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Biomedical subjects

M H Williams

Publications and source records attributed to M H Williams.

At least 37 records · Page 2Linked to original sources
PubMed1995

Nutritional ergogenics in athletics.

Nutritional ergogenic aids may be theorized to improve performance in athletics in a variety of ways, primarily by enhancing energy efficiency, energy control or energy production. Athletes have utilized almost every nutrient possible, ranging from amino acids to zinc, as well as numerous purported nutritional substances, such as ginseng, in attempts to enhance physical performance. This review focuses primarily on nutritional ergogenic aids thought to enhance performance by favourably affecting energy metabolism. Although most purported nutritional ergogenic aids have not been shown to enhance physical performance in well-trained, well-nourished athletes, some reliable scientific data support an ergogenic efficacy of several substances, including caffeine, creatine and sodium bicarbonate, but additional research is needed to evaluate their potential for enhancing performance in specific athletics events.

Body Composition↗
PubMed1995

Antioxidants, carnitine, and choline as putative ergogenic aids.

Three nutritional products that have very different mechanisms of action are antioxidant vitamins, carnitine, and choline. Antioxidant vitamins do not appear to have a direct effect on physical performance in well-fed people but have been touted for their ability to detoxify potentially damaging free radicals produced during exercise. Carnitine purportedly enhances lipid oxidation, increases VO2max, and decreases plasma lactate accumulation during exercise. However, studies of carnitine do not generally support its use for ergogenic purposes. Choline supplements have been advocated as a means of preventing the decline in acetylcholine production purported to occur during exercise; this decline may reduce the transmission of contraction-generating impulses across the skeletal muscle, an effect that could impair one's ability to perform muscular work. However, there are no definitive studies in humans that justify choline supplementation. Much of the scientific data regarding the aforementioned nutrients are equivocal and contradictory. Their potential efficacy for improving physical performance remains largely theoretical.

Acetylcholine↗
PubMed1995

Quality of life measurement in patients with oesophageal cancer.

Quality of life (QOL) measurement may aid decision making in the treatment of patients with oesophageal cancer but must be clinically valid to be useful. This study considered if the European Organisation for Research and Treatment of Cancer QOL questionnaire, the QLQ-C30, showed differing results in two clinically distinct groups of patients with oesophageal cancer and also investigated the correlation between dysphagia grade and various scales of QOL. Patients treated by oesophagectomy reported significantly better physical, emotional, cognitive, and global health scores than those in the palliative treatment group. Patients who received palliative treatment had significantly worse pain, fatigue, appetite loss, constipation, and dysphagia. The correlations between dysphagia grade and each of the QOL scales and items in both groups of patients were poor. This questionnaire differentiates clearly between the two clinically distinct groups of patients, but to be an entirely appropriate indicator of QOL in patients with oesophageal cancer, an additional specific oesophageal module including a dysphagia scale is required.

Aged↗
PubMed1995

How useful are clinical reports concerning the consequences of therapist-patient sex?

The harmfulness and prevalence of sex between therapist and patient are difficult to research. One reason for this is the difficult of establishing a rate of harm; general population trends cannot be established within reasonable limits. A second problem involves determining the cause of observed harm. Therapists who treat patients who have had sex with a therapist may incorrectly conclude that symptoms resulted from that inappropriate relationship, while another therapist might attribute them to childhood sexual abuse or other causes. Patients with borderline or histrionic personality disorder may be at greatest risk of therapist-patient sex. Outrage at these violations of professional ethics must be separated from assessment of symptoms. Important questions are: (1) did lasting harm result? and (2) if harm resulted, how much did the sex contribute to it? Outrage should not alter the standards of validity adopted by authors of clinical reports.

Adaptation, Psychological↗
PubMed1995

Death and thromboembolic disease after total hip replacement. A series of 1162 cases with no routine chemical prophylaxis.

We studied 1162 consecutive total hip replacements (THR) to establish the incidence of fatal pulmonary embolism (PE), clinical non-fatal PE and deep-vein thrombosis (DVT) in the six months after surgery. Chemical thromboprophylaxis had not been routinely used. We used a validated questionnaire supplemented by post-mortem records and a review of the clinical notes. Follow-up was 100%. The death rate from PE was 0.34% (95% CI 0.09 to 0.88), with one fatal PE after discharge 40 days after operation. The clinical PE rate confirmed by imaging was 1.20% (CI 0.65 to 2.02), with 0.7% of patients readmitted. The venographically-confirmed clinical DVT rate was 1.89% (CI 1.11 to 2.76), with 1.13% readmitted. The total thromboembolic morbidity was 3.4% (95% CI 2.5% to 4.7%); prophylaxis to reduce this would be justifiable if the complications of such prophylaxis did not produce an alternative morbidity. The fatal PE rate after THR without routine chemical prophylaxis was low; a very large randomised clinical trial would be required to demonstrate directly whether any prophylactic measure could reduce this. There is a large discrepancy between the high DVT rate reported in clinical trials using universal screening venography and the symptomatic DVT rate shown in this study. We found insufficient evidence to recommend continuing thromboprophylaxis after discharge from hospital.

Aged↗
PubMed1994

Making heterogeneous medical databases interoperable.

The increasing use of computer systems for storing patient information in different hospitals, in different departments within the same hospital, in clinics and even in doctors' surgeries, is creating a problem in terms of the fragmentation of the patient record. The lack of any coordination or standardization in the way in which data are represented and stored in these different systems makes the task of finding and retrieving data that much more difficult. This paper considers two aspects of this problem and describes an architecture which can be used to overcome them.

Communication↗
PubMed1994

The use of nutritional ergogenic aids in sports: is it an ethical issue?

As nutritional technology advanced, scientists have been able to synthesize and manufacture all known nutrients, and many of their metabolic by-products, essential to human physiology. Many of these substances are theorized to possess ergogenic potential when taken in quantities or forms normally not found in typical foods or diets. Research, although limited in most cases, supports the ergogenicity of some nutrients (e.g., creatine) when consumed in substantial amounts, suggesting such nutrients may function as drugs or nutraceuticals. The International Olympic Committee (IOC) doping legislation stipulates that any physiologic substance taken in abnormal quantity with the intention of artificially and unfairly increasing performance should be construed as doping, violating the ethics of sport performance. Given this stipulation, the IOC and other athletic-governing organizations should consider the legality and ethics underlying the use of ergogenic nutraceuticals in sport.

Doping in Sports↗
PubMed1994

Prevalence of total hip replacement: how much demand has been met?

OBJECTIVE: To determine the prevalence of completed elective total hip replacements in a defined elderly population. DESIGN: Cross sectional postal questionnaire survey with additional data and validation from general practice and hospital records. SETTING: Six general practices in the English counties of Avon, Somerset, and Oxfordshire. SUBJECTS: A total of 7806 patients aged 65 years and over (94.7% response). RESULTS: The overall prevalence (95% confidence intervals) of elective total hip replacement was 5.3 (4.8,5.8)% Age and sex specific prevalences were 2.7 (2.0,3.5)% in men and 4.1 (3.3,4.9)% in women aged 65-74 years, and 5.2 (4.0,6.5)% in men and 8.8 (7.6,10.0)% in women aged 75 years and over. Of the 415 patients who had received elective total hip replacement, 28.2% had required bilateral surgery, 20% had received at least one operation privately, and 13% had required revision surgery. CONCLUSION: Our results show an increased level of satisfied demand for total hip replacement in elderly people compared with earlier estimates. The increasing prevalence of hip replacement is an indicator of increasing potential demand for revision procedures. Population based surveys are required to establish the level of unmet demand for primary procedures. Differences in past surgical activity may be important in interpreting the wide variation in current surgical rates.

Age Factors↗
PubMed1994

Oregon's civil commitment law: 140 years of change.

Legislatures, professional groups, and mental health consumers across the United States are currently engaged in a debate about the need for change in civil commitment procedures. The authors summarize modifications of legislation and judicial opinion in the history of Oregon's civil commitment procedures from 1853 to the present to show that changes in civil commitment reflect broader shifts in the social and political aspects of the mental health system. Many current issues in civil commitment, such as the question of a patient's competency to make treatment decisions, are not new, and they are likely to continue to be controversial as mental health systems attempt to balance concerns about the liberty interests of mentally ill persons with concerns about providing appropriate treatment for mental illness.

Advance Directives↗
PubMed1993

Evidence of unmet need in the care of severely physically disabled adults.

OBJECTIVE: To identify unmet needs in the care of severely disabled people aged 16-64. DESIGN: Detailed personal interview and physical assessment of physically disabled adults; personal or telephone interview with carers. SETTING: Somerset Health District. SUBJECTS: 181 severely disabled adults and their carers. MAIN OUTCOME MEASURES: Independence in activities of daily living; identity of requirements for assessing communication disorders; appropriate provision of services and allowances. RESULTS: 53 (29.3%) of the 181 disabled subjects had unmet needs for aids to allow independence in activities of daily living-namely, 43% of subjects (41/95) with progressive disorders and 14% of subjects (12/86) with non-progressive disorders. The prevalence of unmet need was higher among subjects whose sole regular professional contact was with health services personnel (48 (40.3%) of 119 subjects). Only 18 (31.6%) of the 57 subjects with communication disorders had ever been assessed by a speech therapist. CONCLUSIONS: This study shows that the needs of severely physically disabled adults in the community--especially those with progressive disorders--are being monitored inadequately by health professionals.

Activities of Daily Living↗
PubMed1993

Excluding personality disorders from the insanity defense--a follow-up study.

Examining the effects of Oregon's statutory reform excluding personality disordered individuals from the insanity defense, we previously identified a study sample of insanity acquittees, each of whom was given a primary diagnosis of a personality disorder during subsequent evaluation at the state hospital. In the present study we explore the relationship between that diagnosis and the pretrial psychiatric diagnosis presented to the trial court. By reading the forensic mental health evaluations used at trial we found that 50 percent of our study sample of 34 personality disordered patients were diagnosed with psychotic disorders, affective disorders, retardation, and organic brain disorders. In addition to investigating the diagnosis offered as evidence at trial, we performed assessments of 38 mental health reports using published standards for forensic evaluation reports. We found compliance rates in the various categories ranged from 8 to 84 percent with a mean of 45 percent. We question the value of the mental health input to these trials, and believe that the data tend to validate past aspersions of forensic practice.

Adolescent↗
PubMed1992

Exploitation and inference. Mapping the damage from therapist-patient sexual involvement.

A growing body of evidence documents a clinical pattern of harmful effects of therapist-patient sexual involvement. In addition, surveys suggest that 1 to 12% of all therapists may have engaged in this behavior at least once in their careers. In order to develop a more comprehensive research agenda, several of these studies are reviewed in terms of inferences that may or may not be drawn. Case studies and surveys may provide for inference of clinical harm and syndrome, but they are limited in terms of generalizations about incidence in the overall population. A population approach coupled with case sampling may provide a useful tool by which to approximate a minimum level of incidence and of effects.

Adaptation, Psychological↗
PubMed1992

Ergogenic and ergolytic substances.

Genetic endowment and proper training are the major factors contributing to athletic success in endurance and ultraendurance events. Proper nutrition, primarily adequate carbohydrate and fluid, prior to and during the event is also critical. Endurance athletes often utilize other nutritional substances or practices, often referred to as ergogenics, in attempts to obtain a competitive edge by enhancing energy utilization and delaying the onset of fatigue. Numerous nutritional ergogenics have been used in attempts to enhance endurance performance, but with several exceptions most have been shown to be ineffective, including bee pollen, L-carnitine, CoQ10, inosine, amino acids, alkaline salts, and vitamin E at sea level. Research findings are equivocal relative to the ergogenicity of caffeine, phosphate salts, and vitamin E at altitude. Loss of excess body fat, a nutritional practice, may be an effective ergogenic. Conversely, some agents such as alcohol may impair performance, an ergolytic effect. Additional research is necessary to support the efficacy of several nutritional ergogenics to enhance prolonged endurance performance, such as caffeine, phosphates, specific amino acids, and various commercial products. Such research should involve exercise tasks comparable in intensity and duration to that experienced in the marathon and similar endurance events.

Amino Acids, Branched-Chain↗