Biomedical subjects
J Lawton
Publications and source records attributed to J Lawton.
Gaining and maintaining consent: ethical concerns raised in a study of dying patients.
This article provides a frank discussion of the practical and ethical issues that emerged during the process of setting up and conducting a participant observation study within an inpatient hospice. A general overview of the participant observation approach is used to prefigure a discussion of its strengths and weaknesses when employed as a research and evaluation tool among palliative care populations. Although participant observation provided a flexible and viable means of collecting data in the hospice, it also created a number of dilemmas that in many cases could not be satisfactorily resolved. Difficulties arose, in particular, with obtaining informed consent from patients and assuming that consent remained valid after patients had deteriorated physically and mentally. Further complications stemmed from the role conflict and ambiguity inherent within an approach that requires a researcher to work simultaneously as a participant and as an observer.
Numbers or words? A randomized controlled trial of presenting screen negative results to pregnant women.
The Objective of this study was to test the hypothesis that presenting risk information using numbers rather than words is a more effective way of communicating the residual risk inherent in a screen negative test result. We used a randomised controlled trial in a large UK teaching hospital. Two hundred and twenty pregnant women who received negative results on serum screening for Down syndrome participated. Presentation of screen negative test results were given either as a numerical probability (e.g. you have a 1:650 chance of having a baby with Down syndrome) or as a verbal probability (your chance of having a baby with Down syndrome is low). In both interventions the verbal anchor 'it is unlikely that your baby has Down syndrome' was used. Our aims were to measure the understanding of the residual risk in a screen negative result, and anxiety. Immediately after receipt of the results, 97% of those receiving their results in the form of a numerical probability and 91% of those receiving their results in the form of a verbal probability correctly understood that their baby probably did not have Down syndrome (95% CI for difference: 0% to 12%; p=0.04). All those who were incorrect believed that their baby definitely did not have Down syndrome. Subgroup analysis showed that this effect was confined to those with lower levels of education (i.e. those without a university degree), amongst whom understanding was poorer. There was no difference between intervention groups in understanding the results at four months. There were no differences between intervention groups in the levels of anxiety at one week or four months after receiving their results. In conclusion, communicating residual risks using numbers rather than words has a small beneficial effect of increasing awareness of residual risks without raising anxiety. Further work is needed to estimate the size of this effect in less well-informed and less highly educated populations.
Withdrawal reaction associated with venlafaxine.
Explore the source record for details and available documents.
Treatment of coronary artery disease in an anomalous coronary artery by placement of an intracoronary stent.
We report the use of coronary stenting to treat disease in an anomalous coronary artery. The patient had a single coronary artery with anomalous left anterior descending artery arising from the right sinus of Valsalva and coursing between the aorta and pulmonary artery. Although balloon angioplasty has been used in patients with anomalous coronary arteries, this is the first report of stent placement in this circumstance.
Anti-neutrophil cytoplasmic antibodies (ANCA) and inflammatory bowel diseases in Chinese.
Inflammatory bowel diseases are uncommon in the Chinese, but the incidence is rising. Their differentiation from infective colitis is often not clear-cut and diagnosing inflammatory bowel diseases can be difficult in Asia. We have studied Chinese patients with ulcerative colitis (N = 19) and Crohn's disease (N = 12) for anti-neutrophil cytoplasmic antibodies (ANCA) by indirect immunofluorescence (IIF) and enzyme-linked immunosorbent assays (ELISA). Patients with enteric fever (N = 29) and irritable bowel syndrome (N = 24) were recruited as controls. Seventy-three percent of ulcerative colitis patients exhibited either p-ANCA (31%) or c-ANCA (42%) by IIF. Twenty-five percent of Crohn's disease patients were found to be p-ANCA positive. However, these ANCA were nonreactive to anti-alpha granule, antiproteinase 3, antimyeloperoxidase, or antilactoferrin. All positive patients had extensive colitis. Sera collected from patients suffering from enteric fever and irritable bowel syndrome were negative for ANCA by IIF and ELISA. We concluded that the detection of ANCA is helpful in diagnosing inflammatory bowel diseases. Further attempts to characterize these autoantibodies are needed.
Patterns of exoprotein production in isolates of Staphylococcus schleiferi and Staphylococcus lugdunensis.
Explore the source record for details and available documents.
The health effects of chemical waste in an urban community.
This paper presents the results of a community health survey of people living near a hazardous chemical waste site in Kingston, Queensland. In comparison with a matched control group, people near the site were no more likely to report serious diseases, and reports of cancer and mortality rates did not differ in the two groups. Kingston residents reported higher rates of symptoms of general poor health, high levels of stress and anxiety and a higher incidence of miscarriages. The reports of poor physical health appear to be independent of proximity to the hazardous waste site and duration of residence in the area. Symptom prevalence and perceived recent decline in health correlate most strongly with the stress and anxiety measures. While long-term investigation is necessary, it appears at this stage that the chemical waste is not associated with an increase in major diseases as reported by those who were interviewed. When health in a broader sense is considered, however, it is clear that the situation has had a negative impact.
Ecology: case of the diffusion squirrels.
Explore the source record for details and available documents.
Guidance of myogenic cell migration by oriented deposits of fibronectin.
Fibronectin mediates myoblast-substratum attachment; one region of the molecule binds directly to the cell surface, while others bind to collagen, glycosaminoglycans, and other fibronectin molecules. There is evidence to suggest that fibronectin-containing extracellular matrices guide cell migration in vivo. We describe a method for producing regular deposits of fibronectin in vitro that can serve as a model system for studying cell-substrate interactions, cell orientation, and contact guidance. The novel culture substrate is prepared by allowing an aqueous solution of fibronectin and urea to dry in a culture dish and then washing away the urea crystals. Myogenic cells in vitro adhere to, align with, and migrate along, parallel streaks of fibronectin. This leads to the formation of myotubes that are long and thin, with little branching. Myogenic clones are highly elongated in the direction of the deposits, in contrast with the roughly circular clones seen in conventional cultures. Fibroblasts and limb bud mesenchymal cells align with fibronectin deposits, assuming a bipolar shape.
Autoimmunity in ocular and generalised myasthenia gravis.
Restricted ocular myasthenia gravis (OMG) and generalised myasthenia gravis (GMG) have been shown to differ in a number of respects. In OMG, antiacetylcholine receptor, antistriational and antinuclear antibodies were rare relative to their frequency in GMG. In contrast, antithyroid antibodies and a history of thyroid disease were much more prevalent in OMG than in GMG, OMG was not associated with the female predominance seen in GMG and appeared to be relatively common in some races rather than others. It is suggested that different pathogenetic mechanisms are responsible for these two forms of MG.
The assessment of protein-calorie malnutrition in patients with gastrointestinal cancer.
Daily protein and calorie intake, three plasma protein estimations, two upper limb anthropometric measurements, and estimated weight loss were all determined in 31 patients attending a surgical oncology outpatient department. The patients, who had had prior resection of a gastrointestinal cancer, could be divided into three groups depending on (i) the absence of clinically detectable tumour; (ii) the presence of clinically detectable tumour with survival over the ensuing four-month period; and (iii) clinically detectable tumour without survival over the ensuing four-month period. The variables least able to discriminate between these groups, and to interrelate to the other variable in a cross-correlation matrix, were the dietary intake data and the estimated weight loss. It is concluded that protein-calorie malnutrition can be adequately assessed in patients with advanced cancer from studies of the plasma albumin, prealbumin, transferrin, arm fat area, and arm muscle area.
Modified McBride bunionectomy.
Explore the source record for details and available documents.
Post-perfusion syndrome due to Epstein-Barr virus. Report of two cases and review of the literature.
The post-perfusion syndrome is rarely due to Epstein-Barr virus (EBV), because most adult patients already carry protective neutralizing antibodies in their sera. Data are presented from two patients in whom heterophil-antibody-positive infectious mononucleosis developed 35 and 48 days after open-heart surgery. The diagnoses of their predominantly febrile illnesses were delayed because of late appearance of atypical lymphocytes and heterophil antibodies. EBV-specific antibody responses were also delayed, with peak titers appearing several weeks or months after onset. The differences in evolution of the present cases, compared to those of classic infectious mononucleosis, were presumably due to different portals of entry (blood stream versus oropharynx).
Breast care. Skin reactions to radiotherapy.
Explore the source record for details and available documents.
Pharmacological management of alcohol withdrawal.
Alcohol withdrawal is a common disorder, yet its pharmacological management varies widely. This article outlines the clinical features and complications encountered during alcohol withdrawal. It discusses when and where treatment should be initiated and suggests therapeutic recommendations for pharmacological management.
Palliative care--a room with a view.
Explore the source record for details and available documents.