Search PubMed⌕ Search

Biomedical subjects

J Wright

Publications and source records attributed to J Wright.

At least 55 records · Page 3Linked to original sources
PubMed2003

Hospital at home for acute exacerbations of chronic obstructive pulmonary disease.

BACKGROUND: Hospital at home schemes are a recently adopted method of service delivery for the management of acute exacerbations of chronic obstructive pulmonary disease aimed at reducing demand for acute hospital in-patient beds and promoting a patient centered approach through admission avoidance. However, evidence in support of such a service is contradictory. OBJECTIVES: To evaluate the efficacy of "hospital at home" compared to hospital inpatient care in acute exacerbations of chronic obstructive pulmonary disease. SEARCH STRATEGY: The Cochrane Central Register of Controlled Trials; electronically available databases e.g. MEDLINE (1966-current), EMBASE (1980-current), PubMed, ClincalTrials, Science Citation Index and on-line individual respiratory journals; bibliographies of included trials were all searched and contact with authors was made to obtain studies. The most recent searches were carried out in August 2003. SELECTION CRITERIA: Only randomised controlled trials were considered where patients presented to the emergency department with an exacerbation of their chronic obstructive pulmonary disease. Studies must not have recruited patients that are usually deemed obligatory admissions. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected articles for inclusion, evaluated methodological quality of the studies and abstracted data. MAIN RESULTS: Seven studies with 754 patients were included in the review. Studies provided data on hospital readmission and mortality both of which were not significantly different when the two study groups were compared (RR 0.89; 95%CI 0.72 to 1.12 & RR 0.61; 95%CI 0.36 to 1.05, respectively). Both the patients and the carers preferred hospital at home schemes to inpatient care (RR 1.53; 95%CI 1.23 to 1.90). Other reported outcomes included few studies. REVIEWER'S CONCLUSIONS: This review has shown that one in four carefully selected patients presenting to hospital emergency departments with acute exacerbations of chronic obstructive pulmonary disease can be safely and successfully treated at home with support from respiratory nurses. This review found no evidence of significant differences between "hospital at home" patients and hospital inpatients for readmission rates and mortality at two to three months after the initial exacerbation. Both the patients and carers preferred "hospital at home" schemes to inpatient care.

Acute Disease↗
PubMed2003

Oral appliances for obstructive sleep apnoea.

BACKGROUND: Obstructive sleep apnoea-hypopnoea is a syndrome characterised by recurrent episodes of partial or complete upper airway obstruction during sleep that are usually terminated by an arousal. Nasal continuous positive airway pressure is the primary treatment for obstructive sleep apnoea-hypopnoea, but many patients are unable or unwilling to comply with this treatment. Oral appliances are an alternative treatment for sleep apnoea. OBJECTIVES: The objective was to review the effects of oral appliance in the treatment of sleep apnoea in adults. SEARCH STRATEGY: We searched MEDLINE 1966-2003, and the Cochrane Airways Group Sleep Apnoea RCT Register. Searches were current as of July 2003. Reference lists of articles were also searched. SELECTION CRITERIA: Randomised trials comparing oral appliance with control or other treatments in adults with sleep apnoea. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and two reviewers extracted data independently. Study authors were contacted for missing information. MAIN RESULTS: Twelve trials involving 509 participants were included. All the studies had some methodological shortcomings. Oral appliances improved apnoea-hypopnoea index compared with inactive control (-13.17 AHI [-18.53 to -7.80] parallel group data - four studies). Oral appliances reduced daytime sleepiness in two trials (WMD -1.77 [95%CI: -2.91 to -0.62]). Oral appliances were less effective than continuous positive pressure in reducing apnoea-hypopnoea index (WMD 13 [95% CI: 7.63, 18.36], parallel studies - two trials; WMD 6.75 [4.93, 8.57] cross-over studies - six trials). However, no significant difference was observed on symptom scores (3 trials). Nasal continuous positive pressure was more effective at improving minimum arterial oxygen saturation during sleep compared with oral appliance. In two small crossover studies, participants preferred oral appliance therapy to continuous positive airways pressure. REVIEWER'S CONCLUSIONS: There is some limited evidence suggesting that oral appliance improves subjective sleepiness and sleep disordered breathing compared with a control. Nasal continuous positive airways pressure appears to be more effective in improving sleep disordered breathing than oral appliance. Until there is more definitive evidence on the effectiveness of oral appliances, it would appear to be appropriate to restrict oral appliance therapy to patients with sleep apnoea who are unwilling or unable to comply with continuous positive airways pressure therapy.

Adult↗
PubMed2003

Polychlorinated biphenyl (PCB) congener concentrations in seabirds found dead in mortality incidents around the British coast.

Livers from 121 birds killed in mortality incidents in U.K. coastal waters between 1991 and 1996 were analyzed for 16 PCB congeners (IUPAC numbers 8, 18, 28, 31, 52, 77, 101, 118, 126, 128, 138, 149, 153, 169, 170, and 180). Species analyzed were guillemot (Uria aalge), shag (Phalacrocorax arisotelis), kittiwake (Rissa tridactyla), puffin (Fratercula arctica), razorbill (Alca torda), fulmar (Fulmarus glacialis), gannet (Sula bassana), and herring gull (Larus argentatus). This is the first report of PCBs in U.K. seabird tissues to be presented since 1983. Mean concentrations of total PCBs ranged from 0.47 to 15.8 mg/kg WW, similar to concentrations reported for North Sea birds during the 1970s and 1980s and lower than those reported for the same species in the Irish Sea during the late 1960s and early 1970s. The congeners generally present in the highest concentrations were (in decreasing order) 153, 138, 180, 118, and 170. Despite the birds having similar diets, both inter- and intraspecies differences in PCB congener profile were found. In guillemots from several sites on the east coast, the dominant congener was 138, compared to guillemots from the south coast, which had the more typical congener pattern found in seabirds. Some of the differences in total PCB values could be due to different causes of death, with a subsequent effect on body lipid levels.

Animals↗
PubMed2003

Direct lung delivery of para-aminosalicylic acid by aerosol particles.

Para-aminosalicylic acid (PAS), a tuberculostatic agent, was formulated into large porous particles for direct delivery into the lungs via inhalation. These particles possess optimized physical properties for deposition throughout the respiratory tract, a drug loading of 95% by weight and physical stability over 4 weeks at elevated temperatures. Upon insufflation in rats, PAS concentrations were measured in plasma, lung lining fluid and homogenized whole lung tissue. Systemic drug concentrations peaked at 15 min, with a maximum plasma concentration of 11+/-1 microg/ml. The concentration in the lung lining fluid was 148+/-62 microg/ml at 15 min. Tissue concentrations were 65+/-20 microg/ml at 15 min and 3.2+/-0.2 microg/ml at 3h. PAS was cleared within 3 h from the lung lining fluid and plasma but was still present at therapeutic concentrations in the lung tissue. These results suggest that inhalation delivery of PAS can potentially allow for a reduction in total dose delivered while providing for higher local and similar peak systemic drug concentrations as compared to those obtained upon oral PAS dosing. Similar particles could potentially be used for the delivery of additional anti-tuberculosis agents such as rifampicin, aminoglucosides or fluoroquinolones.

Administration, Inhalation↗
PubMed2003

The importance of associated extra-renal vascular disease on the outcome of patients with atherosclerotic renovascular disease.

Atherosclerotic renovascular disease (ARVD) is a disease of ageing. It is usually a manifestation of widespread vascular disease and although it may be symptomless, many patients with ARVD present with the effects of extra-renal vascular disease, such as peripheral vascular (PVD), coronary heart (CHD) and cerebrovascular disease. ARVD is a common cause of hypertension and chronic renal failure (CRF), and it is one of the most common renal diagnoses in elderly patients accepted on to dialysis programmes with end-stage renal failure (ESRF). The cause of renal impairment in these patients is still a matter of debate. Patients with ARVD have a high mortality, especially those with renal failure. In this review we examine the relationships between ARVD and co-morbid extra-renal vascular disease, and the impact of these associated vascular pathologies upon renal functional and mortality outcomes is considered. The latest evidence concerning the likely pathogenesis of renal dysfunction in patients with ARVD is also reviewed.

Arteriosclerosis↗
PubMed2003

A pilot study of 'fast track' antenatal screening for haemoglobinopathies.

The NHS Plan launched in 2000 advocated a linked antenatal and neonatal screening programme for haemoglobinopathies. Currently screening practices vary widely across the UK and patient sampling is generally performed in a hospital setting. The process is flawed and frequently fails to provide accurate and timely information. In this study we demonstrate that organisational changes can improve the efficiency and quality of screening. The primary care screening process described here has increased partner testing rates and allowed early identification of at risk couples.

Caribbean Region↗
PubMed2003

Developing risk-based screening guidelines for dioxin management at a Melbourne sewage treatment plant.

Dioxin is a generic term used to refer to the congeners of polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs). The principal source of dioxin production is generally thought to be from unintended by-products of waste incineration, but dioxins are also naturally formed from volcanic activity and forest fires (WHO, 1998). Estimates of dioxin emissions in Australia suggest that approximately 75% of the total PCDD and PCDF emissions derive from prescribed burning and wild bushfires. Currently, no screening guidelines for dioxins within soils are available in Australia. This paper presents the general approach and results of a human health risk-based assessment performed by URS Australia in 2001 to develop site specific reference criteria for remediation of a former sewage plant in Melbourne. Risk-based soil remediation concentrations for dioxins at the sewage treatment plant site were developed using tolerable daily intake values of 4, 2 and 1 pg/kg/day. The potentially significant exposure pathways and processes for exposure to dioxins were identified and risk-based soil concentrations derived in accordance with the general method framework presented in the National Environmental Protection Measure (Assessment of Site Contamination). The derived dioxin reference criteria were used to develop an effective risk management program focussed on those conditions that present the greatest contribution to overall risk to human health.

Australia↗
PubMed2002

The manipulation of food resources reveals sex-specific trade-offs between parental self-feeding and offspring care.

Parent Palestine sunbirds (Nectarinia osea) feed on flower nectar that is not fed to their nestlings. This phenomenon provided a unique opportunity to manipulate self-feeding rates of parent birds independently of the rate at which they feed arthropod prey to their offspring. Based on provisioning models, we predicted that parents would invest more in their young as the energy content of their own food increased. From our earlier work, we also predicted that the levels of sex-specific activities of males and females would differ as the energy content of their food increased. Sunbird pairs with two or three nestlings were provided with feeders containing a low-, medium- or high-concentration sucrose solution. As the sugar concentration increased, the females delivered arthropods at a greater rate to their nestlings, removed proportionally more faecal sacs and spent longer at the nest, while the males increased their mobbing effort. Nestling food intake and body mass, but not tarsus length or bill size, were larger in small broods than in large broods, and increased with increasing feeder sugar concentration. These results imply that increasing the energy content of food consumed by parent sunbirds allows them to increase the rate at which other foods are delivered to their young and to increase other parental care activities as well. The results also add credence to the idea that behavioural decisions reflect life-history trade-offs between parental self-feeding and investment in current young.

Animals↗
PubMed2002

Pressurised metered-dose inhalers versus all other hand-held inhalers devices to deliver bronchodilators for chronic obstructive pulmonary disease.

BACKGROUND: Bronchodilator therapy for COPD may be delivered by a number of different inhaler devices. OBJECTIVES: To determine the efficacy of pressurised metered dose inhalers (pMDI) compared to any other handheld inhaler device for the delivery of bronchodilators in non-acute COPD. SEARCH STRATEGY: The Cochrane Collaboration, Asthma and Wheeze Randomised Controlled Clinical Trials register was searched for studies. The UK pharmaceutical companies who manufacture inhaled COPD medication were also contacted. SELECTION CRITERIA: Two reviewers independently reviewed the results of computerised search and any potentially relevant articles were obtained in full. DATA COLLECTION AND ANALYSIS: One reviewer extracted details of each trial and a second reviewer checked all extracted data. Dichotomous outcomes such as exacerbation rate were assessed using relative risk, with 95% confidence interval (CI). MAIN RESULTS: Fourteen studies appeared potentially relevant but only three studies (61 patients) met the entry criteria. Two studies compared a dry powder device (Turbuhaler or Rotahaler) with a pMDI for beta2-agonist delivery, and one (36 patients cross-over design) the Respimat (soft mist device for ipratropium) vs a pMDI. For the Turbuhaler and Rotahaler, none of the reported outcome measures were significantly different. The Rotahaler study used a high and low dose of medication with or without large volume spacer. The study using the Respimat showed significant increases in FEV1 when compared to a pMDI (difference in change from base line 70 ml, 95% CI 10, 130 ml). The effect on change in FVC was of similar size. There were no differences between these two devices for any other reported outcomes. Although none of the included studies required prior patient ability to use any of the inhalers (and no study mentioned device training), it was assumed that all patients randomised into the study would have undergone training in use of the study inhalers and were capable of using those devices. REVIEWER'S CONCLUSIONS: In patients with stable COPD, pMDI produced similar outcomes to a dry powder device for delivering beta2-agonists, but the very small number of studies and included patients does not permit firm conclusions to be drawn. The soft mist device for ipratropium was more effective than a pMDI, but the data come from one small study. There need to be further well designed randomised controlled trials to define the role of inhaler devices using bronchodilators in stable COPD.

Adrenergic Agonists↗
PubMed2002

Drug treatments for obstructive sleep apnoea.

BACKGROUND: The treatment of choice for moderate to severe obstructive sleep apnoea (OSA) is continuous positive airway pressure (CPAP) via a mask during sleep. However this is not tolerated by all patients and its role in mild OSA is not proven. Drug therapy has been proposed as an alternative to CPAP in some patients with mild to moderate sleep apnoea. The mechanisms by which drugs might reduce OSA include; a reduction in the proportion of rapid eye movement (REM) sleep (during which apnoeas tend to be more frequent), an increase in ventilatory drive or an increase in upper airway muscle tone during sleep. OBJECTIVES: To determine the efficacy of drug therapies in the treatment of sleep apnoea. SEARCH STRATEGY: Searches were carried out on the Cochrane Airways Group RCT Register. Additional hand searching was performed as relevant. SELECTION CRITERIA: Double blind, randomised placebo controlled trials were included, involving patients with confirmed obstructive sleep apnoea. Trials were excluded if continuous positive airways pressure, mandibular devices or oxygen therapy were used. No restriction was placed upon publication language or trial duration. DATA COLLECTION AND ANALYSIS: A total of 51 references were identified by electronic searches. 42 studies were retrieved for selection and 9 trials were included in the review. The results for 91 patients were available. No response for further information was forthcoming from the study authors. Results were expressed as (WMD) and 95% Confidence Intervals (95% CI) MAIN RESULTS: Only acetazolamide reduced the Hypopnoea Index (1 crossover trial of 9 patients, Weighted Mean Difference -24; 95%Confidence Intervals (95% CI): -4, -44). However there was no symptomatic response and the drug was poorly tolerated. Protriptyline led to a symptomatic improvement (improved vs not improved) in two out of three crossover trials (13 patients, Peto Odds Ratio 29.2; 95%CI 2.8, 301.1) but there was no change in the apnoea frequency. No beneficial effects were found for medroxy progesterone, clonidine, buspirone, aminophylline, theophylline or sabeluzole. REVIEWER'S CONCLUSIONS: The data available do not support the use of drugs as a therapy for OSA. Although the studies examined had limitations there was little to justify further trials of these particular drugs.

Humans↗
PubMed2002

Reduced vitamin E antioxidant capacity in sickle cell disease is related to transfusion status but not to sickle crisis.

In homozygous sickle cell disease (SCD), decreased serum Vitamin E is present. Excessive transfusions may lead to iron overload. We hypothesised a relationship between the two and found that Vitamin E type antioxidant capacity was significantly lower in 30 SCD patients than in 30 age- and sex-matched controls (P < 0.001). Antioxidant capacity was lower in 10 transfused patients compared with 20 non-transfused patients (P < 0.001). Transfusional iron overload in SCD may increase the potential for oxidative damage, and low antioxidant capacity may compound this effect.

Adult↗
PubMed2002

Effects of prior apparatus experience and novelty of testing environment on locomotor activity following MK-801.

Robust increases in locomotor activity are observed following administration of dizocilpine maleate (MK-801). The present study investigated the effects of prior apparatus experience and manipulation of the testing environment on locomotor activity following peripheral MK-801. Gerbils were given zero or nine sessions of apparatus exposure prior to testing with MK-801 (0.1 mg/kg ip) or saline. Sessions were 10 min in duration and separated by 24 h. As previously reported, naive animals treated with MK-801 were significantly more active relative to controls. Exposure to the apparatus for nine sessions resulted in a significant reduction in MK-801-induced activity, but did not alter the activity levels of control animals. To evaluate the effect of changes to the testing environment, animals previously evaluated in the familiar condition were retested in the identical apparatus relocated to a novel experimental room. MK-801-treated animals exhibited a significant increase in activity when tested in this novel environment while the locomotor activity of control gerbils was not significantly altered. The results illustrate the importance of repetitive testing and environmental changes as moderating variables in studies that evaluate locomotor activity. These data also indicate that the effects of MK-801 on activity are sensitive to prior experience with the apparatus and the novelty of the testing environment.

Animals↗
PubMed2002

Increased non-transferrin bound iron in plasma-depleted SAG-M red blood cell units.

BACKGROUND AND OBJECTIVES: Non-transferrin bound iron (NTBI) is associated with increased morbidity in a number of transfusion-dependent disease states such as the severe haemoglobinopathies. We hypothesized that this may be related to excess NTBI present in plasma-depleted red blood cell units that are free of clear haemolysis. MATERIALS AND METHODS: The level of NTBI was determined using the bleomycin assay in samples from 20 stored plasma-depleted red cell units, at approximate 5-day intervals up to day 33 after donation. Forty units of fresh-frozen plasma (FFP) and 40 units of platelet concentrates were used as negative controls, and samples from 12 units of FFP were also serially assessed. RESULTS: Median [interquartile range (IQR)] NTBI was 0 microm (0-0.35) in samples taken from units 3-10 days after donation. Thereafter, the levels of NTBI increased, becoming significant (median 3.05; IQR: 0.05-6.7 microm) 17-22 days after donation. After 30 days, NTBI was detectable in all red cell units. NTBI was undetectable in platelet concentrates and FFP. CONCLUSIONS: Increased levels of NTBI become detectable 17-22 days after donation and increase further with storage time. This excess NTBI may promote bacterial infection in iron-loaded individuals.

Bacterial Infections↗
PubMed2002

Artichoke leaf extract reduces mild dyspepsia in an open study.

A recent post-marketing study indicated that high doses of standardised artichoke leaf extract (ALE) may reduce symptoms of dyspepsia. To substantial these findings, this study investigated the efficacy of a low-dose ALE on amelioration of dyspeptic symptoms and improvement of quality of life. The study was an open, dose-ranging postal study. Healthy patients with self-reported dyspepsia were recruited through the media. The Nepean Dyspepsia Index and the State-Trait Anxiety Inventory were completed at baseline and after 2 months of treatment with ALE, which was randomly allocated to volunteers as 320 or 640 mg daily. Of the 516 participants, 454 completed the study. In both dosage groups, compared with baseline, there was a significant reduction of all dyspeptic symptoms, with an average reduction of 40% in global dyspepsia score. However, there were no differences in the primary outcome measures between the two groups, although relief of state anxiety, a secondary outcome, was greater with the higher dosage (P = 0.03). Health-related quality of life was significantly improved in both groups compared with baseline. We conclude that ALE shows promise to ameliorate upper gastro-intestinal symptoms and improve quality of life in otherwise healthy subjects suffering from dyspepsia.

Cholagogues and Choleretics↗
PubMed2002

Reduction of Cr(VI) and bioaccumulation of chromium by gram positive and gram negative microorganisms not previously exposed to Cr-stress.

Resistance to Cr(VI) is usually associated with its cellular exclusion, precluding enrichment techniques for the isolation of organisms accumulating Cr(VI) via bioreduction to insoluble Cr(III). A technique was developed to screen for potential Cr(VI) reduction in approx. 2000 isolates from a coastal environment, based on the non-specific reduction of selenite and tellurite to Se0 and Te0, and reduction of tetrazolium blue to insoluble blue formazan. The most promising strains were further screened in liquid culture, giving three, which were identified by 16S rRNA sequence analysis as Bacillus pumilus, Exiguobacterium aurantiacum and Pseudomonas synxantha, all of which reduced 100 microM Cr(VI) anaerobically, without growth. The respective removal of Cr(VI) was 90% and 80% by B. pumilus and E. aurantiacum after 48 h and 80% and by P. synxantha after 192 h. With the gram positive strains Cr(VI) promoted loss of flagella and, in the case of B. pumilus, lysis of some cells, but Cr was deposited as an exocellular precipitate which was identified as containing Cr and P using energy dispersive X-ray microanalysis (EDAX). This prompted the testing of Citrobacter sp. N14 (subsequently re-assigned by 16S rRNA sequence analysis and biochemical studies as a strain of Serratia) which bioprecipitates metal cation phosphates via enzymatically-liberated phosphate. This strain reduced Cr(VI) at a rate comparable to that of P. synxantha but Cr(III) was not bioprecipitated where La(III) was removed as LaPO4, even though a similar amount of phosphate was produced in the presence of Cr(III). Since B. pumilus removed most of the Cr(VI), with the formation of cell-bound CrPO4 implicated, this suggests that this strain could have future bioprocess potential.

Bacillus↗