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Biomedical subjects

J Hayward

Publications and source records attributed to J Hayward.

At least 19 recordsLinked to original sources
PubMed1999

Clinical governance. Thin on the ground.

Clinical governance is being led by two people, usually a GP and a nurse, in most of the PCGs that responded to the survey. A fifth of the leads for clinical governance had no experience of working on quality issues. Nearly a third of respondents felt that their health authority had provided poor support or none at all. Only 10 PCGs had identified a clinical governance budget. No PCG was working with a finance manager to develop clinical governance and only five were working with an information manager.

Data Collection↗
PubMed1999

Endothelial-monocyte activating polypeptide II, a novel antitumor cytokine that suppresses primary and metastatic tumor growth and induces apoptosis in growing endothelial cells.

Neovascularization is essential for growth and spread of primary and metastatic tumors. We have identified a novel cytokine, endothelial-monocyte activating polypeptide (EMAP) II, that potently inhibits tumor growth, and appears to have antiangiogenic activity. Mice implanted with Matrigel showed an intense local angiogenic response, which EMAP II blocked by 76% (P < 0.001). Neovascularization of the mouse cornea was similarly prevented by EMAP II (P < 0.003). Intraperitoneally administered EMAP II suppressed the growth of primary Lewis lung carcinomas, with a reduction in tumor volume of 65% versus controls (P < 0.003). Tumors from human breast carcinoma-derived MDA-MB 468 cells were suppressed by >80% in EMAP II-treated animals (P < 0.005). In a lung metastasis model, EMAP II blocked outgrowth of Lewis lung carcinoma macrometastases; total surface metastases were diminished by 65%, and of the 35% metastases present, approximately 80% were inhibited with maximum diameter <2 mm (P < 0.002 vs. controls). In growing capillary endothelial cultures, EMAP II induced apoptosis in a time- and dose-dependent manner, whereas other cell types were unaffected. These data suggest that EMAP II is a tumor-suppressive mediator with antiangiogenic properties allowing it to target growing endothelium and limit establishment of neovasculature.

Animals↗
PubMed1998

Unilateral asymptomatic carotid disease does not require surgery.

BACKGROUND AND PURPOSE: The efficacy of carotid endarterectomy (CEA) in symptomatic patients with > 70% stenosis is accepted. The stroke risk of asymptomatic patients may not justify surgical intervention. The aim of this study is to use natural history data from a single unit to identify asymptomatic patients who would benefit from CEA. METHODS: Five hundred and sixty-four patients attending for duplex ultrasound assessment of the internal carotid artery between 1986 and 1993 were retrospectively identified as focally asymptomatic with > 40% ipsilateral stenosis. Patients were traced using hospital records, family practitioner databases and the Office of Population of Census and Surveys. The number of strokes, transient ischaemic attacks and cause of death were determined. Exclusions were 15 (2.7%) asymptomatic occlusions and 49 patients (8.7%) who underwent surgery for asymptomatic disease. RESULTS: Thirteen patients (2.6%) were not traced, leaving 487 study patients. The average follow-up was 41 months (range, 1-120 months). Mean presentation age was 69 years (S.D. 8.9), and the male to female ratio was 3:2. One hundred and fifty-six (32%) patients died. Forty-three patients suffered strokes, of whom two had bilateral strokes. In total there were 16 (i/p) strokes, 25 (c/l) strokes and four strokes undetermined. The average yearly stroke rate was 2.74 per 100 person years and the (i/p) rate 1.02 per hundred person years. There was no effect of age, sex or degree of stenosis on stroke. The presence of bilateral disease did increase the risk of stroke (rel risk 2.35, p = 0.029) but not ipsilateral stroke (rel risk 1.6, p = 0.39). Patients with unilateral asymptomatic carotid disease had an all stroke rate of less than 5% in the first year after presentation and this was unaffected by degree of stenosis. In patients with bilateral disease the stroke rate in the first year after presentation increased with degree of stenosis to a stroke rate of 9.6 per 100 person years in patients with > 90% contralateral stenosis. CONCLUSIONS: This data suggests that CEA will not benefit patients with unilateral asymptomatic disease. Patients with bilateral disease warrant inclusion in clinical trials.

Aged↗
PubMed1997

Understanding the relation between research and clinical policy: a study of clinicians' views.

OBJECTIVES: To describe the relation between research evidence and local obstetric unit policy for specific areas of care and to explore clinicians' views about the reasons for any discrepancies identified. DESIGN: An independent evaluation of a project undertaken by a district maternity services liaison committee (MSLC) to promote evidence based maternity care in specific areas of care. The evaluation involved a combination of qualitative methodologies including documentary analysis, non-participant observation, semi-structured interviews, and self completed open ended questionnaires. SETTING: One English health district with three obstetric units. MAIN MEASURES: Congruence between unit policies and research evidence in specific areas of care. Views expressed by unit staff concerning the reasons for any discrepancies identified. Consistency between staff views within and between units. Unit attitudes to modification of discrepant policies and details of any subsequent changes made. RESULTS: Of the 12 unit policies considered, seven were consistent with the research evidence. In all cases in which unit policy did not reflect the evidence, provider unit staff thought that the differences were justified. In several cases there were substantive differences of view between staff in different units. No differences of view were expressed between staff in the same unit. There were three different types of concern about the research evidence and the problems of using it as a basis for deciding unit policy. These were: concerns about the adequacy or completeness of the evidence; concerns about the applicability of the evidence in the local setting; and concerns about local capacity to act on the evidence. At the time of the project, none of the units expressed any intention of modifying the policies under discussion. Subsequently, two of them did make changes of this sort. CONCLUSION: The results suggest the need for further research to ascertain what factors may produce such varying assessments of the validity and adequacy of particular sets of research findings as were found between clinicians in this study and to understand what considerations other than views about evidence may affect decisions to alter clinical policy. IMPLICATIONS: When clinicians have clear reasons for not following research evidence, two contrasting responses are possible. One is to take the view that the clinicians are mistaken, and seek to change their attitudes or persuade them to change their behaviour regardless of their views. An alternative response is to accept that the concerns they express may be legitimate and consider how their doubts may be addressed. The challenge is to recognise which response is preferable in any particular situation.

Attitude of Health Personnel↗
PubMed1996

A novel tumor-derived mediator that sensitizes cytokine-resistant tumors to tumor necrosis factor.

Therapeutic successes following treatment of murine tumors with tumor necrosis factor-alpha (TNF) have not been easily applied to clinical oncology because the concentrations of TNF required in humans induces systemic toxicity. This has led us to identify mediators which could sensitize tumors to the effects of TNF, permitting administration of lower doses and possible realization of the therapeutic potential of this cytokine. Our study reports the ability of a novel cytokine, endothelial-monocyte-activating polypeptide II (EMAP II), to sensitize initially resistant murine and human tumors to TNF-induced regression employing a murine model. Recombinant (r) EMAP II was purified from Escherichia coli transformed with a plasmid expressing mature EMAP II. The B16 melanoma, raised in C57BL/6 mice, or a human fibrosarcoma (HT-1080), grown in immunocompromised mice, was injected intratumorally with either vehicle or rEMAP II/heat-treated EMAP II (50-100 micrograms) followed by systemic TNF/heat-treated TNF (5 micrograms) and assessed for tumor volume, hemorrhage, and histologic appearance. Both the B16 melanoma and the HT-1080 human fibrosarcoma underwent thrombohemorrhagic and acute inflammatory changes concomitant with regression or significantly slowed growth after administration of intratumor EMAP II followed by systemic TNF. Omission or inactivation of either cytokine abrogated this effect. These results demonstrate that local treatment of certain tumors with EMAP II results in enhanced susceptibility to TNF-mediated induction of thrombohemorrhage and regression.

Animals↗
PubMed1993

Career guidance during nurse training: findings from an exploratory study.

This research into the career guidance experiences of nurses during their training was undertaken as an exploratory study upon which a series of larger studies will subsequently be based. Additionally, it contributed to a national cohort study of the careers of newly qualified registered general nurses. One hundred and twelve nurses were involved in the development and testing of questions for a postal questionnaire to be used in the cohort study of careers. Some problems encountered when investigating career guidance by questionnaire are described, in the light of which a revised research design is proposed and the career guidance experiences of 31 nurses presented. Twenty-one aspects of guidance were investigated, covering information and advice about applying for first post, post-basic courses and longer-term plans.

Career Choice↗
PubMed1993

After the deluge.

Explore the source record for details and available documents.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1992

Duplex ultrasonography and pulse-generated run-off in selecting claudicants for femoropopliteal angioplasty.

Non-invasive assessment of lower limb vasculature may avoid unnecessary angiography in claudicants. Colour duplex ultrasonography of the femoral and popliteal arteries was performed to assess patency and the presence of any stenoses, and pulse-generated run-off (PGR) was used to assess the distal vasculature. In 65 legs colour duplex scanning was successful, compared with angiography, in identifying the site and type of disease in the femoropopliteal segment and 23 lesions were correctly identified as suitable for angioplasty. More patent distal vessels were demonstrated by PGR than by angiography; no vessels patent on angiography were missed by PGR. The estimated cost of diagnostic angiography was 330 pounds per test compared with 52 pounds for non-invasive assessment. By using duplex examination as a screening test, a potential saving of 8062 pounds could have been made in this series. Duplex ultrasonography offers a non-invasive and cost-effective alternative to diagnostic angiography for clinically suspected infrainguinal arterial disease presenting as claudication. PGR was not of clinical value in assessing suitability for angioplasty.

Aged↗
PubMed1990

SIDS: race as a factor.

In Wisconsin, the rate of postneonatal deaths attributed to sudden infant death syndrome (SIDS) for the period 1978-1987 was 6.7 per 1,000 live births for Native Americans, 3.6 for blacks, and 1.4 for whites. To investigate racial differences in case ascertainment and risk for SIDS mortality, this study used matched birth-death certificate data for the 1,111 reported SIDS deaths during the 10-year period. At least 90% of all SIDS deaths occurred before 6 months of age; seasonal variation in time of death and autopsy rates were similar by race. The reported higher risk of SIDS for male infants and those with low birth weights did not occur among Native Americans. Low birth weight was a stronger risk for SIDS among whites than blacks. Our findings suggest that diagnostic practices may not account for racial differences in SIDS mortality. Patterns of risk, however, appear to vary by race.

Black People↗