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Biomedical subjects

M Clarke

Publications and source records attributed to M Clarke.

At least 109 records · Page 6Linked to original sources
PubMed1999

Rapid identification of Candida dubliniensis with commercial yeast identification systems.

Candida dubliniensis is a newly described species that is closely related phylogenetically to Candida albicans and that is commonly associated with oral candidiasis in human immunodeficiency virus-positive patients. Several recent studies have attempted to elucidate phenotypic and genotypic characteristics of use in separating the two species. However, results obtained with simple phenotypic tests were too variable and tests that provided more definitive data were too complex for routine use in the clinical laboratory setting. The objective of this study was to determine if reproducible identification of C. dubliniensis could be obtained with commercial identification kits. The substrate reactivity profiles of 80 C. dubliniensis isolates were obtained by using the API 20C AUX, ID 32 C, RapID Yeast Plus, VITEK YBC, and VITEK 2 ID-YST systems. The percentages of C. dubliniensis isolates capable of assimilating or hydrolyzing each substrate were compared with the percentages from the C. albicans profiles in each kit's database, and the results were expressed as percent C. dubliniensis and percent C. albicans. Any substrate that showed >50% difference in reactivity was considered useful in differentiating the species. In addition, assimilation of methyl-alpha-D-glucoside (MDG), D-trehalose (TRE), and D-xylose (XYL) by the same isolates was investigated by the traditional procedure of Wickerham and Burton (L. J. Wickerham and K. A. Burton, J. Bacteriol. 56:363-371, 1948). At 48 h (the time recommended by the manufacturer for its new database), we found that the assimilation of four carbohydrates in the API 20C AUX system could be used to distinguish the species, i.e., glycerol (GLY; 88 and 14%), XYL (0 and 88%), MDG (0 and 85%), and TRE (15 and 97%). Similarly, results with the ID 32 C system at 48 h showed that XYL (0 and 98%), MDG (0 and 98%), lactate (LAT; 0 and 96%), and TRE (30 and 96%) could be used to separate the two species. Phosphatase (PHS; 9 and 76%) and alpha-D-glucosidase (23 and 94%) proved to be the most useful for separation of the species in the RapID Yeast Plus system. While at 24 h the profiles obtained with the VITEK YBC system showed that MDG (10 and 95%), XYL (0 and 95%), and GLY (26 and 80%) could be used to separate the two species, at 48 h only XYL (6 and 95%) could be used to separate the two species. The most useful substrates in the VITEK 2 ID-YST system were TRE (1 and 89%), MDG (1 and 99%), LAT (4 and 98%), and PHS (83 and 1%). While the latter kit was not yet commercially available at the time of the study, it would appear to be the most valuable for the identification of C. dubliniensis. Although assimilation of MDG, TRE, and XYL proved to be the most useful for species differentiation by the majority of commercial systems, the results with these carbohydrates by the Wickerham and Burton procedure were essentially the same for both species, albeit following protracted incubation. Thus, it is the rapidity of the assimilation achieved with the commercial systems that allows the differentiation of C. dubliniensis from C. albicans.

AIDS-Related Opportunistic Infections↗
PubMed1999

Using an annual over-75 health check to screen for depression: validation of the short Geriatric Depression Scale (GDS15) within general practice.

OBJECTIVE: To validate the short Geriatric Depression Scale (GDS15) as a screening instrument and determine the optimal cutpoint for detecting depression among older people living in the community. DESIGN: Two stage study with the first stage consisting of a health check of people aged 75 years and over by a practice nurse which included the GDS15. A second-stage diagnostic interview including the criterion standard was carried out blind to GDS15 score. SETTING: A large general practice in Melton Mowbray, Leicestershire, UK. PATIENTS: A random sample (stratified according to first-stage GDS15 score) of 257 older people living in the community, without significant cognitive impairment, were selected for the second-stage diagnostic interview. MEASURES: The first-stage GDS15 score was compared with diagnostic status for depression and anxiety disorders (according to ICD-10 criteria) and presence of depressive symptoms at the second-stage clinical interview. RESULTS: Ninety-three per cent of those eligible for the study were successfully screened with the GDS15. A cutpoint of <3/3+ had a sensitivity of 100% and specificity of 72% in detecting cases of depression but fewer than one in five of those testing positive reached a diagnostic threshold. Only 25% of those with a diagnosis of depression had any mention of mental health problems in their medical notes in the year prior to the clinical interview. For detecting depressive symptoms the same cutpoint was 79% sensitive and 78% specific with a positive predictive value of 46%. CONCLUSIONS: Used as part of an annual over-75 health check in primary care, the GDS15 would detect a significant amount of hidden morbidity which would serve the original purpose of the annual elderly health checks in the UK.

Aged↗
PubMed1999

Teledermatology--UK experience of setting up an integrated teledermatology service.

Telemedicine has traditionally been seen as an all or nothing solution to the problem of providing medical service to remote communities. In the UK, however, the majority of the population lives within easy travelling distance of medical service, and it is inappropriate to apply telemedicine for the same reasons and in the same way. We describe an alternative approach, where telemedicine is used to complement the existing clinical infrastructure of the outreach clinic and hospital visit, and the patient may opt to have any follow up appointments by video conference. We also describe the concept of the virtual consultation that we have developed to support our work.

Dermatology↗
PubMed1999

AIDMAN--advanced informatics distributed medical access network.

We describe AIDMAN, a pilot project in which health clinics in remote areas of Greece are connected with mainland hospitals, to provide routine clinical service for both chronic health care and accident and emergency. Clinical practice is supported through the use of the Virtual Consultation Workstation that is being developed and evaluated specifically for the project and which is based on readily available commercial products and international standards. The communication infrastructure remains a major obstacle to any telemedicine project, and for this reason, satellite communication is used in the AIDMAN project to overcome the current lack of digital links and bandwidth. The proposed system will provide real time video, high definition image, shared applications and data over a link running at 128 kbps. In this paper we discuss the design of the AIDMAN system, the Virtual Consultation Workstation and the communication channel.

Computer Communication Networks↗
PubMed1998

Seasonal influences on admissions in schizophrenia and affective disorder in Ireland.

Although the seasonal patterns of admissions of affective disorder have been extensively studied, less attention has been given to the seasonal admission patterns of schizophrenia. The traditional method of aggregating the data over a study period, rather than analysing by year of admission may obscure potentially relevant fluctuations in the seasonal pattern. We examined the year-to-year variation in the admission patterns of schizophrenia and affective disorder in Ireland. Using the National Psychiatric Inpatient Reporting System (NPIRS), individuals admitted with an ICD-9/10 diagnosis of a first episode of schizophrenia or affective disorder during the 6-year period 1989-1994 were identified. Seasonal variations in their admission patterns were examined statistically and graphically. There was a significant seasonal variation in the monthly admission patterns of both schizophrenia and affective disorder. This pattern was more marked for individuals with affective disorder. However, the seasonal pattern was not constant from year to year, particularly for schizophrenia.

Humans↗
PubMed1998

Discussion sections in reports of controlled trials published in general medical journals: islands in search of continents?

CONTEXT: Several journals have adopted the Consolidated Standards of Reporting Trials (CONSORT) recommendations to make assessment of the quality of randomized controlled trials (RCTs) easier. One of these recommendations is that the trial's results be discussed in light of the totality of the available evidence. OBJECTIVE: To assess the extent to which reports of RCTs published in 5 general medical journals have discussed new results in light of all available evidence. DESIGN: Assessment of the discussion sections in all 26 reports of RCTs published during May 1997 in Annals of Internal Medicine, BMJ, JAMA, The Lancet, and The New England Journal of Medicine. MAIN OUTCOME MEASURE: The inclusion or mention of a systematic review in the discussion section of each article. RESULTS: In only 2 articles were the RCT's results discussed in the context of an updated systematic review of earlier trials. In a further 4 articles, references were made to relevant systematic reviews, but no attempts were made to integrate the results of the new trials in updated versions of these reviews. One article was probably the first published trial to address the question studied. The remaining 19 articles included no evidence that any systematic attempt had been made to set the reported trial's results in the context of previous trials. CONCLUSION: There is little evidence that journals have adequately implemented the CONSORT recommendation that results of an RCT be discussed in light of the totality of the available evidence.

Periodicals as Topic↗
PubMed1998

Capsaicin sensitivity is associated with the expression of the vanilloid (capsaicin) receptor (VR1) mRNA in adult rat sensory ganglia.

A vanilloid receptor (VR1) has recently been cloned and shown to be a target for capsaicin, the excitotoxic component of capsicum peppers (Caterina, M.J., Schumacher, M.A., Tominaga, M., Rosen, T.A., Levine, J.D. and Julius, D., Nature, 389 (1997) 816-824). The effects of capsaicin appear to be selective for a subset of sensory neurones which includes polymodal nociceptors. The present study describes the distribution of VR1 mRNA, together with measurements of capsaicin sensitivity, in sensory nerve ganglia of different embryological origins and a single sympathetic ganglion, the superior cervical ganglion (SCG). In situ hybridisation revealed the expression of VR1 mRNA in small-to-medium-sized neurones of the dorsal root, trigeminal and vagal ganglia. No hybridisation signal was observed in the SCG neurones. This pattern of expression correlated with capsaicin sensitivity measured by whole-cell voltage clamp where, in similar sized cells, over 80% of neurones from dorsal root and vagal ganglia were capsaicin sensitive, but all SCG neurones were insensitive to capsaicin.

Animals↗
PubMed1998

A comparison of temperature measurements using three ear thermometers.

Following anecdotal and research-based reports of inaccuracies encountered with the use of ear thermometers in patient care settings, this two-phase study was designed to compare the accuracy of three ear thermometers when used in a multioperator environment. The within-subject variation (limits of agreement) in ear temperature measurements obtained with the three ear thermometers in a multioperator condition by using an oral temperature reference standard ranged from +/- 1.25 degrees F to 1.85 degrees F. In multioperator, multisubject patient care environments using a pulmonary artery catheter core temperature as the reference standard, the limits of agreement for ear temperature measurements obtained with the three different ear thermometers ranged from +/- 2.19 degrees F to 2.85 degrees F. These results suggest that there is substantial variation in ear measurements and raise questions about the use of ear thermometers when there are multiple personnel taking temperatures, as occurs in hospital-based clinical practice environments. Handedness of the operator, position of the patient, and the ear used for measurement did not produce clinically significant variability in ear temperature measurements.

Adult↗
PubMed1998

Individual patient data meta-analysis in cancer.

As in many areas of health care, treatments for cancer may differ only moderately in their effects on major end points, such as death. But, such differences are worth knowing about, particularly in common diseases in which they could represent a substantial benefit to public health. Large-scale randomized evidence allows moderate differences to be investigated reliably, and one way to achieve this is by meta-analyses of updated and centrally collected individual patient data from all relevant trials. This paper illustrates why this form of research can often be important in cancer. It also offers the first list of such projects, as a source of information on current and past research in this area.

Humans↗
PubMed1998

Nursing Outcomes Classification implementation projects across the care continuum.

The health care environment in which nurses deliver care is experiencing constant change characterized by decreased lengths of stay in acute care settings, increased use of technology, increasing emphasis on computerized patient records and care planning options, increasing markets dominated by managed care, and an emphasis on outcomes rather than process. These changes dictate that nursing as a profession ensures that the work of nursing is visible in this health care environment and included in the data used to make health policy decisions. This article describes the rich history of a Midwestern hospital's use of standardized nursing languages for the last 25 years. Currently this facility is in the process of implementing the Nursing Outcomes Classification (NOC). Four projects are described that illustrate the ways nurses can use this language with diagnoses from the North American Nursing Diagnoses Association (NANDA) and interventions from the Nursing Interventions Classification (NIC).

Continuity of Patient Care↗
PubMed1998

Interleukin-12 gene therapy prevents establishment of SCC VII squamous cell carcinomas, inhibits tumor growth, and elicits long-term antitumor immunity in syngeneic C3H mice.

Interleukin-12 (IL-12) is an immunostimulatory agent with very promising antitumor activity. Using a retroviral expression vector, the authors have successfully transduced the genes encoding the two subunits of murine IL-12 to the squamous cell carcinoma cell line, SCC VII. Once IL-12 gene transcription and protein production were successfully verified, IL-12 expression was found to inhibit the establishment of SCC VII tumors in syngeneic C3H/HeJ mice inoculated with 1 x 10(6) SCC VII/IL-12 viable tumor cells. Mice immunized in this manner and rechallenged with parent SCC VII were capable of rejecting tumor up to 40% of the time. Treatment of established SCC VII tumors with irradiated IL-12-producing tumors cells led to significant tumor regression in a high percentage of animals.

Animals↗
PubMed1998

Epileptic aphasia: a consequence of regional hypometabolic encephalopathy?

A series of 25 children, 13 females and 12 males, who had an acquired communication disorder together with epilepsy, but did not fulfil the strict criteria of the Landau-Kleffner syndrome, was studied. All children had a clinical neurological evaluation, speech and language assessment, an awake and sleep EEG, cranial MRI, SPET scan, and audiometry. Clinical seizures were most often polymorphic in type (17 of 25). Atypical absences were the commonest individual seizure type occurring in 15 cases. All patients had an unequivocal epileptiform EEG. Normal sleep phenomena were only observed in 10 cases, enhancement of epileptiform activity in sleep was seen in 16. Cranial MRI was abnormal in six and normal in 19 cases. The SPET scans were abnormal in 22 of 25 children. The language deficits were classified neurologically as receptive aphasia, 24 of 25; expressive aphasia, 20 of 25; nominal aphasia, eight of 25; articulatory dyspraxia, 10 of 25; and auditory agnosia, nine of 25. It is hypothesized that the loss of communication skills is due to an encephalopathy secondary to the persistent epileptic discharge and manifests as a hypometabolic area on the SPET scan.

Adolescent↗