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Biomedical subjects

K G Harding

Publications and source records attributed to K G Harding.

At least 73 records · Page 4Linked to original sources
PubMed1995

Pressure sore prevention in a hospice.

This study investigated the influence on the number of pressure sores developing in patients nursed in a hospice when three levels of pressure support were used in association with a risk assessment tool. The study was designed as phase one of an epidemiological study examining the use of a modified Norton scoring system. This was followed by a second phase of the study, when patients were allocated to pressure sore support systems according to their risk assessment score. A total of 327 patients entered, 223 in phase one and 104 in phase two. A significant reduction in the development of pressure sores was observed in the second phase of the study.

Aged↗
PubMed1995

The aetiology and healing rates of chronic leg ulcers.

Data from published studies of leg ulcer aetiology concentrate on venous and arterial disease as the main aetiological factors. The records of 490 patients attending leg ulcer clinics over a two-year period in 1992 and 1993 were reviewed. Although 58% of the ulcers studied resulted from venous disease, the remainder were caused by a wide range of factors. Our venous ulcer healing rate of 53% at six months was not as impressive as other published data, although this can be accounted for. By comparing the management and outcome for ulcers of various aetiologies, it was shown that they require different methods of treatment, often including referral to another specialty. Ulcers also exhibit differential healing rates depending on the underlying aetiology. Some ulcer aetiologies, particularly vasculitis, present particular problems and have very poor healing rates.

Chronic Disease↗
PubMed1994

Inappropriate neutrophil activation in venous disease.

Neutrophil oxygen radical production was studied in 18 limbs with class 2 or 3 venous disease and compared with that of nine normal limbs. Neutrophils were isolated from arm and leg venous samples. Free radical production was determined using chemiluminescence after stimulation with the chemotactic peptide formyl-methionyl-leucyl-phenylalanine (FMLP) or the ester phorbol myristate acetate (PMA). The ratio of leg to arm luminescence was greater after FMLP stimulation in patients with venous disease (median 1.52 (95 per cent confidence interval (c.i.) 1.27-2.60)) than in controls (median 0.97 (95 per cent c.i. 0.70-1.12); P < 0.01). These changes were not observed with PMA (venous disease 1.16 (95 per cent c.i. 1.05-1.40); controls 0.95 (95 per cent c.i. 0.78-1.24)). There were fewer FMLP receptors on activated leg neutrophils (median 20.19 (95 per cent c.i. 3.58-51.42) fluorescence units) than arm neutrophils (median 36.03 (95 per cent c.i. 13.00-65.28) fluorescence units; P < 0.05), indicating an amplification of signal transduction. Intracellular calcium imaging demonstrated a larger release of calcium after stimulation of leg neutrophils (median 25.0 per cent (95 per cent c.i. 15.7-43.9 per cent)) compared with neutrophils from the arm (median 8.0 per cent (95 per cent c.i. 5.6-16.1 per cent); P = 0.04), demonstrating calcium-dependent activation. Neutrophils in patients with chronic venous disease inappropriately produce more oxygen free radical as a result of amplification of a calcium-dependent signal pathway.

Aged↗
PubMed1994

The pathogenesis of hypertrophic/keloid scarring.

The formation of hypertrophic and keloid scars after cutaneous wounding is of particular relevance to the practice of maxillofacial surgery. This paper reviews current knowledge of the local and systemic factors underlying the formation of these scars and outlines the current and potential treatment modalities for these lesions.

Cicatrix, Hypertrophic↗
PubMed1994

Stimulation of glycosaminoglycan synthesis in cultured fibroblasts by hyperbaric oxygen.

In this study we examined the effect of hyperbaric oxygen treatment on the synthesis of glycosaminoglycans by fibroblasts isolated from wounds and normal skin. Fibroblast cultures were exposed to seven treatments of intermittent hyperbaric oxygen, and then metabolically labelled with D-[6-(3)H] glucosamine. Hyaluronic acid and proteoglycan synthesis were determined by measuring the radioactivity precipitated with cetylpyridinium chloride before and after digestion with hyaluronidase. Hyperbaric oxygen treatment resulted in an increased synthesis of hyaluronic acid and proteoglycans by fibroblasts from wounds and normal skin. Overall, the average increase in total glycosaminoglycan synthesis after hyperbaric oxygen treatment was 28%, whereas fibroblast proliferation was decreased by 7%. These results suggest that one of the effects of this treatment on a wound may be to increase the ratio of extracellular matrix to cells. Such a change could have important consequences for cellular activities essential for effective wound healing, such as migration of cells into the wound and control of cell function.

Acute Disease↗
PubMed1994

Methods of measuring wound size: a comparative study.

The lack of an accepted method of accurate and objective measurement of wound dimensions is a major obstacle to the assessment of effective wound management regimes. This study compares three different wound volume measurement techniques (filling the lesion with saline, molding of a dental impression material and a computer vision method based on image processing and the Structured Light technique) in terms of accuracy, precision and practicability in a clinical environment. Three groups of hospital staff, doctors, nurses and technicians, repeatedly measured a set of 6 different models of wounds. Measuring wound volume by filling it with saline produces results with standard deviations between 9 percent and 18 percent of the actual volume. Dental impression material performs better, between 5 percent and 16 percent, but is difficult to apply and time consuming to use. Apart from the advantage of providing instant optical records of wounds, the image processing method produces more reliable volume measurements with a standard deviation of between 3 percent and 15 percent. The results demonstrate that the computer based method yields the most reproducible results with a minimum of inter-observer error but the method is not applicable for undermined, very deep and very large wounds.

Anthropometry↗
PubMed1991

Leg ulcers.

Explore the source record for details and available documents.

Humans↗
PubMed1990

Continuing education for general practice and the role of the pharmaceutical industry.

A survey of the involvement in and attitudes towards continuing medical education of 101 general practitioners achieved a 95% response rate. Ninety per cent of the 96 doctors worked in practices which held meetings the content of which was organized by representatives of pharmaceutical companies but only 46% worked in practices which organized their own educational meetings. Seventy six per cent attended meetings away from their practice which were organized by drug companies and 75% had attended at some time continuing medical education activities organized by a local postgraduate centre. The promotional aspects of the drug company organized meetings were disliked by a majority of respondents (58%); more of the trainers (62%) and more of those who had entered general practice within the last seven years (71%) disliked this aspect. Nonetheless the educational content of both meetings held in the practice and those held elsewhere was the aspect most liked by over half of the respondents (59% and 53% respectively). Only 16% of all respondents thought that visits by representatives from pharmaceutical companies were educationally valuable and 37% thought that educational events organized by these companies were of value. Surprisingly 60% of those who worked in practices which held meetings organized by drug company representatives thought them to be of little or no educational value. There is clearly a need for practice based continuing medical education but the current level of dependence on drug companies for organizing these meetings must be questioned. Alternative strategies for the provision of independent non-sponsored educational activities should be sought.

Drug Industry↗
PubMed1990

Using modern dressings to effect debridement.

Before sloughy or necrotic wounds can begin to heal, they must be debrided. Some of the modern wound dressings are not only extremely effective in this, but they do not damage surrounding tissue.

Bandages, Hydrocolloid↗
PubMed1989

General practitioners' continuing medical education within and outside their practice.

To study continuing medical education 96 out of 101 general practitioners chosen at random from the list held by a family practitioner committee were interviewed. The results provided little evidence of regular attendance at local postgraduate centre meetings, though practice based educational meetings were common. Thirty one of the general practitioners worked in practices that held one or more practice based educational meetings each month at which the doctors provided the main educational content. Performance review was undertaken in the practices of 51 of the general practitioners, and 80 of the doctors recognised its value. The general practitioners considered that the most valuable educational activities occurred within the practice, the most valued being contact with partners. They asked for increased contact with hospital doctors. The development of general practitioners' continuing medical education should be based on the content of the individual general practitioner's day to day work and entail contact with his or her professional colleagues.

Clinical Competence↗