Search PubMedSearch

Biomedical subjects

L Elliott

Publications and source records attributed to L Elliott.

At least 19 recordsLinked to original sources

An audit of waiting times in a haematology clinic before and after the introduction of point-of-care testing.

Haematology patients are frequent attenders at haematology clinics either as a result of their illness or their treatment. We identified that waiting times in the haematology clinic were an important quality indicator for patients within the haematology service. In this study we have surveyed 50 consecutive patients in order to establish maximum waiting times in the haematology clinic. We then prospectively audited waiting times against these standards. An evaluation of the introduction of an air-tube transport system for conveying samples to the laboratory combined with the electronic transfer of results back to the clinic in an attempt to reduce waiting times has been compared with the introduction of point-of-care testing in the clinic. Point-of-care testing was introduced by transporting our backup analyser from the haematology laboratory to the clinic on a weekly basis. The tests were performed by nurse specialists who were already in the clinic and had been trained in the use of the analyser. The patient survey resulted in the establishment of a maximum waiting time of 30 min with a longer term aim to reduce this to a maximum of 20 min. The introduction of an air-tube transport system linked to electronic transfer of results, despite repeated audits, could not achieve the waiting time standard. Once point-of-care testing had been introduced, the clinic waiting times consistently achieved the standard that had been set by patients.

Hematology

A community based lesbian sexual health service - clinically justified or politically correct?

Lesbian sexual health care is still a neglected issue. In order to address this, a needs assessment was carried out in Glasgow amongst the lesbian community and 200 responses were received. More than 40% of the respondents said they were unable to disclose their sexual orientation to their GP and were unable to discuss sexual health issues with them. Eighty-one percent said there was a need for a lesbian sexual health service and 71% said they would use such a service if it existed. Therefore a pilot clinic was set up in Glasgow and was co-ordinated by a multidisciplinary advisory group. The clinical component of the service was audited and it was found that gynaecology and fertility issues were the most common presenting condition (52%), followed by psychosocial issues (26%). Genitourinary problems, such as vaginal discharge, constituted 20% of presentations. Client satisfaction with the clinic was high. This pilot service showed that areas of sexual health care, such as the need for inclusion in cervical smear programmes and equality of access to assisted conception, are issues which are important to this minority group and which need to be addressed. The clinic is now ongoing as a result of the pilot scheme and is the only family planning based lesbian health service in the UK.

Adolescent

Curcumin blocks cyclosporine A-resistant CD28 costimulatory pathway of human T-cell proliferation.

INTRODUCTION: Curcumin (Cur) is a phenolic component of common spice, turmeric. We have reported earlier that it possesses antineoplastic and immunosuppressive properties in vitro. It has been reported that cyclosporine A (CyA), a commonly used immunosuppressant does not inhibit CD28 costimulatory pathway of T-cell activation. We hypothesized that Cur, a tyrosine kinase inhibitor, would block CyA-resistant CD28 costimulatory pathway of human T cell proliferation. MATERIALS AND METHODS: Human T-lymphocytes were isolated from healthy donors using gradient centrifugation and rosetting techniques. In four separate experiments T-cells were plated in triplicate in 96-well plates at a density of 2X105 cells/well. These cells were stimulated with 0.5 ng/ml phorbol myristate acetate (PMA) + 0.5 (g/ml anti-CD28 antibody (PMA-CD28 group) or 2.5 microgram/ml PHA (PHA group). Cur or CyA at varying concentrations (0.31, 0.625, 1.25, 2.5, 5, or 10 microgram/ml and 1.25, 2.5, 5, 10, 20, or 250 ng/ml, respectively) was added and cellular proliferation was measured by the uptake of [3H]thymidine and is reported (mean cpm/well(SD). Cells from the PMA-CD28 group that were treated with either curcumin or 0.4% DMSO (vehicle control for curcumin) were studied for evidence of apoptosis by staining with viable dyes MC540 and Hoechst 33342 and subsequently analyzed in the cell sorter. RESULTS: Cur caused a concentration-dependent inhibition of T-cell proliferation in the PMA-CD28 group (from 32775 +/- 3084 to 66 +/- 42 at 5.0 microgram/ml of cur) and PHA group (from 50956 +/- 5747 to 24 +/- 12 at 5.0 microgram/ml) with a calculated ED50 of 3.5 and 7.7, microM respectively. CyA inhibited T-cell proliferation in the PHA group with a calculated ED50 of 2.7 ng/ml but failed to block PMA + anti-CD28-stimulated T-cell proliferation even at 250 ng/ml. PMA-CD28 group cells treated with 10 microgram/ml curcumin showed a significantly increased apoptosis as compared to control (0.4% DMSO). CONCLUSION: Since Cur blocks the CyA-resistant PMA + anti-CD28 pathway of T-cell proliferation, it may have novel adjuvant immunosuppressive properties.

Anti-Inflammatory Agents, Non-Steroidal

Effect of topical anesthetic use on initial patient satisfaction and overall success with rigid gas permeable contact lenses.

BACKGROUND: Rigid gas permeable (RGP) contact lenses have numerous benefits; however, RGP lens use is not increasing in the United States. An important factor for this trend has been initial comfort. Studies have demonstrated that how RGPs are presented to patients, in addition to lens design, can play an important role in the initial comfort process. Another important factor could be the use of a topical anesthetic during the fitting and dispensing visits. The purpose of this study was to use a multicenter format to determine if topical anesthetic use increased the likelihood of patient satisfaction and success. METHODS: A total of 80 subjects, with no previous rigid lens wear experience, was entered into this 1-month study, including 20 subjects from each of 4 institutions. Subjects were randomly divided into the following two groups: (A) anesthetic or (B) placebo, with the former group receiving one drop of a topical anesthetic before lens insertion at both the diagnostic fitting and dispensing visits, whereas the latter group received a placebo. Subjects completed a questionnaire on their perception of rigid lens wear both immediately before fitting and at the 1-month visit. After diagnostic fitting with rigid lenses, subjects completed an adaptation questionnaire after 15 min, 1 week, 2 weeks, and 1 month of lens wear. RESULTS: Seventy of the 80 subjects completed the study and, of the 10 subjects who discontinued, 8 were in the placebo group. In all categories evaluated, the anesthetic group experienced a more optimum adaptation experience at each visit vs. the placebo group. Specifically, overall comfort was rated significantly higher at both dispensing and 2 weeks. In addition, the anesthetic group exhibited significantly greater overall satisfaction with rigid lens wear at 2 and 4 weeks. Also, the anesthetic group perceived their adaptation, sensitivity, and adaptation time to be significantly better at the 1-month visit. There was no significant difference in corneal staining between these two groups at each visit, with the exception of a greater amount of staining in the central quadrant for the placebo group at the 1-month visit. CONCLUSIONS: The use of a topical anesthetic at the fitting and dispensing visits for first-time wearers of RGP lenses resulted in significantly fewer dropouts, improved initial comfort, an enhanced perception of the adaptation process, and greater overall satisfaction after 1 month of lens wear as compared to the use of a nonanesthetizing placebo at those visits. This result, in combination with both presenting RGP lenses in a nonthreatening manner and optimizing the lens design and fitting relationship, should result in a positive adaptation process and successful wear of RGP contact lenses.

Adaptation, Physiological

Cerebral syncope: loss of consciousness associated with cerebral vasoconstriction in the absence of systemic hypotension.

Transcranial Doppler (TCD) ultrasonography done during head-upright tilt induced neurocardiogenic syncope has demonstrated that cerebral vasoconstriction occurs concomitant with (or precedes) loss of consciousness. This article demonstrates evidence that cerebral blood flow changes alone (vasoconstriction), in the absence of systemic hypotension, may result in syncope. Five patients (4 men, 1 woman; mean age 41 +/- 17 years) with recurrent unexplained syncope were evaluated by use of an upright tilt table test for 45 minutes with or without an infusion of low dose isoproterenol. TCDoppler ultrasonography was used to assess middle cerebral artery systolic velocity (Vs); diastolic velocity (Vd); mean velocity (Vm); and pulsatility index (PI = Vs = Vd/Vmean). Syncope occurred in five patients during the baseline tilt and in one patient during isoproterenol infusion. During tilt induced syncope, at an average mean arterial pressure of 89 +/- 16 mmHg, TCD sonography showed a 2% +/- 10% increase in systolic velocity; a 51% +/- 27% decrease in diastolic velocity; and a 131% +/- 87% increase in pulsatility index. One patient underwent continuous electroencephalographic recording during tilt, which demonstrated diffuse slow wave activity (indicating cerebral hypoxia) at the time of syncope concomitant with the aforementioned TCD changes in the absence of systemic hypotension. These findings reflect an increase in cerebrovascular resistance secondary to arteriolar vasoconstriction distal to the insonation point of the middle cerebral artery, that occurred concomitant with loss of consciousness and in the absence of systemic hypotension. We conclude that in some individuals abnormal baroreceptor responses triggered during orthostatic stress may result in a derangement of cerebral autoregulation leading to cerebral vasoconstriction with resultant cerebral hypoxia in the absence of systemic hypotension.

Adolescent

Inhibition of bovine nasal cartilage degradation by selective matrix metalloproteinase inhibitors.

N-terminal analysis of aggrecan fragments lost from bovine nasal cartilage cultured in the presence of recombinant human interleukin 1alpha revealed a predominant ARGSVIL sequence with an additional ADLEX sequence. Production of the ARGSVIL-containing fragments has been attributed to the action of a putative proteinase, aggrecanase. The minor sequence (ADLEX) corresponds to a new reported cleavage product; comparison of this sequence with the available partial sequence of bovine aggrecan indicates that this is the product of a cleavage occurring towards the C-terminus of the protein. Matrix metalloproteinase (MMP) inhibitors inhibited aggrecan loss from bovine nasal explants incubated in the presence of recombinant human interleukin 1alpha. A strong correlation between inhibition of aggrecan metabolism and inhibition of stromelysin 1 (MMP 3) (r=0.93) suggests a role for stromelysin or a stromelysin-like enzyme in cartilage aggrecan metabolism. However, the compounds were approx. 1/1000 as potent in inhibiting aggrecan loss from the cartilage explants as they were in inhibiting stromelysin. There was little or no correlation between inhibition of aggrecan metabolism and inhibition of gelatinase B (MMP 9) or inhibition of collagenase 1 (MMP 1). Studies with collagenase inhibitors with a range of potencies showed a correlation between inhibition of collagenase activity and inhibition of collagen degradation in the cartilage explant assay. This indicates that in interleukin 1alpha-driven bovine nasal cartilage destruction, stromelysin (or a closely related enzyme) is involved in aggrecan metabolism, whereas collagenase is principally responsible for collagen degradation.

Aggrecans

Ro 32-3555, an orally active collagenase inhibitor, prevents cartilage breakdown in vitro and in vivo.

1. Ro 32-3555 (3(R)-(cyclopentylmethyl)-2(R)-[(3,4,4-trimethyl-2,5-dioxo-1- imidazolidinyl)methyl]-4-oxo-4-piperidinobutyrohydroxamic acid) is a potent, competitive inhibitor of human collagenases 1, 2 and 3 (Ki values of 3.0, 4.4 and 3.4 nM, respectively). The compound is a selective inhibitor of collagenases over the related human matrix metalloproteinases stromelysin 1, and gelatinases A and B (Ki values of 527, 154 and 59 nM, respectively). 2. Ro 32-3555 inhibited interleukin-1 alpha (IL-1 alpha)-induced cartilage collagen degradation in vitro in bovine nasal cartilage explants (IC50 = 60 nM). 3. Ro 32-3555 was well absorbed in rats when administered orally. Systemic exposure was dose related, with an oral bioavailability of 26% at a dose of 25 mg kg-1. 4. Ro 32-3555 prevented granuloma-induced degradation of bovine nasal cartilage cylinders implanted subcutaneously into rats (ED50 = 10 mg kg-1, twice daily, p.o.). 5. Ro 32-3555 dosed once daily for 14 days at 50 mg kg-1, p.o., inhibited degradation of articular cartilage in a rat monoarthritis model induced by an intra-articular injection of Propionibacterium acnes. 6. Ro 32-3555 is a potential therapy for the treatment of the chronic destruction of articulating cartilage in both rheumatoid and osteoarthritis.

Administration, Oral

The Sexual Health Help Centre: a service for young people.

BACKGROUND: The Sexual Health Help Centre (SHHC) was opened in 1995 to provide treatment, advice and information on family planning and sexual health issues for young people under the age of 20 years, in a way which is open and non-threatening. This paper describes an evaluation conducted during the first 9 months of service operation. METHODS: Young people's experience of the SHHC were elicited, and compared with their experiences of conventional family planning services in Glasgow. RESULTS: The SHHC has been successful in attracting young people for help with family planning problems and provides a more acceptable environment than conventional family planning services. However, a greater number of young men and young people under the age of 16 should be encouraged to attend the service. CONCLUSION: Young people are more likely to visit family planning services if they are offered a wide range of family planning and sexual health services in a non-judgmental, non-threatening environment.

Adolescent

Proposed model for estimating dose to inhabitants of 60Co contaminated buildings.

A model to predict the time weighted exposures to gamma radiation was developed for buildings constructed with structural steel having some contamination from 60Co. Several buildings throughout sixteen city blocks in downtown Taipei were built about ten years ago with this material. These buildings were used for residential, business, and educational purposes with radiation levels ranging from background to five hundred times background. A comprehensive epidemiologic study by the National Yang Ming University Medical School in Taipei is underway to study the effects of this exposure to the building occupants. An evaluation of external radiation exposure was performed using survey instruments and thermoluminescent dosimeters. Exposure data from the survey instruments were used in a computer model developed to calculate cumulative radiation exposure estimates for the epidemiologic research. While the survey instrument data provided radiation levels at a point in time, the thermoluminescent dosimeters were placed in fixed locations and on several volunteers for a period of one month to verify the modeling results. The model itself is a mathematical algorithm that provides estimates with minimum and maximum range values by taking into account differences in the survey data between adults and children, variable occupancy patterns, background radiation, and radioactive decay. Several assumptions (background rates, height adjustment values, and occupancy factors) are easily adjusted to improve the estimated radiation exposures. The model predicted the exposures as measured by the thermoluminescent dosimeters with greater reliability for adults than for children. The differences between the two methods were about 10-15% for the adults and about 60% for the child. This strategy, its advantages, limitations, and its performance against actual thermoluminescent dosimeter measurements are presented.

Activities of Daily Living

Injecting-related harm and treatment-seeking behaviour among injecting drug users.

AIMS: This study aims to identify the physical harm associated with injecting drug use and examine the treatment-seeking behaviour of injecting drug users (IDUs). Specific attention is given to the factors associated with presentation and non-presentation of injecting-related problems. DESIGN: Participants were interviewed by research staff using a semi-structured questionnaire, then physically examined by a medical team. SETTING: Needles exchanges in Glasgow. PARTICIPANTS: One hundred and twelve injecting drug users. FINDINGS: Respondents' accounts of their current injecting-related problems were found to be consistent with the clinician's findings, suggesting that IDUs are able to self-diagnose injecting-related harm. However, almost three-quarters had not sought help for these problems. Qualitative data suggest the main reasons for non-presentation, or delayed presentation, of injecting-related problems are normalization of injecting-related harm and a reluctance to attend available services. Almost half of those seeking treatment for injecting-related problems did so during an emergency or crisis. CONCLUSIONS: Low threshold services, such as needle exchanges, may have to take a more proactive stance to encourage injectors to present with injecting-related problems. This may help reduce injecting-related harms, especially the resulting medical complications, which would in turn relieve the pressure on other services such as hospital Accident and Emergency Departments.

Abscess

Olivopontocerebellar pathology in multiple system atrophy.

Olivopontocerebellar atrophy (OPCA) is widely accepted as part of the neuropathological spectrum of multiple system atrophy (MSA). The distribution of affected sites in the olivopontocerebellar (OPC) system and their interrelationship remain poorly understood due to lack of quantitative studies. To further investigate the OPC pathology in MSA, we performed a morphometric analysis of 20 MSA cases and eight healthy controls. In the MSA cases, mean neuronal cell densities were significantly reduced in (medial and dorsal) accessory and principal inferior olives, pontine nuclei, cerebellar vermis (except nodulus), and hemispheres. Inferior olives and pontine nuclei were more severely affected than cerebellar Purkinje cells in most cases. Cerebellar Purkinje cells were more severely depleted in vermis rather than in hemisphere. There was a poor topographic correlation between neuronal cell loss in inferior olives and cerebellar cortex. These results suggest a primary degeneration of olivopontine nuclei and cerebellar Purkinje cells in OPCA. Inferior olives, pontine nuclei and cerebellar cortex were all significantly more severely affected in cases with a pure or predominating cerebellar syndrome (OPCA type, n = 4) compared to those with pure or predominating parkinsonism (SND type, n = 14). However, although cerebellar signs had been noted in life in only six cases, morphometry revealed OPCA in 17 of the 20 MSA brains.

Adult

A primary health care service for Glasgow street sex workers--6 years experience of the "drop-in centre', 1989-1994.

In Glasgow, a health and social care centre opened in 1988 principally to facilitate HIV prevention among street prostitutes, most of whom are injecting drug users. During 1992 to 1994, 551 women made 17,554 visits to the medical room which is functional 5 nights per week. The mean age of the sex workers was 26 years (range 15 to 62) and 89% injected drugs. Fifty-five per cent of the attendances were for needle/syringe exchange only whilst the remainder involved other health care provision. Common presenting problems included abscesses, burns and venous thromboses, reflecting the high proportion of sex workers who injected drugs. Most women always used condoms for penetrative commercial sex and symptomatic sexually transmitted disease was seen infrequently. In addition to the provision of injecting equipment and condoms, other key prevention activities included Hepatitis B vaccination and cervical screening. The prevalence of HIV infection amongst the women remains under 5% and most seropositives were known to be infected before the Centre opened. This initiative shows that if multidisciplinary health and social services are provided to street sex workers at a time and place convenient to their work, the benefits are considerable.

Adolescent

Theatre in AIDS education--a controlled study.

Theatre is now widely used in HIV and AIDS education for young people. However, research concerning its effectiveness has largely been conducted without using comparison or control groups and there is little evidence that other types of intervention are more or less effective. The present study was designed to measure the effects of a theatre production on HIV knowledge, attitudes and risk behaviour of young people compared with that of a standard health education seminar which used group work techniques. Both interventions were designed for young people between the ages of 12 and 18 and held in 10 youth projects in socially deprived areas of Glasgow. Five youth projects were randomly assigned to each intervention. All participants were asked to complete a self-administered HIV knowledge, attitude and behavioural questionnaire immediately before and after the event and 2 months later. Research focus groups were also used. A total of 35 young people attending the standard seminars completed three self-administered questionnaires, and 18 participated in all three focus groups. Forty-two young people attending the theatre performances completed three self-administered questionnaires and 16 participated in all three focus groups. There was little impact on the knowledge and attitudes of either audience, although there was some evidence of attitudinal change among those exposed to the health education discussion session. More of the theatre group reported a behavioural change 2 months after attending the play but only in relation to buying and carrying condoms. It is uncertain whether this led to safer sex practices. This study does not support the view that theatre in AIDS education has a significant impact on HIV knowledge, attitudes and risk behaviour.

Acquired Immunodeficiency Syndrome