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Biomedical subjects

J E Ward

Publications and source records attributed to J E Ward.

At least 73 records · Page 4Linked to original sources
PubMed1996

Why we need guidelines for guidelines: a study of the quality of clinical practice guidelines in Australia.

OBJECTIVE: To appraise the quality of clinical practice guidelines (CPGs) produced in Australia. DESIGN: Cross-sectional survey. PARTICIPANTS AND SETTING: 76 organisations, comprising all clinical colleges and faculties, federal and state health departments and national and state non-government agencies involved in health policy in Australia in October 1993. OUTCOME MEASURES: Ratings for how CPGs met 18 criteria ("fully", "partially" or "not at all") for validity, reproducibility, applicability, clinical flexibility, clarity, multidisciplinary process, documentation and scheduled review. RESULTS: Response rate was 87%, with 32 organisations submitting 42 documents; 34 of these were classified as CPGs. None of the 34 CPGs fully met all criteria for quality. None fully stated costings or described processes for retrieving and synthesising evidence; only six (18%) explicitly stated the expected health outcomes; six (18%) described the method to reach consensus; and seven (21%) fully stated controversies and potential conflict with other guidelines. However, at least 75% of CPGs fully met all criteria for applicability, flexibility, multidisciplinary input and documentation and two out of three criteria for clarity. Zero to 103 references to scientific data were cited per CPG. CONCLUSION: Australian guidelines developed before the publication of the NHMRC "guidelines for guidelines" in 1995 did not meet internationally recognised criteria for quality. There is a need to apply the recommended NHMRC process and to monitor future CPG quality.

Australia↗
PubMed1996

The prevention of postoperative nausea and vomiting using a combination of ondansetron and droperidol.

We have studied the effect of combination antiemetic therapy (ondansetron and droperidol) with morphine delivered by patient-controlled analgesia following major gynaecological surgery. Sixty patients were randomly allocated to one of three treatment regimens; ondansetron alone (4 mg bolus and 0.13 mg.ml-1 in the morphine solution), droperidol alone (1.25 mg bolus and 0.05 mg.ml-1 in the morphine solution), or both drugs in combination. For the first 12 postoperative hours, patients receiving combination therapy experienced significantly less nausea than those receiving single antiemetic therapy (p < 0.001). There was no difference between the regimens from 12 to 18 h. We conclude that a combination of ondansetron and droperidol added to morphine in a patient-controlled analgesia system reduces postoperative nausea to a greater extent than treatment with either drug alone following major gynaecological surgery.

Adult↗
PubMed1995

Mental health care practices and educational needs of general practitioners.

OBJECTIVES: To describe current mental health care practices of general practitioners and to identify their educational priorities and training preferences. METHOD: Self-administered questionnaire to a stratified random sample of New South Wales general practitioners. SUBJECTS: 721 full-time general practitioners, of whom 534 (74%) responded. RESULTS: Mental health problems recognised by general practitioners at least once per week were psychosomatic (93%), emotional (89%), addiction (79%), social/economic (71%) and family (69%). At least two-thirds recognised sexual problems, sexual abuse and major psychiatric problems less frequently than once per week. Sixty-four per cent of general practitioners reported that patients felt uncomfortable about being referred to psychiatrists; 53% that referral service waiting lists were too long; 51% that there were insufficient local mental health services; and 25% that communication difficulties between referring general practitioners and mental health specialists obstructed optimal care. Educational priorities were diagnostic and counselling skills, with particular emphasis on crisis, family, individual and marital counselling and strategies to prevent general practitioner burn-out. CONCLUSIONS: General practitioners are interested in improving their mental health counselling and diagnostic skills but barriers remain. Both structural and educational initiatives are essential to enhance the quality of mental health care in general practice.

Adolescent↗
PubMed1995

Collateral development and angiogenesis after major artery ligation does not alter hindquarter vascular reactivity in conscious rabbits.

We tested whether vasodilator and vasoconstrictor responses of the hindquarter vasculature in conscious rabbits were altered 1 day, 2 weeks, and 6 months after bilateral superficial femoral artery ligation (SFAL). With pharmacological autonomic blockade, hindquarter flow (Doppler flowmeter) was restored to 84% of control values 1 day postligation (n = 5). Responses to aortic balloon inflation (5-80 s), and intraaortic infusion of norepinephrine, angiotensin II, serotonin, acetylcholine, sodium nitroprusside, and adenosine were similar to pre-SFAL responses. Two weeks post-SFAL, acrylic casts showed an extensive collateral network originating from branches of internal iliac and deep femoral arteries. Acetylcholine-induced dilatation was attenuated postligation (n = 7) relative to controls (n = 13). Serotonin caused constriction in two rabbits postligation but dilatation in all others; however responses to all other agents tested were similar to controls. Reactive hyperemia and vascular reactivity were similar in rabbits 6 months post-SFAL (n = 5) and controls (n = 5). Thus, despite extensive vascular remodeling after SFAL, global hyperemic flow responses of the rabbit hindquarter vasculature appeared normal. We found only minimal changes in vascular reactivity to constrictor and dilator stimuli. This model of peripheral vascular disease does not reflect the clinical syndrome.

Acetylcholine↗
PubMed1993

Acute and chronic inhibition of nitric oxide synthase in conscious rabbits: role of nitric oxide in the control of vascular tone.

Acute and chronic effects of Nw-nitro-L-arginine (L-NNA), an inhibitor of nitric oxide synthase, were examined on the hindquarter hemodynamics of conscious rabbits. After pharmacological autonomic reflex blockade on four experimental days (days 0, 1, 2, and 7), responses to aortic occlusion (balloon cuff, 5-80 s inflation), intra-aortic infusion of acetylcholine, adenosine, and sodium nitroprusside (SNP) were measured before and after vehicle (day 0) or L-NNA (16 mg/kg/h i.v., days 1, 2, and 7). On day 1, L-NNA raised the mean arterial pressure (MAP), and lowered the heart rate (HR) and hindquarter vascular conductance (HVC = abdominal aortic Doppler blood flow/MAP). On days 2 and 7, L-NNA only slowly raised the MAP. The dilator response to acetylcholine was inhibited by L-NNA on day 1 and before and after L-NNA on days 2 and 7. The responses to aortic occlusion, adenosine, or SNP infusion were unaffected by L-NNA treatment on any day. Thus, if nitric oxide synthase inhibition by L-NNA abolishes NO release, then (i) reactive hyperaemia is independent of NO, (ii) basal NO release normalises the arterial pressure in the short term but other factors become important in the long term, and (iii) the blockade by L-NNA of receptor-stimulated NO release by acetylcholine is only very slowly reversible.

Acetylcholine↗
PubMed1993

Construction and characterization of Tn5virB, a transposon that generates nonpolar mutations, and its use to define virB8 as an essential virulence gene in Agrobacterium tumefaciens.

Transfer of the T-DNA from the Ti plasmid of Agrobacterium tumefaciens into plant cells involves movement of a single-stranded DNA-protein intermediate across several membrane and cell wall barriers. The 11 VirB proteins encoded by the Ti plasmid are hypothesized to form at least part of a membrane-localized T-DNA transport apparatus. Although available genetic and biochemical analyses support this hypothesis, detailed study of this transport apparatus is hindered by the fact that most available mutations in the virB operon are in the form of transposon insertions that have polar effects. In this study we constructed a transposon, Tn5virB, that can be used to generate nonpolar insertions in operons of A. tumefaciens and used it to demonstrate that virB8 is an essential virulence gene.

Agrobacterium tumefaciens↗
PubMed1992

A technique for making an esthetic maxillary complete denture surgical stent.

A technique for making an esthetic complete denture as a surgical stent to be used in conjunction with hydroxyapatite augmentation surgery of the maxillary arch is presented. The technique involves the use of an articulator, a remount jig, and duplication of a surgically prepared cast.

Alveolar Ridge Augmentation↗
PubMed1992

Effect of repair surface design, repair material, and processing method on the transverse strength of repaired acrylic denture resin.

The transverse strengths of blocks of denture base acrylic resin repaired with autopolymerizing monomer and polymer and autopolymerizing monomer and heat-cured polymer were measured with a three-point bending test. Three repair joints were studied: butt, round, and 45-degree bevel. Three processing methods were used: bench cure, hydroflask with hot water for 10 minutes, and hydroflask with hot water for 30 minutes. The strengths of repairs made with round and 45-degree bevel joint designs were similar and significantly greater than those with a butt joint design. The strengths of repairs processed in a hydroflask for 10 minutes and 30 minutes were similar and significantly greater than those cured on the bench top. There was no difference in the strength of repairs made with autopolymerizing monomer and polymer and autopolymerizing monomer and heat-cured polymer.

Acrylic Resins↗
PubMed1992

Release of endothelium-derived relaxing factor from resistance arteries in hypertension.

Aortic rings from SHR are reported to have a decreased relaxation response to the endothelium-dependent agent acetylcholine compared with rings from WKY rats. Thus, a reduced EDRF (nitric oxide) response could contribute to hypertension. We found that in mesenteric small resistance arteries (200 microns I.D.) taken from 5- to 50-week old rats and mounted in a Mulvany-Halpern myograph, that the concentration-response curves to acetylcholine were similar in range and sensitivity (EC50) in arteries from SHR and WKY rats at the same age. Similarly, in small resistance arteries from human buttock skin, the relaxation to acetylcholine was not different between vessels from normotensive volunteers (mean BP = 95.2 +/- 1.5 mm Hg) and patients with untreated essential hypertension (mean BP = 116.5 +/- 2.5 mm Hg). In rabbits with chronic renovascular hypertension (cellophane renal wrap), acetylcholine and adenosine infusions into the lower abdominal aorta caused falls in hindquarter resistance that were enhanced in range, but with no change in sensitivity compared with normotensive rabbits. In normotensive rabbits, nitric oxide synthase inhibition with N omega-nitro-L-arginine infusion caused a rise in blood pressure, fall in hindquarter conductance and blockade of the acetylcholine responses. These experiments suggest that at the level of resistance arteries in vivo and in vitro, a defect in the receptor-stimulated response to EDRF associated with hypertension could not be detected. Apparently, basal nitric oxide is important in resting vasodilator tone, but its role in chronic hypertension is still unclear.

Acetylcholine↗
PubMed1992

Relationship between the sympatholytic action of nebivolol and hypotension.

Nebivolol, a chemically novel beta 1-adrenoceptor antagonist, acutely lowers blood pressure in spontaneously hypertensive rats, anaesthetised normotensive dogs, and hypertensive patients. We have investigated the actions of dl-nebivolol in five conscious normotensive rabbits (sham, mean blood pressure (BP) of 82.2 +/- 4.1 mm Hg, mean +/- SEM) and four hypertensive rabbits (renal wrap hypertension) (wrap, mean BP of 117.6 +/- 1.5 mm Hg). Nebivolol (1 mg/kg i.v.) did not significantly lower the BP or heart rate in either group 30 min after injection. In the same rabbits, on another day, after autonomic blockade (mecamylamine), nebivolol (0.1, 0.3, and 1.0 mg/kg i.v.) right shifted the bolus i.v. isoproterenol tachycardia dose-response curves by dose ratios of 5, 18, and 90 in sham rabbits, respectively, and 5, 11, and 23 in wrap rabbits, respectively, indicating significant cardiac beta 1-adrenoceptor antagonism. In guinea pig isolated right atria pretreated with atropine (1 microM) and desipramine (DMI, 0.1 microM), norepinephrine concentration-response curves were antagonised competitively by nebivolol (3-100 nM), giving a pKb of 7.90. In separate atria without DMI pretreatment, neither nebivolol (100 nM) nor propranolol (100 nM) had any significant effect on the increase in the rate of norepinephrine efflux following electrical field stimulation (0.5-2 Hz, 3 min). These findings suggest that at concentrations of nebivolol that show substantial beta 1-adrenoceptor antagonism, there is no evidence of hypotension or bradycardia nor additional effects on cardiac norepinephrine release. Why nebivolol lowers blood pressure in some species but not in the conscious rabbit is not known.

Adrenergic beta-Antagonists↗
PubMed1992

Treatment of acute diarrhea with norfloxacin during Desert Storm deployment.

A retrospective study on the treatment of diarrhea in a U.S. Air Force Wing deployed to Egypt during Operation Desert Storm was conducted. Two groups of patients were compared for treatment efficacy. One group was treated with norfloxacin 800 mg as a single dose with the onset of symptoms. The other group was treated conservatively. The group treated with norfloxacin was noted to become asymptomatic in one-fourth the time of the group treated conservatively. This was highly significant, statistically, and in practice. It is recommended that diarrhea be treated aggressively during deployments to third world countries.

Acute Disease↗
PubMed1991

Activity of the Agrobacterium T-DNA transfer machinery is affected by virB gene products.

The oriT (origin of transfer) sequence and mob (mobilization) genes of plasmid RSF1010 can functionally replace transfer DNA (T-DNA) borders to generate an RSF1010 intermediate transferable to plants through activities of the tumor-inducing (Ti)-plasmid virulence (vir) genes of Agrobacterium tumefaciens. Because the Ti plasmid virB gene products are hypothesized to form a membrane-localized T-DNA transport apparatus, we investigated whether specific virB genes were needed for RSF1010 transfer. Here we report that transformation of Nicotiana tabacum leaf explants by an RSF1010-derivative plasmid (pJW323) requires the essential virulence genes virB9, virB10, and virB11, consistent with the hypothesis that both the T-DNA and RSF1010 transfer intermediates utilize the same transport machinery. Further, while pJW323 is transferred into plant cells by Agrobacterium strains harboring both pJW323 and pTiA6, the initiation of crown gall tumors (i.e., T-DNA transfer) is greatly suppressed. Coordinate overexpression of the virB9, virB10, and virB11 gene products relieves pJW323-mediated oncogenic suppression and restores tumorigenicity, but does not increase the transfer frequency of pJW323 into plant cells. We propose that the virB9, virB10, and virB11 gene products function coordinately and stoichiometrically to enhance DNA transfer in a fashion specific for the T-DNA intermediate.

Journal Article↗
PubMed1991

Strategies to increase preventive care in general practice.

OBJECTIVE: To develop strategies to overcome barriers to preventive care in general practice. METHOD: Participants invited to attend a one-day workshop ranked barriers to preventive care in a pre-workshop survey. During the workshop, small groups generated strategies to overcome the most influential barriers. After the workshop, participants nominated strategies for implementation in the ideal world and in the realities of resource constraints. PARTICIPANTS: Twenty-six participants representing general practice, medical academe, funding authorities, health policy planners, researchers, medicopolitical organisations and consumers. RESULTS: The surveys yielded preferred strategies for implementation in the ideal world and 10 preferred strategies for implementation given likely resource constraints. CONCLUSIONS: Authoritative guidelines are needed to guide clinical practice and to evaluate research. Other comprehensive strategies to overcome barriers to preventive care must be implemented and evaluated for effectiveness and acceptability in field experiments before wider implementation. The controlled implementation and evaluation of these strategies requires genuine collaboration amongst clinicians, health policy planners, researchers, funding authorities and general practice academe.

Australia↗
PubMed1991

Reactivity of canine isolated epicardial collateral coronary arteries. Relation to vessel structure.

To study the relation between structure and vascular reactivity in mature coronary collateral arteries, we prepared 17 dogs with a casein occluder near the origin of the circumflex coronary artery. At least 24 weeks later, we examined the reactivity of surface collateral arteries (approximately 500 micron i.d.) to a range of constrictor and dilator agents and compared them with normal left anterior descending coronary arteries of similar size branching away from the collateral zone. Pairs of normal and collateral arteries 2 mm long were mounted in a double-vessel myograph for isometric force recording. Arteries were contracted by K+ (124 mM) or by cumulative addition of endothelin-1 (1-100 nM) or U46619 (1-300 nM), a thromboxane A2 mimetic drug. In each case, the collateral vessels contracted to approximately half the force generated by the normal arteries. When partially contracted by K+ (25-30 mM), the collateral vessels had a greater range of relaxation and similar sensitivity to acetylcholine, sodium nitroprusside, and cromakalim compared with normal arteries. Morphological and morphometric analyses revealed that the collateral arteries had thickened adventitia, thinner media, ruptured internal elastic laminae, and a thick neointima lined by endothelium. Theoretical calculations of luminal area were made for isotonic conditions in response to constrictor stimuli. Despite the poor contractility of the collateral arteries, the neointimal luminal encroachment further reduced the lumen to zero, an exaggerated response compared with normal arteries. Coronary collateral arteries are thus compromised flow conduits that may play a role in vasospastic angina.

Animals↗