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Biomedical subjects

L Kay

Publications and source records attributed to L Kay.

At least 19 recordsLinked to original sources
PubMed2006

Current provision of rheumatology education for undergraduate nursing, occupational therapy and physiotherapy students in the UK.

OBJECTIVES: Rheumatological conditions are common and all health professionals (HPs) therefore need sufficient knowledge and skills to manage patients safely and effectively. The aim of this study was to examine current undergraduate education in rheumatology for HPs in the UK. METHODS: A questionnaire was sent to curriculum organizers and clinical placement officers for all undergraduate courses in adult nursing, occupational therapy (OT) and physiotherapy (PT) in the UK to ascertain the nature and amount of rheumatology theory and clinical exposure provided. RESULTS: Of the 47 adult nursing, 26 OT and 30 PT undergraduate courses surveyed, 85-90% responded. Overall, rheumatology teaching is 5-10 h over 3 yr. Nursing students receive moderate/in-depth teaching on rheumatoid arthritis (RA) in only 52% of courses (OT 91%, PT 96%) and on osteoarthritis (OA) in 63% (OT 91%, PT 92%). Clinical experience of RA is probably/definitely available in only 56% of nursing courses (OT 72%, PT 88%), with similar results in OA. Overall, nursing students receive the least rheumatology exposure, particularly in psychosocial issues and symptom management, while PT students receive the most. OT students have limited opportunities for clinical exposure to psychosocial and joint protection issues. Use of local rheumatology clinical HP experts is variable (18-93%) and cross-disciplinary exposure is limited (0-36%). Many educators consider their rheumatology training to be insufficient (nursing 50%, PT 42%, OT 24%). CONCLUSIONS: Rheumatology training for undergraduate HPs is limited in key areas and often fails to take advantage of local clinical expertise, with nursing students particularly restricted. Clinical HP experts should consider novel methods of addressing these shortfalls within the limited curriculum time available.

Allied Health Occupations↗
PubMed2004

Regional Examination of the Musculoskeletal System (REMS): a core set of clinical skills for medical students.

OBJECTIVES: The aim of this study was to determine an agreed set of core regional musculoskeletal examination skills for medical students to learn. METHODS: Initially focus groups were undertaken amongst Rheumatologists, Orthopaedic Surgeons, Geriatricians and General Practitioners. These findings were used to inform the production of a questionnaire survey. The findings from both the questionnaire survey and focus groups were assessed using a group nominative technique with national representation from each of the four specialties involved. RESULTS: This process has led to the identification of 50 items, considered to be core regional musculoskeletal examination skills for medical students. CONCLUSIONS: This core set of musculoskeletal clinical skills may now be used to inform the production of teaching materials aimed at medical students.

Attitude of Health Personnel↗
PubMed2003

Treatment of urinary incontinence in cystic fibrosis.

BACKGROUND: Urinary incontinence (UI) is a newly recognised problem in cystic fibrosis. Whilst prevalence is well documented, there are no reports of assessment and treatment of the problem. METHODS: A previous study reports the prevalence of UI in women with CF to be 51/75 (68%). Nineteen women subsequently requested help for the problem and were referred to a physiotherapist specialising in women's health. A digital assessment was performed to measure pelvic floor muscle strength and endurance. An individualised programme of pelvic floor muscle exercises (PFME) was taught based on the assessment. A questionnaire addressed issues of assessment and treatment. RESULTS: 12 women were assessed. The median (range) age, FEV1% predicted and BMI were 20.9 (19.3-46.1) years, 45.9 (14.8-82.7) and 20.5 (16.1-26.0), respectively. The median strength of the pelvic floor muscle was moderate (Oxford Scale grade 3) with a hold time (endurance) of 5 s. At reassessment (median time 13.1 weeks), there was an improvement in endurance (P = 0.04), with no change in strength. This was supported by a subjective improvement in symptoms. Patients found the exercises were difficult to perform, difficult to fit into their treatment programme and adherence was poor. CONCLUSIONS: PFME are effective at improving endurance and reducing leakage over the short-term. Women are reluctant to be assessed and the CF team should provide support and encouragement with treatment. Long-term outcome and the mechanisms of UI in this group of patients need further evaluation.

Adolescent↗
PubMed2001

Intracellular energetic units in red muscle cells.

The kinetics of regulation of mitochondrial respiration by endogenous and exogenous ADP in muscle cells in situ was studied in skinned cardiac and skeletal muscle fibres. Endogenous ADP production was initiated by addition of MgATP; under these conditions the respiration rate and ADP concentration in the medium were dependent on the calcium concentration, and 70-80% of maximal rate of respiration was achieved at ADP concentration below 20 microM in the medium. In contrast, when exogenous ADP was added, maximal respiration rate was observed only at millimolar concentrations. An exogenous ADP-consuming system consisting of pyruvate kinase (PK; 20-40 units/ml) and phosphoenolpyruvate (PEP; 5 mM), totally suppressed respiration activated by exogenous ADP, but the respiration maintained by endogenous ADP was not suppressed by more than 20-40%. Creatine (20 mM) further activated respiration in the presence of ATP and PK+PEP. Short treatment with trypsin (50-500 nM for 5 min) decreased the apparent K(m) for exogenous ADP from 300-350 microM to 50-60 microM, increased inhibition of respiration by PK+PEP system up to 70-80%, with no changes in MgATPase activity and maximal respiration rates. Electron-microscopic observations showed detachment of mitochondria and disordering of the regular structure of the sarcomere after trypsin treatment. Two-dimensional electrophoresis revealed a group of at least seven low-molecular-mass proteins in cardiac skinned fibres which were very sensitive to trypsin and not present in glycolytic fibres, which have low apparent K(m) for exogenous ADP. It is concluded that, in oxidative muscle cells, mitochondria are incorporated into functional complexes ('intracellular energetic units') with adjacent ADP-producing systems in myofibrils and in sarcoplasmic reticulum, probably due to specific interaction with cytoskeletal elements responsible for mitochondrial distribution in the cell. It is suggested that these complexes represent the basic pattern of organization of muscle-cell energy metabolism.

Adenosine Diphosphate↗
PubMed2001

Functional complexes of mitochondria with Ca,MgATPases of myofibrils and sarcoplasmic reticulum in muscle cells.

Regulation of mitochondrial respiration in situ in the muscle cells was studied by using fully permeabilized muscle fibers and cardiomyocytes. The results show that the kinetics of regulation of mitochondrial respiration in situ by exogenous ADP are very different from the kinetics of its regulation by endogenous ADP. In cardiac and m. soleus fibers apparent K(m) for exogenous ADP in regulation of respiration was equal to 300-400 microM. However, when ADP production was initiated by intracellular ATPase reactions, the ADP concentration in the medium leveled off at about 40 microM when about 70% of maximal rate of respiration was achieved. Respiration rate maintained by intracellular ATPases was suppressed about 20-30% during exogenous trapping of ADP with excess pyruvate kinase (PK, 20 IU/ml) and phosphoenolpyruvate (PEP, 5 mM). ADP flux via the external PK+PEP system was decreased by half by activation of mitochondrial oxidative phosphorylation. Creatine (20 mM) further activated the respiration in the presence of PK+PEP. It is concluded that in oxidative muscle cells mitochondria behave as if they were incorporated into functional complexes with adjacent ADP producing systems - with the MgATPases in myofibrils and Ca,MgATPases of sarcoplasmic reticulum.

Adenosine Diphosphate↗
PubMed2001

Bioacoustic spatial perception by humans: a controlled laboratory measurement of spatial resolution without distal cues.

The angular spatial resolution of a wide-angle air sonar using a continuous transmission frequency-modulated radiation, with the output coupled binaurally to the auditory system of a user, was measured under restrained controlled conditions. This was done to determine the effect of adding a narrow central field of view of 9 deg to a wide-angle sonar. The target objects were three equidistant vertical rods initially spaced apart by 10 deg. This was varied down to a spacing of 4 deg. Ten nonvisual subjects achieved an angular resolution of 6 deg. Four of these ten subjects continued learning to achieve an unexpected spatial resolution of 4 deg within the 9 deg central field. A mean error of approximately 1 deg in direction accuracy was achieved. It is inferred that the unique variations in the octave band ultrasonic echoes within the narrow field, and the invariance of the on-axis echo as one's head is turned, enables this angular resolution and accuracy to be achieved within the wide binaural field of view of 50 deg. This ability to resolve specula objects within a narrow angular resolution element of 9 deg is linked to the bat's ability to seemingly resolve object glints within a distal resolution element of less than 2 wavelengths.

Acoustic Stimulation↗
PubMed2000

[Differences in definitions of irritable bowel syndrome].

Irritable bowel syndrome is inconsistently defined. The resulting difference in study populations may impede general application of results from one study to another. The aim of this study was to evaluate the consistency of various definitions. At a follow-up of a sex-and age-stratified randomly selected cohort, participants filled in a questionnaire about abdominal symptoms. Questions categorized the participants according to five different definitions of irritable bowel syndrome:1) two Manning criteria,2) Rome criteria,3) consensus report by Drossman,4) definition by Talley and 5) definition by Kay. The participation rate was 64.4%. Manning and Rome criteria were consistent with a kappa value of 0.72. Consistency was also present comparing definitions of Drossman. Tallay and Kay (kappa values of 0.60-0.66) All other comparisons had kappa values below 0.42. It is concluded that variations in study population selected by different definitions of Irritable Bowel Syndrome are so large that they impede general application of any results. There is a need for an international agreement on a definition of irritable bowel syndrome.

Abdominal Pain↗
PubMed2000

Direct evidence for the control of mitochondrial respiration by mitochondrial creatine kinase in oxidative muscle cells in situ.

The efficiency of stimulation of mitochondrial respiration in permeabilized muscle cells by ADP produced at different intracellular sites, e.g. cytosolic or mitochondrial intermembrane space, was evaluated in wild-type and creatine kinase (CK)-deficient mice. To activate respiration by endogenous production of ADP in permeabilized cells, ATP was added either alone or together with creatine. In cardiac fibers, while ATP alone activated respiration to half of the maximal rate, creatine plus ATP increased the respiratory rate up to its maximum. To find out whether the stimulation by creatine is a consequence of extramitochondrial [ADP] increase, or whether it directly correlates with ADP generation by mitochondrial CK in the mitochondrial intermembrane space, an exogenous ADP-trap system was added to rephosphorylate all cytosolic ADP. Under these conditions, creatine plus ATP still increased the respiration rate by 2.5 times, compared with ATP alone, for the same extramitochondrial [ADP] of 14 microM. Moreover, this stimulatory effect of creatine, observed in wild-type cardiac fibers disappeared in mitochondrial CK deficient, but not in cytosolic CK-deficient muscle. It is concluded that respiration rates can be dissociated from cytosolic [ADP], and ADP generated by mitochondrial CK is an important regulator of oxidative phosphorylation.

Adenosine Diphosphate↗
PubMed2000

Role of the creatine/phosphocreatine system in the regulation of mitochondrial respiration.

The mechanism of metabolic regulation of mitochondrial respiration in cardiac muscle cells was studied experimentally in the permeabilized heart fibres of mice and by computer modelling in silico. The experiments showed that the rate of mitochondrial respiration could be controlled by local production of ADP by mitochondrial creatine kinase in the intermembrane space of mitochondria. The spatially inhomogenous reaction-diffusion model of compartmentalized energy transfer was used to analyse which metabolite level in cytoplasm may be important for regulation of respiration. At low and moderate workloads, up to VO2 equal to 70 micromol min-1 g-1 dry weight, the only factor to which respiration responded was inorganic phosphate. At the values of VO2 higher than 70 micromol min-1 g-1 dry weight, the respiration rate responded mostly to changes in creatine, phosphocreatine and then time-averaged (over the contractile cycle) ADP concentrations in the cytoplasm. These results are taken to show that under conditions of moderate workloads, creatine kinase activity at given physiological creatine and phosphocreatine concentrations (apparent maximal activity achievable under these conditions) is in excess to oxidative phosphorylation rate, which is controlled by Pi concentration changes starting from very low values of the latter. At higher workloads mi-CK should be upregulated by increasing creatine and decreasing phosphocreatine concentrations, and only at very high workloads the ADP diffusion flux should be increased to upregulate oxidative phosphorylation. Thus, on the basis of the study in silico of compartmentalized energy transfer by phophocreatine/creatine system, the authors conclude that there exist multiple parallel regulatory factors controlling the rate of oxygen consumption in dependence of the workload. If creatine kinase is inhibited (and there is no myokinase activity), respiration requires high diffusive flux of ADP back into mitochondria, which is the sole regulator of respiration. This needs, however, increased ADP concentrations in the cytoplasm, which in turn result in inhibition of contraction.

Animals↗
PubMed2000

A ureterocutaneous fistula forty years after nephrectomy.

The case of a woman presenting with a ureterocutaneous fistula 40 years after nephrectomy is described. Because of advanced respiratory disease and absence of infective activity, a conservative line of treatment with saline rinse was given. At 3 months follow-up the fistula had become chronic, with a small opening without signs of infection and ultrasound revealed no abscess.

Aged↗
PubMed2000

Auditory perception of objects by blind persons, using a bioacoustic high resolution air sonar.

A high-resolution octave band air sonar for spatial sensing and object imaging by blind persons is described. The system has wide-angle overlapping peripheral fields of view with a narrow central field superposed. It is noninvasively coupled to the auditory system for neural processing and spatial imaging. Blind persons learn to comprehend the auditory cortical multiple-object image that is created. The real-time synchronous relationship between hearing a change in the sensor sounds and the sensed motor actions causing the change seems to aid the learning process. Computer based testing of the sensor system is described so as to relate the physical system performance with the time-varying human auditory perception. This is so that the basic psychometric experiments studying the sensor bio-acoustic spatial resolution, resulting from the superposition of two wide-angle peripheral fields with one central narrow field, may be better understood. These tests confirm that the auditory ability of subjects to resolve close objects using the combined fields is significantly improved relative to using the peripheral fields alone. These measurements are supported by blind children learning to use the sensor system.

Acoustic Stimulation↗
PubMed1999

Lower urinary tract symptoms--a population survey using the Danish Prostatic Symptom Score (DAN-PSS) questionnaire.

OBJECTIVE: To describe voiding problems and the trouble they cause in a Danish population. Furthermore, to find symptoms specific for the ageing man, and thereby symptoms that might relate to an enlarged prostate. MATERIAL AND METHODS: The DAN-PSS questionnaire was mailed to a gender- and age-stratified random sample of 500 inhabitants in Herlev municipality. Prevalence of the symptoms and the trouble they cause were calculated and related to age and gender by the x2 test for trend and the chi2 test, respectively. RESULTS: The response rate was 73.6%. In total, 84.5% of the subjects had experienced at least one symptom within the previous fortnight. The various symptom prevalences ranged from 3.8-67.1%. Although many subjects experienced symptoms, they were not always bothered by them, and women were generally more bothered than men. Weak stream, hesitancy and dribbling occurred more often among men, whereas incontinence (stress, mixed) occurred more often among women. Nocturia and mixed incontinence increased in prevalence with increasing age among both men and women. Weak stream, incomplete emptying, stress and urge incontinence showed an age-related increase in prevalence among men, but not among women. These might therefore be symptoms of an enlarged prostate. CONCLUSION: Lower urinary tract symptoms occur with high prevalence in the background population, but they do not always cause trouble. Weak stream, incomplete emptying, stress and urge incontinence seem to be symptoms of an enlarged prostate.

Adult↗
PubMed1998

Improving musculoskeletal clinical skills teaching. A regionwide audit and intervention study.

OBJECTIVE: To identify factors that influence medical students' perceptions of the quality of a clinical skills course; to apply these factors to the course at one hospital; to measure the effect of this change. DESIGN: Cross sectional questionnaire survey; application of identified factors; repeat questionnaire survey. SETTING: Three teaching hospitals and five district general hospitals in north east England. SUBJECTS: Third year medical students attending locomotor clinical skills courses in two consecutive years. MAIN OUTCOME MEASURES: Score awarded by students in five categories; numbers of patients seen by each student; comparisons with other clinical skills weeks. RESULTS: Response rates were 71 of 150 and 89 of 161. Factors associated with a high awarded score were: organisation of the course by a rheumatologist (p < 0.01); teaching from a rheumatologist (p < 0.01); higher number of patients seen (r = 0.76). Mean number of patients seen varied widely, from 7 per student at one hospital to 20.4 at another. Teaching hospitals scored poorly. In the second year, after making changes at one teaching hospital the mean total score improved (p < 0.01), and students saw more patients (p < 0.01). The ranking of this hospital rose from 6 to 1. The additional cost of the modified course was 640 pounds per student. CONCLUSIONS: The standard of teaching of locomotor clinical skills varies widely and can be improved by application of factors identified in this survey, although additional costs are incurred.

Clinical Competence↗