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Biomedical subjects

J Wilson

Publications and source records attributed to J Wilson.

At least 91 records · Page 5Linked to original sources
PubMed2001

Economic evaluation of the fentanyl transdermal system for the treatment of chronic moderate to severe pain.

The fentanyl transdermal system (Duragesic) is an opioid analgesic indicated for the management of chronic moderate to severe pain. The purpose of this analysis is to estimate its economic value compared to two long-acting oral opioids. A cost-utility analysis was performed using a three-phased decision analytic model. The transdermal system had the highest expected cost during the first year of therapy ($2,491), moderately higher than the cost of a year of therapy with controlled-release morphine ($2,037) or controlled-release oxycodone ($2,307). The system also had the highest expected number of quality-adjusted life-days (QALDs) (244 compared to 236 for morphine and 231 for oxycodone), despite conservative assumptions. The fentanyl transdermal system achieved incremental cost-utility ratios of $20,709 (vs. morphine) and $5,273 (vs. oxycodone) per quality-adjusted life year (QALY) gained. In a conservative modeled analysis, the fentanyl transdermal system led to increased QALDs at a nominal increased cost. In the absence of head-to-head clinical trials, models help clarify cost and outcome trade-offs and provide a consistent theoretical framework for use by individual decisionmakers.

Administration, Cutaneous↗
PubMed2001

Hybrid classification of sphincter of Oddi dysfunction based on simplified Milwaukee criteria: effect of marginal serum liver and pancreas test elevations.

To date, when using the Milwaukee classification for sphincter of Oddi dysfunction (SOD), one cannot accurately classify patients with marginal elevations in laboratory tests; ie, < 1.5 x the upper limit of normal (ULN). Since subsequent treatment may depend on how they are classified, we sought to determine whether these patients should be considered as type II or type III. Between January 1993 and October 1996, 113 consecutive patients (82 females and 31 males; ages 12-87 years) without prior sphincterotomy were referred to consider a diagnosis of SOD type II or III. SOD II patients had pancreaticobiliary-type pain and laboratory elevations >1.5 x ULN or dilated ducts, while SOD III patients had pain only. Hybrid patients had pain and marginal laboratory elevations <1.5 x ULN, with normal duct diameters. Drainage times, frequency, duration, and propagation were not assessed. Sphincter of Oddi manometry (SOM) was performed in each case, and the frequency of abnormal biliary and/or pancreatic basal sphincter pressure was compared, with respect to type II, III, and hybrid SOD. Successful SOM was obtained in 113/114 patients: Abnormal basal sphincter pressure was found in 65, 89, and 43% of type II, hybrid, and type III SOD, respectively. We found no statistical difference between type II and hybrid patients. In contrast, there was statistical difference between types II and III patients and between type III and hybrid patients. In conclusion, there was no significant difference in the frequency of elevated basal sphincter pressure in SOD type II versus hybrid, and thus they should be considered as one group.

Adolescent↗
PubMed2001

Adenoviral vector-mediated insulin gene transfer in the mouse pancreas corrects streptozotocin-induced hyperglycemia.

Therapy for type 1 diabetes consists of tight blood glucose (BG) control to minimize complications. Current treatment relies on multiple insulin injections or an insulin pump placement, beta-cell or whole pancreas transplantation. All approaches have significant limitations and have led to the realization that novel treatment strategies are needed. Pancreatic acinar cells have features that make them a good target for insulin gene transfer. They are not subject to autoimmune attack, a problem with pancreas or islets transplantation, they are avidly transduced by recombinant adenoviral vectors, and capable of exporting a variety of peptides into the portal circulation. Recombinant adenoviral vectors were engineered to express either wild-type or furin-modified human insulin cDNA (AdCMVhInsM). Immunodeficient mice were made diabetic with streptozotocin and injected intrapancreatically with the vectors. BG and blood insulin levels have normalized after administration of AdCMVhInsM. Immunohistochemistry and electron microscopy showed the presence of insulin in acinar cells throughout the pancreas and localization of insulin molecules to acinar cell vesicles. The data clearly establish a relationship between intrapancreatic vector administration, decreased BG and elevated blood insulin levels. The findings support the use of pancreatic acinar cells to express and secrete insulin into the blood stream.

Adenoviridae↗
PubMed2001

Dissociative identity disorder and the nurse-patient relationship in the acute care setting: an action research study.

This paper presents the results of an action research study into the acute care experience of Dissociative Identity Disorder. The study, which was grounded in principles of critical social science, utilized focus group interviews and narrative construction. Nurses and patients are under-represented in all clinical evaluation and their voices need to be heard if services are to be truly collaborative. Findings of the study extend intrapsychic theories of trauma to emphasize the interpersonal relationship between nurse and person who can work together to facilitate recovery from trauma, make connections both intra and interpersonally and build resilience.

Acute Disease↗
PubMed2001

Remote area aboriginal health services managers: key practice challenges.

The following reflections on the author's management practice are based on the text of an address given by the author at the 1999 International Conference of the Royal Australasian College of Medical Administrators in Sydney. These reflections arise out of the author's experience for the past 5 years as manager of Nganampa Health Council, an Aboriginal community-controlled health organisation located in the remote north-west of South Australia. Nganampa Health Council is a large regional service with a national reputation for clinical and administrative excellence. It has several leading-edge health programs, which provide an exemplar for other remote health services across Australia. The author discusses three generic key management issues that remote health services managers typically encounter and argues that services are likely to be most effective when resources are applied in a focused and strategic manner and when management practices that are pragmatic and culturally appropriate are adopted.

Efficiency, Organizational↗
PubMed2001

Mechanisms of inverse agonism of antipsychotic drugs at the D(2) dopamine receptor: use of a mutant D(2) dopamine receptor that adopts the activated conformation.

The antipsychotic drugs have been shown to be inverse agonists at the D(2) dopamine receptor. We have examined the mechanism of this inverse agonism by making mutations in residue T343 in the base of the sixth transmembrane spanning region of the receptor. T343R, T343S and T343K mutant D(2) dopamine receptors were made and the T343R mutant characterized in detail. The T343R mutant D(2) dopamine receptor exhibits properties of a receptor that resides more in the activated state, namely increased agonist binding affinity (independent of G-protein coupling and dependent on agonist efficacy), increased agonist potency in functional tests (adenylyl cyclase inhibition) and increased inverse agonist effects. The binding of agonists to the mutant receptor also shows sensitivity to sodium ions, unlike the native receptor, so that isomerization of the receptor to its inactive state may be driven by sodium ions. The binding of inverse agonists to the receptor is, however, unaffected by the mutation. We conclude that inverse agonism at this receptor is not achieved by the inverse agonist binding preferentially to the non-activated state of the receptor over the activated state. Rather the inverse agonist appears to bind to all forms of the receptor but then renders the receptor inactive.

1-Methyl-3-isobutylxanthine↗
PubMed2001

The role of anger and depression in recurrent headache.

Individuals with tension-type headache report significant anger, depression, anxiety, and stressors. However, it is not clear to what extent these variables are interrelated. The objective of the present study was to explore the role of anger in headaches, and to examine its relationship to anxiety, depression, and daily life stressors. Participants were 65 young adult women who suffered from recurrent headaches. The sample was obtained in a large-scale screening of young adult women using the Headache Symptoms List to identify those with recurrent headache. Those individuals reporting headaches completed a battery of assessment measures that included the State-Trait Anger Expression Inventory, the Mood and Anxiety Symptoms Questionnaire, and the Hassles Scale. Results revealed a significant relationship between anger suppression and depression (r = 0.40, P<.01), as well as anger expression and anxiety (r = 0.41, P<.01) for those with headache. The use of the Mood and Anxiety Symptoms Questionnaire allowed for the separate analysis of general distress symptoms and symptoms more specific to anxiety and depression. Results indicated that those with headache experience more general, nonspecific distress rather than symptoms indicative of anxiety and depression (P<.01). In addition, the mixed headache group scored high on both general (mean, 28.96) and specific measures of depression (mean, 65.76) and on anger suppression (mean, 20.12), suggesting that they might experience more psychological distress than those with tension-type headache. The present results indicate the need to distinguish the unique dimensions of anxiety and depression that should be assessed in the population with recurrent headache.

Adult↗
PubMed2001

Intensity of vascular endothelial growth factor expression is associated with increased risk of recurrence and decreased disease-free survival in papillary thyroid cancer.

BACKGROUND: Vascular endothelial growth factor (VEGF) induces proliferation of endothelial cells, stimulates angiogenesis, and increases vascular permeability. Increased VEGF expression has been associated with poor clinical outcomes in many malignancies. Several recent reports have documented over expression of VEGF in papillary thyroid cancer. We hypothesized that increased expression of VEGF would be associated with either an increased risk of recurrence or a decreased recurrence-free survival in papillary thyroid cancer. METHODS: Immunohistochemistry was used to detect VEGF expression in archival paraffin-embedded surgical thyroid specimens from 96 subjects with papillary thyroid cancer. RESULTS: VEGF expression was detected in 98% (94/96) of the samples, predominantly of slight-to-moderate intensity in the majority of malignant cells. However, the specific finding of a diffuse pattern of intense immunostaining for VEGF was detected significantly more often than less intense, patchy immunostaining patterns in subjects with distant metastasis at diagnosis (63% versus 15%, P =.005), local recurrence (58% versus 13%, P =.001), and distant recurrence (83% versus 14%, P =.001). Furthermore, this specific pattern of diffuse, intense VEGF expression was associated with a significantly shorter recurrence-free survival than other staining patterns (P =.007). CONCLUSIONS: These data demonstrate that the immunohistochemical pattern of VEGF staining in the initial surgical specimen is strongly associated with the incidence of local and distant metastasis in papillary thyroid cancer.

Adult↗
PubMed2001

A comparison of the anthropometric, strength, endurance and flexibility characteristics of female elite and recreational climbers and non-climbers.

There is limited information on the anthropometry, strength, endurance and flexibility of female rock climbers. The aim of this study was to compare these characteristics in three groups of females: Group 1 comprised 10 elite climbers aged 31.3 +/- 5.0 years (mean +/- s) who had led to a standard of 'hard very severe'; Group 2 consisted of 10 recreational climbers aged 24.1 +/- 4.0 years who had led to a standard of 'severe'; and Group 3 comprised 10 physically active individuals aged 28.5 +/- 5.0 years who had not previously rock-climbed. The tests included finger strength (grip strength, finger strength measured on climbing-specific apparatus), flexibility, bent arm hang and pull-ups. Regression procedures (analysis of covariance) were used to examine the influence of body mass, leg length, height and age. For finger strength, the elite climbers recorded significantly higher values (P < 0.05) than the recreational climbers and non-climbers (four fingers, right hand: elite 321 +/- 18 N, recreational 251 +/- 14 N, non-climbers 256 +/- 15 N; four fingers, left hand: elite 307 +/- 14 N, recreational 248 +/- 12 N, non-climbers 243 +/- 11 N). For grip strength of the right hand, the elite climbers recorded significantly higher values than the recreational climbers only (elite 338 +/- 12 N, recreational 289 +/- 10 N, non-climbers 307 +/- 11 N). The results suggest that elite climbers have greater finger strength than recreational climbers and non-climbers.

Abdominal Muscles↗
PubMed2001

What prevents GPs from using outside resources for women experiencing depression? A New Zealand study.

BACKGROUND: GPs, often the 'gatekeepers' to mental health and related support services, have been found to refer on less often than seems desirable. OBJECTIVES: The aim of this study was to explore what issues GPs would discuss with, and which treatments and support services they would consider for, depressed women; and to investigate barriers to referrals to other resources. METHODS: All (217) GPs in one region of Auckland received questionnaires with a vignette and quantitative and qualitative questions concerning their responses to women experiencing depression. Twelve of the 86 respondents were interviewed. RESULTS: GPs wanted to know about a range of medical, psychological and social issues. The solutions valued were biological and psychological, with some also favouring social interventions, such as assistance with childcare. However, the GPs reported limited referrals to outside resources, and frequent use of medication, because of the high cost and limited availability of psychological treatment, and difficulties accessing practical help. CONCLUSIONS: This sample of GPs support improved accessibility, availability and affordability of psychological treatments and support services.

Depression↗
PubMed2001

Efficacy of in-feed tylosin phosphate for the treatment of necrotic enteritis in broiler chickens.

The efficacy of tylosin phosphate for the treatment of necrotic enteritis (NE) was investigated in a floor pen study of 2,000 broiler chickens. A model in which Clostridium perfringens was administered in the feed on Days 14 to 16 was used to initiate an outbreak of NE. Treatments, allocated at the pen level in a randomized complete block design, consisted of five levels of tylosin phosphate (0, 50, 100, 200, or 300 ppm) administered in the feed on Days 15 to 22, following the identification of an outbreak of NE on Day 15. Mortality due to NE was significantly reduced (P < 0.05) for medicated birds at all dose levels of tylosin phosphate compared to unmedicated birds. Mean NE lesion scores on Day 17 were significantly reduced (P < 0.05) by all levels of tylosin treatment compared to those of unmedicated birds, decreasing linearly from 2.66 at 0 ppm to 0.38 at 100 ppm and 0 at higher doses. Tylosin at all levels provided improvement in Day 29 body weight, average daily gain, feed to gain ratio, and average daily feed intake compared to unmedicated birds. The results of this study provide evidence that tylosin phosphate, when administered in feed, is effective in the treatment of clinical outbreaks of NE in broiler chickens and suggest that the optimal dose for this purpose is 100 ppm.

Animal Feed↗
PubMed2001

Infected wound management: advanced technologies, moisture-retentive dressings, and die-hard methods.

Wound infection is a significant problem for the complicated, critically ill patient. A critical care patient's plan of care can be challenging enough without complicating it with the additional comorbidity of a wound infection. Wound infection delays wound closure, disrupts wound tensile strength; increases hospital length of stay and costs; and escalates the patient's risk of bacteremia, sepsis, multisystem organ failure, and death. The goal is to reduce and eliminate the wound infection before it leads to such drastic consequences, especially in the age of antibiotic-resistant organisms. It is paramount to identify classic and not-so-obvious signs and symptoms of wound infections, correctly collect a wound specimen, and assist in appropriate systemic and topical wound management. Techniques to prevent wound infection and reduce bioburden include nontoxic wound cleansing, debridement of necrotic tissue, proper antibiotic management, and appropriate use of moisture-retentive dressings. Advanced technologies in moisture-retentive dressings include sustained-release silver and cadexomer iodine antimicrobial dressings and negative-pressure wound therapy. Accurate wound assessment, knowledge of new technologies, and applying current wound care standards to clinical practice will assist the critical care nurse in treating and preventing wound infections.

Bandages↗