 trainee general practitioners and 255 principals in 62 training practices in the north of England were prospectively recorded during one week in each of four consecutive years. RESULTS: Trainee general practitioners saw a higher proportion of younger patients and those categorized as suffering from an acute minor condition compared with principals. They saw a lower proportion of patients categorized as suffering from chronic intermediate, chronic major and female conditions. The reported content of trainee and principal consultations differed over all four years in that trainees examined more patients, issued more new prescriptions, issued fewer repeat prescriptions, arranged fewer return appointments and referred fewer patients. However, adjusting for case mix reduced the number of significant differences between trainees and principals to two: trainees issued fewer repeat prescriptions and had more consultations lasting longer than nine minutes. CONCLUSION: The case mix and content of consultations differ between trainees and principals and some of the differences in content are due to the differences in case mix; trainees generally behave more like principals than has been previously suggested. Thus, case mix is an important factor in understanding the content of trainee consultations.

Diagnosis-Related Groups↗
PubMed1993

Absent friends.

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Appointments and Schedules↗
PubMed1993

Percutaneous absorption of diazinon in humans.

Diazinon is an organophosphorus insecticide which, through general use, comes into contact with human skin. To investigate its percutaneous absorption, human volunteers were exposed for 24 hr to 14C-labelled diazinon applied in acetone solution (2 micrograms/cm2) to the forearm or abdomen, or in lanolin wool grease (1.47 micrograms/cm2) to the abdomen. Complete void urine samples were collected daily for 7 days. Percutaneous absorption ranged from 2.87 +/- 1.16% (mean +/- SD, n = 6) to 3.85 +/- 2.16% of the applied dose, and there were no statistically significant differences with regard to site or vehicle of application. In rhesus monkeys, over the 7 days after iv dosing (2.1 microCi [14C]diazinon, 31.8 micrograms) a total of 55.8 +/- 6.8% (n = 4) of the dose was excreted in the urine, and 22.6 +/- 5.2% was eliminated in the faeces (78.4% total accountability). In in vitro percutaneous absorption studies with human abdominal skin, 14.1 +/- 9.2% of the applied dose accumulated in the receptor fluid over 24 hr of exposure to 0.25 microgram/cm2 (acetone vehicle). The calculated mass absorbed was the same (0.035 microgram/cm2) for both in vitro and in vivo absorption through human skin.

Administration, Cutaneous↗