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Biomedical subjects

J Grimshaw

Publications and source records attributed to J Grimshaw.

At least 19 recordsLinked to original sources
PubMed1996

Quantitative analysis of hyaluronan in human synovial fluid using capillary electrophoresis.

The glycosaminoglycan, hyaluronan, can be detected in human synovial fluid by capillary electrophoresis (CE). Variations in peak shape make this technique unsuitable for quantitative analysis of hyaluronan in raw synovial fluid. Quantitative analysis was achieved by hydrolysis of the polymeric hyaluronan to the tetrasaccharide by the action of testicular hyaluronidase and separation of the product using CE. A UV detector operating at 200 nm was used. The X-ray contrast material, omnipaque, a propriety aqueous solution of iohexol was used as internal standard. A second peak in the electropherogram of synovial fluid was quantified. The variation in concentrations of these two components correlate with the arthritic disease state of a joint.

Arthritis, Rheumatoid↗
PubMed1995

'Life' for a non-progressor.

A "non-progressor" with HIV, diagnosed in 1984, comments from a personal perspective on how people with HIV are affected by social and professional attitudes. The failure of some professionals to develop an understanding of HIV beyond their own particular field of expertise contributes to the disempowerment experienced by those infected and can result in broader social and and psychosocial aspects of HIV, such as discrimination, being inadequately addressed.

HIV Infections↗
PubMed1994

Quantitative analysis of hyaluronan in vitreous humor using capillary electrophoresis.

Capillary electrophoresis was used for the separation and quantitative analysis of the glycosaminoglycan hyaluronan in human and bovine vitreous with detection by UV absorbance at 200 nm. Calibration was carried out using standards made up from known concentrations of hyaluronan of umbilical cord origin. The purity of the standard was examined by 1H NMR (nuclear magnetic resonance). Concentrations as low as 25 micrograms/mL could be detected by capillary electrophoresis. Confirmation that the signal was due to hyaluronan was obtained by depolymerization of the native mucopolysaccharide by hyaluronidase. This resulted in loss of the hyaluronan peak and appearance of several new peaks corresponding to the oligomeric fragments which had shorter migration times. Capillary electrophoresis is a reproducible and sensitive technique for the quantification and characterisation of hyaluronan in vitreous samples.

Animals↗
PubMed1994

Fundholding: the next five years.

On 1 April 1993 third-wave fundholders (second-wave fundholders in Scotland) received their budgets. In some areas, over 50 per cent of the population are now served by fundholding practices. This paper examines the limited evidence to date on the effects of fundholding. Four areas of concern are identified: priority setting by fundholders; the management of financial risk; budget setting; and the allocation of resources between fundholders and non-fundholders. In each of these areas, ways in which the scheme might be improved are discussed.

Budgets↗
PubMed1994

A taxonomy of shared care for chronic disease.

BACKGROUND: Shared care is promoted as a way of integrating primary and secondary services and achieving one of the targets set for the NHS in the 1990s. We aimed to compose a taxonomy of shared care schemes for chronic disease in order to inform the development of develop shared care. METHODS: A two-phase postal questionnaire survey of Scotland and North West Thames Region, England. In the first phase we identified the number of shared care schemes for chronic disease, which were followed up in the second phase. RESULTS: Shared care schemes were classified into six groups, or models, according to their method of data transfer. These are: (I) community clinics, where the specialist undertakes a clinic in general practice; (II) basic, where communication comprises the regular exchange of letters or standardized record sheets; (III) liaison, where the hospital team and general practitioner (GP) meet to discuss and agree the management of patients under shared care; (IV) shared care record cards, where the exchange of information is made through a booklet or 'cooperation card', commonly carried by the patient; (V) computer-assisted shared care, where a circuit of information is established between GP and hospital specialist based on data collected at each patient visit and mediated through computer-generated summaries; (VI) electronic mail, where hospital specialist and GP both have access to the same data on patients shared between them. CONCLUSION: Despite substantial variation in the operation of shared care, schemes can be broadly classified and constructed in six different ways. In establishing this taxonomy, a choice is offered to health care workers wishing to develop shared care.

Chronic Disease↗
PubMed1994

The detection, quantification and partial characterisation of cathepsin B-like activity in human pathological synovial fluids.

In this study, the levels of the cysteine proteinase--cathepsin B were measured in diseased synovial fluids using a steady state fluorometric assay. Cathepsin B-like activity was shown to be present in all the samples analysed, with the rheumatoid arthritic synovial fluids possessing significantly higher concentrations (mean value ca. 416 mg/l) than the osteoarthritic fluids (mean value ca. 142.4 mg/l). In addition, upon treatment with pepsin, all of the rheumatoid arthritis samples were shown to possess additional cathepsin B-like activity, suggesting the presence of a reservoir of latent precursor molecules. By utilising a recently developed biotinylated affinity label for cathepsin B-like proteinases and sheep anti-(human cathepsin B) antibodies, used in combination with SDS-PAGE and Western blotting, the rheumatoid arthritic synovial cathepsin B was shown to exist in two forms with apparent molecular masses of M(r) 29,000 and 42,000. We propose that the former is a functionally active proteinase, whereas the latter is a pepsin activatable proform which, when cleaved by this aspartyl proteinase, is converted into a catalytically competent species of M(r) 20,000.

Affinity Labels↗
PubMed1994

Factors influencing general practitioners' referral to hospital of adults with presumed infective diarrhoea.

BACKGROUND: Acute infective diarrhoea is one of the commonest reasons for admission to hospital with an infectious disease. AIM: This study set out to describe the clinical features of infective diarrhoea at the time of presentation in adults managed in the community or admitted to hospital in 1990-91, in order to try to understand the decision-making process which led to referral to hospital. METHOD: Data were collected from general practitioners by computer assisted telephone interview for 114 patients with presumed infective diarrhoea referred to the infection unit at the City Hospital, Aberdeen from all practices in the Grampian region and for 121 non-referred patients managed within seven practices. RESULTS: General practitioners appeared to use examination, investigation and referral selectively in patients presenting with diarrhoeal illness. A comparison of referred and non-referred patients identified differences in patients' reasons for consultation and the general practitioners' clinical findings, suggesting these were important in the decision to refer the patient for hospital admission. General practitioners were more likely to refer adult patients with infective diarrhoea if the patients were older, were seen at home and were more acutely unwell with fever, dehydration and abdominal tenderness. CONCLUSION: The identification of these criteria may help general practitioners to decide when to refer a patient with infective diarrhoea to hospital.

Diarrhea↗
PubMed1993

Do clinical guidelines improve general practice management and referral of infertile couples?

OBJECTIVE: To evaluate guidelines for general practice management and referral of infertile couples. Guidelines were implemented with a disease specific reminder at the time of consultation (the guidelines were embedded within a structured infertility management sheet for each couple). DESIGN: Pragmatic randomised controlled trial. Participating practices were randomised to a group that received the guidelines and a control group. SETTING: 82 general practices in Grampian region. SUBJECTS: 100 couples referred by general practitioners receiving the guideline and 100 couples referred by control general practitioners. MAIN OUTCOME MEASURES: Whether the general practitioner had taken a full sexual history and examined and investigated both partners appropriately. RESULTS: Characteristics of patients referred by study and control general practitioners did not differ significantly at baseline. Compliance with the guidelines increased for all targeted activities. General practitioners in the study group were more likely to take a sexual history (for example, couples' use of fertile period, 85% v 69%, p < 0.01); examine both partners (female partner, 68% v 52%, p < 0.05; male partner 39% v 13%, p < 0.01); and investigate both partners (day 21 progesterone, 72% v 41%, p < 0.001; semen analysis, 51% v 41%, p > 0.05). Improvements were greater when general practitioners used the disease specific reminder. CONCLUSION: Receiving guidelines led to improvements in the process of care of infertile couples within general practice. This effect was enhanced when the guidelines were embedded in a structured infertility management sheet for each couple.

Adolescent↗
PubMed1993

1H-nuclear magnetic resonance studies of human synovial fluid in arthritic disease states as an aid to confirming metabolic activity in the synovial cavity.

1. A 1H-n.m.r. method was used to measure concentrations of valine, alanine, lactate, acetate, hyaluronan and lipids in synovial fluid obtained, during the normal course of examination from the knee joints of patients attending rheumatology and orthopaedic clinics. Fluid was available from 16 patients with osteoarthritis, 18 patients with rheumatoid arthritis, four patients with meniscal tear and one patient each with systemic lupus erythematosis, mono-arthritis, synovitis and loose bodies. Four normal specimens were obtained for comparison. 2. Valine, alanine and acetate levels all showed a normal Gaussian distribution, reflecting the distributions within the serum of the sample population. 3. Lactate concentrations divided into two distinct patterns. At concentrations below 2.5 mmol/l the lactate levels showed a Gaussian distribution, reflecting the distribution in normal serum. The normal synovial fluid specimens belong to this distribution. Above 2.5-3.0 mmol/l, lactate levels were asymmetric in distribution with a long tail at higher concentrations. These high levels of lactate can be explained by the generation of lactate through anaerobic metabolism within the synovial cavity. This metabolic process is triggered by a general inflammatory condition such as in rheumatoid arthritis. 4. The distribution of n.m.r.-observable lipid concentrations in rheumatoid arthritis and osteoarthritis each shows a normal distribution and the mean concentration is significantly higher in rheumatoid arthritis. 5. An increased n.m.r.-observable hyaluronan concentration is associated with an inflammatory situation. 6. It is concluded that raised levels of lactate and n.m.r.-observable hyaluronan and lipids are useful markers to aid the clinical distinction between rheumatoid arthritis and osteoarthritis.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetates↗
PubMed1993

The use of a computer-assisted telephone interview technique in a general practice research study.

We describe the principles and practice of computer-assisted telephone interviewing, and its successful deployment in a general practice-based research study into the referral behaviour of general practitioners (GPs) in the Grampian region of Scotland. Participating GPs were interviewed concerning the acceptability of the method. It proved to be an efficient and acceptable method for collecting data from a large number of practitioners in this large geographical area. Our experience confirms that this efficient method of data collection could be much more widely utilized in primary care research.

Computers↗
PubMed1989

Verb processing during sentence comprehension: contextual impenetrability.

This paper examines verb processing during sentence comprehension. We describe two experiments that assess the interaction between verb complexity and the structural information contained in a sentence. Verb complexity is defined in terms of a verb's possible argument structure arrangements--linguistic information arrayed against a verb's entry in the mental lexicon. Normal subjects had to perform a secondary task presented in the immediate vicinity of the verb while listening to a sentence for meaning. Reaction times to this secondary task show that all of a verb's possible argument structures are momentarily and exhaustively activated in the vicinity of the verb, even in sentences that are structurally biased toward one particular argument structure. We thus argue that verb processing in sentences involves a contextually impenetrable subcomponent of the language comprehension system.

Adult↗