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Biomedical subjects

M Elliott

Publications and source records attributed to M Elliott.

196 records · Page 11Linked to original sources
PubMedDate not supplied

Interagency relationships among rural early intervention collaboratives.

Interagency collaboration is used to coordinate services and programs, pool resources, or achieve goals. This study utilizes the Interagency Collaboration Model to assess interagency relationships of Early Intervention (EI) collaboratives in three rural Ohio counties. The model includes five constructs: environmental factors (broader community environment), situational factors (organizational factors), task characteristics (project's scope and complexity), interagency processes (between agency processes), and outcomes (end products). Respondents from 42 agencies completed the 18-item Interagency Collaboration Assessment Tool (ICAT) and demographic questions. The ICAT uses a 5-point Likert-type scale to assess the five domains of the model. Respondents included public health nurses, representatives from schools, social service agencies, and hospitals. State policies were perceived as encouraging local interagency collaboration; respondents knew staff and goals of other agencies, but agencies did not share funding sources or provide similar services. Diverse specialists were needed to accomplish goals. Some information was exchanged between agencies. Interagency activities were not perceived to be well coordinated and outcomes were only moderately positive. Path analysis revealed that interagency processes were directly affected by environmental and situational factors, but not task characteristics (R2 = 0.42). Situational factors, and interagency processes predicted outcomes (R2 = 0.60). Awareness of personnel, goals and services of other agencies were key to positive interagency process and perceived outcomes.

Analysis of Variance↗
PubMedDate not supplied

Fluoxetine in pathologic skin-picking: open-label and double-blind results.

Various studies suggest that selective serotonin reuptake inhibitors (SSRIs) may be useful in treating pathologic skin-picking. The authors investigated the effectiveness of fluoxetine in treating this behavior. Fifteen subjects with clinically significant skin-picking were recruited by newspaper advertisement. They received 6 weeks of open-label treatment with fluoxetine. Responders were then randomized to 6 weeks of double-blind fluoxetine or placebo. Treatment effect was assessed with standardized rating scales. All 15 subjects completed open-label treatment, and 8 were responders. Of these eight, the four randomized to double-blind fluoxetine maintained clinically significant improvement. The four randomized to placebo returned to their baseline symptom level. Larger studies are needed to determine which individuals are likely to respond to fluoxetine and the relative effectiveness of fluoxetine, other SSRIs, and other forms of treatment.

Adult↗
PubMedDate not supplied

Providing support and care through a hospital at home.

The greater emphasis on community care and consumer choice lead to the introduction of a hospital-at-home scheme in Kingston and District Community NHS Trust. The rationale for the scheme, its structure and the way in which it works are discussed in this paper.

Choice Behavior↗
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Targeting TNF alpha for the therapy of rheumatoid arthritis.

Our pre-clinical studies have demonstrated a pathogenic role for TNF alpha in RA. Firstly, TNF alpha and its receptors are upregulated and co-expressed in the synovium and cartilage-pannus junction of RA joints. Secondly, mononuclear cells from RA joints maintained in culture produce many cytokines with pro-inflammatory activity, including TNF alpha. Neutralizing TNF alpha antibodies in vitro reduces the production of these pro-inflammatory cytokines, including IL-1, IL-8, and GM-CSF. Thirdly, when injected into arthritic DBA/l mice with collagen-induced arthritis, monoclonal anti-TNF antibodies decrease inflammatory damage of joints. Clinical trials employing cA2, a monoclonal chimeric anti-TNF alpha antibody, in open-label and randomized placebo-controlled studies have demonstrated a dose-dependent efficacy with impressive improvement in disease activity and acute phase responses lasting several weeks. We conclude that TNF alpha is a critical mediator of inflammation in RA and is an important therapeutic target in this disease.

Antibodies, Monoclonal↗
PubMedDate not supplied

Transcutaneous electrical nerve stimulation (TENS) for pain management during cavity preparations in pediatric patients.

The purpose of this study was to evaluate the effectiveness of Transcutaneous Electrical Nerve Stimulation (TENS) in pain reduction during cavity preparations in pediatric patients. Twenty patients, ages eight to fourteen years, were treated for Class I amalgam restorations in mandibular first permanent molars using TENS in a double blind protocol. Randomized assignments were made for ten experimental and ten control patients. Using the visual analogue scale, the ANOVA test indicated a significant decrease (p < 0.01) in patient ratings between the TENS experimental and the control group. It can be concluded there was a statistically significant decrease in the pain perceptions of pediatric patients during Class I amalgam cavity preparations in mandibular first permanent molars.

Adolescent↗
PubMedDate not supplied

Incidence of obliterative bronchiolitis after heart-lung transplantation in children.

Between June 1988 and February 1993, combined heart-lung transplantation was performed in 30 children and adolescents aged 3.6 to 18.6 years (mean, 12.2 years) at The Hospital for Sick Children in London. Original diagnoses included cystic fibrosis (n = 25), Eisenmenger's syndrome (n = 4), and chronic graft-versus-host disease of the lung (n = 1). Posttransplantation maintenance immunosuppression comprised a triple regimen, with methylprednisolone and antithymocyte globulin given perioperatively and for episodes of allograft rejection. Actuarial survival was 63% (95% confidence interval: 42%-78%) at 1 year and 48% (95% confidence interval: 27%-66%) at 3 years. Obliterative bronchiolitis has been diagnosed in 13 patients (43%). Actuarial freedom from obliterative bronchiolitis in survivors was 76%, 59%, and 37% at 12, 24, and 36 months after transplantation, respectively. Recipients in whom obliterative bronchiolitis developed within the first year (n = 6) had more episodes of pulmonary rejection during the first 6 months after transplantation (mean, 5.7 episodes per patient) than those in whom "premature" obliterative bronchiolitis did not develop (mean, 3.2 episodes per patient). Infection of the pulmonary allograft was implicated to a lesser extent in predisposing to obliterative bronchiolitis. At 2, 3, and 6 months, tracheal stenosis developed in three patients, all of whom died with obliterative bronchiolitis within 10 months of transplantation. Noncompliance with therapy was considered a contributory factor in producing obliterative bronchiolitis in four adolescent recipients. The high incidence of obliterative bronchiolitis observed in this pediatric cohort may have a multifactorial cause.

Actuarial Analysis↗
PubMedDate not supplied

TNF-alpha in rheumatoid arthritis and prospects of anti-TNF therapy.

Our work has shown that TNF alpha is produced by cultured mononuclear cells from rheumatoid arthritis joints and appears to regulate the production of IL-1. Immunohistochemical examination has shown the presence of TNF alpha in the synovium, e.g. in the lining layer, some endothelial cells and most importantly, in the cells in the cartilage pannus junction. TNF receptors (both p55 and p75) have a similar distribution, thereby suggesting that TNF has the potential for autocrine and paracrine activity in the joint. The concept that TNF alpha is pathogenic in inflammatory arthritis has been validated by showing that neutralizing monoclonal anti-TNF antibodies significantly attenuate collagen-induced arthritis in mice. In preliminary trials in rheumatoid patients anti-TNF appears to have an impressive effect on indices of disease activity including C-reactive production and serum amyloid-A production. TNF alpha appears to be a relevant therapeutic target in rheumatoid disease.

Animals↗
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Care management in the community: a case study.

The rhetoric surrounding the reforms of the NHS and Community Care Act makes much of the benefits to clients. The reforms have been promoted as a means of improving efficiency and making services more responsive to the needs of clients and carers. A case study is described here and the issues raised are considered. The incident occurred in 1994, the year following the implementation of the NHS and Community Care Act. It shows lack of coordination of services and teamwork, a poor response to identified needs and gaps in service provision.

Case Management↗
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Balanced mix.

Explore the source record for details and available documents.

Health Care Costs↗