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Biomedical subjects

M Hughes

Publications and source records attributed to M Hughes.

At least 127 records · Page 7Linked to original sources
PubMed1995

The use of cranial CT scans in the triage of pediatric patients with mild head injury.

OBJECTIVE: Recent evidence suggests that patients with a normal cranial CT scan after head injury can be safely discharged home from the emergency department. However, supporting data from previous studies has relied on incomplete patient follow-up. We utilized a statewide comprehensive hospital abstract reporting system (CHARS) to assess whether children with normal CT scans after head injury subsequently developed intracranial sequelae in the month following their initial injury. DESIGN: Retrospective case-series study, with comprehensive statewide follow-up for 1 month. SETTING: The emergency department of a Level 1 Trauma Center in Seattle, Washington. PARTICIPANTS: All children (n = 400) with head injury, Glasgow Coma Score of 13 to 15, and initial normal CT scan seen over a 4.5-year time period. All were matched against CHARS to evaluate admissions within 30 days after emergency department disposition. For readmissions, International Classification of Diseases (9th revision) discharge and procedure information was collected. All children were also matched against the state death files. RESULTS: Four children were readmitted for neurologic reasons within 1 month following injury. One child on coumadin for heart disease developed a symptomatic subdural hematoma 5 days after head injury, requiring neurosurgical drainage. One child developed a symptomatic hemorrhagic contusion 3 days after injury, requiring observation only. Two children were readmitted 1 day after injury for concussive symptoms; both were discharged home after observation only. There were no deaths among the study population. CONCLUSIONS: Among children with a normal cranial CT scan after mild head injury, delayed intracranial sequelae requiring intervention are extremely uncommon. In otherwise stable patients, a normal cranial CT scan can identify patients to be safely discharged from the emergency department, and would be more cost-effective than 1 to 2 days of hospital observation.

Adolescent↗
PubMed1994

Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey.

BACKGROUND: This study presents estimates of lifetime and 12-month prevalence of 14 DSM-III-R psychiatric disorders from the National Comorbidity Survey, the first survey to administer a structured psychiatric interview to a national probability sample in the United States. METHODS: The DSM-III-R psychiatric disorders among persons aged 15 to 54 years in the noninstitutionalized civilian population of the United States were assessed with data collected by lay interviewers using a revised version of the Composite International Diagnostic Interview. RESULTS: Nearly 50% of respondents reported at least one lifetime disorder, and close to 30% reported at least one 12-month disorder. The most common disorders were major depressive episode, alcohol dependence, social phobia, and simple phobia. More than half of all lifetime disorders occurred in the 14% of the population who had a history of three or more comorbid disorders. These highly comorbid people also included the vast majority of people with severe disorders. Less than 40% of those with a lifetime disorder had ever received professional treatment, and less than 20% of those with a recent disorder had been in treatment during the past 12 months. Consistent with previous risk factor research, it was found that women had elevated rates of affective disorders and anxiety disorders, that men had elevated rates of substance use disorders and antisocial personality disorder, and that most disorders declined with age and with higher socioeconomic status. CONCLUSIONS: The prevalence of psychiatric disorders is greater than previously thought to be the case. Furthermore, this morbidity is more highly concentrated than previously recognized in roughly one sixth of the population who have a history of three or more comorbid disorders. This suggests that the causes and consequences of high comorbidity should be the focus of research attention. The majority of people with psychiatric disorders fail to obtain professional treatment. Even among people with a lifetime history of three or more comorbid disorders, the proportion who ever obtain specialty sector mental health treatment is less than 50%. These results argue for the importance of more outreach and more research on barriers to professional help-seeking.

Adolescent↗
PubMed1994

Sex and depression in the National Comorbidity Survey. II: Cohort effects.

Data from a nationally representative sample of the general population are used to study cohort differences in the prevalence of DSM-III-R Major Depressive Episode (MDE). We document increasing lifetime prevalence of MDE among both men and women in more recent cohorts, but no major change in the sex ratio over the 40-year period retrospectively covered in the survey. We find a cohort difference in 12-month MDE, with older women much more likely than older men to have recurrent episodes. This sex difference in recurrence plays an important part in the elevated 12-month prevalence of depression among women compared to men in the 45-54 age range.

Adolescent↗
PubMed1994

Dynamic patterns of movement of squash players of different standards in winning and losing rallies.

The aim of this work was to analyse and compare the dynamic motions of squash players of varying technical abilities, and link these to the tactics that the different standard players adopt. A computerized tracking system utilized mixed images on the VDU of both the tracking surface, and the subject during competitive matchplay. Four groups of squash players were categorized Elite (international); Provincial (provincial representatives); Club A/B (players at either the A or B level in the inter-club leagues in British Columbia); and Club C/D (players at the C or D level in the inter-club leagues in British Columbia). Six competitive matches of different players were analysed for each group. Each game in each match was analysed separately and means-per-rally calculated for: positional data, X and Y; lateral and longitudinal velocities, Vx and Vy; average velocities, V; distances travelled, D; and accelerations, A. The longitudinal position in the winning rallies for all groups was closer to the front wall than that in the losing rallies (p < 0.10), supporting previous research and demonstrating the operational validity of this methodology. The Elite and Provincial groups had significant differences in all the velocities and the accelerations between the winning rallies and losing rallies (p < 0.10), confirming the hypothesis that their tactic was to attempt to reduce their opponents' playing time by taking the ball as early as possible and use all of the court.(ABSTRACT TRUNCATED AT 250 WORDS)

Aptitude↗
PubMed1994

Delivery of a secretable adenosine deaminase through microcapsules--a novel approach to somatic gene therapy.

Many current gene therapy protocols require genetic modification of autologous cells. An alternate approach is to use universal recombinant cell lines engineered to secrete in vivo the desired gene products. Enclosing these cells within immunoprotective devices before implantation would prevent rejection of the nonautologous donor cells. To overcome the limitation that not all therapeutic gene products are secreted, we now propose to fuse a signal sequence to the amino terminus of a nonsecreted protein such as human adenosine deaminase (ADA), thus directing the product into a secretory pathway for release from the cells. A fusion gene constructed between the cDNA of the beta-lactamase signal sequence and human ADA expressed a product after in vitro transcription and translation that was immunologically similar to the human protein. Mouse fibroblasts transfected with the fusion gene demonstrated secreted ADA activity that resembled the human cytosolic enzyme in its heat stability, pH optimum, KM, electrophoretic mobility, and immunologic reactivity. Hence, the secreted enzyme expressed from the fusion gene is antigenically and enzymatically similar to the authentic human form. When transfected mouse fibroblasts or myoblasts were enclosed in permselective alginate-poly-L-lysine alginate microcapsules, ADA activity was secreted from the microcapsules and the cells remained viable for over 5 months. Hence, a secretable and functional human ADA has been constructed that can be delivered from recombinant cells within immunoprotective capsules. The success of this strategy provides the prototype for engineering nonsecreted gene products for therapy via this novel method of somatic gene therapy.

Adenosine Deaminase↗
PubMed1994

Stability of the DDD pacing mode in patients 80 years of age and older.

We reviewed the records of 119 consecutive patients aged 80 years or older (mean age 84 +/- 3.7 years) in whom a dual chamber pacemaker was implanted between 1984 and 1991. Follow-up data was available up to February 1993. Immediate postimplantation complications were rare. Nine patients were lost to follow-up, all within 6 months of implantation. An additional seven patients died within 6 months of implantation. Long-term follow up for at least 6 months from implantation was available for 103 of the 119 patients (87%). Of these 89 (86%) remained in functioning DDD mode for a mean of 22 +/- 15 months from implantation. Nine patients were reprogrammed to VVI mode, six due to atrial fibrillation and three due to failure of atrial sensing or pacing. One patient was programmed DVI for failure of atrial sensing; 94 of 112 patients (84%) whose status was definitely known in February 1993 remained in functioning DDD mode until death or last follow-up. Cumulative survival in DDD mode was 78% at 30 months. We conclude that DDD pacing is stable in the great majority of patients in their ninth and tenth decades who present with rhythms amenable to dual chamber pacing and who have no history of sustained atrial fibrillation.

Aged↗
PubMed1994

Preschool weights and heights of Europeans and five subgroups of Asians in Britain.

Heights and weights of five subgroups of Asian (545) and European children (685) were recorded after birth, at 1 year, 2 years, and at 5 years. Asian children were divided into Muslim Gujarati, Muslim Pakistani, Muslim Bangladeshi, Hindu, and Sikh. Although the Europeans were significantly the heaviest at birth (3.42 kg boys and 3.26 kg girls) when compared with any of the other groups, it was the Sikhs who had the best weight gain. They were also the heaviest at 5 years when compared with other groups, including the Europeans (20.13 kg and 19.22 kg for Sikh boys and girls respectively compared with 18.83 kg and 18.42 kg for European boys and girls respectively). Hindus had the lightest birth weight. Their weight at 5 years (17.41 kg boys and 16.93 kg girls) and that of the Muslim Gujaratis (17.27 kg boys and 17.20 kg girls) was comparable and was lowest, whereas that of the Bangladeshis at this age was the greatest among the Muslims (18.56 kg for boys and 17.87 kg for girls). Sikh boys and girls were found to be the tallest of all the groups, including the Europeans, at all periods of measurements--including at 5 years when the Sikh boys and girls were 3 cm and 1.5 cm taller than the European boys and girls. Hindus were the shortest of all the groups throughout the period of study.

Asia↗
PubMed1994

Management of bacterial urinary tract infections in adults.

OBJECTIVE: To provide a comprehensive review of the diagnosis and therapeutic management considerations in patients with urinary tract infections (UTIs). DATA SOURCES: A MEDLINE search was used to identify pertinent English language literature, including reviews. Infectious disease textbooks were used for background information. STUDY SELECTION: Clinical trials evaluating drug therapy in a variety of patient populations with UTIs were reviewed. DATA EXTRACTION: Background information was obtained from comprehensive reviews. Drug dosing strategies and efficacy comparisons were extracted from the investigations in this area. DATA SYNTHESIS: Information was processed to provide general guidelines and resources for practitioners to use in managing UTIs. CONCLUSIONS: There are a number of useful antibiotics for the management of UTIs. The distinctions between infection severity and underlying risk factors within a given population influence the appropriateness of drug selection and duration of treatment.

Adult↗
PubMed1994

How parents cope with the experience of neonatal intensive care.

Thirty-two mothers and 25 fathers described their coping efforts during the initial weeks of their preterm infants' hospitalization in a neonatal intensive care unit. Utilizing procedures developed by Lazarus and Folkman (1984) in which coping is linked with a specific stressful event, parents reported what they did to cope with the stressor they perceived to be the most stressful. They also completed the Ways of Coping Questionnaire (Folkman & Lazarus, 1988). Results showed that there were similarities and differences in the types of coping strategies used by mothers and fathers. In addition, factors such as neonatal morbidity and appraisal of control were differentially associated with the use of certain types of coping strategies. Implications for future research and clinical practice are discussed.

Adaptation, Psychological↗
PubMed1993

The effects of chronic oral milrinone therapy on early postinfarction left ventricular remodeling.

Left ventricular remodeling following acute transmural myocardial infarction may result in early left ventricular enlargement. To characterize the effects of milrinone on components of early left ventricular dilation, rats (n = 120) underwent left coronary artery ligation or sham surgery. In the immediate postoperative period, rats received either no treatment or milrinone (3.17 +/- 0.08 mg/kg/day) dissolved in drinking water for 20 days. Twenty-one days after the initial surgery, hemodynamic measurements were made. The rats were then put to death and the hearts arrested in diastole were excised and fixed at a constant pressure for morphometric analysis. To examine the effects of milrinone on the relative contribution of infarcted and noninfarcted segments to early left ventricular dilation after acute myocardial infarction, a subgroup of infarcted rats chosen randomly was put to death 3 days after the initial surgery for morphometric analysis. Compared with infarcted untreated rats, infarcted milrinone-treated rats had a lower left ventricular volume (1.41 +/- 0.07 ml/kg vs 2.16 +/- 0.19 ml/kg, p < 0.001), lower left ventricular wall stress (0.64 +/- 0.03 vs 0.91 +/- 0.06, p < 0.001), and a lower expansion index (1.61 +/- 0.12 vs 2.61 +/- 0.22, p < 0.001). Morphometric analysis revealed that the noninfarcted segment length did not differ between the two infarcted groups either 3 days or 21 days after left coronary artery ligation. Infarct segment length also did not differ between the two infarcted groups at 3 days, but at 21 days infarct segment was shorter in the milrinone-treated group compared with the untreated group (p < 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1993

How do physiological components of balance affect mobility in elderly men?

The purpose of this study was to assess the relationship between physiological components of balance and mobility in elderly men without significant disease. Our a priori hypothesis was that physical function is influenced more by accumulated modest impairments than by a single deficit. We examined 39 ambulatory men (> 69 years). Subjects were classified functionally as high, intermediate, or low. Assessment included mobility functions (6-minute walk, mobility skills, reach, 10ft walk time) and physiological components of balance: sensory (vibration, proprioception, vision, vestibular), effector (ankle, knee, hip strength, range of motion), and central processing (response time to perturbations). All mobility functions were significantly (p < .05) different between groups. Impairments in components of postural control were rarely different between groups: the major differences were in ankle strength and visual fields. The number of impaired domains differed across the three groups. Nineteen percent of the low group had at least three domains impaired; none of the intermediate or high groups were impaired in three domains. Fifty-six percent of the low, 20% of the intermediate, and 7% of the high were impaired in two or more domains. Variability in specific mobility measures was also predicted by the number of impaired domains. The decline in physical function may be better explained by the accumulation of deficits across multiple domains than by any single specific impairment.

Accidental Falls↗
PubMed1993

Subcutaneous ketorolac--a new development in pain control.

Pain due to advanced malignant disease does not always respond to opioids, or the possible use of opioids may be limited by the occurrence of adverse effects. This paper describes the successful use of ketorolac, a new nonsteroidal anti-inflammatory drug, given by continuous subcutaneous infusion. Seven patients with pain due to advanced malignant disease taking opioid analgesia were considered to have inadequate symptom control because of opioid unresponsiveness (n = 1), opioid-related adverse effects (n = 2) or both (n = 4). All patients became symptom-free with the introduction of ketorolac by subcutaneous infusion and the total daily opioid requirement was substantially reduced in three and reduced to zero in four patients.

Aged↗