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K Heslop

Publications and source records attributed to K Heslop.

6 recordsLinked to original sources
PubMed1997

Who is a heavy service user? Preliminary development of a screening instrument for prospective consumers of a mobile intensive treatment team.

OBJECTIVE: The mobile intensive treatment team (MITT) of the Valley Integrated Adult Mental Health Service in Brisbane, Australia, aims to provide services in the community to people with severe and persistent mental illness who have traditionally been heavily reliant on inpatient services (i.e. heavy service users). The MITT screening instrument (MITTSI) was developed to provide an objective measure to appropriately identify patients for referral to the service. METHOD: A literature review and a panel of multidisciplinary clinicians were consulted to identify a list of specific attributes that would assist in the detection of heavy service users. These attributes were then formulated into an easy-to-administer screening instrument entitled the MITTSI. The MITTSI was administered in an interview format to MITT case managers (intensive case management) and to case managers in standard case management with prospective MITT patients (prospective heavy service users). RESULTS: Analyses of the responses indicated support for the MITTSI as a valid screening instrument in identifying heavy service users and for determining appropriate patients for referral to the MITT. CONCLUSION: The MITTSI is an easy-to-administer screening instrument which provides clear guidelines for inclusion and exclusion, and is an objective measure regarding the patients' urgency for referral to the MITT. Follow-up of the MITTSI within a broader, longer-term project will attempt to further refine the MITTSI and to further determine its validity. Outcomes will be published at a later stage.

Adult↗
PubMed1994

Lipid metabolism and insulin resistance in cirrhosis.

Fasting patients with cirrhosis have high plasma non-esterified fatty acids, and a high turnover and oxidation of non-esterified fatty acids, despite high plasma insulin levels. To assess whether increased non-esterified fatty acid availability impairs utilisation of circulating glucose, and contributes to the insulin insensitivity in cirrhosis, we measured glucose, non-esterified fatty acid and glycerol flux rates, in patients with cirrhosis and controls, in the basal state and during a 0.05 U.kg-1.h-1 hyperinsulinaemic euglycaemic clamp. After an overnight fast, basal blood glucose and glucose turnover were similar in both groups. Basal plasma glycerol and non-esterified fatty acid levels were higher in patients with cirrhosis as were 1-14C-nonesterified fatty acid turnover (4.48 +/- 0.53 vs 2.54 +/- 0.45 mumol.kg-1.min-1, p < 0.05) and 2H5-glycerol turnover (3.27 +/- 0.34 vs 2.24 +/- 0.15 mumol.kg-1.min-1, p < 0.05), indicating increased lipolysis in patients with cirrhosis; metabolic clearance rate of non-esterified fatty acids and glycerol were similar in both groups, suggesting no impairment of tissue uptake in patients. The euglycaemic clamp showed patients with cirrhosis to be markedly insensitive to insulin. The glucose metabolic clearance rate increased during the clamp in controls (p < 0.005) but not in patients with cirrhosis, indicating that infused insulin had little or no effect on glucose disposal in the patients. Clamp glucose turnover in controls was higher than in the basal state (p < 0.001); in patients with cirrhosis it was lower. The profound insulin insensitivity and the clamping of blood glucose below fasting levels explains the fall in glucose turnover in patients with cirrhosis during the clamp. In both groups serum non-esterified fatty acid and glycerol levels, and their appearance rates, were suppressed during the clamp, but levels remained significantly higher in patients with cirrhosis (non-esterified fatty acids, 0.20 +/- 0.4 vs 0.10 +/- 0.01 mmol/l, p < 0.05; glycerol 74 +/- 9 vs 46 +/- 4 mumol/l, p < 0.05). This, with the high basal non-esterified fatty acid and glycerol levels seen in patients with cirrhosis, despite high insulin levels, suggests resistance of adipose tissue lipolysis to insulin. There was no correlation between glucose infusion requirements and non-esterified fatty acid turnover. The normal turnover of blood glucose in fasting patients with cirrhosis, despite increased non-esterified fatty acid turnover, suggests utilisation mainly by tissues with an obligatory requirement for glucose, which may be similar in patients with cirrhosis and controls.(ABSTRACT TRUNCATED AT 400 WORDS)

Adipose Tissue↗
PubMed1993

Differential metabolic actions of biosynthetic insulin analogues in normal man assessed by stable isotopic tracers.

Insulin analogues have been produced with high affinity for the insulin receptor and with affinity lower than that of native insulin, but differences in activity when administered in vivo to man are unconvincing. We have used very low dose insulin (0.005 units kg-1 h-1) to investigate possible differences in effect of these insulin analogues on lipolysis in seven healthy subjects. Only minor effects on blood glucose concentration were observed and glucose turnover measured isotopically with 6,6 2H glucose and leucine turnover measured with 1-13C leucine did not change significantly. Fatty acid levels decreased with insulin (area under curve, median (range) -23 (-41-10) mmol l-1) and with the low affinity analogue (-28 (-42-19) mmol l-1 h,), but the high affinity analogue had no significant effect compared with controls (high affinity analogue -8 (-28-35) mmol l-1 h; control +15 (11-53) mmol l-1). Glycerol production measured isotopically decreased with insulin (-0.54 (-1.50-0.63) mumol kg-1 min-1) and with the low affinity analogue (-0.74 (-1.76-0.72) mumol kg-1 min-1), but the high affinity analogue at these doses had no significant effect on glycerol turnover (-0.19 (-0.74-1.13) mumol kg-1 min-1). Thus at these low infusion rates insulin itself and the low affinity analogue suppressed lipolysis, as assessed by glycerol turnover and by circulating fatty acid concentrations. The high affinity analogue was cleared rapidly from the circulation producing no measurable increase in immunoreactive insulin concentrations, and no effect was observed on lipolysis.

Adult↗
PubMed1990

Clinical, autonomic and therapeutic observations in two siblings with postural hypotension and sympathetic failure due to an inability to synthesize noradrenaline from dopamine because of a deficiency of dopamine beta hydroxylase.

A brother and sister with long-standing symptoms of postural hypotension are described. They were considerably worse in the morning, after exercise and in warm weather. In the male, erection was unaffected but ejaculation was prolonged or absent. Both had nocturia, but there were no urinary bladder, bowel or sweating abnormalities. Autonomic function tests confirmed sympathetic adrenergic failure with spared sympathetic cholinergic and intact parasympathetic function. There were no other neurological abnormalities. Noradrenaline and adrenaline were undetectable in the plasma, but plasma dopamine was elevated. Urinary levels of noradrenaline and adrenaline metabolites were below detection limits, but dopamine metabolites were normal or elevated. Dopamine beta-hydroxylase activity was undetectable in the plasma. Immunohistochemical studies of perivascular cutaneous tissue confirmed normal peptidergic and tyrosine hydroxylase immunoreactivity, with absent dopamine beta-hydroxylase immunoreactivity. The findings were consistent with an enzymatic deficit in the conversion of dopamine to noradrenaline. The parents were clinically and biochemically normal. Treatment of both patients with the synthetic amino acid, d-l-threo-dihydroxyphenylserine, which contains a hydroxyl group and is converted to noradrenaline by dopa-decarboxylase, reduced symptoms and signs of postural hypotension and increased levels of plasma noradrenaline and its urinary metabolites. In the male, ejaculation became possible. Behavioural changes included a feeling of confidence and optimism, with a tendency to be argumentative. The laevo isomer also raised blood pressure and plasma noradrenaline levels. The drug had no direct pressor effects, as its actions were prevented by the dopa-decarboxylase inhibitor, carbidopa.

Adult↗