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J Batchelor

Publications and source records attributed to J Batchelor.

At least 19 recordsLinked to original sources
PubMed2006

Derivation of the children's head injury algorithm for the prediction of important clinical events decision rule for head injury in children.

BACKGROUND: A quarter of all patients presenting to emergency departments are children. Although there are several large, well-conducted studies on adults enabling accurate selection of patients with head injury at high risk for computed tomography scanning, no such study has derived a rule for children. AIM: To conduct a prospective multicentre diagnostic cohort study to provide a rule for selection of high-risk children with head injury for computed tomography scanning. DESIGN: All children presenting to the emergency departments of 10 hospitals in the northwest of England with any severity of head injury were recruited. A tailor-made proforma was used to collect data on around 40 clinical variables for each child. These variables were defined from a literature review, and a pilot study was conducted before the children's head injury algorithm for the prediction of important clinical events (CHALICE) study. All children who had a clinically significant head injury (death, need for neurosurgical intervention or abnormality on a computed tomography scan) were identified. Recursive partitioning was used to create a highly sensitive rule for the prediction of significant intracranial pathology. RESULTS: 22,772 children were recruited over 2 1/2 years. 65% of these were boys and 56% were <5 years old. 281 children showed an abnormality on the computed tomography scan, 137 had a neurosurgical operation and 15 died. The CHALICE rule was derived with a sensitivity of 98% (95% confidence interval (CI) 96% to 100%) and a specificity of 87% (95% CI 86% to 87%) for the prediction of clinically significant head injury, and requires a computed tomography scan rate of 14%. CONCLUSION: A highly sensitive clinical decision rule is derived for the identification of children who should undergo computed tomography scanning after head injury. This rule has the potential to improve and standardise the care of children presenting with head injuries. Validation of this rule in new cohorts of patients should now be undertaken.

Algorithms↗
PubMed2004

Association of verrucous skin lesions and skin ulcers on the feet in patients with diabetic neuropathy.

We report the simultaneous or chronological association of verrucous skin lesions and diabetic ulcers on the feet of three diabetic patients. All three patients had poor diabetic control and were suffering from complications such as neuropathy, retinopathy and nephropathy at the time of presentation. In patient 1, verrucous skin lesions on the feet in diabetic neuropathy (VSLDN) and a diabetic skin ulcer developed simultaneously. In patient 2, VSLDN preceded the development of diabetic ulcers, while in patient 3, diabetic ulcers preceded VSLDN. These associations suggest that VSLDN and diabetic ulcers are closely related in their aetiology and pathogenesis. Strategies for the treatment and prevention of VSLDN should include multiple treatment modalities combined with foot care as proposed by the international working group on the diabetic foot.

Aged↗
PubMed2004

A meta-analysis of variables that predict significant intracranial injury in minor head trauma.

BACKGROUND: Previous studies have presented conflicting results regarding the predictive effect of various clinical symptoms, signs, and plain imaging for intracranial pathology in children with minor head injury. AIMS: To perform a meta-analysis of the literature in order to assess the significance of these factors and intracranial haemorrhage (ICH) in the paediatric population. METHODS: The literature was searched using Medline, Embase, Experts, and the grey literature. Reference lists of major guidelines were crosschecked. Control or nested case-control studies of children with head injury who had skull radiography, recording of common symptoms and signs, and head computed tomography (CT) were selected. OUTCOME VARIABLE: CT presence or absence of ICH. RESULTS: Sixteen papers were identified as satisfying criteria for inclusion in the meta-analysis, although not every paper contained data on every correlate. Available evidence gave pooled patient numbers from 1136 to 22 420. Skull fracture gave a relative risk ratio of 6.13 (95% CI 3.35 to 11.2), headache 1.02 (95% CI 0.62 to 1.69), vomiting 0.88 (95% CI 0.67 to 1.15), focal neurology 9.43 (2.89 to 30.8), seizures 2.82 (95% CI 0.89 to 9.00), LOC 2.23 (95% CI 1.20 to 4.16), and Glasgow Coma Scale (GCS) <15 of 5.51 (95% CI 1.59 to 19.0). CONCLUSIONS: There was a statistically significant correlation between intracranial haemorrhage and skull fracture, focal neurology, loss of consciousness, and GCS abnormality. Headache and vomiting were not found to be predictive and there was great variability in the predictive ability of seizures. More information is required about the current predictor variables so that more refined guidelines can be developed. Further research is currently underway by three large study groups.

Child↗
PubMed2004

The implications of NICE guidelines on the management of children presenting with head injury.

BACKGROUND: NICE guidelines for the management of head injury were published in June 2003. Their recommendations differ markedly from previous guidelines published by the Royal College of Surgeons (RCS). In place of skull radiography and admission, computed tomography (CT) is advocated. The impact of these guidelines on service provision in the UK is unknown. METHODS: Data on all clinical correlates of children presenting with any severity of head injury was collected in three hospitals in the northwest of England. The current skull radiograph (SXR), CT scan, and admission rates were determined. The rates of SXR, CT scan, and admission that should have occurred when following either the RCS or NICE guidelines were then determined. RESULTS: Data from 10 965 patients who attended three hospitals between February 2000 and August 2002 was studied. Twenty five per cent of patients received a SXR, 0.9% a CT scan, and 3.7% were admitted. Strict adherence to the RCS guidelines would have resulted in a 50% SXR rate, a 1.6% CT scan rate, and a 7.1% admission rate. Adherence to NICE guidelines would result in a 0.3% SXR rate, an 8.7% CT scan rate, and a 1.4% admission rate, although the CT rate would drop to 6.3% if vomiting three or more times in the under 12s was used instead of more than one vomit. CONCLUSIONS: The new NICE guidelines do not increase the workload caused by patients attending with head injury but they move their management from the observation ward to the radiology department.

Adolescent↗
PubMed2003

Use of a novel carbon fibre composite material for the femoral stem component of a THR system: in vitro biological assessment.

A novel, low elastic modulus femoral component for THR has been developed using a composite of polyetheretherketone and carbon fibre. The objectives of this study were to investigate human osteoblast-like cell and macrophage responses to this material in vitro. Cells were grown on composite discs and controls. Osteoblast attachment and proliferation was not significantly different to that on Ti6Al4V. The levels of alkaline phosphatase activity, Type I collagen production and osteocalcin production were not significantly different to that on Ti6Al4V by the end of the experimental period. Hydrogen peroxide production by macrophages was significantly less than that detected for cells cultured on copper, but was still greater than that detected for cells cultured on tissue culture plastic and Ti6Al4V. Beta-glucoronidase activity was not significantly different to that detected for cells cultured on tissue culture plastic. The in vitro biocompatibility assessment of this composite undertaken in this study showed initial osteoblast attachment at least comparable to that of the tissue culture plastic and Ti6Al4V controls, with proliferation similar to the controls at all time points up to 11 days. Alkaline phosphatase activity was similar to that of Ti6Al4V but reduced compared to tissue culture plastic controls. Whilst hydrogen peroxide production by macrophages was raised on composite surfaces compared to controls, beta-glucoronidase activity and osteoblastic production of Type I collagen and osteocalcin were similar to levels detected on Ti6Al4V.

Alkaline Phosphatase↗
PubMed2002

A meta-analysis of GCS 15 head injured patients with loss of consciousness or post-traumatic amnesia.

OBJECTIVES: The classification of patients with "minor head injury" has relied largely upon the Glasgow Coma Scale (GCS). The GCS however is an insensitive way of defining this heterogeneous subgroup of patients. The aim of the study was to develop an extended GCS 15 category by meta-analysis of previously published case-control studies that have identified symptom risk factors for an abnormal head tomogram. METHODS: Eligibility for the study was defined as: (1) Full papers and not abstracts. (2) Case-control or nested case-control studies on GCS 15 patients (adults or adults plus children). Outcome variable being head tomography: normal or abnormal. (3) Documentation of one or more symptom variables such that the odds ratio could be calculated. Five symptom variables were defined for the purpose of the study: headache, nausea, vomiting, blurred vision, and dizziness. RESULTS: Three articles fulfilled the criteria for the study. The Mantel-Haenszel test using a pooled estimate was used to calculate the common odds ratio for an abnormal head tomogram for each of the five symptom variables. The odds ratio for the symptom variables was: dizziness 0.594 (95%CI 0.296 to 1.193), blurred vision 0.836 (95%CI 0.369 to 1.893), headache 0.909 (95% CI: 0.601 to 1.375), severe headache 3.211 (95% CI: 2.212 to 4.584), nausea 2.125 (95% CI 1.467 to 3.057), vomiting 4.398 (95% CI 2.790 to 6.932). CONCLUSION: The results of this study provide a framework on which GCS category 15 patients can be stratified into four risk categories based upon their symptoms.

Adult↗
PubMed2001

Spectrum: the clinician and the "difficult" patient.

Through the years, practitioners have attempted to discover more successful and empathic responses to address the needs of what has been referred to as the "difficult" patient. Writers in the past found it useful to define and cull out the distinctions that separated one type of "difficulty" in working with patients from another so as to "handle" some patients more effectively. Recently, it has been recognized and generally accepted that the "difficulty" in caring for patients frequently arises out of an interactional process between the patient and caregiver. This understanding requires practitioner self-awareness as well as reflection about motivations and responses to difficult clinical encounters. Two poems from the medical literature are explored as "clinical" examples that broaden our experience and understanding of the mystery and complexity of all human relationships.

Attitude of Health Personnel↗
PubMed2000

Adaptation to childhood parental loss: the experience of growing up in an "orphanage" and its meaning over time.

Intrigued by a newspaper ad in the Argus Leader, placed by The Sioux Falls Children's Home Society in their hope of reuniting adults formerly institutionalized there as children, I wondered what we might learn from the experiences of people having grown up as "orphans." After exploration, I was invited to attend their reunion to facilitate some of the discussion of former residents who were "welcomed home" from various parts of the country. The participants expressed a wide range of emotions as they rediscovered one another--sometimes from childhood memory, sometimes contrasting childhood faces in old photos with the faces of people now present in middle or old age. As the group reminisced, one man told of his calling out the home's upper-story window each evening to his older sister who lived a floor below. He recalled his sadness on the day when there was silence in response, as she had been sent to a foster home. A woman "alumni" sang word for word, with others joining in, an old Christian hymn that they had sung decades before. And, an elderly woman described how the church across the street from the original children's home facility on tenth street, had a large stain glass window depicting the outstretched arms of God. She told how every night, when it was time for her to go to bed, the window would be lit up. Movingly, she related how she would lie in her bed and look through the window of her room, feeling "held" until she fell asleep. Over the many months that followed, men and women who had been institutionalized there throughout childhood entrusted to me their life stories. This article is a summary of their narratives. In general, it seemed that the participants were set apart by the enormity of the poverty of their early years, the enduring quality of their losses, and by a certain tenacity, decency, and striving for restoration.

Adolescent↗
PubMed1996

Screening potential corneal donors for HIV-1 by polymerase chain reaction and a colorimetric microwell hybridization assay.

PURPOSE: Current screening of potential corneal donors for human immunodeficiency virus type 1 (HIV-1) involves serologic detection of antibodies to the virus. However, this approach cannot detect infection during the seronegative window period of the disease. We therefore evaluated the polymerase chain reaction (PCR) assay for viral nucleic acid as a possible alternative to screening cadaveric blood for HIV-1. METHODS: Blood specimens from cadavers diagnosed at autopsy with acquired immunodeficiency syndrome (AIDS) (n = 21), at high risk for HIV-1 infection (n = 47), and at no known risk (n = 350) were screened by PCR for HIV-1 proviral DNA and human leukocyte antigen (HLA)-DQ alpha sequences, and for HIV antibodies. RESULTS: All AIDS group samples were seropositive; of these, 18 (86%) and 20 (95%) of 21 were positive for HIV by PCR of proteinase K- and Chelex-extracted pellets, respectively. The seropositive samples negative by PCR testing were shown to inhibit PCR amplification. Nine (19%) of 47 high-risk specimens were HIV-positive. The no-known-risk group yielded negative results. The overall sensitivities for PCR in the proteinase K- and Chelex-treated groups were 90% and 97%, respectively, compared with Western blot reactivity. If PCR-inhibitory samples and HLA-DQ alpha-negative samples had been eliminated, sensitivity would have been 100%. Specificity was 100% for each group. CONCLUSIONS: Screening cadaveric blood by PCR may be feasible, but further refinement of the assay and blood specimen collection practices will be necessary for it to become routine. Future studies should focus on optimizing specimen procurement and preparation to reduce or eliminate specimens that inhibit PCR.

AIDS Serodiagnosis↗
PubMed1996

Harmonization of animal clinical pathology testing in toxicity and safety studies. The Joint Scientific Committee for International Harmonization of Clinical Pathology Testing.

Ten scientific organizations formed a joint international committee to provide expert recommendations for clinical pathology testing of laboratory animal species used in regulated toxicity and safety studies. For repeated-dose studies in rodent species, clinical pathology testing is necessary at study termination. Interim study testing may not be necessary in long-duration studies provided that it has been done in short-duration studies using dose levels not substantially lower than those used in the long-duration studies. For repeated-dose studies in nonrodent species, clinical pathology testing is recommended at study termination and at least once at an earlier interval. For studies of 2 to 6 weeks in duration in nonrodent species, testing is also recommended within 7 days of initiation of dosing, unless it compromises the health of the animals. If a study contains recovery groups, clinical pathology testing at study termination is recommended. The core hematology tests recommended are total leukocyte (white blood cell) count, absolute differential leukocyte count, erythrocyte (red blood cell) count, evaluation of red blood cell morphology, platelet (thrombocyte) count, hemoglobin concentration, hematocrit (or packed cell volume), mean corpuscular volume, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration. In the absence of automated reticulocyte counting capabilities, blood smears from each animal should be prepared for reticulocyte counts. Bone marrow cytology slides should be prepared from each animal at termination. Prothrombin time and activated partial thromboplastin time (or appropriate alternatives) and platelet count are the minimum recommended laboratory tests of hemostasis. The core clinical chemistry tests recommended are glucose, urea nitrogen, creatinine, total protein, albumin, calculated globulin, calcium, sodium, potassium, total cholesterol, and appropriate hepatocellular and hepatobiliary tests. For hepatocellular evaluation, measurement of a minimum of two scientifically appropriate blood tests is recommended, e.g., alanine aminotransferase, aspartate aminotransferase, sorbitol dehydrogenase, glutamate dehydrogenase, or total bile acids. For hepatobiliary evaluation, measurement of a minimum of two scientifically appropriate blood tests is recommended, e.g., alkaline phosphatase, gamma glutamyltransferase, 5' -nucleotidase, total bilirubin, or total bile acids. Urinalysis should be conducted at least once during a study. For routine urinalysis, an overnight collection (approximately 16 hr) is recommended. It is recommended that the core tests should include an assessment of urine appearance (color and turbidity), volume, specific gravity or osmolality, pH, and either the quantitative or semiquantitative determination of total protein and glucose. For carcinogenicity studies, only blood smears should be made from unscheduled sacrifices (decedents) and at study termination to aid in the identification and differentiation of hematopoietic neoplasia.

Animal Welfare↗
PubMed1993

Regional cerebral blood flow during memory recognition and neuropsychological performance in patients referred for investigation of dementia.

Regional cerebral blood flow was studied at rest and during a memory recognition activation task in a preliminary investigation carried out in patients with mild to moderate dementia of Alzheimer type and in 2 control groups of subjects. There were differences in the sites of activation-increased blood flows between the normal controls and the controls with major depression, while the Alzheimer's disease subjects showed more variable patterns of flow response, which differed overall from those present in the 2 control groups.

Alzheimer Disease↗
PubMed1992

Neuropsychological abnormalities in patients with pituitary tumours.

Neuropsychological assessment of 65 patients with pituitary tumours revealed impairment of memory and executive function. This did not appear to be related to the size or type of tumour or the effects of radiotherapy or surgery. It is possible that the problems arose from multiple unconnected factors but this observation lends support to the suggestion that pituitary or hypothalamic hormones have a role in the modulation of memory and behavioural pathways. Whatever the cause, neuropsychological impairment is common in patients with pituitary tumours and is an aspect of their disability which has received insufficient attention in the past.

Adenoma↗
PubMed1991

Regional cerebral blood flow and recognition memory in elderly normals: potential application to Alzheimer's disease.

Regional cerebral blood flow, a physiological measure of brain function, has been used for the assessment of cognitive dysfunction in Alzheimer's disease. A number of studies have found diminished temporo-parietal regional cerebral blood flow (RCBF) in Alzheimer's disease patients at rest and have differentiated these patients from normal subjects with a high degree of sensitivity. However the majority of the Alzheimer's disease patients have been in the moderate to severe stages of the disorder. Few studies have assessed RCBF in the early stages of Alzheimer's disease. With increasing emphasis now being placed on the early detection of such patients we chose to examine RCBF during a task which made demands on those cognitive processes which are impaired in the early stages of the disease, viz. a recognition--memory task. Using a 32-channel RCBF system, we examined 20 normal control subjects over the age of 60 years and 10 patients with early to moderate Alzheimer's disease. RCBF was examined during a task of recognition--memory, and also at rest. Normal subjects showed a global increase in RCBF, with marked left frontal activation, as compared with when at rest. Resting perfusion was decreased in the Alzheimer's subject, and there appeared to be a greater degree of intersubject variability in flow during activation.

Aged↗