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Biomedical subjects

L McGill

Publications and source records attributed to L McGill.

At least 19 recordsLinked to original sources
PubMed1997

Alzheimer's disease in the United Kingdom: developing patient and carer support strategies to encourage care in the community.

Alzheimer's disease is a growing challenge for care providers and purchasers. With the shift away from the provision of long term institutional care in most developed countries, there is a growing tendency for patients with Alzheimer's disease to be cared for at home. In the United Kingdom, this change of direction contrasts with the policies of the 1980s and 90s which focused more attention on controlling costs than on assessment of the needs of the patient and carer and patient management. In recent years, the resources available for management of Alzheimer's disease have focused on institutional care, coupled with drug treatment to control difficult behaviour as the disease progresses. For these reasons, the current system has led to crisis management rather than preventive support--that is, long term care for a few rather than assistance in the home before the crises occur and institutional care is needed. Despite recent innovations in the care of patients with Alzheimer's disease, the nature of the support that patients and carers receive is poorly defined and sometimes inadequate. As a result of the shift towards care in the community, the informal carer occupies an increasingly central role in the care of these patients and the issue of how the best quality of care may be defined and delivered is an issue which is now ripe for review. The objective of this paper is to redefine the type of support that patients and carers should receive so that the disease can be managed more effectively in the community. The needs of patients with Alzheimer's disease and their carers are many and this should be taken into account in defining the quality and structure of healthcare support. This paper shows how new initiatives, combined with recently available symptomatic drug treatment, can allow patients with Alzheimer's disease to be maintained at home for longer. This will have the dual impact of raising the quality of care for patients and improving the quality of life for their carers. Moreover, maintaining patients in a home environment will tend to limit public and private expenditure on institutional care due to a possible delay in the need for it.

Aged↗
PubMed1996

Radiographic interpretation in the emergency department.

This study examined the concordance of radiographic readings between emergency department (ED) attending physicians and radiologists in a community teaching hospital. In addition, the incidents of misinterpretations leading to an alteration in patient care were also reviewed. All radiographs obtained from January through October 1993 were initially interpreted by ED attending physicians with subsequent final review by attending radiology staff. Misread radiographs were placed into one of three categories. The groupings included overread radiographs with no change in treatment, underread radiographs with no change in treatment, and radiograph misinterpretations with a change in treatment. Of 15,585 radiographs obtained during the study period, there were 120 misreads; 12,099 (77.6%) of the 15,585 radiographs had an initial emergency physician interpretation. Radiographic misinterpretations included 7 (5.78%) overreads, 57 (47.1%) underreads, and 57 (47.51%) misreads requiring follow-up (MR-FU). The five most frequently misread radiographs were: abdominal, 12/247 (4.4%); rib, 3/99 (3.0%); foot, 13/621 (2.1%); hip, 3/152 (1.9%); and ankle 11/758 (1.4%). The most frequently obtained radiographs included: chest, 7,012 (0.33% MR-FU); cervical spine, 1,112 (0.18% MR-FU); ankle, 758 (0.66% MR-FU); knee, 633 (0.32% MR-FU); and foot, 621 (0.97% MR-FU). In this study, 99.0% of all emergency department radiographs were read correctly on initial review by ED attending physicians. Of all misread radiographs, less than half (46%) were deemed clinically significant and required a follow-up intervention.

Diagnostic Errors↗
PubMed1994

ATPase kinetics for wild-type Saccharomyces cerevisiae F1-ATPase and F1-ATPase with the beta-subunit Thr197-->Ser mutation.

Unisite ATPase kinetic constants were measured for wild-type yeast Saccharomyces cerevisiae F1-ATPase and F1-ATPase with the Thr197-->Ser mutation in the beta subunit. Under unisite conditions, the concentration of ATP is greater than that of the enzyme, ATP hydrolysis is slow and the affinity of the enzyme for ATP and ADP is high. The Thr197-->Ser mutation in the yeast F1-ATPase increases the specific activity of ATP hydrolysis threefold and makes the enzyme much less sensitive to azide and oxyanions [Mueller, D. M. (1989) J. Biol. Chem. 264, 16552-16556]. A unifying hypothesis is that the affinity of F1-ATPase for ADP is altered by azide, oxyanions and the Thr197-->Ser mutation. To address this hypothesis, kinetic and thermodynamic constants were measured for the wild-type and mutant enzymes in the absence and presence of azide and oxyanions. The results indicate that sulfite and azide do not significantly alter unisite thermodynamic binding constants of either enzyme for ADP at the catalytic site. The mutation Thr197-->Ser has little effect on the binding constant for ADP, or on other unisite kinetic constants of the enzyme, in the presence or absence of azide or oxyanions. However, the binding of ADP to the enzyme was affected by oxyanions and the Thr197-->Ser mutation as measured by determining the KiADP values for multisite ATPase activity (saturating ATP). The Ki for ADP on ATPase activity was measured for the wild-type and mutant enzymes in the presence and absence of sulfite under multisite conditions. Sulfite increases the KiADP values for ATP hydrolysis under multisite conditions approximately threefold for the wild-type and mutant enzymes and the Thr197-->Ser mutation increases KiADP ninefold. The effect of sulfite on KiADP is additive to the effect of the Thr197-->Ser mutation, suggesting that these are distinct effects. These results indicate that the effects of azide, oxyanions, and the Thr197-->Ser mutation on the biochemistry of F1-ATPase are limited primarily to multisite conditions. Both sulfite and the Thr197-->Ser mutation decrease the affinity of the enzyme for ADP, as measured by the increase in the Ki values. Furthermore, the mechanisms of activation by sulfite and the Thr197-->Ser mutations are different. This difference occurs despite their common biochemical consequences on the apparent affinity for ADP.

Adenosine Diphosphate↗
PubMed1992

AIDS/HIV knowledge level and perceived chance of having HIV among rural adolescents.

Behaviors that increase the risk of acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) among adolescents living in rural areas have been reported to be as frequent as those of lower socioeconomic minority youth living in large urban areas. Little is known, however, about whether rural adolescents possess adequate knowledge upon which to make responsible decisions to avoid exposure to HIV. In order to address this deficit, we administered the Centers for Disease Control (CDC) 1989 Secondary School Health Risk Survey to 294 sixth, seventh, and eighth grade students (30.2% sample) from a rural county with significant social problems including epidemic sexually transmitted diseases STDs, sex-for-drugs, poverty, and drug abuse. The sample was 65% African-American, 50% female, with a mean age of 12.9 +/- 1.3 years. Although 68% reported having received school-based AIDS education, a lower proportion (greater than or equal to 10%) the students were found to correctly answer 8 of 17 AIDS/HIV knowledge questions than those from a national comparison group. The mean was 12.8 +/- 3.1 of 17 items answered correct. Lower AIDS/HIV knowledge was associated with lower school grade (rho = 0.46, p less than or equal to 0.0001); being African-American, Hispanic, or Native American (p less than or equal to 0.043); and never receiving school-based AIDS/HIV education (p less than or equal to 0.0001). Based on multivariate analysis of variance (ANOVA), only school-based AIDS/HIV education was a significant predictor (p less than or equal to 0.0001) of knowledge.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1991

Sexually transmitted disease treatment and return for test of cure of adolescents in a family planning clinic.

This retrospective study assessed the return for treatment and test-of-cure rates for gonorrhea and chlamydial infection among 154 adolescents and young adults attending a family planning clinic. Eighty-four percent returned for treatment and 57% of those returned for a test of cure. No statistical differences in race/ethnicity, marital status, gravida, age, presence of symptoms, or type of infection were found between those returning and those not returning for treatment. Issues associated with sexually transmitted disease treatment and follow-up in the family planning clinic setting are discussed.

Adolescent↗
PubMed1989

Vaginal douching in teenagers attending a family planning clinic.

This study assessed the knowledge and usage patterns of vaginal douching in sexually active teenagers attending a family planning clinic. A questionnaire was administered consecutively to 94 black, 36 Hispanic, and 12 Anglo females ranging in age from 13 to 19 years. The survey showed that vaginal douching is a common practice, with almost two thirds learning about douching from their mother. The technique is primarily used for hygienic reasons with few using it to prevent pregnancy or infection. Age of first douche correlated with age of first intercourse (p less than 0.001). Almost 23% had douched within 2 days of the clinic visit, and 56% reported douching one or more times a week.

Adolescent↗
PubMed1989

Hydrostatic pressure-induced colon trauma from a pool whip.

Hydrostatic pressure-induced colon injury is a rare occurrence in the pediatric population. We present a case of massive hydroperitoneum following a pool whip-induced injury. Although tension pneumoperitoneum or hydroperitoneum is rare, prompt recognition and surgical intervention are essential.

Cecum↗
PubMed1988

Predominant sexually transmitted diseases among different age and ethnic groups of indigent sexually active adolescents attending a family planning clinic.

The present study analyzed a group of 113 sexually active, indigent female adolescents attending a family planning clinic, for age, ethnic, or racial trends in the recovery of Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma species, and Ureaplasma urealyticum. The overall recovery rate for N. gonorrhoeae was 8/112 (7.1%), with the highest rate occurring in black patients (7/82, 8.5%). The overall recovery rate for C. trachomatis was 31/113 (27.4%), with the highest rate occurring in Hispanics (7/21, 33.3%). The isolation of C. trachomatis was evenly divided among patients grouped by reason for visit. Neisseria gonorrhoeae, on the other hand, was isolated more frequently from patients coming for a sexually transmitted disease screen than from those attending for other reasons. There was a significant (p less than 0.05) increase in isolation of Mycoplasma species from 18-19-year-old patients, but no such difference was observed for U. urealyticum when compared to younger age groups. Factors associated with venereal disease prevalence in our teenage indigent population as well as implications for the future reproductive health of such patients are discussed.

Adolescent↗
PubMed1987

Automated quantitative fluorescent image analysis of cervical cytology.

Cervical cytology from 122 patients with histories of one or more abnormal Pap smears were studied using slide-based automated quantitative fluorescence image analysis (QFIA) in order to determine the usefulness of the QFIA technique in detecting neoplasias. The purpose of the study was to evaluate the accuracy and validity of QFIA as a cytological method for the early detection of cervical cancer, based on comparisons with the conventional Pap smear and histopathology. The results of the analysis demonstrated that the sensitivity of the automated QFIA cytology was 100% for high-grade neoplasms (CIN III and invasive carcinoma), compared with 82% for the Pap smear. Evaluation of lower grade neoplasms was also performed. Initial analyses of the data indicate that QFIA, which uses objective biochemical criteria to identify cells with increased nuclear nucleic acid content, is a more sensitive detector of cervical neoplasia of all grades than is conventional Pap cytology.

Acridine Orange↗
PubMed1987

Hispanic adolescent conception and contraception profiles. A comparison.

Marital status, contraception, desire for pregnancy, and social support relationships were analyzed by ethnicity for a group of pregnant and postpartum adolescents. Although no significant differences were found among ethnic groups for birth control information and use, the desire for pregnancy, grouped by marital status at conception, was significantly different for Hispanics. Positive evaluations of the life changes associated with pregnancy were found more frequently among Hispanic mothers. Hispanic teen mothers, however, were least likely to understand the menstrual cycle. The role of ethnic background in adolescent fertility behaviour is discussed, and potential clinical applications for more effectively serving sexually active Hispanic adolescents are presented.

Adolescent↗
PubMed1987

Perinatal market penetration rate. A tool to evaluate regional perinatal programs.

Very small babies born in tertiary centers fare better than outborn babies referred for tertiary care after birth. Viewing the 1001-1500 gm regional cohort of fetuses as a potential "market" for center delivery, and measuring a center's penetration into this market, quantitates how well a center draws to itself these small, high-risk fetuses for delivery. An Illinois center's annual penetration rate into its regional market for the years 1973-1983 is presented and significant increases are found. The penetration rates of nine Illinois perinatal centers are calculated and wide discrepancies are found. Defining a high-risk regional cohort as a market stresses a perinatal center's obligation to its region. The penetration rate into a defined market measures how well a center fulfills this obligation.

Catchment Area, Health↗
PubMed1986

Health problems and sexual activity of selected inner city, middle school students.

Physical examinations were performed and health and sexual histories were taken on 496 12-14-year-old, inner city, middle school students participating in extracurricular activities. Health problems were identified in 9.5% of students. Twenty-one percent of a subgroup of 276 students reported sexual activity; males were three times as likely as females to report intercourse. More than one-half of a smaller subgroup named their parents as their primary source of information on sex. The value of the screening exam is discussed, and suggestions are offered on the content of preventive health and sex education curricula for this age group.

Adolescent↗