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Biomedical subjects

K Wilson

Publications and source records attributed to K Wilson.

At least 181 records · Page 10Linked to original sources
PubMed1996

Long-term survival analysis of total hip replacement.

The results of 1555 primary total hip replacements in 1375 patients performed over an 11-year period were reviewed. When analysed by standard life tables, our findings show encouraging results with survival rates of 96% at 10 years, and are similar to those already published from specialist units. In all, 35 patients had undergone revision surgery. The most common reason for revision was deep postoperative infection. The perioperative mortality was 2% with 0.25% of patients having fatal pulmonary emboli. We believe the cemented Charnley total hip replacement continues to give excellent long-term results in the hands of general orthopaedic surgeons and its continued widespread use can be recommended.

Adult↗
PubMed1996

The prevalence and meaning of fatigue in rheumatic disease.

OBJECTIVE: To determine the prevalence of fatigue in rheumatic disease; to characterize the strength of associations between demographic and clinical features and fatigue; to identify predictors of fatigue, and to determine the consequence of clinically significant fatigue. METHODS: 1488 consecutive patients with rheumatic disease were assessed with the Clinical Health Assessment Questionnaire, a health status instrument with scales for fatigue, pain, global severity, sleep disturbance, gastrointestinal problems, anxiety, depression, health status, health satisfaction, and work ability. All patients underwent rheumatic disease examinations and laboratory testing. RESULTS: Fatigue measured by visual analog scale (VAS) was present in 88-98% of patients, but clinically important levels of fatigue (> or = 2.0 on VAS) were present in more than 41% of patients with rheumatoid arthritis (RA) or osteoarthritis (OA) and 76% of those with fibromyalgia (FM). Fatigue was related to almost all demographic and clinical variables, but in multivariate analyses the strongest independent predictors of fatigue were pain, sleep disturbance, depression, tender point count and Health Assessment Questionnaire (HAQ) disability. About 90% of the R2 of the model (all patients = 0.51, RA = 0.49, OA = 0.45, FM = 0.41) was explained by pain, sleep disturbance, and depression. In RA assessed by erythrocyte sedimentation rate, joint count and grip strength, no association of the inflammatory process with fatigue could be found in the multivariate analyses. In measuring health status, fatigue was strongly associated with work dysfunction and general measures of health (VAS of global severity, health status, and health satisfaction). CONCLUSION: Fatigue is common across all rheumatic diseases, associates with all measures of distress, and is a predictor of work dysfunction and overall health status. The correlates of fatigue are generally similar across RA, OA and FM. Fatigue assessment adds much to understanding and management of patients and diseases.

Adolescent↗
PubMed1996

Professional closure: the case of the professional development of nursing in Rotorua 1840-1934.

The argument that the development and progress of nursing in Rotorua were influenced by the forces of professional closure, and that nursing practice throughout New Zealand reflected this during the period 1840-1934, is the focus of this thesis. Rotorua provided a unique backdrop against which to examine the professional development of nursing as it encouraged and exerted forces of professional closure.

Health Resorts↗
PubMed1996

Should everyone be monitored for upper-airway resistance and how?

Preliminary data indicate that the use of a morphometric model, an expert system with standardized questions, and an evaluation of snoring can be effective tools for diagnosing upper-airway sleep-disordered breathing (UASDB) in many cases. This eliminates the need for many sleep recordings.

Airway Obstruction↗
PubMed1995

Crystallization and preliminary diffraction studies of the structural domain E of Thermus flavus 5S rRNA.

The ribosomal 5S RNA is an essential constituent of the large ribosomal subunit. To overcome the difficulties of crystallizing large RNA molecules such as 5S rRNAs, we decided to divide the 5S rRNA in five domains A through E to determine their structure. Recently we determined the crystal structural of the helical domain A. Here we report the crystallization of the chemically synthesized domain E of the Thermus flavus 5S rRNA. The crystal form is trigonal with unit cell dimensions: a = b = 42.80 A and c = 162.20 A. Diffraction-data to 2.8 A have been recorded and the structure solution is currently underway by means of MIR and MAD techniques.

Base Sequence↗
PubMed1995

Detection of p53 mutations in benign and dysplastic nevi.

We have examined melanocytic cells derived directly from fresh biopsy tissue for the presence of p53 mutations. Using selective media that permits growth of melanocytes and inhibits growth of fibroblasts and keratinocytes, we established short-term, primary cultures of melanocytes from skin biopsies of common acquired nevi, dysplastic nevi, and from metastatic melanoma. Using PCR-single-stranded conformational polymorphism analysis, we have detected p53 mutations in 2 of 11 benign compound nevi and 2 of 5 dysplastic nevi. All nevi positive for p53 mutations were derived from patients who previously had cutaneous moles and three of the four had a family and/or personal history of melanoma.

Base Sequence↗
PubMed1995

Community perceptions of adolescent health and sexuality. Results from a southern community-based project.

OBJECTIVE: To describe the attitudes about adolescent health issues, especially school-based health services, held by adults in a rural community. DESIGN: "Before-after," quasi-experimental design involving independent, cross-sectional population-based surveys in 1989 and 1992. SETTING: Rural county located in the southeastern United States. PARTICIPANTS: Probability sample of adults, 18 years and older, who were residents of the county, including 831 respondents in the first survey and 210 respondents in the second survey. INTERVENTION: County-wide public education campaign involving public service announcements on television and radio, newspaper advertisements, posters, and open-to-the-public adolescent health programs and events. MAIN OUTCOME MEASURES: Attitudes about the types of health services that should be included in a public school-based adolescent health program. RESULTS: Rural adults' attitudes toward public school-based adolescent health services were similar before and after the community-wide campaign. Respondents believed the public schools should provide teenagers with information and counseling on substance abuse, sexual activity, birth control, and the acquired immunodeficiency syndrome but should not provide primary health care or birth control products. Most adults believed that sex and acquired immunodeficiency syndrome education should begin before high school. CONCLUSIONS: A comprehensive, public school-based adolescent health program providing health information but not health services may be acceptable to this community. Adults' attitudes about adolescent health issues do not appear to have been modified by the adolescent health awareness campaign.

Adolescent↗
PubMed1995

Tolerance of Staphylococcus epidermidis grown from indwelling vascular catheters to antimicrobial agents.

During a prospective study of indwelling vascular catheter-related infections, 134 isolates of Staphylococcus epidermidis were grown from 700 catheter tips. In vitro antimicrobial susceptibility testing of these isolates to oxacillin, vancomycin and ofloxacin was performed using the standard broth microdilution technique. These results were compared to those for the same organisms grown in biofilm before the addition of antimicrobial agents. In 96-well flat bottom microtiter plates, 10(4)-10(5) colony forming units of S. epidermidis in 0.1 ml broth were grown for 18 h at 37 degrees C, at which time a biofilm was observed for all isolates. Different concentrations of antimicrobial agents (0.1 ml) were then added to the plates. The plates were incubated for 18 h at 37 degrees C. Since MICs could not be estimated in these plates, all the wells were subcultured after mixing the biofilm with the broth. Minimum bactericidal concentrations (MBCs) were defined as 99.9% reduction in colony forming units. For organisms grown in suspension, 100% of the isolates were susceptible to vancomycin, 81% to ofloxacin and 40% to oxacillin. MBCs of susceptible isolates were within four-fold differences for vancomycin (53%), oxacillin (50%), and ofloxacin (51%). When grown as a biofilm, 78%, 93% and 71% of isolates had MBCs of > or = 2048 micrograms ml-1 of oxacillin, vancomycin and ofloxacin respectively. These data demonstrate the reduced bactericidal activity of antimicrobial agents against S. epidermidis in a biofilm and a simple method for its detection in the microbiology laboratory.

Anti-Bacterial Agents↗
PubMed1995

Modelling patterns of parasite aggregation in natural populations: trichostrongylid nematode-ruminant interactions as a case study.

The characteristically aggregated frequency distribution of macroparasites in their hosts is a key feature of host-parasite population biology. We begin with a brief review of the theoretical literature concerning parasite aggregation. Though this work has illustrated much about both the sources and impact of parasite aggregation, there is still no definite analysis of both these aspects. We then go on to illustrate the use of one approach to this problem--the construction of Moment Closure Equations (MCEs), which can be used to represent both the mean and second moments (variances and covariances) of the distribution of different parasite stages and phenomenological measures of host immunity. We apply these models to one of the best documented interactions involving free-living animal hosts--the interaction between trichostrongylid nematodes and ruminants. The analysis compares patterns of variability in experimental infections of Teladorsagia circumcincta in sheep with the equivalent wildlife situation--the epidemiology of T. circumcincta in a feral population of Soay sheep on St Kilda, Outer Hebrides. We focus on the relationship between mean parasite load and aggregation (inversely measured by the negative binomial parameter, k) for cohorts of hosts. The analysis and empirical data indicate that k tracks the increase and subsequent decline in the mean burden with host age. We discuss this result in terms of the degree of heterogeneity in the impact of host immunity or parasite-induced mortality required to shorten the tail of the parasite distribution (and therefore increase k) in older animals. The model is also used to analyse the relationship between estimated worm and egg counts (since only the latter are often available for wildlife hosts). Finally, we use these results to review directions for future work on the nature and impact of parasite aggregation.

Age Factors↗
PubMed1995

Endocarditis in a dog due to infection with a novel Bartonella subspecies.

Vegetative valvular endocarditis involving the aortic and, to a lesser extent, mitral valves was diagnosed echocardiographically in a 3-year-old spayed female Labrador retriever. Historically, the dog had been treated with tetracycline hydrochloride and prednisolone for positive seroreactivity to Ehrlichia canis and antinuclear antigens. Although three aerobic and anaerobic blood cultures failed to grow bacteria, blood cultured simultaneously by the lysis centrifugation technique grew a fastidious, gram-negative organism. Despite an initial therapeutic response, the owner elected euthanasia 17 days later. Necropsy confirmed aortic and mitral valvular endocarditis. Bacteria phenotypically similar to Bartonella species were visualized in the heart valve by light and electron microscopy, and Bartonella DNA from a frozen heart valve was amplified by PCR. Subsequent phenotypic and genotypic characterization of the isolate, including biochemical testing, cellular fatty acid analysis, DNA hybridization, and sequencing of the 16S rRNA gene indicated that this organism, which can induce endocarditis in dogs, is a novel Bartonella subspecies containing an insertion sequence unique among currently recognized Bartonella species. The name Bartonella vinsonii subsp. berkoffii subsp. nov. will be proposed for this organism.

Animals↗
PubMed1995

Medical complications during stroke rehabilitation.

BACKGROUND AND PURPOSE: We sought to evaluate the effect of setting on the rate of medical complications during stroke rehabilitation. METHODS: A study of the frequency and nature of medical complications in stroke rehabilitation was undertaken in 245 patients managed either on a stroke rehabilitation unit (n = 124) or on general medical wards (n = 121). The stroke unit setting was characterized by established protocols for prevention, early diagnosis, and management of complications (eg, aspiration, infections, thromboembolism, pressure sores, depression, stroke progression). Similar protocols did not exist on general medical wards except for thromboembolism, pressure sores, and secondary stroke prevention. RESULTS: Medical complications were documented in 147 patients (60%) and were more common in patients with severe strokes (97%). The frequency of reported complications was similar in both settings. Aspiration (33% versus 20%; P < .01) and musculoskeletal pain (38% versus 23%; P < .05) were more commonly documented on the stroke unit, whereas urinary problems (18% versus 7%; P < .01) and infections (49% versus 25%; P < .01) were more commonly seen on general medical wards. The reported frequency of deep vein thrombi, pressure sores, and stroke progression was similar in both settings. Although depression was reported equally in both settings (34% on the stroke unit versus 27% on general wards), patients on the stroke unit were more likely to be treated compared with general wards (67% versus 36%; P < .05). CONCLUSIONS: The study shows that inpatient stroke rehabilitation is a medically active service. Management on specialist units is associated with earlier detection and management of stroke-related problems and prevention of potentially life-threatening complications.

Cerebrovascular Disorders↗
PubMed1995

Certification of pediatric oncology nurses: from roundtable discussion to reality.

Certification for pediatric oncology nurses became a reality in 1993 when the first national certification examination was administered in Reno, NV. Some members of the Association of Pediatric Oncology Nursing initially voiced an interest in certification at a roundtable discussion held during the 1988 annual meeting. The momentum lead to the formation of a task force to initiate the certification process. The task force led to an ad hoc committee, organized to design and implement certification. Certification is now overseen by the Certification Corporation of Pediatric Oncology Nurses. The benefits of certification and a historical overview of pediatric oncology nursing certification is discussed in this article. Details of how the test was designed are offered, as well as results from the pilot study. This article concludes with data from the first examination.

Certification↗
PubMed1995

Kinetics of ranitidine metabolism in dog and rat isolated hepatocytes.

1. Freshly isolated hepatocytes from rat and dog have been evaluated as a model for the metabolism of ranitidine in vivo. 2. Isolated hepatocytes from the male and female dog and male Wistar and random hooded rat metabolized ranitidine to ranitidine N-oxide, ranitidine S-oxide, desmethylranitidine and two unidentified minor metabolites. The furoic acid metabolite of ranitidine, previously reported to be a minor metabolite in vivo in rat and dog, was not detected in hepatocytes from either species. 3. The kinetics for ranitidine metabolism in hepatocytes were monophasic for the formation of the three major metabolites in dog and Wistar rat and for N-demethylation of ranitidine in the random hooded rat, but biphasic in this latter strain for the N- and S-oxidation of ranitidine. 4. Ranitidine N-oxide was reduced to ranitidine by Wistar rat hepatocytes but not by hepatocytes from the random hooded rat or dog. Ranitidine S-oxide was metabolized by hepatocytes from both species to one of the unidentified metabolites but was not reduced to ranitidine in either species. Desmethylranitidine was not a substrate for metabolism in hepatocytes from either species. 5. The relative quantitative importance of ranitidine N-oxide, ranitidine S-oxide and desmethylranitidine produced by the hepatocytes was consistent with the profiles of these three metabolites in vivo in rat and dog. The results confirm the value of isolated hepatocytes as a predictive model for in vivo drug metabolism.

Animals↗
PubMed1995

Dexamethasone-induced ocular hypertension in perfusion-cultured human eyes.

PURPOSE: Glucocorticoid administration can lead to the development of ocular hypertension and corticosteroid glaucoma in a subset of the population through a decrease in the aqueous humor outflow facility. The purpose of this study was to determine whether glucocorticoid treatment can directly affect the outflow facility of isolated, perfusion-cultured human eyes. METHODS: The anterior segments of human donor eyes from regional eye banks were placed in a constant flow, variable pressure perfusion culture system. Paired eyes were perfused in serum-free media with or without 10(-7) M dexamethasone for 12 days. Intraocular pressure was monitored daily. After incubation, the eyes were morphologically characterized by light microscopy, transmission and scanning electron microscopy, and scanning laser confocal microscopy. RESULTS: A significant increase in intraocular pressure developed in 13 of the 44 pairs of eyes perfused with dexamethasone with an average pressure rise of 17.5 +/- 3.8 mm Hg after 12 days of dexamethasone exposure. The contralateral control eyes, which did not receive dexamethasone, maintained a stable intraocular pressure during the same period. The outflow pathway of the untreated eyes appeared morphologically normal. In contrast, the dexamethasone-treated hypertensive eyes had thickened trabecular beams, decreased intertrabecular spaces, thickened juxtacanalicular tissue, activated trabecular meshwork cells, and increased amounts of amorphogranular extracellular material, especially in the juxtacanalicular tissue and beneath the endothelial lining of the canal of Schlemm. The dexamethasone-treated nonresponder eyes appeared to be morphologically similar to the untreated eyes, although several subtle dexamethasone-induced morphologic changes were evident. CONCLUSION: Dexamethasone treatment of isolated, perfusion-cultured human eyes led to the generation of ocular hypertension in approximately 30% of the dexamethasone-treated eyes. Steroid treatment resulted in morphologic changes in the trabecular meshwork similar to those reported for corticosteroid glaucoma and open angle glaucoma. This system may provide an acute model in which to study the pathogenic mechanisms involved in steroid glaucoma and primary open angle glaucoma.

Aged↗
PubMed1995

A rapid test for endotoxin in whole blood.

A rapid whole blood agglutination test has been developed for the detection of endotoxin. The test reagent consists of polymyxin B (PmB) conjugated to the Fab fragment of the anti-glycophorin antibody 1C3/86. After addition of reagent to whole blood, red cell agglutination occurs within two minutes in samples from endotoxaemic patients or with the addition of either whole Gram negative bacteria, supernatants from Gram negative bacterial cultures or purified endotoxin. In clinical samples there was a strong correlation (r = 0.83) between the strength of agglutination and the level of endotoxin measured by the Limulus amaebolysate test (LAL). The prospect of a rapid and accurate test for endotoxin may enable better clinical management of Gram negative sepsis.

Adult↗