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Biomedical subjects

J Donovan

Publications and source records attributed to J Donovan.

At least 73 records · Page 4Linked to original sources
PubMed1997

Diagnosis, management and screening of early localised prostate cancer.

The incidence of prostate cancer is rising worldwide, caused mainly by demographic factors, particularly the increasingly elderly population and, more importantly, the increasing number of cases identified following prostate specific antigen (PSA) testing. It is commonly quoted that many more men die with prostate cancer than of it. Autopsy/post-mortem studies show that while a very high proportion of elderly men have histological evidence of the disease, a much smaller proportion develop clinically apparent cancer. The natural history of prostate cancer is poorly understood, but progression appears to be related to stage and grade of tumour. Prostate cancer can be diagnosed by digital rectal examination (DRE), serum PSA test, and/or transrectal ultrasound (TRUS), with confirmation by biopsy. Each test identifies a proportion of cancers, with higher rates of detection when they are used in combination. The tests are also used to determine which tumours are localised within the prostate and are, thus, potentially treatable. Unfortunately, clinical staging is unreliable, with approximately one half of all tumours upstaged following surgery. Three major treatment options are available for localised prostate cancer: radical prostatectomy, radical radiotherapy and conservative management (involving monitoring and treatment of symptoms). Although radical treatment rates are rising, good quality evidence concerning their comparative effectiveness and cost-effectiveness is lacking. Observational studies of highly selected patient groups suggests that there may be a slightly lower mortality rate following radical treatments compared with conservative management, but there has been very little research into treatment complications and quality of life of men after any of the treatments. In the past, investigations of prostate cancer were reserved largely for patients exhibiting symptoms, but the introduction of the PSA test has opened up the possibility of screening healthy men for the disease. Observational studies suggest that DRE and PSA, combined with TRUS and biopsy, can identify localised prostate cancer in 3-5% of men, although the tests do result in a number of false positives and negatives. Major questions remain concerning the natural history of the disease, potential costs (financial, social and psychological) of a screening programme, and the effectiveness and cost-effectiveness of treatments for localised disease. The lack of good quality data and the strength of these concerns means that population screening for prostate cancer cannot be recommended.

Biopsy, Needle↗
PubMed1996

Distribution of mossy fibres in the hippocampus of two closely related species of mice.

The relative volumes of different parts of the mossy fibre projection system- the suprapyramidal mossy fibres (SP-MF) and the intra- and infrapyramidal mossy fibres (IIP-MF)- were determined in the hippocampi of Apodemus sylvaticus and A. flavicollis. The mean contribution of the IIP-MF to the mossy fibre system differed significantly between the two species. An increased relative size of the IIP-MF as compared to the SP-MF in A. sylvaticus was linked with a reduction in the relative size of the hilus found in a previous study. In addition, the two species differed significantly in the amount of intraspecific variability observed. Despite size differences, the distribution of volume along the dorsoventral axis of the hippocampus was remarkably similar for the two species. We also compared measures from five mid-septotemporal sections with results for the whole structure. Mid-septotemporal measures correctly predicted the direction of difference in relative size but overestimated its magnitude in the two species investigated.

Animals↗
PubMed1996

Deprivation and cause specific morbidity: evidence from the Somerset and Avon survey of health.

OBJECTIVE: To investigate the association between cause specific morbidity and deprivation in order to inform the debates on inequalities in health and health services resource allocation. DESIGN: Cross sectional postal questionnaire survey ascertaining self reported health status, with validation of a 20% sample through general practitioner and hospital records. SETTING: Inner city, urban, and rural areas of Avon and Somerset. SUBJECTS: Stratified random sample of 28,080 people aged 35 and over from 40 general practices. MAIN OUTCOME MEASURES: Age and sex standardised prevalence of various diseases; Townsend deprivation scores were assigned by linking postcodes to enumeration districts. Relative indices of inequality were calculated to estimate the magnitude of the association between socioeconomic position and morbidity. RESULTS: The response rate was 85.3%. The prevalence of most of the conditions rose with increasing material deprivation. The relative index of inequalilty, for both sexes combined, was greater than 1 for all conditions except diabetes. The conditions most strongly associated with deprivation were diabetic eye disease (relative index of inequality 3.21; 95% confidence interval 1.84 to 5.59), emphysema (2.72; 1.67 to 4.43) and bronchitis (2.27; 1.92 to 2.68). The relative index of inequality was significantly higher in women for asthma (P < 0.05) and in men for depression (P < 0.01). The mean reporting of prevalent conditions was 1.07 for the most deprived fifth of respondents and 0.77 in the most affluent fifth (P < 0.001). CONCLUSIONS: Material deprivation is strongly linked with many common diseases. NHS resource allocation should be modified to reflect such morbidity differentials.

Adult↗
PubMed1996

The Bristol Female Lower Urinary Tract Symptoms questionnaire: development and psychometric testing.

OBJECTIVE: To develop a questionnaire that is sensitive to changes in the symptomatology of the female lower urinary tract, particularly urinary incontinence, providing an instrument that can characterize symptom severity, impact on quality of life and evaluate treatment outcome. PATIENTS, SUBJECTS AND METHODS: Items covering as wide a range of urinary symptoms as possible were devised after consultation with clinicians and a health scientist, a literature review and discussion with patients. Additional items assessed the degree of 'bother' that symptoms were causing. Eighty-five women with clinical symptoms attending for urodynamic assessment and 20 women with none were asked to self-complete the questionnaire. The instrument's validity was assessed by interviewing patients and measuring levels of missing data, comparing symptom scores between clinical and non-clinical populations and comparison with frequency/volume charts and data from pad tests. The instrument's reliability was assessed by measuring both internal consistency and stability, using a 2-week test-retest analysis. RESULTS: The questionnaire was completed by the patients with a mean of only 2% of items missing; most questions were easily understood. Construct validity was good, with the instrument easily differentiating clinical and non-clinical populations. Criterion validity, as tested against frequency/volume charts and pad-test data, was acceptable, with Kappa coefficients of 0.29-0.79 for frequency/volume data and Spearman rank correlations of 0.50-0.97 and 0.31-0.67 for frequency/volume and pad-test data, respectively. The reliability of the instrument was good; a Cronbach's alpha of 0.78 indicated that the symptom questions had high internal consistency, while stability was excellent, with 78% of symptoms and problems answered identically on two occasions, and Spearman rank correlations of 0.86 and 0.90, respectively. CONCLUSION: The instrument has good psychometric validity and reliability. The stability demonstrated at baseline and the ability to differentiate clearly between community and clinical populations suggest that it should be ideal for measuring changes following therapeutic intervention. The addition of life-impact items and a 'bother' factor may provide the opportunity to identify those women who wish treatment for their symptoms; this dimension requires further exploration.

Adult↗
PubMed1996

Men's experiences during their partner's first pregnancy: a grounded theory analysis.

This paper reports on research conducted with 53 men who were attending antenatal classes with their partners who were pregnant for the first time. The men discussed their experience of pregnancy in focus groups that were run by male midwives who were also fathers. A grounded theory analysis of the men's discussions generated the categories of anxiety, ambivalence, adjustment, separation and need to know. There were two core categories, confusion, which was strongly expressed and development which was manifest in a minority of men. A descriptive narrative demonstrated that most first time fathers were confused as their relationship with their partner changed and that their roles in relation to the baby and other people were unclear. The men's sense of self was threatened and they responded negatively to the challenges they experienced and felt distanced from their partners. The findings have implications for clinical and educational services as they show that most men were alienated by the manner in which information was presented. The men also felt that services focused on their partner's labour and the birth of the child and neglected their greatest concerns, that is their changing identity, their relationships and their future role as fathers.

Adolescent↗
PubMed1996

Fluorescence techniques for diagnosing intestinal microsporidiosis in stool, enteric fluid, and biopsy specimens from acquired immunodeficiency syndrome patients with chronic diarrhea.

OBJECTIVE: To evaluate three fluorescent chitin stains for detecting microsporidia spores in specimens from acquired immunodeficiency syndrome (AIDS) patients with chronic diarrhea. METHODS: We compared the Fungifluor, Calcofluor White, and Fungiqual A fluorochrome stains for identifying Enterocytozoon bieneusi and Septata intestinalis spores in stool, intestinal fluid, biopsy imprints, and paraffin biopsy sections. The modified chromotrope trichrome stain was used as the standard light microscopic technique for stool and fluid specimens. Stained and unstained paraffin sections and fluid preparations were also evaluated. Multiple specimens from 50 consecutive symptomatic AIDS patients and archival material from known microsporidia-positive AIDS patients were analyzed. RESULTS: Spores of E bieneusi and S intestinalis fluoresce brightly with all three fluorochrome stains in all of the types of diagnostic specimens. Fluorescing debris and the much larger fungal forms were readily distinguished. Spores were equally well detected in unfixed and formalin-fixed stool specimens, but were not as well detected after sodium acetate-acetic acid, polyvinyl acetate, and ethanol fixation. Bouin's tissue fixative gave a higher background staining than formalin. Spores were readily detected in archival paraffin sections and stool preparations, even when the specimens had been stained previously. Repeat fluorochrome staining was possible. The methods also could detect extraintestinal parasites in paraffin sections. CONCLUSION: The three fluorescent chitin stains are sensitive and rapid methods for detecting microsporidia spores in stool, intestinal fluid, biopsy imprint, and tissue specimens, even from archived material.

Acquired Immunodeficiency Syndrome↗
PubMed1995

The process of analysis during a grounded theory study of men during their partners' pregnancies.

This research builds on the work of Barclay (1993) who studied couples during pregnancy and discovered that there was a mismatch between sexual interest levels of men and women during pregnancy. As well, little is known about the social and emotional experiences of men during their partners' pregnancies. One antenatal group consisting of six men, whose partners were in the second trimester of pregnancy, attended a series of five meetings and subsequent individual interviews. Additional data and insights were gained by the researcher and the research assistant attending other antenatal classes with men and women present. The research data consisted of transcripts of tape-recorded interviews, group discussions, observations and field notes made by the researcher and co-leader following each of the group sessions. The aim was systematically to develop a substantive grounded theory which was drawn from the experiences of the men during this transitional period in their lives. This paper discusses the process of analysis which led to the central phenomenon, the core category of the research, around which the grounded theory is built. Five theoretical constructs emerged from the data collected: (a) ambivalence in the early stages of pregnancy, (b) relationship with baby not real, (c) how should I be as a father?, (d) coping with the changing roles and lifestyle, and (e) disequilibrium in relationship with female partner. The last construct emerged as the basic social process. The nature of this relationship changed over the duration of the pregnancy. Emotional turmoil and anxiety in men contributed to the 'mismatch' in male and female expectations of the relationship.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1995

University of Nebraska Medical Center Liver Transplant Program.

The field of liver transplantation has evolved slowly over the past 5 years. The most important new additions to this field include new immunosuppressive agents and greatly broadened recipient selection criteria. The most compelling problem in transplantation today remains the lack of suitable donors. Innovative surgical techniques, such as auxiliary liver transplantation, extracorporeal support and living-related donation, represent new and important additions to the approach to patients with liver disease.

Academic Medical Centers↗
PubMed1994

Percutaneous angiographic arterial embolization for gynecologic and obstetric pelvic hemorrhage. A report of three cases.

Percutaneous angiographic arterial embolization for control of intractable hemorrhage is being utilized increasingly in general surgery and trauma patients. Recently there have been several reports on the application of this technique in patients experiencing bleeding from the pelvic vasculature. We describe our management of three patients by percutaneous iliac arterial angiographic embolization. One patient, following repeat cesarean section for a twin gestation, developed intraabdominal bleeding that failed to respond to classic maneuvers, including cesarean hysterectomy. A second patient suffered a deep vaginal sulcus tear during spontaneous vaginal delivery. The third patient developed a hemorrhage from the vaginal cuff 31 days after vaginal hysterectomy. In each case, angiography demonstrated extravasation of dye from a branch of the hypogastric artery. Selective embolization was uniformly successful in quickly achieving hemostasis. There were no major complications associated with the procedure.

Adult↗
PubMed1993

Nonsurgical management of biliary tract disease after liver transplantation.

It is not possible to describe every possible biliary tract complication that occurs after liver transplantation. It is important to be aware that almost anything can happen and that the biliary tree should be evaluated in any patient with unexplained allograft dysfunction. Frequently, the endoscopist can aid not only in the determination of the problem but often in its resolution as well.

Biliary Tract Diseases↗