Pooled waiting lists.
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Attitude of Health Personnel↗
Biomedical subjects
Kevin Jones
Publications and source records attributed to Kevin Jones.
Sexual health care of HIV-positive patients: an audit of a local service.
The sexual health care of 175 HIV-positive patients attending the two HIV clinics at Barts and the London NHS Trust was audited for the first time. The audit standard was that 100% of patients should be in receipt of a sexual health screen within six months of their first HIV out-patient appointment. Overall, 44.5% of patients had a sexual health screen, of which 46 (60.5%) were diagnosed with a sexually transmitted infection. Those screened were younger than those who were not. Five factors were identified which were significantly associated with not having a genitourinary screen performed; site of HIV care, setting of HIV diagnosis, stage of HIV disease, specialty of HIV physician and whether a screen was recommended by the HIV physician. A number of recommendations have been implemented to improve the uptake of sexual health screening amongst HIV-positive patients.
Adult↗
A case of failed fibroid embolisation due to an unusual vascular supply.
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Adult↗
ABC of clinical electrocardiography. Conditions affecting the right side of the heart.
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Diagnosis, Differential↗
Endometrial adenocarcinoma following the insertion of a Mirena IUCD.
BACKGROUND: The case histories of two patients who developed endometrial adenocarcinoma with a Mirena intrauterine system (IUS) in place are reported. CASE: Two patients had a Mirena IUS inserted to treat abnormal vaginal bleeding. After 12 and 36 months with the device in place they presented with a recurrence of their heavy, irregular menstrual bleeding. Endometrial biopsies confirmed the presence of endometrial adenocarcinoma, and hysterectomies were performed. In one patient the cancer was localized and below the stem of the device, in the other metastatic disease had developed. CONCLUSION: These cases raises important issues regarding the use of the Mirena IUS to treat menorrhagia.
Adenocarcinoma↗
Complexity measures of event related potential surface Laplacian data calculated using the wavelet packet transform.
We describe a method to obtain estimates of EEG signal complexity using the well-established wavelet packet transform with best basis selection. In particular, we use the two-dimensional wavelet packet transform to obtain estimates of the complexity of two-dimensional images. This allows us to calculate complexity estimates of high-resolution brain potential maps generated from 61 scalp electrode Visual Oddball paradigm, grand-mean data. A significant reduction in the complexity of the surface Laplacian time-slices is observed during and after the Visual Potential 300 (P3) event for the target case, possibly as a result of increased spatial synchrony associated with visual-related tasks. We also present the results of a statistical analysis of the largest principal component of the time-varying complexity curves, for control, high-risk, and alcoholic groups of male subjects. Parametric and non-parametric analyses show differences in the complexity data which are significant between the control group and the alcoholic and high-risk groups.
Algorithms↗
Development of enzymatic assays for quantification of intracellular lamivudine and carbovir triphosphate levels in peripheral blood mononuclear cells from human immunodeficiency virus-infected patients.
In this paper, we describe the development and use of enzymatic assays to determine intracellular lamivudine triphosphate (3TCTP) and carbovir triphosphate (CBVTP) concentrations in peripheral blood mononuclear cells (PBMCs) from human immunodeficiency virus (HIV)-infected patients. The assays involve inhibition of HIV reverse transcriptase (RT), which normally incorporates radiolabeled deoxynucleoside triphosphates into a synthetic template primer. For the 3TCTP assay, a preincubation procedure was added whereby 3TCTP becomes incorporated before [(3)H]dCTP. At a 1:400 template primer dilution, control product formation was reduced by 88.0% with 0.8 pmol of 3TCTP. Standard 3TCTP inhibition curves were performed using this procedure. For the CBVTP assay, 0.1 pmol of CBVTP inhibited control product formation with and without the use of a preincubation step, so inhibition curves were constructed using both procedures. However, reduced template primer stability with assays using preincubation steps led to a single-incubation procedure being adopted for future studies. The presence of PBMC extracts interfered with the 3TCTP assay. However, this was overcome by the addition of CuSO(4). PBMC extracts did not interfere with the CBVTP assay. Intracellular 3TCTP and CBVTP concentrations were determined in PBMCs from HIV-infected patients over 24 h or greater. Peak concentrations were obtained 6 to 8 h after dosing, and the half-lives of the anabolites suggested the possibility of once-daily dosing. These assays are currently being used for determination of 3TCTP and CBVTP concentrations in clinical studies.
Chemistry Techniques, Analytical↗
Intracellular accumulation of human immunodeficiency virus protease inhibitors.
Intracellular accumulation of the protease inhibitors (PIs) saquinavir (SQV), ritonavir (RTV), and indinavir (IDV) was determined in 50 human immunodeficiency virus-positive patients. Following extraction, PIs were quantified by mass spectrometry. Paired plasma and intracellular samples were collected over a full dosing interval from patients (13 on SQV, 6 on RTV, 8 on IDV, 16 on SQV plus RTV, 7 on IDV plus RTV) with a plasma viral load of <400 copies/ml. Data were expressed as intracellular/plasma drug concentration ratios. A hierarchy of intracellular accumulation was demonstrated by the following medians: 9.45 for SQV > 1.00 for RTV > 0.51 for IDV. Coadministration of RTV did not boost ratios of SQV or IDV within the cell or in plasma, although absolute plasma and intracellular SQV concentrations were increased by RTV. Seven individuals receiving SQV in hard-gel capsule form (median, 32 months) had higher intracellular/plasma drug ratios than all other patients receiving SQV (median, 17.62 versus 4.83; P = 0.04), despite consistently low plasma SQV concentrations. How this occurs may provide insight into the mechanisms that limit adequate drug penetration into sanctuary sites.
Adolescent↗
Implementation of an oxygen therapy clinic to manage users of long-term oxygen therapy.
STUDY OBJECTIVES: To evaluate the initial benefits of establishing an oxygen therapy clinic (OTC) to manage users of long-term oxygen therapy (LTOT). DESIGN: Cross-sectional observational study. SETTING: Military-affiliated, tertiary care hospital. PATIENTS OR PARTICIPANTS: Current users of LTOT at our institution and patients with new oxygen prescriptions between June 2000 and May 2001. INTERVENTION: The OTC evaluation consisted of a focused medical interview and physical examination by a respiratory therapist. Demographic data, indications for supplemental oxygen, oxygen-related diagnoses, cardiopulmonary review of systems, pertinent physical examination findings, pulmonary function testing, and oximetry data were recorded. Patients prescribed oxygen during hospitalization were followed up for recertification within 90 days based on the recommendations of the Fifth Oxygen Consensus Conference. Also, patients with existing oxygen prescriptions and new oxygen prescriptions during the study period were evaluated in the OTC. Data are provided for the initial evaluation in this clinic. MEASUREMENTS AND RESULTS: A total of 283 patients were evaluated in the OTC during the study period. Ninety-seven patients with a new oxygen prescription during hospitalization were evaluated, with a mean +/- SE time from discharge to evaluation of 2.6 +/- 0.4 months. At follow-up, 50.5% of these patients no longer met Medicare guidelines for LTOT. A significant change in oxygen prescription was required in 27.9% of these patients. A total of 95 outpatients with existing oxygen prescriptions were contacted for recertification in the OTC. Of these patients, 31.6% no longer met Medicare criteria for LTOT and 26% required a significant change to their oxygen prescription. Oxygen therapy was discontinued in 22% of the 91 patients who were referred from other outpatient clinics, and the oxygen prescription was changed in another 29.7%. CONCLUSIONS: Results of this initial evaluation suggest that the institution of a respiratory therapist-managed OTC to manage home oxygen patients can significantly decrease inappropriate supplemental oxygen use, which can result in significant cost savings while providing improved health-care delivery. Further evaluation is necessary to identify the long-term benefits and cost savings in this population.
Aged↗