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Biomedical subjects

J Richardson

Publications and source records attributed to J Richardson.

At least 145 records · Page 8Linked to original sources
PubMed1997

Carcinoid tumour of the lung.

A retrospective analysis of 29 patients with carcinoid tumour of the lung treated between 1980 to 1995 is presented. There were 15 females and 14 males with a mean age of 57 years (range 28-72). Fourteen of the 29 carcinoids were peripheral and the remaining 15 were central. Preoperative histology was available in 17. Surgical resection was carried out in 27 patients, one patient was unfit whilst the other patient had multiple liver metastases at presentation. Surgical treatment offered were lobectomy (n = 19), pneumonectomy (n = 3), sleeve lobectomy (n = 3) and segmentectomy (n = 2). Twenty three patients were stage 1 tumours, 3 were stage II and one was stage III and 1 was stage IV. Postoperative histology confirmed typical carcinoids in 24 patients and the remaining 5 were atypical. There was one perioperative death from massive pulmonary embolism and there was no morbidity. Overall five year survival rate for patients with carcinoid was 96.4%. Five year survival for typical carcinoid and that of atypical carcinoid was 100% and 77.8% respectively. Typical carcinoids carry an excellent prognosis and should be offered conservative lung resection, whilst atypical carcinoids which behave aggressively should be treated by radical lung resections.

Carcinoid Tumor↗
PubMed1997

Continuous paravertebral block for post thoracotomy analgesia in children.

The use of continuous paravertebral analgesia was studied in 15 children with a mean age of 9.8 years (2-16 years). Nine patients received pre-emptive and postoperative paravertebral analgesia while six children studied earlier in the series received only post operative paravertebral analgesia. Excellent pain relief was attained in all patients, as assessed by the graded pictures of facial expression or visual analogue pain scores and morphine requirements. There were no pulmonary complications and no complications related to the continuous paravertebral infusion of bupivacaine. We conclude that continuous paravertebral block is an effective and safe method for post thoracotomy pain relief in children.

Adolescent↗
PubMed1997

Which patients with ankylosing spondylitis derive most benefit from an inpatient management program?

OBJECTIVE: To evaluate the benefit achieved from an inpatient management program by testing the hypothesis that more mobile, younger patients on their first course show the most improvement. METHODS: We assessed 236 patients over an 18 month period. Patients were assessed at the beginning and end of the course by 4 indices, 3 of which were self-administered (disease activity, functional ability, and global well being) and one administered by a trained physiotherapist (metrology). Paired t tests and ordinary least squares regression analysis were used to compare pre and postcourse results for each index. RESULTS: The wide range of disease duration (0-53 years) and disease severity [0.69-9.39 (on a 0-10 scale)] reveal that patients are from a wide spectrum of disease. Results revealed a mean improvement of 18-27% over baseline in the 4 indices. Significant predictors of greater improvement over the 2 week course were found for each index. CONCLUSION: Our results confirm the benefit of an intensive regime of inpatient physiotherapy. Although the original hypothesis cannot be accepted or rejected as the results were different for the 4 indices, the following general conclusions may be drawn: (1) there is a trend for females to improve more than males; (2) patients who have attended fewer courses tend to achieve more improvement; (3) younger patients do better than older patients; and (4) age of disease onset has little effect.

Adult↗
PubMed1997

Why do we continue to take unnecessary smears?

A questionnaire survey of all general practices and family planning doctors in Manchester Health Authority was undertaken to determine why many more smears are taken in primary care than are scheduled by the screening programme. An 82% response rate was obtained. The indications for additional smear tests most frequently cited by responders were postcoital (88%), postmenopausal (84%), or intermenstrual bleeding (55%); genital warts (87%); and multiple sexual partners (52%). Forty-six per cent think that a woman should have a repeat test within one year of her first ever test. We discuss why these are not valid indications for additional smear tests.

England↗
PubMed1996

The reliability and validity of work measurement in Australian general practice consultations.

OBJECTIVES: To examine the reliability of relative work value assessment in general practice consultations and to determine whether different methods of assessing work produce consistent rankings. DESIGN: Cross-sectional observational assessment of general practice consulations. SETTING: General practices in Victoria between October 1991 and October 1992. PARTICIPANTS: 686 patients attending one of 58 general practitioners (GPs) drawn from a random, stratified sample. METHODS: Each participating GP had one day of consultations videotaped. They rated the work value of each consultation by using a magnitude estimation scale relative to a reference vignette. Three GP observers independently applied the same scale to the videotaped consultations. After three months, the observers applied a second measurement of work value, a compensation scale (also relative to the reference vignette), to the videotaped consultations. Duration of consultation was the third rating method. MAIN OUTCOME MEASURES: The reliability of work value assessment for each scale. Consultation rank order correlation coefficients among all rating methods. RESULTS: Observer reliability was high for both scales. Practising GPs showed lower levels of reliability in assessing the work value of their consultations. Strong positive correlations were found for consultation rankings among the observer scales and duration of the consultation. The duration of the consultation emerged as an important predictor of consultation work value. CONCLUSIONS: Scaling methods appear to be of little value to the practising GP in reliably assessing the relative work value of their consultations; training in the use of these scales may improve their reliability. However, the duration of consultation may be a reasonable proxy for relative work value assessment in general practice consultations.

Australia↗
PubMed1996

Workplace organizational correlates of lost-time accident rates in manufacturing.

We report the results of a questionnaire survey of manufacturing workplaces related to the lost-time frequency rates (LTFR) for Workers' Compensation claims. Six types of industry were chosen.' metal articles, plastic articles, grain products, textile manufacturing, printing, and automobile manufacturing. LTFR were standardized by type of industry. Stratifying simultaneously by number of employees and LTFR category, we sampled 718 workplaces. A mail questionnaire to labor and management representatives provided at least some information on 58%. Response rates were similar across LTFR categories, and telephone interviews of non-responders showed little difference in their replies from those obtained in completed questionnaires. A large number of variables were examined. Apart from statistical significance, we looked for consistency in trends across LTFR categories and in patterns for similar questions. Significant associations grouped into several areas. Lower LTFR were associated with: concrete demonstration by management of its concern for the workforce; greater involvement of workers in general decision-making; greater willingness of the Joint Health and Safety Committee to solve problems internally; and greater experience of the workforce. Variables that were not significant included profitability and financial performance. A final stepwise multiple regression explained 19% of the variance in LTFR, although this analysis suffered from several limitations.

Absenteeism↗
PubMed1996

Resonance assignments for Oncostatin M, a 24-kDa alpha-helical protein.

Oncostatin M (OM) is a cytokine that shares a structural and functional relationship with interleukin-6, leukemia inhibitory factor, and granulocyte-colony stimulating factor, which regulate the proliferation and differentiation of a variety of cell types. A mutant version of human OM in which two N-linked glycosylation sites and an unpaired cysteine have been mutated to alanine (N76A/C81A/N193A) has been expressed and shown to be active. The triple mutant has been doubly isotope-labeled with 13C and 15N in order to utilize heteronuclear multidimensional NMR techniques for structure determination. Approximately 90% of the backbone resonances were assigned from a combination of triple-resonance data (HNCA, HNCO, CBCACONH, HBHACONH, HNHA and HCACO), intraresidue and sequential NOEs (3D 15N-NOESY-HMQC and 13C-HSQC-NOESY) and side-chain information obtained from the CCONH and HCCONH experiments. Preliminary analysis of the NOE pattern in the 15N-NOESY-HMQC spectrum and the 13C alpha secondary chemical shifts predicts a secondary structure for OM consisting of four alpha-helices with three intervening helical regions, consistent with the four-helix-bundle motif found for this cytokine family. As a 203-residue protein with a molecular weight of 24 kDa, Oncostatin M is the largest alpha-helical protein yet assigned.

Amino Acid Sequence↗
PubMed1996

The significance of age and duration of effect in social evaluation of health care.

To give priority to the young over the elderly has been labelled 'ageism'. People who express 'ageist' preferences may feel that, all else equal, an individual has greater right to enjoy additional life years the fewer life years he or she has already had. We shall refer to this as egalitarian ageism. They may also emphasise the greater expected duration of health benefits in young people that derives from their greater life expectancy. We may call this utilitarian ageism. Both these forms of ageism were observed in an empirical study of social preferences in Australia. The study lends some support to the assumptions in the QALY approach that duration of benefits and hence old age, should count in prioritising at the budget level in health care.

Age Factors↗
PubMed1996

Synthetic peptides entrapped in microparticles can elicit cytotoxic T cell activity.

Peptides from Plasmodium berghei circumsporozoite protein (CS) and influenza A virus nucleoprotein (NP) were entrapped in microparticles prepared from poly (lactide-co-glycolide) polymers, and the microparticles were administered parenterally to mice. After immunization with single or multiple doses, splenocytes were tested for a cytotoxic T cell (CTL) response and high levels of CTL activity were detected. The CTL induced were CD8+, MHC class I restricted, and could recognize virus infected cells. Peptide entrapped in microparticles of mean size < 500 nm were better inducers of CTL than larger microparticles (mean > 2 microns and above). Microparticles could also be used to deliver lipid modified peptides (lipopeptides) and elicited higher levels of cytolytic activity than either free peptide in microparticles or lipopeptide alone. Microparticles provide a novel way of inducing a CTL response using synthetic peptides.

Adjuvants, Immunologic↗
PubMed1996

The measurement of utility in multiphase health states.

To examine the validity of the additive quality-adjusted life year model used to evaluate a multiphase health state, data from a pilot study of mammography were used to determine whether the values assigned to a multiphase postmastectomy health state could be estimated from a combination of the independently rated constituent health state values. The results suggest that they cannot.

Adult↗
PubMed1996

Spatial patterns in the control of human arm movement.

Generalized Procrustes analysis was used to investigate the spatial paths of pointing movements. In Experiment 1, 3 participants produced similar spatial paths of the hand when repeating a pointing movement many times, despite variability in the position and orientation of the movements. The average spatial path indicates a fundamental spatial pattern of the motor system, or motor primitive. This pattern varied across the workspace. Anterioposterior movements were straight, but repeated movements had variable spatial patterns. Lateral movements were curved away from the body but had regular spatial patterns. Experiment 2 extended these results to movements of different amplitudes in 7 participants. The motor primitive seems to be abandoned at the end of the movement in favor of final adjustments to bring the hand to the target position. In Experiment 3, the same participants produced similar motor primitives both with and without vision.

Arm↗
PubMed1996

Differences in patient throughput between community health centre and private general practitioners.

This study sought to compare the rate of patient throughput by community health centre general practitioners (GPs) and their private practice fee-for-service counterparts. The study group comprised 44 community health centre GPs (out of an identified 51) in 16 community health centres; the control group comprised 268 GPs. Community health centre GPs were found to have significantly fewer consultants and significantly smaller rebates than their private practice counterparts. The difference of means for consultation numbers and rebates was 30.3 per cent. The pattern was reversed in the case of rural community health centre GPs (who retain fee-for-service arrangements). Figures are uncorrected for patient status, and data relate to Medicare billing practices rather than observed activity or outcome. However, at face value they would indicate that if Australian general practice moved to a community health centre model, with predominantly salaried GPs, then patient throughput in general practice could be expected to drop. Whether these reflect the impact of incentives on throughput and, if so, whether this indicates a difference in the quality or accessibility of the service provided to patients is not certain.

Adult↗
PubMed1996

Neutralization sensitivity and accessibility of continuous B cell epitopes of the feline immunodeficiency virus envelope.

Antibodies elicited during natural infection of domestic cats by the feline immunodeficiency virus (FIV) recognize continuous epitopes in nine domains of the virus envelope glycoproteins. Whereas antibodies directed against the V3 envelope region can neutralize laboratory-adapted virus, neutralization of FIV has been shown to depend upon cellular substrate, and virus adaptation to laboratory cell lines may alter sensitivity to neutralizing antibodies. We therefore undertook a systematic analysis of the continuous B cell epitopes of the envelope of a primary FIV isolate, Wo. The capacity of feline antisera elicited against nine envelope domains to neutralize primary and laboratory-adapted virus was evaluated in feline peripheral blood mononuclear cells (PBMC). The laboratory-adapted strain Petaluma was used to compare neutralization in PBMC and Crandell feline kidney cells (CrFK). Antibodies specific for the V3 region neutralized both primary and laboratory-adapted virus whether residual infectivity was measured in CrFK or in feline PBMC. However, a large discrepancy in the efficiency of neutralization was observed in these ex vivo models of infection, perhaps reflecting diversity in the interaction between virus and different cellular targets. We also examined the accessibility of epitopes on the functional oligomeric envelope complex of FIV. Most of the epitopes were poorly exposed on native envelope glycoproteins at the surface of live infected cells. The most accessible domain was the only domain sensitive to neutralizing antibodies. These results suggest that inaccessibility on oligomeric envelope glycoproteins may frequently underlie the insensitivity of diverse lentivirus B cell epitopes to neutralization.

Amino Acid Sequence↗
PubMed1996

Thoracic paravertebral space location. A new method using pressure measurement.

The major drawback of paravertebral space location using the traditional method of loss of resistance to air or saline is a failure rate of at least 10%. We investigated whether pressure measurement during needle advancement could improve reliability. Twenty-nine blocks in 14 awake adult patients undergoing treatment for chronically painful neuralgic conditions of the chest or abdominal wall were studied. In erector spinae, the mean inspiratory pressure (29.5 mmHg, SD 14.2), exceeded the expiratory pressure (19.4 mmHg, SD 9.7). However, upon traversing the superior costo-transverse ligament, there was a sudden lowering of pressures and the mean expiratory pressure (7.6 mmHg, SD 3.7) exceeded the inspiratory pressure (3.3 mmHg, SD 2.9). No negative pressures were recorded. Correct needle placement was confirmed by X ray screening and contrast injection. All blocks were successful and uncomplicated. Location of the paravertebral space by this objective method of 'pressure inversion' improves sensitivity and specificity and should lead to an improvement in the success rate of thoracic paravertebral analgesia.

Adult↗
PubMed1996

An audit of discharge medication for secondary prophylaxis post-myocardial infarction.

BACKGROUND AND OBJECTIVE: Prophylactic pharmacotherapy post-myocardial infarction (post-MI) has been shown to reduce the risk of subsequent non-fatal infarction and to reduce overall mortality. The present study aimed to review the therapy of such patients in a teaching hospital. METHOD: Medicines prescribed to 77 post-MI patients for secondary prophylaxis were reviewed. The drugs prescribed by a cardiologist-led team were compared with those prescribed by a general medical team. Seventeen patients died before discharge, leaving a study cohort of 60 patients to complete the audit. RESULTS: Thirty-nine of the 60 patients (65%) met the discharge standard, and there was no significant difference in adherence to the audit standard when the consultant cardiologist and the general medical consultant were compared. The audit highlighted the therapeutic dilemma concerning the appropriateness of initiating low-dose aspirin in patients already receiving warfarin therapy. CONCLUSION: The audit has enabled us to develop guidelines which feed into the multi-disciplinary cardiac rehabilitation programme, helping to improve prescribing adherence to the discharge standard. A follow-up audit is planned.

Adrenergic beta-Antagonists↗