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Biomedical subjects

J Robinson

Publications and source records attributed to J Robinson.

At least 109 records · Page 6Linked to original sources
PubMed2000

Using the Boazul cuff to reduce blood loss in varicose vein surgery.

OBJECTIVE: this study was designed to assess if the use of a sterile exsanguination tourniquet (Boazul cuff) reduced blood loss from the groin and avulsion wounds during varicose vein surgery, (saphenofemoral disconnection, stripping to knee and multiple avulsions). DESIGN: prospective, parallel cohort study. MATERIALS: thirty-eight patients undergoing primary varicose vein surgery. METHODS: the blood loss and number of avulsion wounds were recorded for each patient. RESULTS: the tourniquet was used on 21 legs and there were 24 legs in the non-tourniquet group. In the tourniquet group, the median blood loss from the groin was 15 ml, (range 5-70 ml), and from the leg was 5 ml, (range 0-120 ml). The corresponding figures for the group without the tourniquet were a median of 17.5 ml, (range 5-105 ml), and a median of 95 ml, (range 10-505 ml). The mean number of avulsions in the tourniquet group was 25 (range 9-38), and in the non-tourniquet group was 15, (range 5-40). There was significantly less blood loss from the leg in the tourniquet group (p<0.0001) despite the fact that there were more avulsions in the tourniquet group (p<0.001). CONCLUSIONS: use of the Boazul cuff significantly decreases the blood loss from the avulsion sites during routine varicose vein surgery, and may encourage the surgeon to perform more avulsions.

Adolescent↗
PubMed2000

Nursing home staffing and its relationship to deficiencies.

OBJECTIVES: The authors examined the relationships between different types of nursing home staffing and nursing home deficiencies to test the hypothesis that fewer staff hours would be associated with higher numbers of deficiencies. METHODS: Data were from the On-Line Survey, Certification, and Reporting System for all certified nursing homes in the United States. Regression models examined total deficiencies, quality of care, quality of life, and other deficiencies. RESULTS: Fewer registered nurse hours and nursing assistant hours were associated with total deficiencies and quality of care deficiencies, when other variables were controlled. Fewer nursing assistant staff and other care staff hours were associated with quality of life deficiencies. Fewer administrative staff hours were associated with other deficiencies. Facilities that had more depressed and demented residents, that were smaller, and that were nonprofit or government-owned had fewer deficiencies. Facilities with more residents with urinary incontinence and pressure sores and with higher percentages of Medicaid residents had more deficiencies, when staffing and resident characteristics were controlled. DISCUSSION: Facility characteristics and states were stronger predictors of deficiencies than were staffing hours and resident characteristics. Because only a small portion of the total variance in deficiencies could be explained, much work remains to explore factors that influence deficiencies.

Aged↗
PubMed2000

The effect of home visiting programmes on uptake of childhood immunization: a systematic review and meta-analysis.

BACKGROUND: The aim of the study was to evaluate the effectiveness of home visiting programmes on the uptake of childhood immunization. METHODS: A systematic review was carried out of the literature of controlled studies evaluating home visiting programmes involving at least one post-natal visit, which included tasks within the remit of British health visiting and reporting outcomes relevant to British health visiting. Eleven studies were considered, nine of which used socio-economically disadvantaged families. The outcome measure was uptake of a range of childhood immunizations. RESULTS: Eleven studies reported uptake of immunization. Effect sizes from nine studies were included in the meta-analysis. Fixed effects models demonstrated a significant effect of home visiting for all studies and also for several subgroups of studies, but with significant heterogeneity of effect sizes. A random effects model failed to demonstrate an effect of home visiting. CONCLUSIONS: Home visiting programmes have not been shown to be effective in increasing the uptake of immunization. Other methods of increasing uptake and reducing inequalities in uptake will need to be explored.

Child, Preschool↗
PubMed2000

Gender-specific characteristics of 5-year-olds' play narratives and associations with behavior ratings.

OBJECTIVES: To examine the content and structure of children's play narratives in a large sample of 5-year-olds in order to replicate previous findings, explore the role of gender differences, and identify a pattern that can provide useful information about children's behavior. METHOD: The MacArthur Story Stem Battery and coding system was used to code content themes and coherence from play narratives of 652 twins in a nonclinical sample. To measure behavior problems, parents completed the Child Behavior Checklist when their children were aged 5 and 7 years; teachers completed the Teacher's Report Form when the children were aged 7 years. RESULTS: Girls told more coherent narratives with less aggression than boys. Aggressive themes were found to correlate with behavior problems as in previous studies. Upon further examination, this correlation held for girls but not boys. Children who told repeated aggressive/incoherent narratives had more behavior problems than those who did not show this narrative pattern. CONCLUSIONS: The Story Stem methodology is useful for gaining access into the young child's inner world. The gender of the child, content of the story, and coherence of the story all provide useful information in identifying narratives that may indicate more risk for behavior problems.

Aggression↗
PubMed2000

Comparative lipoplasty analysis of in vivo-treated adipose tissue.

A comparative histologic and chemical analysis was undertaken of adipose tissue treated in vivo with traditional, ultrasound-assisted, and external ultrasound-assisted lipoplasty. A series of six healthy women undergoing elective liposuction according to the superwet technique using a 1:1 infiltration ratio with the estimated quantity of fat to be removed was included in the study. Four separate regions on each patient were treated independently in vivo with traditional liposuction, internal ultrasound-assisted liposuction, or external ultrasound-assisted liposuction for 7 minutes. External massage was used as a control. Four separate specimens of adipose tissue from each patient were assessed for cellular disruption using blinded histologic evaluation. The remainder of tissue was centrifuged to separate the aqueous phase from the cellular components and then spectrophotometrically analyzed for creatinine kinase and glycerol 3-phosphate dehydrogenase activity as markers of cellular disruption. Histologic analysis confirmed 70 to 90 percent cellular disruption with internal ultrasound-assisted liposuction. Suction-assisted and external ultrasound-assisted liposuction showed 5 to 25 percent disruption, whereas massage controls showed only 5 percent. Only internal ultrasound-assisted liposuction showed 5 to 20 percent thermal liquefaction. Absorbance analysis showed creatine kinase activity (sigma units) greatest in ultrasound-exposed tissue. Both external and internal ultrasound-assisted liposuction gave creatine kinase levels 28 to 33 percent greater than suction-assisted liposuction, which varied only 10 percent from controls. Glycerol 3-phosphate dehydrogenase activity was 44 percent greater for internal ultrasound-assisted liposuction than that detected with suction-assisted liposuction. Glycerol 3-phosphate dehydrogenase activity with external ultrasound-assisted liposuction and massage did not vary much from each other, at only 14 percent and 11 percent activity compared with internal ultrasound-assisted liposuction, respectively. Histologic and enzyme analysis of the different types of liposuction and their effect on adipocyte cellular disruption revealed no significant effect of external ultrasound or massage on the adipocytes. Further experimental studies are necessary to evaluate the role and efficacy of alternative techniques for body contouring.

Adipose Tissue↗
PubMed2000

Effect of ascorbic acid and growth factors on collagen metabolism of flexor retinaculum cells from individuals with and without carpal tunnel syndrome.

The effects of ascorbic acid and various growth factors on the proliferation rate and collagen metabolism were studied in cells from the flexor retinaculum of individuals with carpal tunnel syndrome (FR-CTS) and without carpal tunnel syndrome (FR control) and in human dermal fibroblasts. Ascorbic acid and four growth factors, including basic fibroblast growth factor, transforming growth factor, platelet-derived growth factor, and epidermal growth factors, were used. Ascorbic acid stimulates type I collagen production more in FR control than in FR-CTS. Growth factor treatment resulted in the following responses by the cells: (1) a higher mitogenic response than in the control cells; (2) a higher stimulation of type III collagen production and a lower stimulation of type I collagen production in CTS cells as compared with control cells; and (3) more alpha 2 (I) than alpha 1 (I) collagen production in CTS cells, unlike in control cells. We concluded that cells of the FR from individuals with CTS are physiologically altered.

Adult↗
PubMed2000

Lysyl oxidase activity in the cells of flexor retinaculum of individuals with carpal tunnel syndrome.

Lysyl oxidase (LO) is produced by myofibroblast cells in some tissues and can be influenced by transforming growth factor beta 1 (TGF beta 1). Myofibroblast-like cells are present in the flexor reticulum of patients with carpal tunnel syndrome (CTS). The goal of the current study was to determine LO activity and the effects of TGF beta 1 on LO expression in the cells from patients with CTS. Tissues from both hands of five individuals with CTS were used for this study. LO activity with and without TGF beta 1 stimulation was assayed in 7-day cell culture specimens. A significant difference in LO activity among individual patients, but not between right and left hands of the same patient, was observed. There was no correlation between the severity of CTS determined by nerve conduction studies and LO activity. Addition of TGF beta 1 significantly increased LO in all cell lines.

Adult↗
PubMed2000

Prospective blinded trial of a fecal antigen test for the detection of Helicobacter pylori infection.

OBJECTIVE: We prospectively studied an FDA-approved stool test for the diagnosis of Helicobacter pylori infection based on the detection of antigens shed in stool. METHODS: We studied 108 patients undergoing endoscopy. Stool samples were collected on the day of the endoscopy and read in a blinded manner by a technician who was unaware of the findings of the endoscopy. The results of stool testing were compared to those of the rapid urease test (Pyloritek). RESULTS: There were 51 patients infected with H. pylori by rapid urease testing and 57 who were not. The sensitivity of the stool test was 86% (95% confidence interval: 77-96%), the specificity was 91% (81-97%), with a positive predictive value of 89% (77-96%) and a negative predictive value of 88% (81-97%). The likelihood ratio for a positive test was 10.18 and the likelihood ratio for a negative test was 0.11. CONCLUSIONS: The stool test was sensitive and specific for the detection of H. pylori in a U.S. population.

Antigens, Bacterial↗
PubMed2000

Performance of a multiplex qualitative PCR LCx assay for detection of human immunodeficiency virus type 1 (HIV-1) group M subtypes, group O, and HIV-2.

Early detection of human immunodeficiency virus (HIV) in blood and blood products can be achieved by a sensitive nucleic acid amplification-based assay. We report on the performance of a PCR-based qualitative assay that detects both HIV type 1 (HIV-1) and HIV-2 with a sensitivity of 20 to 50 copies/ml. The assay has a specificity of 99.6% and an inhibition rate of 1.7%. One milliliter of sample is processed with a manifold system and Qiagen columns, and one-third of the extracted sample is used for PCR amplification. An internal control sequence, which is processed and amplified with each sample, monitors for amplification inhibition. Samples are reverse transcribed and are then amplified by reverse transcription-coupled PCR, after which HIV-1- and HIV-2-specific probes are hybridized to the amplified products. Following hybridization, samples are detected in the LCx instrument by microparticle enzyme immunoassay techniques. The detection system has an automated inactivation step that controls for PCR contamination. The HIV-1/2 qualitative RNA assay detects HIV-1 group M subtypes A, B, C, D, E, F, and G and group O. Testing of several HIV-1 seroconversion panels has demonstrated that the HIV-1/2 qualitative RNA assay detects HIV infection on the average of 6 days before p24 antigen can be detected and 11 days before antibodies can be detected.

HIV Antibodies↗
PubMed2000

The N-terminal V3 loop glycan modulates the interaction of clade A and B human immunodeficiency virus type 1 envelopes with CD4 and chemokine receptors.

We investigated the underlying mechanism by which the highly conserved N-terminal V3 loop glycan of gp120 conferred resistance to neutralization of human immunodeficiency virus type 1 (HIV-1). We find that the presence or absence of this V3 glycan on clade A and B viruses accorded various degrees of susceptibility to neutralization by antibodies to the CD4 binding site, CD4-induced epitopes, and chemokine receptors. Our data suggest that this carbohydrate moiety on gp120 blocks access to the binding site for CD4 and modulates the chemokine receptor binding site of phenotypically diverse clade A and clade B isolates. Its presence also contributes to the masking of CD4-induced epitopes on clade B envelopes. These findings reveal a common mechanism by which diverse HIV-1 isolates escape immune recognition. Furthermore, the observation that conserved functional epitopes of HIV-1 are more exposed on V3 glycan-deficient envelope glycoproteins provides a basis for exploring the use of these envelopes as vaccine components.

Binding Sites↗
PubMed2000

Does home visiting improve parenting and the quality of the home environment? A systematic review and meta analysis.

AIMS: To evaluate the effectiveness of home visiting programmes on parenting and quality of the home environment. DESIGN: Systematic review of the literature of randomised controlled trials and quasi-experimental studies evaluating home visiting programmes involving at least one postnatal visit. SUBJECTS: Thirty four studies reported relevant outcomes; 26 used participants considered to be at risk of adverse maternal or child health outcomes; two used preterm or low birth weight infants; and two used infants with failure to thrive. Only eight used participants not considered to be at risk of adverse child health outcomes. RESULTS: Seventeen studies reported Home Observation for Measurement of the Environment (HOME) scores, 27 reported other measures of parenting, and 10 reported both types of outcome. Twelve studies were entered into the meta analysis. This showed a significant effect of home visiting on HOME score. Similar results were found after restricting the analyses to randomised controlled trials and to higher quality studies. Twenty one of the 27 studies reporting other measures of parenting found significant treatment effects favouring the home visited group on a range of measures. CONCLUSIONS: Home visiting programmes were associated with an improvement in the quality of the home environment. Few studies used UK health visitors, so caution must be exercised in extrapolating the results to current UK health visiting practice. Further work is needed to evaluate whether UK health visitors can achieve similar results. Comparisons with similar programmes delivered by paraprofessionals or community mothers are also needed.

Child↗
PubMed2000

A pilot study of radiotelemetry for continuous cardiopulmonary monitoring of patients at home.

We have conducted a trial of a wireless device for continuous cardiopulmonary monitoring. Its performance, user acceptance and safety were assessed for monitoring in the patient's home. The study included 20 patients: six with chronic obstructive pulmonary disease, six with chronic heart failure, seven with atrial fibrillation and palpitations, and one with a snoring problem. The system recorded the heart rate and respiratory rate, blood pressure, electrocardiogram and body temperature. The results were transmitted automatically to a central monitoring station. The accuracy of the measurements was checked by a comparison system and also by conventional measurements performed by a nurse. The system was acceptable to patients and functioned satisfactorily in the home. An important facet of home telemonitoring may turn out to be its greater reliability in collecting objective data.

Adult↗
PubMed2000

Application of draft European Commission reference levels to a regional CT dose survey.

A survey of CT doses in Northern Ireland in the period between October 1995 and March 1997 was carried out. The survey included all but one of the 10 scanners in use at the time, and, additionally, two others that were replacement machines. The method used was to study standard protocols and calculate doses to the NRPB mathematical phantom, so that a direct comparison could be made with other surveys carried out in a similar fashion elsewhere. The survey addressed the patient radiation dose but not image quality or clinical outcomes. It is estimated that in Northern Ireland the contribution to collective dose to the population from CT is about 40% of that from all medical X-rays. The proposed European Commission reference quantities, weighted CT dose index and dose-length product were computed and their potential use evaluated. A full study of mean values of effective dose per examination revealed the average dose per examination was not significantly different from that found in the 1989 UK survey, although several procedures gave rise to doses that were high enough to be investigated with a view to justification or reduction. One of the scanners was found to give consistently high doses. It is likely that a revision of the mAs values used on this scanner will produce a significant reduction in patient doses without compromising image quality. When compared with the draft EC reference levels, fewer procedures were found to have excessively high dose values. The proposed EC reference levels would therefore be useful for continual monitoring of CT dose status, but do not appear to provide as comprehensive an assessment of patient exposure as that given by consideration of effective doses.

Clinical Protocols↗
PubMed2000

Evaluation of models of acute and subacute acidosis on dry matter intake, ruminal fermentation, blood chemistry, and endocrine profiles of beef steers.

Crossbred steers (n = 20; 316 +/- 4 kg BW), each fitted with a ruminal cannula, were used to evaluate the effects of acute acidosis (AA) and subacute acidosis (SA) on DMI, ruminal fermentation, blood chemistry, and endocrine profiles. Animals were blocked by BW and assigned to treatments including 1) intraruminal (via cannula) steam-flaked corn (3% of BW; AA); 2) intraruminal dry-rolled wheat:dry-rolled corn (50:50; 1.5% of BW; SA); 3) offering forage-adapted steers ad libitum access to a 50% concentrate diet (AA control; AC); and 4) offering 50% concentrate diet-adapted steers ad libitum access to a 50% concentrate diet (SA control; SC). Samples of ruminal fluid and whole blood were collected on the day of the challenge (d 0) and 3, 7, 10, and 14 d after the challenge. Daily DMI responded quadratically (P < 0.01) through d 7 for AA and SA steers and increased linearly (P < 0.01) for AC steers. Dry matter intake by AA steers reached a nadir (< 3 kg/d) on d 3 and gradually increased to a level similar to other treatments (7 kg/d) by d 10, whereas DMI by SA steers increased through d 3. Blood pH, bicarbonate, base excess, and total CO2 were decreased (P < 0.03) for AA steers and increased (P < 0.03) for SC steers through d 7. Ruminal pH decreased quadratically (P < 0.01) in AA and AC steers and increased (P = 0.01) in SA steers through d 7. Ruminal total lactate concentration and osmolality responded quadratically (P < 0.01) for AA and AC steers. Ruminal total lactate peaked on d 3 for AA steers and on d 0 for AC and decreased to basal concentrations by d 7. Plasma NEFA concentration increased (P < 0.04) on d 3 and 7 for AA steers. Serum Na decreased (P < 0.05) on d 0 for AA and SA steers and on d 7 and 14 for AA steers. Serum P decreased (P = 0.01) for AA steers through d 7 and decreased quadratically (P = 0.01) for AC steers through d 7. Serum albumin and cholesterol decreased (P < 0.02) for AA and AC steers through d 7. Area under the GH curve decreased (P = 0.02) for AA and AC steers through d 7. Considerable variation was evident in the ability of an animal to cope with a carbohydrate challenge. Results of data modeling generally suggest that serum amylase activity, cholesterol and potassium concentrations, and plasma NEFA concentrations were useful in distinguishing between steers classified as experiencing subacute acidosis or not affected by a carbohydrate challenge.

Acidosis↗
PubMed2000

Empowerment & reminiscence: possible tools in dietary health promotion in the elderly.

The COMA report "The Nutrition of Elderly People" recommended that elderly people should be targeted for health education programmes in order to maintain nutritional status in this group. Recent research indicates that interventions which aim to influence nutritional behaviour are more likely to succeed if they involve target populations at all stages of the process. This paper outlines a preliminary action research project which attempted to identify some key issues influencing eating behaviour in a group of elderly people based in the Halewood area of Knowsley, Merseyside. An innovative methodology, combining empowerment and reminiscence, was used to produce a nutritional advice leaflet which will be used as a resource within the local community.

Aged↗