Biomedical subjects
Publications and source records attributed to J Ward.
Falls by older people are a major public health issue with much of the resulting illness and death potentially preventable. Falls are often a pointer to underlying conditions that warrant intervention. This article, which is part of a series on elderly care, explores this difficult area and the important role the general practitioner may play.
Despite a realisation that antioxidants will not delay ageing in healthy older people, there is increasing scientific interest in the role of free radical oxidants in a number of diseases associated with older age. For most of these diseases there is suggestive theoretical and laboratory evidence but not confirmatory clinical evidence. Free radical damage seems likely to be significant in the pathophysiology of atherosclerosis, ischaemia-reperfusion injury, Parkinson's disease, cataract, some cancers and rheumatoid arthritis. Evidence to suggest a protective effect from antioxidant vitamins exists for ischaemic heart disease, cataract and some cancers. Attempts to influence the outcome of other diseases such as ischaemia-reperfusion injury, Parkinson's disease and rheumatoid arthritis have so far failed to achieve positive results. Research interest in the field is increasing although hampered by methodological difficulties and the limited financial return for drug companies. In the meantime there seems no reason to discourage older people who wish to ingest extra vitamin E and vitamin C. A diet with adequate vegetables and fruits should provide sufficient beta carotene.
The enormous pleasure that older people derive from an exercise class to music or from an aquarobics group makes instant converts of any professionals involved in these health promotion activities. Irrefutable evidence now exists to show that regular physical activity slows the rate of decline of most of the physiological parameters that we associate with health and fitness--muscle strength, aerobic capacity, reaction time and joint flexibility. Master athletes at age 60 can perform considerably better than some sedentary men at age 30. The ideal is clearly to maintain a regular regimen of physical activity throughout adult life. It has now been shown that such exercise does not need to be heavy to maintain cardiovascular and musculoskeletal fitness. Walking and swimming are as good and much safer than jogging provided the regimen entails at least 30 minutes three to four times a week. The evidence is equally strong that sedentary older people can benefit from taking up an exercise program in later life. Significant gains in muscle strength and aerobic capacity can result from gentle exercise programs carried out at least three times a week. Improvements in balance, bone density and psychological health have yet to be confirmed. Exercise and fitness programs for older adults can attract large numbers and achieve high compliance rates if the programs are accessible, affordable and, above all, fun. Men tend to be more interested in monitoring fitness levels while women are satisfied to enjoy themselves and feel better. Older adults can also continue or take up competitive sports provided simple precautions are taken to ensure cardiovascular health and to minimise injury.(ABSTRACT TRUNCATED AT 250 WORDS)
Explore the source record for details and available documents.
OBJECTIVE: To investigate the acceptability, feasibility and value of needs assessment in planning and conducting a seminar about skin cancer for general practitioners. METHOD: A self-administered questionnaire was developed to assess general practitioners' educational needs in skin cancer prevention, early detection and management. Registrants for a one-day interactive skin cancer seminar conducted by the NSW Cancer Council were each mailed this questionnaire. Responses received before the seminar were collated and discussed with resource persons involved in the seminar. RESULTS: We achieved an 80% response rate to the pre-seminar needs assessment. Responses indicated gaps in knowledge, widespread differences in views about skin surveillance recommendations and a hierarchy of preferences for practical procedures. The seminar was modified, contributing to high levels of participant satisfaction with its educational content. CONCLUSIONS: It is feasible to conduct a needs assessment in continuing medical education which achieves high response rates and provides vital information to resource persons about the educational needs of participants. Needs assessment holds promise as a strategy to assist general practitioners to identify their own goals for learning. Needs assessment as described here is necessary also to evaluate the outcome of continuing medical education. We recommend needs assessment as an integral part of educational programs for general practitioners although the time, planning and resources required to assess learning needs should not be underestimated.
The minimal replicon of pIJ101 was defined to a 2.0-kb BalI-SacII fragment containing the rep ORF and a non-coding region of DNA, but not orf56 (pQR435). This non-coding region of DNA was found to be crucial for plasmid replication in Streptomyces lividans and may contain either the origin of replication or the rep promoter (or both). A 1.4-kb NotI-SacII fragment containing only the rep ORF produced a 54-kDa protein in vitro when expressed from the lacZ promoter. pQR435 was structurally unstable in S. lividans and accumulated single-stranded (ss)DNA. The insertion of the site for second-strand initiation (ssi) into pQR435 did not prevent the plasmid from rearranging or from accumulating ssDNA.
Magnetic resonance imaging was performed at 1.0 T in seven patients with severe acute pancreatitis. A T2-weighted spin echo sequence and a breath-hold multislice rapid gradient echo sequence (TurboFLASH) were used in each patient. TurboFLASH imaging was performed before and after intravenous gadopentetate-dimeglumine (Gd-DTPA). All MRI images were compared with a recent contrast-enhanced CT scan. Postgadolinium MRI was equivalent to contrast-enhanced CT in differentiating viable pancreatic parenchyma from areas of pancreatic necrosis. MRI identified the presence of gas in a case of pancreatic abscess but failed to identify small foci of pancreatic calcification demonstrated in one case by CT. MRI was also equivalent to CT in assessing the location and extent of peripancreatic inflammatory changes and fluid collections. However, MRI, particularly the T2-weighted spin echo, was superior to CT in characterizing the complex nature of such inflammatory changes in one case. Initial experience suggests that MRI is a valuable technique in assessing patients with severe acute pancreatitis.
This paper uses the New South Wales experience with methadone maintenance treatment in prison to address the question: should methadone maintenance treatment be provided in Australian prisons for opioid-dependent prisoners? First, it outlines three rationales for providing drug dependence treatment in prisons: as a way of giving prisoners access to community-based forms of drug treatment in the prison setting; as a measure to reduce recidivism in opioid-dependent prisoners; and as a measure to prevent the transmission of HIV and other infectious diseases within prisons, and to the sexual partners of prisoners on their release. Secondly, it reviews the kind of research evidence that supports the effectiveness of community-based methadone maintenance treatment in Australia. Thirdly, the effectiveness of the New South Wales Prison Methadone Programme, one of the few prison-based methadone programmes in the world, is evaluated in the light of the available research evidence.
We investigated the development of a positive direct antiglobulin test associated with the use of the nonsteroid anti-inflammatory drug sulindac. The drug was shown to be the cause of the positive direct antiglobulin test using red cells treated in vitro with solutions of native sulindac and its two major metabolites. Serum from the patient contained sulindac-dependent red cell antibodies which could not be demonstrated when red cells having the Rh phenotype D-- were employed in the test procedure. An eluate prepared from the patients' red cells reacted against untreated red cells having common Rh phenotypes, but not against target red cells with the Rh phenotypes D-- or Rh null. The eluate showed stronger reactivity against the cells having common Rh phenotypes when they were treated with solutions of a metabolite of sulindac, but failed to react against treated red cells having the Rh phenotype D-- or Rh null. The results of our investigations point to an interaction between sulindac and/or its metabolites and Rh structures on the red cell membrane as the initial step in the production of drug dependent and autoantibodies leading to the positive direct antiglobulin test.
1. The aim of this investigation was to identify static gamma-axons which do not drive any Ia afferents at any stimulus frequency in any spindle which they supply, and to determine their occurrence in various hindlimb muscles (peroneus tertius, brevis, longus and tenuissimus). 2. Ia responses to static gamma stimulation were classified as 'non-driven' when the discharge did not follow the stimulation frequency, or its subharmonics, at any time during a linear increase in stimulus frequency up to 150 Hz lasting 2-3 s, and when tested at two muscle lengths--except in the tenuissimus muscle. In almost all experiments, cross-correlograms were used in addition to evaluate the percentage of these 'non-driven' responses in which a time-locking of discharge to stimulus pulses was obscured by irregularity of the Ia discharge. 3. In 104 spindles, out of 347 responses to stimulation of single static gamma-axons 332 (93%) could be characterized, and of these, 57% (183) were of the non-driven type. The mean number of static gamma effects characterized per spindle was 4.1 (fourteen experiments). In the large majority of spindles (79%, 82 out of 104) at least one response was of the non-driven type. 4. Of the static gamma-axons studied 16% were called 'non driving' ('ndr' gamma s-axons) because they elicited non-driven effects, and since they had the same qualitative effect consistently in all spindles whose discharge was modulated by stimulating them they were called specific 'ndr' axons. If axons with non-driven effects, but acting on one spindle were included in the 'non-driving' category the proportion was 23%. Of spindles tested 63% were innervated by at least one 'ndr' axon. 5. Absence of Ia driving during ramp frequency stimulation of gamma s-axons has been equated with selective bag2 contraction. All the non-driven responses identified in this study cannot be attributed to exclusive bag2 involvement because the total number of 'ndr' responses was too high. In fact, in the isolated spindle preparation bag2 and chain co-contraction were shown to elicit non-driven responses, so chain contraction is not detected reliably in all experimental conditions. Possibly chain fibre contraction is sometimes too weak to dominate the response, or can be of a non-driving character.(ABSTRACT TRUNCATED AT 400 WORDS)
1. The hindlimb vasoconstrictor effects of distension of the urinary bladder were studied at different levels of input from the carotid sinus baroreceptors in the dog anaesthetized with a mixture of chloralose and urethane. 2. The vascularly isolated hindlimb was perfused at constant blood flow through its femoral artery, so that a change in pressure gradient (mean femoral arterial perfusion pressure minus mean inferior vena caval pressure) indicated a similar directional change in vascular resistance. The vascularly isolated carotid sinus regions were perfused with blood at a constant pulsatile flow. 3. Raising the carotid sinus mean perfusion pressure in randomly selected steps of 30 mmHg from 60 to 210 mmHg had little effect on heart rate unless the blood pressure was controlled, when a progressive bradycardia occurred, but caused a progressive reduction in arterial blood pressure and vasodilatation in the perfused hindlimb. Distension of the bladder at each level of carotid sinus pressure resulted in tachycardia, hypertension and hindlimb vasoconstriction. 4. The cardiac responses to bladder distension were the same at all carotid sinus pressures. When the blood pressure was controlled, however, the response was reduced at high and low sinus pressures. 5. The relationship between the carotid sinus perfusion pressure and hindlimb perfusion pressure (i.e. vascular resistance) was affected by distension of the bladder in two ways. In the one, hindlimb perfusion pressure increased by approximately the same amount at all levels of carotid sinus pressure indicating resetting of the carotid sinus baroreceptor reflex control of hindlimb vascular resistance towards vasoconstriction without change in gain of the reflex. In the other, the pressure increases were diminished at the higher levels of carotid sinus pressure indicating both resetting and an increase in gain of the reflex. 6. Both types of response occurred in the spontaneously breathing animal, in animals artificially ventilated, while pacing the heart, with the arterial blood pressure maintained constant at about 100 mmHg, and after division of the cervical vagosympathetic nerves. The frequency of occurrence of each type of response, however, varied under the different conditions. 7. The possible reasons for the two types of vascular response are discussed.
OBJECTIVE: To test the hypotheses that adaptive rate atrial (AAIR) pacing: significantly increases maximal exercise capacity, and results in significant suppression of supraventricular and ventricular arrhythmia compared with fixed rate atrial (AAI) pacing. DESIGN: Prospective, randomised, single blind, crossover study with maximal treadmill exercise testing and 24 hour ambulatory electrocardiographic monitoring in AAIR and AAI modes. SETTING: Regional pacing centre. PATIENTS: 30 consecutive patients (mean SD age 65 (12) years) with sick sinus syndrome who required permanent pacing, without evidence of conduction disturbance on 12 lead electrocardiograms or 24 hour ambulatory electrocardiographic monitoring and without other cardiovascular or systemic disease. INTERVENTIONS: Activity sensing or minute ventilation driven systems (AAI/AAIR) were implanted alternately. RESULTS: The mean (SD) peak heart rate in AAI mode was 122(28)v 130(22) in AAIR mode (p < 0.02) for the whole group and 104(17) v 120(5) (p < 0.003) for the patients with chronotropic incompetence. Exercise time was 12.3 (4.1) minutes in AAI and 12.3 (3.8) minutes in AAIR mode (NS) in the chronotropically incompetent patients. There were no significant differences in the Borg scores at peak exercise in AAI v AAIR mode in either group. The frequency per hour of atrial and ventricular arrhythmias showed no significant differences between the two modes in either the group as a whole or in the subgroups with chronotropic incompetence. CONCLUSION: AAIR pacing confers little benefit in sick sinus syndrome compared with AAI pacing.
Explore the source record for details and available documents.
The purpose of this study was firstly to show the diagnostic value of a rapid acquisition multislice sequence (TurboFLASH) during bolus injection of gadolinium-DTPA by comparing it with the pulse sequences currently used for abdominal studies and secondly to develop improved scanning protocols for the liver. Patients were referred for upper abdominal studies including portal vein assessment. 40 patients were imaged in the coronal plane using a multislice TurboFLASH (TF) sequence (TR = 100; TE = 4) acquired during a breath-hold period of 19 s. The short echo time allows up to 11 slices of 5 mm thickness to be acquired simultaneously. Images were obtained before, during and after bolus administration of Gd-DTPA. The slices from each acquisition were combined using a maximum intensity projection algorithm to include all the vessels on a single image. Initially each patient was scanned using a conventional axial T2 weighted spin-echo sequence (T2W-SE) (TR2000; TE = 45/90) and a coronal T1 weighted spin-echo sequence (TR450; TE = 15). The clarity of the demonstration of vascular anatomy was compared and scored for all sequences by two radiologists. Vessel patency, the conspicuity of mass lesions and the spread of tumour to adjacent structures were also scored. The anatomy of the main portal vein was significantly better shown by coronal TF images after bolus injection than on T2W-SE images or TF before Gd-DTPA. The right and left portal veins were equally well shown by coronal TF with Gd-DTPA and T2W-SE images. There was no significant difference between contrast enhanced TF and T2W-SE imaging in visualization of the hepatic veins. More lesions were demonstrated by post-contrast TF than by T2W-SE imaging. Portal venous occlusion was better appreciated by post-contrast TF. Our results demonstrate that Gd-DTPA TF imaging improves visualization of the main portal vein compared with SE sequences and provides a more accurate assessment of vessel patency. The segmental anatomy of the liver is better appreciated and the demonstration of focal liver lesions compared with T2W-SE images is improved during the non-equilibrium phase of enhancement. TF acquisitions before and after Gd-DTPA are obtained in approximately 5 min; thus a marked reduction in examination time can be achieved.
A prospective study using contrast enhanced turbo-FLASH (Fast Low-Angle Shot) magnetic resonance (MR) angiography was performed to assess the arterial anatomy in patients who had advanced atherosclerotic aortoiliac disease. This new imaging sequence was employed in 17 patients and the results were compared with conventional abdominal aortography. MR angiography accurately detected all aortic occlusions (3/3), their sites and their extent. All nine iliac occlusions were correctly identified (sensitivity 100%, specificity of 90%). The sensitivity was 100% for stenosis of 50% or greater in the abdominal aorta, and the iliac and common femoral arteries. The degree of stenosis was overgraded in 20 of 51 lesions (39.2%). Mild stenosis was overgraded as moderate stenosis in 10 and as severe stenosis in three. Moderate stenosis was overgraded as severe stenosis in four. None of the mild or moderate stenoses resulted in areas of signal voids suggestive of occlusions. Three severe stenoses were seen as areas of signal voids (two iliac, one femoral). In the eight patients who had in total 10 aneurysmal dilatations of the aorta or the iliac arteries, MR angiography was superior in demonstrating the true extent of the aneurysms. We conclude that turbo-FLASH MR angiography has the potential to be a useful non-invasive imaging technique for patients with advanced aortoiliac disease.
BACKGROUND: An opportunistic reminder for a Pap smear is effective and acceptable in general practice. Women's views of strategies to promote ongoing attendance for Pap smears were unknown at the time of this study. OBJECTIVE: To determine women's perceptions of strategies to help them attend for their next Pap smear. SETTING AND PATIENTS: Randomly selected male general practitioners in urban Sydney and 174 of their female patients. RESULTS: Seventy-eight per cent response rate to a questionnaire sent after a consultation in which opportunistic screening was offered. A reminder letter from the GP was nominated as likely to help 'a lot' by at least 50 per cent of respondents. Free Pap smears and child-minding were nominated by at least 50 per cent of respondents as making 'no difference'. CONCLUSION: This survey has explored women's perceptions of potential strategies to promote continuing Pap smear screening. Given the disappointing results when these strategies have been implemented in individual general practices, however, the authors recommend prospective controlled evaluation before widespread adoption.
Using Healthy People 2000 as the source document, regional task forces were formed at the request of the Health Promotion Section of the California Department of Health Services to set health promotion objectives and recommendations for the state's ethnic populations. The topics chosen by regional African-American task forces were (1) violence and abusive behavior, (2) physical activity and fitness, (3) nutrition, (4) tobacco, (5) educational and community-based programs, (6) cancer, and (7) heart disease and stroke. Objectives were expanded, linked together, and revised to meet felt needs. The regional task forces presented the first draft of the document for review at the Multiethnic Health Promotion Conference held in Sacramento, California, June 11 through 13, 1991. The expanded task force, including conference participants, amended the recommendations and ranked the topic areas in order of priority. The group also responded to the challenge of developing implementation strategies for the recommendations. We discuss the early stages of dissemination and implementation of the agenda among California African-American communities. American Indian, Asian/Pacific Islander, and Latino Task Forces have prepared similar documents, and each document will be used to prepare the Multiethnic Health Promotion Agenda for California. We summarize the process by which the papers were developed and provide detailed analysis of the African-American process.
Explore the source record for details and available documents.