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Biomedical subjects

K McCaul

Publications and source records attributed to K McCaul.

34 records · Page 2Linked to original sources
PubMed1997

Risk factors for repeat attendance at hospital emergency departments among adults and children with asthma.

BACKGROUND: Acute asthma attacks are frequent causes of attendance at hospital Emergency Departments (EDs) and a subgroup of these patients repeatedly present for such treatment. AIMS: This study sought to characterise patients who were repeat attenders at EDs, to assist the targetting of appropriate future interventions aimed at reducing avoidable presentation. METHODS: A cross-sectional survey was undertaken of patients presenting with an asthma attack to the EDs of six teaching hospitals in Adelaide, South Australia between 14 May and 30 June 1994. Patients were interviewed within six weeks of their attendance about aspects of their asthma history, severity, medications, self-management, attitudes and environment. Repeat attenders, defined as two or more visits over the course of the preceding year, were compared with those who reportedly attended on one occasion only, using logistic regression analyses. RESULTS: Sixty-two per cent of 272 patients aged under 15 years and 40% of 165 patients aged 15 years or more reported having attended two or more times over the course of the preceding year. Among adults, the variables independently associated with repeat attendance principally related to asthma severity. Among children, repeat attendance was associated with parental attitudinal variables relating to appraisal of their child's asthma severity, management of asthma attacks and parental worry. CONCLUSIONS: The factors underlying repeated presentations at EDs differ between adults and children and interventions to minimise avoidable presentation will require different emphasis for these patient subgroups.

Adolescent↗
PubMed1997

Continuous passive motion after primary total knee arthroplasty. Does it offer any benefits?

We report a prospective randomly controlled trial to examine the effectiveness of continuous passive motion (CPM) in improving postoperative function and range of movement after total knee arthroplasty (TKA). We allocated 53 patients (57 knees) to one of three postoperative regimes: no CPM (n = 19); CPM at 0 to 40 degrees (0 to 40 CPM; n = 18); and CPM at 0 to 70 degrees (0 to 70 CPM; n = 20). Those in the CPM groups had CPM for 48 hours and all patients had an identical regime of physiotherapy. There was an even distribution of various cemented and cementless TKAs in each group. Patients were assessed preoperatively and at one week and at one year postoperatively. At one week, there was a statistically significant increase in the range of flexion and total range of movement in the 0 to 70 CPM group compared with the no-CPM group. At one year we found no significant differences in mean flexion, overall range of movement, fixed flexion deformity or functional results in the three groups. Those who had CPM had a significant increase in analgesic requirement (p = 0.04). There was an increased mean blood drainage postoperatively in those who had 0 to 70 CPM (1558 ml) compared with those with no CPM (956 ml) (t = 2.96, p = 0.005) and with 0 to 40 CPM (1017 ml) (t = 2.62, p = 0.01). Our findings show that CPM had no significant advantage in terms of improving function or range of movement, and that its use increased blood loss and analgesic requirements.

Aged↗
PubMed1997

A risk screening questionnaire for adult asthmatics to predict attendance at hospital emergency departments. South Australian Asthma Reference Panel.

STUDY OBJECTIVES: To develop a practical screening tool that could identify adult patients highly likely to attend a hospital emergency department (ED) in a 1-year period. DESIGN: Retrospective case-control study of patients who did and did not attend a hospital ED for asthma in the past year. SETTING: Adelaide, South Australia. PARTICIPANTS: One hundred sixty-five adults attending an ED for asthma were compared with 260 adults with asthma from a community survey who had not attended an ED in the previous year. MEASUREMENTS AND RESULTS: The following variables were independently related to ED attendance: having been woken from sleep by asthma in past month; having been admitted to hospital because of asthma in the past year; having seen more than one general practitioner for asthma in the last 12 months; a moderate or severe self-rating of asthma in the last month; and having taken oral steroid medication for asthma in past month. A risk screening questionnaire using the weighted responses to these five variables with a cutoff score of 30/100 demonstrated a sensitivity of 90% and specificity of 88%. CONCLUSIONS: These findings agree with those of previous studies that markers of asthma severity and discontinuity of care are risk factors for adverse asthma outcomes. Validation of the risk screening questionnaire is required in a prospective study.

Adolescent↗
PubMed1997

Elevated stromal chondroitin sulfate glycosaminoglycan predicts progression in early-stage prostate cancer.

Curative therapies for clinically localized prostate cancer have significant morbidity, and those patients who might be cured by aggressive management are not easily identified using current clinical information. Better biomarkers of tumor behavior need to be identified to improve clinical outcome. Chondroitin sulfate (CS), a glycosaminoglycan, may be a potentially useful biomarker as it is known to influence cell growth and differentiation and might influence malignant progression. In this study, CS was immuno-localized to the periacinar and peritumoral fibromuscular stromal tissue of nonmalignant and malignant prostates. The CS concentration was increased in the prostate tissue of men with early-stage prostate cancer compared with tissue from men without cancer (P < 0.0001). Using Cox's univariate analysis, CS concentration, tumor grade, preoperative serum prostate-specific antigen (PSA), extracapsular extension of disease, positive surgical margins, and patient age were associated with an increased risk of PSA failure. The CS concentration was compared with the other features in two-variable regression analyses. CS and preoperative serum PSA concentrations were independent predictors of PSA failure. CS was a stronger prognostic feature than tumor grade and could predict outcome for patients with moderately differentiated tumors. Patients with a low CS concentration had significantly better progression-free survival following radical prostatectomy than patients with high levels of CS (Kaplan-Meier plot, 91% versus 49% PSA progression free at 5 years, respectively, P = 0.0038). Only postoperative pathological indices (extracapsular extension, surgical margins) were stronger predictors than CS. We conclude that measurement of prostatic CS concentrations at diagnosis may allow stratification of patients with early-stage prostate cancer for adjunctive or alternate therapies.

Adolescent↗
PubMed1996

Vimentin expression is not associated with poor prognosis in breast cancer.

The clinical significance of vimentin intermediate filament (VIF) expression was studied in relation to other established prognostic parameters in primary breast cancer. Archival tumour samples embedded in paraffin were examined by immuno-histochemistry with monoclonal antibodies (MAbs) to VIF, p53 protein and cell proliferation marker MIB-I. The vimentin staining pattern was heterogeneous, but in vimentin-positive areas > 80% of the tumour cells were positive. There was no association between vimentin expression and tumour size or the number of axillary lymph nodes involved. Vimentin expression was significantly associated with high-grade tumours, absence of hormone receptors, increased p53 expression and high tumour proliferation fraction as estimated by MIB-I count. Despite these associations with several recognised features of tumour aggressiveness, vimentin expression was not associated with increase in risk of relapse or death from breast cancer.

Antibodies, Monoclonal↗
PubMed1996

Relationship between minimal residual disease and outcome in adult acute lymphoblastic leukemia.

In children with acute lymphoblastic leukemia (ALL), the level of minimal residual disease (MRD) at the end of induction strongly predicts outcome, presumably because it measures both drug sensitivity and the number of leukemic cells requiring elimination. Children with high levels (> 10(-3) leukemic cells per marrow cell) nearly always relapse, whereas those with low levels (<2 x 10(-5)) seldom do. However, the importance of MRD in adult ALL is unclear. We studied 27 patients aged 14 to 74 who were treated with a standard protocol and who attained morphological remission. MRD in the marrow at first remission was quantified by using the polymerase chain reaction (PCR), with the rearranged immunoglobulin heavy chain gene as a molecular marker. Levels of MRD varied from 3 x 10(-1) to <7 x 10(-7). The probability of long-term relapse-free survival was significantly related to the level of MRD and only one of nine patients with MRD >10(-3) did not relapse. For patients who did relapse, there was an inverse relationship between MRD level and the length of remission. Overall, MRD in adults in whom a translocation had not been identified was significantly higher than in comparably-treated children, suggesting that ALL in adults is more drug-resistant than in children.

Adolescent↗
PubMed1996

Relationship between p53 gene abnormalities and other tumour characteristics in breast-cancer prognosis.

The prognostic significance of p53 gene abnormalities was investigated in 919 primary breast-cancer patients. p53 expression and tumour-cell proliferation fraction determined by MIB-1 count, p53 exon 5 and 6 mutations and HER-2/neu oncogene amplification were detected by immunohistochemistry, PCR-SSCP and slot-blot hybridization, respectively. Increased MIB-1 count, p53 expression, HER-2/neu oncogene amplification and p53 mutations were detected in 33%, 29%, 10% and 8% of tumours, respectively. Statistically significant associations were observed between p53 expression or MIB-1 count and age below 50 years, high-grade tumours, medullary carcinomas, and absence of hormone receptors. p53 mutations were associated with increased MIB-1 count, HER-2/neu oncogene amplification and absence of hormone receptors, but not with age, tumour size or grade, histological subtype, or the number of axillary nodes involved. After a median follow-up of 66 months, p53 expression was observed to be associated with significant increases in risk of both relapse and death from breast cancer, but not after adjusting for the effect of other parameters. In these analyses, MIB-1 count, and not HER-2/neu oncogene amplification, was an independent predictor of prognosis. In node-negative patients, only p53 exon 5 and 6 mutations and MIB-1 count were associated with a statistically significant increase in risk of death from breast cancer, independent of tumour size and ER concentration. We conclude that tumour-cell proliferation fraction, as measured by MIB-1 count, is the most useful parameter of breast-cancer prognosis, with the exception of ER, tumour size and the number of axillary nodes involved.

Adult↗
PubMed1996

Prospective study of the prognostic significance of epidermal growth factor receptor in primary breast cancer.

Bearing in mind the continuing controversy over the prognostic significance of epidermal growth factor receptor (EGF-r) expression, we investigated its clinical significance prospectively in 345 primary breast cancer patients. The prognostic significance of EGF-r expression, as measured by a radioligand binding assay, was determined by Cox's multivariate analysis using EGF-r concentration as a continuous or dichotomous variable. Increased EGF-r expression was detected in 20-32% of tumours, depending on the cut-off in concentration used. EGF-r expression, irrespective of the cut-off, was not associated with tumour size or grade or the number of axillary nodes involved. There was, however, a strong inverse association between EGF-r expression and the absence of hormone receptors. After a median follow-up period of 57 months, multivariate analysis suggested that EGF-r expression was associated with increases in risk for both relapse and death from breast cancer, even after adjusting for oestrogen receptor (ER) concentration, tumour size and the number of axillary nodes involved. Patients with ER-positive tumours, which also expressed EGF-r, had increases in risk for both relapse and death from breast cancer compared with tumours without EGF-r. Expression of EGF-r was not a predictor of poor prognosis in either node-negative or ER-negative subgroups of patients.

Adult↗
PubMed1996

A population-based study of the coverage of cancer patients by hospice services.

The aims were to determine the proportion of terminal cancer patients in South Australia who had involvement with a programme of hospice care, to identify the predictors of hospice involvement, and to consider the influence of hospice services, along with other variables, on the place of death. A file of patients of the State's hospice services who died in 1990 was compiled and linked to the population-based Central Cancer Register. We found that 1561 (56%) of the 2800 cancer patients who died in 1990 had care from a hospice service. Patients were less likely to be involved with a hospice service if they were 80 years or older, lived in a rural region, or had a haematological malignancy, and more likely to have hospice care if they had a survival time of more than six months, or were born in the UK or Europe. Patients of hospice services were more likely than other patients to die at home or in an inpatient hospice, and less likely to die in a nursing home or private hospital. A range of other factors were also found to be associated with place of death. We conclude that there has been a rapid acceptance of hospice care in South Australia, with a majority of the target population of cancer patients covered by services. Epidemiological research methods are useful for identifying gaps in the provision of care, and for determining the impact of various factors on where people die. This research is, therefore, important for the formulation and evaluation of policy for the delivery of terminal care.

Adult↗
PubMed1996

Cyclin DI amplification is not associated with reduced overall survival in primary breast cancer but may predict early relapse in patients with features of good prognosis.

Amplification of chromosome 11q13 is frequently observed in human malignancies, including breast cancers. A candidate oncogene at this locus is the CCND1 gene, which encodes the cell cycle regulatory protein cyclin D1. Because published data on the relationship between 11q13 amplification and prognosis in breast cancer have been controversial, we investigated the clinical significance of CCND1 amplification and its association with established clinicopathological features of prognosis in 1014 primary breast cancer patients. Amplification of the CCND1 gene and the INT-2/FGF-3 gene, which also maps to 11q13, was 10% and 17%, respectively. There were no associations between CCND1 or INT-2 amplification and patient age, tumor size, tumor grade, axillary lymph node status, HER/neu amplification, MIB-1 monoclonal antibody to Ki67 antigen count, or p53 expression. CCND1 amplification was predominantly observed in hormone receptor-positive tumors; at a copy number >/=3, CCND1 amplification was significantly correlated with both estrogen receptor (ER; P = 0.036) and progesterone receptor (P = 0.012) positivity. After a median follow-up period of 66 months, CCND1 or INT-2 amplification was not associated with significant increases in relapse or death from breast cancer. However, in the node-negative and ER-positive subgroups, there was a trend for an increased relapse rate in patients with INT-2 or CCND1 amplification. Thus, in this study, assessment of CCND1 or INT-2 amplification at 11q13 by slot-blot hybridization was of little use in determining phenotype or disease outcome in the whole group of patients but had a potential role in identifying a subset of poor-prognosis patients within the node-negative or ER-positive, good-prognosis groups. Because the prevalence of CCND1 amplification is much lower than the reported prevalence of cyclin D1 overexpression, additional studies are required to determine the true prognostic significance of altered cyclin D1 expression in breast cancer.

Adult↗
PubMed1994

The relative prognostic significance of total cathepsin D and HER-2/neu oncogene amplification in breast cancer. The South Australian Breast Cancer Study Group.

Total tumor cathepsin D (TCD) levels were determined prospectively by a radioimmunometric assay in tumor cytosol of 858 primary breast cancer patients diagnosed between 1989-1991. In 581 of these patients, tumor HER-2/neu oncogene amplification was simultaneously determined. In a "training-set" of 313 patients, "high" TCD was associated with significantly shorter disease-free survival (DFS). For the whole group, there was no correlation between TCD and pathologic stage, number of axillary nodes with tumor deposits, tumor size, histologic type and grade, or hormone receptor levels. In the node-positive group, high TCD level was associated with HER-2/neu amplification. After a median follow-up duration of 31 months, univariate analysis indicated that high TCD level was significantly associated with shorter DFS only in node-positive patients. The shorter DFS in association with high TCD levels was observed in both estrogen-receptor-positive and -negative patients. Cox multivariate analysis of DFS confirmed that high TCD level was predictive of shorter DFS in node-positive patients only. Because of the short duration of follow-up, the significance of TCD in overall survival was not determined. We conclude that high tumor TCD in node-positive patients is predictive of shorter DFS, and is often associated with HER-2/neu amplification. The possibility exists that high tumor TCD may act in combination with HER-2/neu amplification to promote dissemination of metastases.

Adult↗
PubMed1993

Clinical significance of HER-2/neu oncogene amplification in primary breast cancer. The South Australian Breast Cancer Study Group.

PURPOSE: To determine prospectively the prognostic significance of HER-2/neu oncogene amplification in the primary tumors of breast cancer patients. METHODS: HER-2/neu amplification in tumor DNA was determined by the slot-blot technique in 1,056 patients with breast cancer (stage I to III) diagnosed between 1987 and 1990. Parameters such as estrogen receptor (ER) and progesterone receptor (PgR) levels, tumor size, axillary nodal involvement, tumor grade, and time to relapse were prospectively obtained. RESULTS: HER-2/neu oncogene amplification, > or = 2, > or = 3, and > or = 5 copy number, was detected in 21%, 11%, and 7% of patients, respectively. In a test set of 529 patients, Cox multivariate analysis showed HER-2/neu copy number > or = 3 or > or = 5 was associated with shorter disease-free survival (DFS) duration. HER-2/neu copy number > or = 3 correlated significantly with pathologic stage of disease, number of axillary nodes with tumor, histologic type, and absence of ER and PgR. For all patients, after a median follow-up duration of 39 months, Kaplan-Meier univariate analysis indicated that tumor oncogene copy number > or = 3 correlated with shorter DFS in both node-negative and node-positive patients. In Cox multivariate analysis, HER-2/neu copy number > or = 3 was associated with shorter DFS, independent of nodal status, ER level, and tumor size. CONCLUSION: Although the follow-up duration of this study is relatively short, we conclude that HER-2/neu amplification is an independent predictor of shorter DFS in both node-negative and node-positive patients.

Adult↗
PubMed1990

Body-image distortion among male and female college and high school students, and eating-disordered patients.

For 179 male and female college and high school students, and 26 female eating-disordered patients body-image distortion was measured using a computer-based image-analysis of redrawn images of standardized human figures. Statistical analysis indicated that body-image distortion was the same for all groups. Body-image distortion was significantly and negatively related to weight:height ratio as a function of a simple polynomial. These results suggest this evaluation of distortion of body-image yields a quantitative measure reliably related to weight status but also suggests the technique, and possibly measurement of body-image distortion in general, may not be a valid discriminator between eating-disordered and normal persons.

Adolescent↗
PubMed1989

Smoking.

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Forecasting↗
PubMed1989

Cervical spine injuries in road traffic crashes in South Australia, 1981-86.

The records of all cases of injury to the cervical spine sustained in road crashes for the 6 year period (1 January 1981 to 31 December 1986) which were admitted to the Spinal Injuries Unit of the Royal Adelaide Hospital, to the Adelaide Children's Hospital, or were identified at post-mortem examination were examined, and the relevant data extracted. There were 291 cases in the non-fatal group, and 161 in the fatal group. These represent a complete enumeration of all such patients in the state of South Australia over the 6 year period, given that up to 50% of cervical injuries in fatal cases can be missed. Comparison of the two groups showed that the fatal group had a much higher proportion of pedestrians, and persons over 50 years of age. About one-half of the fatal group had injuries at the level of C1 or the atlanto-occipital articulation. The most frequent level of injury in the non-fatal group was C2 (29.2%). About 30% of the non-fatal cases had some spinal cord damage. Case fatality rates were calculated, and ranged from 100% for injury at the atlanto-occipital articulation to 8% at C2. The fatality rate of pedestrians was about 4 times higher than that of vehicle occupants. About three-quarters of all cervical spine injuries occurred in vehicle occupants. There was an increase in the number of cases occurring in each year of the period studied. This rise was noted in non-fatal cases, in males, in vehicle occupants, and in crashes in the country.

Accidents, Traffic↗