Search PubMed⌕ Search

Biomedical subjects

K D Allen

Publications and source records attributed to K D Allen.

At least 55 records · Page 3Linked to original sources
PubMed1994

Cost control of out-of-hours laboratory services in district general hospitals.

AIMS: To survey methods for cost control of out-of-hours laboratory services in district general hospitals in England and Wales. METHODS: A questionnaire was distributed to 66 district general hospital laboratories in England and Wales. RESULTS: The response rate was 61%. Most laboratories for which budgetary information was provided had on-call costs ranging between 10-21% of staff costs. Ninety five per cent of respondents had attempted to reduce workload by the use of various strategies. Seventy two per cent of responding laboratories had negotiated a wide variety of on-call agreements outside Whitley Council arrangements. Seventy two per cent were not satisfied with their on-call arrangements, the main desired objective being the introduction of the extended working day. CONCLUSIONS: From this study it seems that Whitley Council agreements for out-of-hours work are no longer appropriate for the average district general hospital laboratory. Workload reduction strategies should include the use of a limited list, audit of the use of the on-call service, and continued education of medical staff. Consideration may also be given to the introduction of fixed payments, extension of the working day, increased multidisciplinary on-call and increased bedside testing.

Cost Control↗
PubMed1993

Clustering of group A streptococcal infections on a burns unit: important lessons in outbreak management.

In a 12-month period 37 patients and four members of staff on a burns unit were infected or colonized by Streptococcus pyogenes (Group A streptococcus). One patient became septicaemic and died. Serotyping revealed five distinct clusters against a low background level of infection. Infection control measures included isolation, screening of patients, staff and environment and the use of prophylactic antibiotics for uninfected patients. We discuss the role of staff and patient carriers and the environment as a continuing source of infection, and the importance of serotyping in outbreak epidemiology.

Aged↗
PubMed1993

Elimination of thumb-sucking as a treatment for severe trichotillomania.

A 5-year-old girl presented with a 3-year history of severe trichotillomania and alopecia. The trichotillomania was observed to covary, or occur only in the presence of thumb-sucking. Thus, the elimination of thumb-sucking was targeted as a treatment for trichotillomania. The investigation evaluated the relative effectiveness of a standard aversive taste treatment, a response-dependent alarm and a response-disrupting thumb-post. Results indicated that only the thumb-post completely eliminated thumb-sucking and the covarying trichotillomania. These results suggest that when trichotillomania is a benign habit disorder, the treatment of a covarying habit such as thumb-sucking can be an effective treatment alternative and that resilient thumb-sucking can be effectively managed with an easily implemented thumb-post that requires little supervision and provides long-term success.

Aversive Therapy↗
PubMed1993

A behavioral prescription for promoting applied behavior analysis within pediatrics.

In recent decades, pediatric medicine has undergone a shift in focus from infectious diseases to the effects of behavior on the health and development of children. At the same time, behavior analysts have increasingly evaluated the direct application of their technology to the development and maintenance of child health behavior. Unfortunately, applied behavior analysts have developed their technology parallel to, rather than collaboratively with, pediatricians and, as a result, are not recognized as experts in the treatment of child health behavior. In addition, behavioral technology is not widely recognized as the treatment of choice by pediatricians. This paper provides a behavioral prescription for behavior analysts who wish to enter pediatrics as expert scientists and technicians. Specific recommendations are provided for stimulating collaborative rather than parallel development between applied behavior analysis and pediatrics in the promotion and maintenance of child health behavior. Strategies for maintaining this collaborative relationship and for strengthening the social relevance of behavior analysis are discussed.

Behavior Therapy↗
PubMed1992

Metronidazole-resistant Bacteroides fragilis wound infection.

We report the isolation of metronidazole-resistant Bacteroides fragilis from a post-operative wound abscess in a 72-year-old woman who had not been treated with metronidazole during the preceding 9 months. The case illustrates the need for caution when identifying anaerobes on the basis of metronidazole sensitivity.

Aged↗
PubMed1992

Costs of an outbreak of wound infections in an orthopaedic ward.

An outbreak of serious wound infections occurring in an orthopaedic ward is reported. The outbreak involved 10 patients, all of whom had undergone clean, orthopaedic operative procedures. The outbreak was eventually terminated by discarding five damaged and contaminated mattresses. The costs incurred during this outbreak were calculated using a retrospective comparative study. The infected patients had an average increased hospital stay of 17 days and average increased costs of 2220 pounds. The outbreak demonstrated the high costs of hospital-acquired infection and the need for further investment in infection control programmes.

Beds↗
PubMed1992

In-vitro activity of ten antimicrobial agents against penicillin-resistant Streptococcus pneumoniae.

The minimum inhibitory concentrations (MICs) of ten antibiotics were determined by the agar dilution method for 40 strains of penicillin-resistant Streptococcus pneumoniae, all of which were clinical isolates from this laboratory. The antibiotics tested were clarithromycin, erythromycin, teicoplanin, vancomycin, ceftriaxone, cefodizime, azithromycin, ramoplanin, ciprofloxacin and MDL 62873. Of these agents, clarithromycin, vancomycin, teicoplanin, ceftriaxone, ramoplanin and MDL 62873 were the most active. The role of these antibiotics as alternatives to penicillin for the treatment of infections caused by penicillin-resistant S. pneumoniae is discussed.

Anti-Bacterial Agents↗
PubMed1992

Biochemical Characterization of Photosystem II Antenna Polypeptides in Grana and Stroma Membranes of Spinach.

The photosystem (PS) II antenna system comprises several biochemically and spectroscopically distinct complexes, including light-harvesting complex II (LHCII), chlorophyll-protein complex (CP) 29, CP26, and CP24. LHCII, the most abundant of these, is both structurally and functionally diverse. The photosynthetic apparatus is laterally segregated within the thylakoid membrane into PSI-rich and PSII-rich domains, and the distribution of antenna complexes between these domains has implications for antenna function. We report a detailed analysis of the differences in the polypeptide composition of LHCII, CP29, and CP26 complexes associated with grana and stroma thylakoid fractions from spinach (Spinacia oleracea L.), making use of a very high-resolution denaturing gel system, coupled with immunoblots using monospecific antibodies to identify specific antenna components. We first show that the polypeptide composition of the PSII antenna system is more complex than previously thought. We resolved at least five type I LHCII apoproteins and two to three type II LHCII apoproteins. We also resolved at least two apoproteins each for CP29 and CP26. In state 1-adapted grana and stroma thylakoid membranes, the spectrum of LHCII apoproteins is surprisingly similar. However, in addition to overall quantitative differences, we saw subtle but reproducible qualitative differences in the spectrum of LHCII apoproteins in grana and stroma membrane domains, including two forms of the major type II apoprotein. The implications of these findings for models of PSII antenna function in spinach are discussed.

Journal Article↗
PubMed1992

Dentist-implemented contingent escape for management of disruptive child behavior.

We evaluated the effectiveness of a dentist-implemented intervention in which brief escape from dental treatment was provided to manage disruptive child behavior during restorative dental treatment. Within a multiple baseline design across subjects, 4 children, aged 3 to 7 years, were provided temporary escape from dental treatment contingent upon brief periods of cooperative behavior. Disruptive behavior decreased when the appropriate escape contingency was used at least 80% of the time. The escape contingency required no more time than traditional management procedures (e.g., tell-show-do, reprimands and loud commands, restraint) to bring disruptive behavior under control. Independent ratings by two dentists provided social validation of the efficacy of the escape contingency.

Child↗
PubMed1991

Resolution of 16 to 20 chlorophyll-protein complexes using a low ionic strength native green gel system.

Conventional native "green gel" systems resolve at most 10 chlorophyll-protein complexes from thylakoid membranes of higher plants and green algae. Such analyses suggest a simplicity of the thylakoid membrane that is not supported by a growing body of evidence on the heterogeneity of photosystems I and II (PSI and PSII) and their associated antennae (LHCI and LHCII). We report here the development and characterization of a low ionic strength native "green gel" system that resolves from 16 to 20, mostly large chlorophyll-protein complexes from a variety of higher plant and green algal species with very little release of free pigment. In Chlamydomonas, this system resolves multiple PSI-LHCI complexes, multiple PSII-LHCII complexes, four oligomeric LHCII complexes, as well as several low electrophoretic mobility reaction center complexes, and a number of small complexes. We have obtained similar resolution with a large number of higher plant and green algal species. We also demonstrate how this system can be used as a sort of "fingerprinting" technique to distinguish thylakoids of different species, and for the analysis of photosynthetic mutants, using the chlorophyll b-less chlorina f2 mutant of barley as an example.

Chlorophyll↗
PubMed1991

EMG biofeedback treatment of pediatric hyperfunctional dysphonia.

A 9-year-old boy with a long history of impaired communication resulting from hyperfunctional dysphonia and vocal nodules had proven to be unresponsive to traditional voice therapy. In this study, he engaged in biweekly visual EMG biofeedback training to reduce laryngeal muscle tension. In a multiple baseline design across two responses with changing criteria, results demonstrated sequential stepwise reductions in muscle tension with each new criterion. Concomitant improvements were found in laryngeal aerodynamic functioning and in voice quality. The treatment also resulted in the elimination of the vocal nodules without surgical intervention. These effects were maintained at 6 month follow-up.

Biofeedback, Psychology↗
PubMed1991

Penicillin-resistant pneumococci.

Penicillin-resistant pneumococci were first reported in Australia in 1967 and appeared in the UK in 1976. Their prevalence is increasing but varies greatly worldwide. The mechanism of resistance lies in the alteration of penicillin-binding proteins. Penicillin-resistant strains are often also resistant to a variety of non-beta-lactam antibiotics. Many different serotypes have been found to be penicillin resistant, type 23 being the most common resistant serotype in the UK. Use of oxacillin discs is recommended for penicillin sensitivity testing, otherwise resistant isolates may escape detection. Treatment of infected patients depends on several factors including the degree of resistance of the infecting strain, the sensitivity to alternative agents and the achievable concentration of antibiotic at the site of the infection. Carriage of penicillin-resistant pneumococci is more common in children, especially the recently hospitalized and those recently exposed to antibiotics. Outbreaks of infection have occurred and various control measures have been suggested in attempts to limit the spread of resistant strains.

Bacterial Proteins↗
PubMed1991

Penicillin-resistant pneumococci in a Merseyside hospital.

Strains of Streptococcus pneumoniae (N = 915) from clinical specimens were examined for penicillin resistance over a 2-year period. The prevalence of resistance [minimum inhibitory concentration (MIC) greater than 0.1 mg l-1] increased from 1.4 to 2.5% per year during this time. In addition, 83% of penicillin-resistant pneumococci (PRP) showed resistance to chloramphenicol. Most PRP were isolated from uninfected children colonized with the organism, but two out of the three adult cases were clinically infected, one by cross-infection between in-patients. In only two cases was there an association with foreign travel. Three children showed prolonged carriage providing a potential reservoir of infection for other members of the community. The percentage of strains showing high level resistance (MIC greater than 1 mg l-1) increased from 0.7% to 1.9% of all isolates during the 2-year study period. This high prevalence of high level resistance has not been reported previously in the UK and if the trend continues, it will have serious implications for the management of invasive pneumococcal infection, particularly meningitis.

Adult↗