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Biomedical subjects

J Walsh

Publications and source records attributed to J Walsh.

At least 37 records · Page 2Linked to original sources
PubMed2002

The UK national study of magnetic resonance imaging as a method of screening for breast cancer (MARIBS).

The UK national study of magnetic resonance imaging as a method of screening for breast cancer (MARIBS) is in progress. The study design, accrual to date, and related research projects are described. Revised accrual rates and expected recruitment are given. 15 cancers have been detected to date, from a total of 1236 screening measurements. This event rate and the tumour grades reported are compared with recent reports from other studies in women at high risk of breast cancer.

Adult↗
PubMed2001

Hybrids of pluripotent and nullipotent human embryonal carcinoma cells: partial retention of a pluripotent phenotype.

To investigate whether the failure of human EC cells that do not differentiate is due to the loss of key differentiation-permissive functions or the acquisition of specific inhibitory functions, we tested the ability to differentiate of 2 hybrids produced between a relatively nullipotent human EC cell line, 2102Ep, and a pluripotent human EC cell line NTERA2. Both hybrids, which exhibited an EC phenotype, were able to differentiate readily in response to retinoic acid. Furthermore, 1 hybrid produced a well-differentiated xenograft tumor, which contained, like the NTERA2 tumors, glandular structures, loose mesenchymal tissues and nodules of cartilage, after injection into a SCID mouse. Thus, the failure of 2102Ep EC cells to differentiate is recessive and due to the loss of a key gene function or functions. Nevertheless, the hybrids differed from the pluripotent NTERA2 line by failing to differentiate in neurons, indicating that 2102Ep cells also had acquired a specific, dominantly-acting, inhibitory mutation specific to the neural lineage. Furthermore, the expression of collagen II by one hybrid before and after induction with retinoic suggested a propensity for spontaneous differentiation not evident in the parental NTERA2 cells. Thus, the mechanisms that restrict the differentiation capacity of the nullipotent 2102Ep line are complex and include both recessive and dominant acting factors.

Animals↗
PubMed2001

Insights obtained from an evaluation of a falls prevention program set in a rural hospital.

An evaluation of a Falls Prevention Program that took place in a 29-bed rural hospital in New South Wales is described. The aim of the project was to ascertain the overall effectiveness of the Program and to explore the usefulness of the assessment criteria in predicting falls. The sample consisted of 111 participants, representing all patients 65 years and over who were admitted to the general ward of the hospital between January and December 1997. The Falls Prevention Program had reduced the incidence of falls and was found to be effective for those patients requiring minimal assistance with walking. However, it was less effective for those using pick-up frames or forearm support frames. The patients who fell were more likely to be in the high risk category and it was concluded that while the assessment criteria was useful in predicting falls, the Falls Prevention Program could only limit the number of falls but not prevent them altogether. Age, mental status and mobility of patients in combination with time and location of falls suggested a pattern that was possibly peculiar to this rural hospital, which has implications for funding and staffing.

Accidental Falls↗
PubMed2001

Pharmaceutical industry-sponsored meetings: good value or just a free meal?

Although the role of the pharmaceutical industry in continuing medical education (CME) has been debated for many years, industry CME funding continues to increase. Because of concern about the educational quality of industry CME, the Hunter Postgraduate Medical Institute (HPMI), an independent Newcastle and Hunter Valley CME provider, evaluated the use and quality of industry CME as reported by rural and urban general practitioners, physicians and psychiatrists. Furthermore, clinicians were asked if they supported increased industry-funded independent CME. Sixty-two per cent of general practitioners and 71% of psychiatrists attended at least three industry-organized meetings each year, compared with 24% of physicians. Twenty-five per cent of general practitioners attended five or more such meetings. Industry meetings were judged to be of good to excellent quality by 81% of generalists, 79% of physicians and 87% of psychiatrists. All clinical groups ranked the topic and then speaker as the most important reason for attending, with CME points, venue and the sponsor ranked lowest. Eighty to 90% of doctors supported a greater role of industry-funded independent CME. Despite the absence of current data on the use and perceived benefits of industry CME, these preliminary results suggest that industry CME is playing an increasingly important role in clinician education. However, many clinicians and industry representatives support a greater role by independent postgraduate organizations in industry-sponsored CME.

Attitude of Health Personnel↗
PubMed2001

Ending clinical relationships with people with schizophrenia.

The potential for the social worker-client relationship to contribute to therapeutic outcomes is not always apparent with clients who have schizophrenia. Their cognitive impairments often make it difficult for these clients to regulate interpersonal boundaries and for social workers to connect with them. Clinical practice is enhanced, however, by recognizing that severely impaired clients have the capacity and desire for relationships with service providers and others. The manner in which the clinical relationship ends is important for maintaining clinical gains and determining whether the client will risk investing in future relationships. The purpose of this article has been to sensitize social workers to the delicate nature of managing the endings of those relationships.

Adult↗
PubMed2001

Emotional change processes in music-assisted reframing.

Affective processes are critical to understanding and promoting lasting therapeutic change. Using a sample of 40 anxious adults, the researchers examined the use of music to increase affective modification and emotional restructuring in a cognitive reframing intervention. Subjects were assigned to either a typical reframing intervention or a music-assisted reframing intervention. Using the State-Trait Anxiety Inventory, Subjective Units of Distress Scale, Depression Adjective Checklist, and a Think-Aloud measure, the groups were compared on basis of anxiety-reduction, affective modification, and imagery vividness. Results indicate that the music-assisted reframing intervention was more efficacious than the typical reframing intervention in reducing anxiety, modifying affect, and promoting imagery-vividness.

Adult↗
PubMed2001

Immunoneutralization of somatostatin, insulin, and glucagon causes alterations in islet cell secretion in the isolated perfused human pancreas.

INTRODUCTION: In this study, immunoneutralization of endogenous insulin, glucagon, and somatostatin with specific antibodies was used in an isolated perfused human pancreas (IPHP) model. AIMS: To study intrapancreatic cellular interactions and pancreatic hormonal secretion. METHODOLOGY: Randomized, sequential 10-minute test intervals of single-pass perfusion with each antibody were performed at 3.9 mM or 11.5 mM steady-state glucose concentrations. Somatostatin, insulin, and glucagon levels were measured in the effluent during basal and immunoneutralization intervals. RESULTS: At 3.9 mM glucose concentration, somatostatin antibody (SS-Ab) stimulated insulin and glucagon secretion, insulin antibody (IN-Ab) inhibited glucagon secretion, and glucagon antibody (GN-Ab) stimulated insulin secretion. At 11.5 mM glucose concentration, SS-Ab stimulated insulin secretion, IN-Ab stimulated glucagon and inhibited somatostatin secretion, and GN-Ab stimulated insulin secretion. CONCLUSION: The variation in hormonal responses to immunoneutralization during stimulated and nonstimulated glucose conditions suggests that a dynamic association exists between the pancreatic cells.

Adolescent↗
PubMed2001

Community health promotion and the randomized controlled trial: approaches to finding common ground.

The randomized controlled trial is the model against which research designs are judged. Concurrent with rising standards of evidence, however, is a trend toward greater inclusiveness in community-based research, exemplified by the Centers for Disease Control and Prevention-funded Prevention Research Centers, a nationwide network of academic-community partnerships engaged in community-based health promotion and disease prevention research. The Yale-Griffin Prevention Research Center developed a replicable process for devising randomized trials in the context of community collaboration. Several examples of trials developed this way and their interim results are provided.

Cardiovascular Diseases↗
PubMed2001

Comorbidities and quality of life in patients with interferon-refractory chronic hepatitis C.

OBJECTIVES: Patients with chronic hepatitis C (HCV) consistently report a reduction in multiple domains of health-related quality of life (HRQOL) that does not correlate with liver disease severity. This may in part be due to the use of insensitive HRQOL instruments or extrahepatic factors that independently influence HRQOL. We hypothesized that a past history of substance abuse or active medical and psychiatric comorbidities would correlate with HRQOL scores. METHODS: In 107 patients who had failed previous interferon therapy, HRQOL was measured by using the modified SF-36, a disease-specific instrument, and the Health Utilities Index (HUI) Mark III, a generic instrument. RESULTS: Multiple SF-36 subscale and summary scores as well as the HUI Mark III attributes of emotion and pain were significantly reduced in the study population compared with healthy controls (p < 0.001). Serum alanine aminotransferase and HCV RNA levels, HCV genotype, liver histology, and HCV risk factors as well as demographic variables did not correlate with modified SF-36 and HUI scores. In addition, a history of alcohol abuse or dependency and intravenous drug use or dependency, identified in 52 and 51% of participants, respectively, did not correlate with HRQOL scores. However, the presence of one or more active medical comorbidities, defined as a chronic medical condition requiring treatment and monitoring, was significantly associated with both the modified SF-36 scores and HUI attribute deficits (p < 0.001). In particular, painful medical comorbidities or depressed mood requiring treatment were significantly associated with modified SF-36 scores and with HUI attribute deficits and utility scores (p < 0.001). CONCLUSIONS: Active medical and psychiatric comorbidities may account for some of the reduction and variability in HRQOL scores in patients with chronic HCV who have failed previous interferon therapy. Future studies that control for the presence of active comorbidities in large groups of treatment naive patients with varying severity of chronic HCV are needed to confirm these findings.

Adult↗
PubMed2001

Bacterial endocarditis following repeated tattooing.

Body decoration in the form of tattooing is becoming increasingly popular, especially among younger age groups. Although serious infections following tattooing are rare they are well documented. The first reported case of endocarditis caused by repeated tattooing in an individual with known valvar heart disease is presented.

Adult↗
PubMed2001

Emotional and behavioral impact of exposure to community violence in inner-city adolescents.

Used multiple methods and measures (i.e., youth report, psychiatric interviews, psychophysiological assessment) to investigate the emotional and behavioral impacts of exposure to community violence. Participants were 185 inner-city high school students (M age = 15.4 years; 42% female; 90% African American). Youth with high levels of community violence exposure reported more fears, anxiety, internalizing behavior, and negative life experiences than those with low exposure. No depression or externalizing behavior differences were observed. In a psychophysiological assessment in which adolescents watched a montage of media violence, youth exposed to high levels of community violence had lower baseline heart rates than those with low exposure. There were no between-group differences in physiologic reactivity. Regression analyses revealed that community violence exposure predicted posttraumatic stress and separation anxiety symptoms. The results suggest a significant link between community violence exposure and anxiety symptomatology. Clinical implications are discussed.

Adolescent↗
PubMed2001

The effects of age on accident severity and outcome in Irish road traffic accident patients.

Road traffic accidents (RTA's) are the leading cause of fatal trauma in Ireland. Although older drivers are the safest group of drivers in the population, once involved in a crash they are more likely to sustain a severe injury or death. The experiences of Irish elderly RTA victims has not been previously documented. We studied older RTA patients admitted to two Irish trauma centres in 1995. Of 525 patients, 39 (7%) were aged over 65. We compared 38 patients aged 16-64 years for comparison and reviewed the notes in detail. Elderly patients were mostly pedestrians (23/38 - 61%) though 21% (8/38) were drivers with 8% (3/38) on public transport. Younger patients were mostly drivers (14/37 - 38%), cyclists (9/37 - 24%) or motorcyclists (7/37 - 19%). Older patients had a higher median Injury Severity Score, p < 0.05, were more likely to be female (p<0.01), involved in RTA's between 9am-5pm (p<0.05) and have pre-existing medical conditions (p<0.01). The following were significantly increased in older patients (p values): surgical (<0.01), medical (<0.01) and therapist workload (p<0.05), complications (<0.0001), length of stay (<0.01). Less elderly were discharged directly to home (p<0.001). Strategies to reduce the mortality and morbidity associated with RTA in the elderly should emphasise a) older pedestrians during daytime hours, b) attention to safety in public transport. Treatment must ensure adequate medical and therapist input to anticipate higher complication rates.

Accidents, Traffic↗
PubMed2001

Use of a GnRH analogue implant to produce reversible long-term suppression of reproductive function in male and female domestic dogs.

Continuous low-dose administration of a GnRH analogue postpones oestrus in bitches and suppresses reproductive function in dogs. A new drug delivery formulation that could enhance the practicality of this approach for the control of reproduction has been developed. The objective of the present study was to determine whether this method of delivery could, by sustained release of the GnRH analogue deslorelin, act as a reversible anti-fertility agent in domestic male and female dogs for periods exceeding 1 year. Several long-term studies were performed, which monitored reproductive function in 30 dogs and 52 bitches. Suppression of reproductive function in male dogs was dose-related. Spermatogenesis was suppressed for more than a year in 14 of 16 dogs that received doses of > 0.25 mg deslorelin kg-1. In females, postponement of oestrus for periods of up to 27 months was observed, but there was no relationship between the stage of the oestrous cycle at the start of treatment and the duration of efficacy. Treatment-induced effects on fertility were reversible in both sexes. In summary, sustained release deslorelin implants were shown to elicit reversible long-term reproductive control in male and female domestic dogs.

Animals↗
PubMed2000

Resistance to glucocorticoid-induced apoptosis in PLP peptide-specific T cell clones from patients with progressive MS.

Glucocorticoids (GC) are commonly used to treat inflammatory disorders such as multiple sclerosis (MS) and may exert their immunosuppressive activity by inducing apoptosis in activated lymphocytes. However, unlike relapsing-remitting MS patients, those with progressive disease respond poorly to GC treatment. The data in this communication indicate that PLP peptide-specific T cell clones from progressive, but not relapsing-remitting MS patients are resistant to GC-induced apoptosis in vitro, in a fashion associated with expression of B-7 co-stimulatory molecules. Thus, failure to respond to GC treatment may reflect defect in apoptosis that develop during the progressive stages of chronic inflammatory disease.

Adult↗
PubMed2000

Causes of death after spinal cord injury.

STUDY DESIGN: Mortality review was undertaken of patients who suffered traumatic spinal cord injury (SCI) between 1955 and 1994 inclusive. OBJECTIVES: The study objective was to provide evidence of reasons for the observed reduction in long-term life expectancy for the SCI population. SETTING: Patients were those who had most, if not all, of their inpatient and outpatient care at Royal North Shore Hospital, Spinal Injuries Unit, Sydney, New South Wales, Australia. METHODS: Data on causes of death for 195 patients fitting the inclusion criteria were analysed by actuarial methods using ICD9CM classifications. RESULTS: The incidence of death in the spinal cord injured, from septicaemia, pneumonia and influenza, diseases of the urinary uystem and suicide, are significantly higher than in the general population. The findings confirm variations in potentially treatable causes of death depending on neurological impairment, attained age and duration since injury. Unlike septicaemia and pneumonia, which have shown a significant reduction since 1980, the death rate for suicide alone has risen. CONCLUSION: This analysis identified complications which affect mortality and morbidity in patients suffering from the effects of SCI.

Adult↗