Biomedical subjects
Publications and source records attributed to J Baker.
The estates function has developed from a mainly operational job to one with considerable strategic importance. John Baker, Estates Manager, Bedford Hospital NHS Trust, outlines the challenges of managing the NHS estate today.
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Care paths and patient pathways are collaborative interdisciplinary tools developed to provide quality care. One goal in progressive renal insufficiency (PRI) care is to provide patients and family members with relevant and timely information to help them cope with medical therapy and lifestyle changes required to slow the progression of renal insufficiency. At Halton Healthcare Services, clinical and patient pathways have been widely used with success. Recognizing the potential benefits of a patient pathway for the PRI population, our interdisciplinary team developed a pathway that outlines the journey to renal replacement therapy. The pathway provides the patient with some insight into the future, as their disease process continues to have impact on their life. Reviewed by a patient within our PRI program during the development process, we have tailored this pathway to meet the needs of this unique population. We predict this patient pathway will have positive impact on the patient's understanding of the role of the PRI clinic and the partnership between the team members, the patient, and the family.
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This paper presents a socioeconomic profile and the prevalence of sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV), among 341 female commercial sex workers (CSWs) in Kathmandu Valley. Most of the CSWs are from outside the valley, but from within Nepal. Over 50% of the CSWs have a secondary or higher level of education. The average age of the CSWs is 21 years. The average age of first sexual intercourse was 16 years; and, at entering the sex trade, 18 years. The most frequently reported type of sexual activity is vaginal intercourse followed by anal intercourse. Although a large proportion of CSWs are aware of condoms, only one-fifth of them reported using condoms most of the time they had intercourse. The majority of the CSWs are aware of general types of STDs. Slightly over 60% are aware of AIDS, and the majority of them know of at least one mode of AIDS transmission. Gynecological examination based on symptoms revealed that 72% of the CSWs were infected with some type of STD. About 47% had vaginal discharges, 36% had pelvic inflammatory disease, 24% had ulcerative disease, and 4% had urethritis. Blood tests of the CSWs revealed that 28% had VDRL (a test for syphilis), hepatitis B, or HIV. The prevalence of VDRL was the most common, followed by hepatitis B. Of the 341 CSWs, 3 (0.9%) were HIV-positive.
HIV/AIDS is a growing problem in Nepal. There has been a 15-fold increase in the number of HIV-infected cases during the period 1990-93. By 1993, 195 cases had been reported to the Ministry of Health. Among the total cases reported, approximately equal numbers of male and female HIV cases are represented. The current estimate of HIV-infected individuals is 5000; however, the number is projected to reach cumulatively 100,000 by the year 2000 if effective preventive measures are not taken. Commercial sex workers and their clients remain the most affected groups. The majority of HIV-infected cases belong to the 20-29 age group. HIV surveillance data indicate that the overall positivity rate increased from 0.20 to 0.70 over the 12-month period, 1991-92. Of the total 195 HIV-infected cases, 24 (12.3%) are reported to be AIDS cases. The AIDS cases doubled between 1991 and 1993. There are three times as many AIDS cases among females than males. Of the total 24 AIDS cases, 11 have died. Case studies illustrate the multi-faceted context in which HIV/AIDS is spreading in Nepal.
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Unwanted pregnancies put women in Kenya at risk of morbidity and mortality associated with childbearing; induced abortion is an option some women seek as a response to that situation. Qualitative research was carried out to document the case histories of 30 Kenyan women who underwent induced abortion. In-depth interviews were conducted among an urban group of low-income women to identify sources of information about induced abortion and the decision-making process, and to describe the abortion experience among this group. Being unmarried and unemployed contributed to the decision to abort. Two main types of induced abortion, one provided in private facilities by medical personnel, and the other performed by a variety of untrained practitioners, are described.
Mainstream Experiences for the Learning Disabled (MELD) was developed to accommodate students with learning disabilities in the mainstream. This article reports the progress of 13 students at the end of 1 year of planning and 1 year of implementing the MELD model in one urban elementary school. Observational and school adjustment data from the implementation year suggest that although the MELD model was not fully incorporated into the mainstream classes, students with learning disabilities adjusted well to a less individualized and more demanding mainstream program. They came to school regularly, did not present serious behavior problems, and spent as much of reading class and more of math class on task as they had in special education. These students in the mainstream were assigned more opportunities to work with text materials rather than workbooks in reading and spent significantly more reading time in teacher-directed lessions. Nevertheless, the students made no significant progress in reading or math and earned lower grades during the implementation year. The authors suggest that students with learning disabilities will not succeed in the mainstream if teachers continue "business as usual" in mainstream classes.
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In this preliminary report, two groups of children were vaccinated with subcutaneous BCG, one on the deltoid area and the other one on the area between the spine and the scapula. The number of hypertrophic scars on the deltoid area was significantly higher that in the area between the spine and the scapula. Vaccination on this area is as effective in turning the P.P.D. positive as on the deltoid area and the risk of hypertrophic scars in minimized.
Cisplatin in combination with other cytotoxic agents is the backbone for a potential cure of testicular germ cell neoplasms and is a critical factor in the substantial activity observed in the treatment of small cell lung cancer, bladder cancer, and ovarian germ cell tumors. Resistance to cisplatin at the onset of treatment or at relapse limits its curative potential, however. Laboratory studies using both cells selected for cisplatin resistance by exposure to sublethal concentrations and biopsy specimens from patients' tumors provide insights for the potential mechanisms of resistance. The mechanisms identified in vitro include a complex and wide array of related and unrelated pathways such as alterations in cellular drug transport, enhanced DNA repair dependent and independent of signal transduction pathways, and enhanced intracellular detoxification such as glutathione and metallothionein systems. Studies of these mechanisms have identified a number of agents with known potential for administration to humans and that reverse cisplatin resistance in vitro; for example, reversal of cellular accumulation defects by dipyridamole; inhibition of DNA repair by hydroxyurea, pentoxifylline, and novobiocin; inhibition of the glutathione system by ethacrynic acid and buthionine sulfoximine; and inhibition of signal transduction pathways by cyclosporine, tamoxifen, and calcium channel-blocking agents. Current phase I clinical trials are focusing on the most effective doses and schedules to administer these agents in combination with cisplatin. Initial uncontrolled trials in limited numbers of patients suggest that the addition of modulators of cisplatin has the potential to reverse resistance in patients previously failing therapy. Another promising avenue for circumventing cisplatin resistance is the development of noncross-resistant platinum analogs.
Prior to 1979, bone marrow transplants were only performed with histocompatible sibling donors. Once it was established that histocompatible, unrelated donors could donate marrow for transplantation, the recruitment of such donors needed to be standardized. Blood donor centers had already identified the histocompatibility locus antigen (HLA) typing for donors who could be recruited to donate bone marrow. Recruiting a large number of donors required systematic evaluation and testing according to defined standards which were published in 1988 by the National Marrow Donor Program (NMDP). Peripheral stem cell collection (PBS) has been added as a transplant source. It promises additional therapeutic modalities, such as gene splicing to address other than cancer therapy.