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J Ward

Publications and source records attributed to J Ward.

At least 181 records · Page 10Linked to original sources
PubMed1996

Effectiveness of telephone prompts when surveying general practitioners: a randomised trial.

BACKGROUND: Response rates to recent surveys of general practitioners have ranged from 44-95%. The effectiveness of a telephone prompt by a non-medical research assistant in advance of survey mail-out was unknown at the time of this study. OBJECTIVE: To determine the effectiveness of a telephone prompt by a non-medical research assistant to enhance response rates to a lengthy survey. SUBJECTS: 364 randomly selected general practitioners randomised into intervention and control groups. OUTCOME VARIABLE: Cumulative response rate at Day 18 and Day 60. DESIGN: Intervention group received a telephone call in advance of the survey. The control group received conventional mail-outs. Non-responders in both groups were telephoned at Day 28 and sent a reminder letter and questionnaire. RESULTS: 77% of the intervention group responded to the survey compared to 64% of the control group. Intention-to-treat analysis demonstrated a significantly earlier response by Day 18 (continuity corrected chi 2 = 18.15; df = 1; p < 0.001) and a significantly higher overall response by Day 60 (continuity corrected chi 2 = 5.41, df = 1, p < 0.009) from the intervention group. CONCLUSION: A telephone prompt by a non-medical research assistant will accelerate and enhance response rates to a survey of general practitioners although the differential effectiveness of a non-medical researcher compared to a medical practitioner conducting such prompts remains unstudied.

Australia↗
PubMed1995

Urinary bladder distension: its effects on carotid baroreceptor reflex left ventricular inotropic response in the dog.

1. The effects of distension of the urinary bladder on heart rate, maximum rate of change of left ventricular pressure (dP/dt max) and hindlimb vascular resistance together with their modulation at different carotid sinus pressures were studied in dogs anaesthetized with a mixture of chloralose and urethane and artificially ventilated. 2. When the carotid sinus mean perfusion pressure was raised in randomly selected steps from 60 to 210 mmHg, it caused a progressive bradycardia, and a reduction in left ventricular dP/dt max and in arterial blood pressure, together with vasodilatation in the perfused hindlimb. Distension of the bladder at each level of carotid sinus pressure resulted in tachycardia, a small but significant increase in left ventricular dP/dt max (160 +/- 30 mmHg s-1) and hindlimb vasoconstriction. 3. When heart rate and arterial blood pressure were held constant to exclude these secondary effects on left ventricular dP/dt max, raising the carotid sinus pressure caused a progressive reduction in left ventricular dP/dt max and hindlimb vasodilatation. Superimposition of tests of bladder distension at each level of sinus pressure resulted in variable responses, but overall there was a significant increase in left ventricular dP/dt max of 190 +/- 54 mmHg s-1. Hindlimb vasocontriction, however, was a consistent finding. 4. The gain of the relationship between the carotid sinus perfusion pressure and left ventricular dP/dt max was unaffected by distension of the bladder. 5. It is concluded that, when changes secondary to increases in heart rate and blood pressure are prevented, distension of the bladder causes a small but significant reflex increase in left ventricular dP/dt max. The responses, however, are variable and the possible reasons for this are discussed.

Adrenergic beta-Antagonists↗
PubMed1995

Gynaecological care of women with abnormal Pap smears: how varied is current practice?

OBJECTIVE: To assess the current management by gynaecologists of women with abnormal Papanicolaou (Pap) smears. DESIGN: Self-administered survey of all gynaecologists registered in New South Wales. RESULTS: 242 gynaecologists (73% response rate) returned completed questionnaires. Accredited laboratories were used by 90% of gynaecologists, but only 61% could confirm their laboratories' participation in quality assurance procedures. Consensus on the management of high grade Pap smear abnormalities was confirmed. In contrast, there was considerable variation in the management of minor lesions, provision of patient information and follow-up after treatment. A small but worrying minority of respondents indicated an apparent misunderstanding of important colposcopic principles: 41% were prepared to institute ablative therapy without histological diagnosis. CONCLUSIONS: Given the nature of practice variation documented in this survey, publication of national guidelines is necessary to improve the screening program. Guidelines in themselves, however, will not be sufficient to ensure that all women with abnormal results of Pap smears receive appropriate and timely management and follow-up. Active dissemination to reduce undesirable variation is required.

Adult↗
PubMed1995

A translocated erythropoietin receptor gene in a human erythroleukemia cell line (TF-1) expresses an abnormal transcript and a truncated protein.

We previously identified a translocation breakpoint in exon 8 of the erythropoietin receptor (EpoR) gene in TF-1 cells, a cell line derived from a human erythroleukemia. To investigate the potential pathogenetic significance of this abnormality, we more precisely mapped the breakpoint within exon 8 and studied the expression of the translocated gene by S1 nuclease mapping of EpoR transcripts and chemical crosslinking of labeled erythropoietin (Epo) to TF-1 cell surface receptors. Transcripts from the abnormal gene were found to be highly expressed in relation to normal EpoR transcripts in TF-1 cells. The breakpoint predicted by S1 mapping of abnormal EpoR transcripts agreed closely with that determined by Southern analysis. Chemical cross-linking of 125I-Epo to TF-1 cells showed an abnormal, low-molecular-weight cross-linked species directly recognized by anti-EpoR antibodies and present in considerable excess over the normal EpoR. Karyotype analysis showed that each of 10 TF-1 cell metaphases had, in addition to multiple other alterations, one chromosome 19 with additional chromosomal material translocated onto the short arm at 19p13.3, the location of the EpoR gene. We conclude that the structurally abnormal EpoR gene in TF-1 cells is highly expressed and produces an abnormal protein. We speculate that the chromosomal material brought into the EpoR locus by translocation is responsible for the high level of expression. We hypothesize that this translocation participated in the evolution of the erythroleukemia from which TF-1 cells were derived.

Base Sequence↗
PubMed1995

Risk-adjusted analysis of surgeon performance: a 1-year study.

A 1-year prospective analysis was undertaken of all non-day-case general surgery in a district general hospital. Using the Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) scoring system 3004 patients were assessed. From the predictions of mortality and morbidity so obtained, a quality measure, the ratio of observed to expected numbers of deaths and complications (O:E ratio) was determined for each surgeon, both overall and within specialty zones. The present study demonstrates the serious hazard in using 'raw' uncorrected mortality and morbidity statistics to compare surgeon performance. Mortality rates varied from 1.0 to 4.9 per cent whereas O:E ratios ranged from 0.83 to 1.06; morbidity rates varied from 5.3 to 12.6 per cent with O:E ratios 0.86-1.02. Great misunderstanding may result from the publication of surgeon or hospital 'league tables'. The present study demonstrates a technique that might allow surgeon performance to be monitored adequately and accurately.

Day Care, Medical↗
PubMed1995

A phase I and pharmacology study of an oral platinum complex, JM216: dose-dependent pharmacokinetics with single-dose administration.

JM216 [bis-acetato-ammine-dichloro-cyclo-hexylamine-platinum (IV)] is an oral platinum complex with in vivo activity against murine and human tumor models and a lack of nephro- and neurotoxicity in rodents. During a phase I study of a single-dose schedule, JM216 was given in dry-filled hard gelatin capsules by mouth without hydration or diuresis. In all, 37 patients were given a total of 88 courses at doses ranging from 60 to 700 mg/m2. The study was stopped before the MTD was reached because of nonlinear pharmacokinetics. Myelosuppression was manifest by leucopenia or thrombocytopenia and showed marked variability at 420-700 mg/m2. Vomiting was mild and controllable by antiemetics in approximately 50% of courses. The onset of vomiting was delayed to 4 h after during ingestion. There was no nephro-, oto- or neuro-toxicity. A partial response was recorded in a patient with recurrent ovarian cancer, and significant falls in plasma tumour markers (CA125) were seen in two further cases. Plasma pharmacokinetics were linear and showed moderate interpatient variability at dose levels of < or = 120 mg/m2. At dose levels of > or = 200 mg/m2, Cmax and AUC increased less than proportionally to dose. This was associated with greater interpatient pharmacokinetic variability and reduced urinary platinum recovery. A significant sigmoidal relationship existed between ultrafilterable plasma AUC and the percentage of reduction in platelet count (r2 = 0.78). Nonlinear absorption was a limitation to this single-dose schedule of oral NM216; however, little non-haematological toxicity was seen at doses associated with myelosuppression and antitumour activity. Clinical studies of divided dose schedules using doses within the range of pharmacokinetic linearity (< or = 120 mg/m2) are now being investigated.

Administration, Oral↗
PubMed1995

Sister-chromatid exchanges, glutathione S-transferase theta deletion and cytogenetic sensitivity to diepoxybutane in lymphocytes from butadiene monomer production workers.

The magnitude of health risks to workers associated with current and past exposures to butadiene has been the subject of considerable recent debate. Butadiene is metabolized in-vivo and in-vitro to the genotoxic intermediates 3,4-epoxybutene and diepoxybutane. Studies in animals and in-vitro systems have clearly demonstrated that 1,3-butadiene is a genotoxin and a potent inducer of sister-chromatid exchanges (SCEs). Data on the genotoxicity of butadiene in humans is, however, limited. Epidemiologic data indicate that butadiene is a probable human carcinogen. Recent work has further demonstrated that cultured lymphocytes from the approximately 20% of the Caucasian population that lack the glutathione S-transferase class theta gene (GSTT1) are relatively sensitive to the induction of cytogenetic damage by butadiene metabolites. In order to test whether butadiene exposure was associated with increases in SCE frequencies in peripheral blood lymphocytes and whether any increase observed could be affected by the DEB sensitivity-GSTT1 deletion, we studied 40 workers employed in the production of butadiene. In these workers baseline frequencies of SCEs, diepoxybutane-induced SCE frequencies and GSTT1 deletion status were assessed. Questionnaires were administered to each worker and exposure to 1,3-butadiene was determined using three separate approaches. Industrial hygiene personal sampling was used to measure breathing zone butadiene exposure and urine was collected to use in measurement of the urinary butadiene metabolite 1,2-dihydroxy-4-(N-acetylcysteinyl-S-)-butane (M1). Exposure to butadiene was generally below 2 ppm. The urinary metabolite M1 was found in all workers, but it did not correlate significantly with exposure. Six of 40 of the workers were GST theta-deleted DEB sensitive. No measure of acute or chronic exposure to butadiene was associated with an increase in SCE frequency. However, smoking and DEB sensitivity-GSTT1 null status were each significantly associated with elevations in baseline SCE frequency.

Adult↗
PubMed1995

Changes in peripheral blood CD5 (Bla) B-cell populations and autoantibodies following blood transfusion.

BACKGROUND: CD5 B cells and the natural autoantibodies they produce play a role in antigen presentation, tolerance induction, and maintenance of an idiotypic immune network. The effects of transfusion on autoantibodies and peripheral blood CD5 B cells were studied. STUDY DESIGN AND METHODS: Eight previously transfused patients with sickle cell anemia and five patients who underwent orthopedic surgical procedures with transfusion were enrolled in the study. Patients in both groups received 1 to 2 units of allogeneic packed red cells. Ten untransfused healthy adults and five patients who underwent orthopedic surgery without transfusion were enrolled as controls. Peripheral blood CD5 B cells, serum levels of IgM, antinuclear antibodies, rheumatoid factor, and anticardiolipin IgM were quantitated either at the beginning of the study (baseline sample), before transfusion, or before surgery and either at 1-, 2-, 4-, 6-, and 8-week intervals after transfusion, after surgery, or after the baseline sample was obtained. RESULTS: IgM levels and the absolute number of B cells that coexpressed CD5 rose to twice pretransfusion levels in six of eight transfused sickle cell anemia patients and in four of five transfused orthopedic surgery patients. No comparable increases in CD5 B cells were noted in untransfused controls. Preexisting rheumatoid factor and antinuclear antibody levels increased in four of five transfused orthopedic surgery patients. One sickle cell anemia patient developed anti-Fya despite receiving Fya-negative blood. Increasing titers of anti-Fya paralleled the increases in IgM and CD5 B cells after transfusion. One patient who developed a positive direct antiglobulin test after transfusion had large increases in serum anticardiolipin IgM. Anticardiolipin IgM was subsequently eluted from direct antiglobulin test-positive red cells obtained after transfusion. Antibodies with anti-Fya-like activity and anticardiolipin IgM were produced in vitro by CD5 B cells and not by conventional CD5-negative B cells. CONCLUSION: An association was found between transfusion-induced increases in CD5 B cells and increased autoantibody production. These data may have implications for immunologic intervention to prevent the induction of red cell antibodies and other changes in the immune system caused by exposure to foreign antigens via blood transfusion.

Adult↗
PubMed1995

Urological training in Australasia: perceptions of recent fellows and current trainees.

In this study we sought to determine the opinions of recent Fellows and current trainees on the state of urological training in Australasia. Self administered questionnaires were mailed to all urologists in Australia and New Zealand who had obtained their FRACS from 1988 to the present, as well as all current advanced urological trainees. Eight-seven per cent of Fellows and ninety-four per cent of trainees completed and returned the questionnaire. Most Fellows and trainees felt that their training adequately equipped them for subsequent independent practice. At the completion of training and FRACS examination the majority of respondents felt competent in dealing with most urological conditions. However, many did not feel confident with paediatric and specialized or complex adult urology, particularly oncology and reconstruction. Post-Fellowship training, however, appears valuable in overcoming these deficiencies. Several limitations were also noted as a consequence of the fact that training is based entirely in the public hospital system. This created particular difficulties with respect to outpatient or 'office' urology as well as exposure to some non-acute conditions such as urinary incontinence and infertility. The current research requirements of training do not appear to provide trainees with an adequate knowledge of scientific method, with many respondents not feeling equipped to critically appraise urological literature. High levels of competence are also not attained for other important professional skills, particularly communication with other medical practitioners. Despite its importance for learning, feedback on progress is not adequately provided and this was seen as a major problem with current urological training in Australasia. The majority of respondents felt that mentors required specific training to facilitate feedback to trainees.

Adult↗
PubMed1995

A comparison of conventional culture and three rapid methods for the detection of Salmonella in poultry feeds and environmental samples.

Three rapid methods, an impedance method (Malthus 2000 Analyzer), a colorimetric DNA hybridization method (Gene-Trak) and a post-enrichment enzyme-linked immunosorbent assay (Salmonella-Tek) were compared with conventional culture for the detection of Salmonella in poultry feeds, and in fluff and dust samples from poultry housing. The percentage positive samples for Salmonella by each of the methods were 25.5% for conventional culture, 38.4% for the Malthus, 28.9% for the Gene-Trak and 28.5% for the Salmonella-Tek. By any method 60/153 (39.2%) of the samples tested were positive on confirmed culture.

Animal Feed↗
PubMed1995

Magnetic resonance imaging in the detection of focal liver lesions: comparison of dynamic contrast-enhanced TurboFLASH and T2 weighted spin echo images.

In a previous study using dynamic contrast-enhanced TurboFLASH (DCETF) for demonstration of the portal venous system we found that this technique showed more liver lesions than T2 weighted spin echo (T2WSE) imaging in the same patients. In this study we have formally compared axial T2WSE images (TR 2000, TE 45/90) with TurboFLASH images (TR 135, TE 4, FA 80 degrees) acquired immediately after bolus injection of Gd-DTPA (0.1 mmol kg-1) in 41 patients referred for hepatic magnetic resonance imaging (MRI) prior to surgery for liver lesions. The images of each sequence were independently reviewed by two observers. The lesions were counted and each sequence was scored for conspicuity, level of artefact and subjective image quality. Contrast-to-noise ratios using user defined regions of interest were calculated. Significantly more lesions were seen on DCETF (n = 186) images than on T2WSE (n = 123) images (p < 0.001). Lesion conspicuity was equal in 53% of cases, better on DCETF in 36% and better on T2WSE in 11%. Contrast-to-noise ratios were significantly higher on DCETF images (p < 0.05). DCETF imaging provided a substantial improvement in lesion detection compared with T2WSE imaging.

Adult↗
PubMed1995

Adolescent diabetes management and mismanagement.

OBJECTIVE: To document the existence and prevalence of adolescent-generated diabetes management techniques. RESEARCH DESIGN AND METHODS: One hundred forty-four adolescents completed the confidential questionnaire developed for this study. Glycohemoglobin was also obtained for each individual. RESULTS: Within the 10 days before their clinic visit, many adolescents admitted to engaging in various mismanagement behaviors, with 25% admitting to missing shots. Parents tend to underestimate adolescent mismanagement. Missing shots was significantly related to poor control (P < 0.01). Older adolescents engaged in more mismanagement than their younger cohorts (P < 0.001). The questionnaire factored into two subscales: blatant mismanagement and faking. CONCLUSIONS: This study shows the importance of recognizing the prevalence of mismanagement among adolescents.

Adolescent↗
PubMed1995

Characteristics of women treated for cervical cancer at Westmead Hospital. Implications for hospital and community-based health services.

This study was conducted to assess the sociodemographic and histopathological characteristics of women presenting to Westmead Hospital with cervical cancer, and to assess the previous opportunities for Pap smear screening and prevention of this disease. This retrospective review of medical records was carried out in the Department of Gynaecological Oncology at Westmead Hospital, New South Wales, using the medical records of the first 33 women with cervical cancer referred to the newly enhanced Department of Gynaecological Oncology between March and June 1994. Twenty-three (70 per cent) presented with early-stage disease. Interpreters were required for five (16 per cent) patients. Only six women (18 per cent) had been screened for cervical cancer within the last two years and 14 (42 per cent) had never been screened. Many of these women had been attending general practitioners for the management of chronic medical conditions and two had undergone major cardiac surgery at Westmead within the previous two years. There are likely to be new and continuing demands for comprehensive health services for these women, including the use of medical facilities, interpreter services and complex psychosexual counselling. Further, lost opportunities to prevent cervical cancer warrant further study.

Adenocarcinoma↗
PubMed1995

The application of an anthropometric database of elderly and disabled people.

We report on the development of an anthropometric database of elderly and disabled people for use by designers. The problems encountered by the designer in developing products for the elderly and disabled are highlighted. Reference is made to previous work carried out using computer modelling to simulate the human product interface, and the problems in specifying the anthropometric data are discussed. From a review of existing anthropometric databases we have noted the lack of data on the elderly and disabled. Not only is there insufficient dynamic anthropometric data available, but there are no standards for the measurement techniques to produce this data. We report briefly on parallel work by the group which is looking at anthropometric measurement techniques, and the computer modelling of the human product interface for elderly and disabled people. The lack of dynamic anthropometric data that is appropriate for use by designers and rehabilitation engineers is the major area to be addressed by the database. We investigate the use of existing medical data available as a possible solution to the problem. The database will also seek to address the problem through its methodology of interpretation and presentation.

Aged↗
PubMed1995

Techniques in anthropometry applied to disabled and elderly populations.

We discuss the requirements of anthropometric and biomechanical data for specific application to the design of assistive devices and other products for elderly and disabled populations, including body size, shape, range of motion and strength data. We analyse available information and the practical and statistical problems involved in the collection of data from such populations. We comment on the different human interface design issues posed by various types of device and compare a task-specific approach to ergonomic analysis with the use of a generic biomechanical database. The specific requirements of a useful biomechanical data collection system intended to fulfil this need, and the conditions under which a practical system would have to operate are discussed. We review a range of available measurement techniques, including manual, mechanical, optical and electronic systems and discuss their relative fitness for the task in question. We propose an approach to the collection of multi-variable biomechanical data from the analysis of various tasks and discuss the use of computer models and other means of interpreting such data to make it available to product designers and engineers.

Aged↗