Precipitation in Manchester: ketorolac/cyclizine.
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Anti-Inflammatory Agents, Non-Steroidal↗
Biomedical subjects
M Jones
Publications and source records attributed to M Jones.
The unusual distribution of the neuronal/lymphoid cell surface CD200 (OX2) glycoprotein is conserved in humans.
OX2 (CD200) is a type-1 membrane glycoprotein that contains two immunoglobulin superfamily domains and which is expressed on a variety of lymphoid and non-lymphoid cells in the rat. The recent characterization of a receptor for OX2 (OX2R) on myeloid cells, and the phenotype of an OX2-deficient mouse, suggests that OX2 may regulate myeloid cell activity in anatomically diverse locations. Here we report the tissue distribution of the human homologue of the rat OX2 glycoprotein using a new monoclonal antibody (mAb), OX104, raised against recombinant human OX2. Human OX2 was expressed at the cell surface of thymocytes, B cells, T cells, neurons, kidney glomeruli, tonsil follicles, the syncytiotrophoblast and endothelial cells. This broad, but not ubiquitous, distribution pattern is very similar to that observed in rats, suggesting that OX2 may regulate myeloid cell activity in a variety of tissues in humans.
Animals↗
Methodologies analysing individual practice in health care: a systematic review.
AIM OF THE REVIEW: The aim of the systematic review was to identify, explore and evaluate the current level of knowledge of methodologies used in comparative analyses of the individual practice of doctors, nurses and midwives. RATIONALE: The question of how roles and responsibilities might be shared differently between professional groups in order to promote improved, cost-effective health care requires a systematic analysis of existing roles and practice. To do this effectively, knowledge of the methodologies available for such an analysis is essential. METHODS: A systematic review of the literature published since 1989 comparing the practice of doctors, nurses and midwives was undertaken. FINDINGS: The findings are presented in tabular format and include the following categories of published methodologies: experimental/quasi-experimental; descriptive/nonexperimental and qualitative studies. The discussion centres on a critique of quantitative methodologies used to analyse individual practice in relation to role substitution and diversification. The potential contribution of qualitative methodologies in the analysis of individual practice is discussed. CONCLUSIONS: The authors conclude that the current level of knowledge is biased towards quantitative research. It is argued that the assessment of health care roles and responsibilities would be well served by a more balanced approach that recognizes the strengths of both quantitative and qualitative work.
Humans↗
Changes in the mouse sciatic nerve action potential after epineural injection of sera from Trypanosoma cruzi infected mice.
Pathology of chronic Chagas' disease involves peripheral nervous system (PNS) compromise. A high prevalence of antibodies reacting with nervous system antigens has been found in the sera of patients and infected animals, although their physiological role in mediating PNS tissue damage is unknown. Here, we demonstrate that epineural injection of sera from Trypanosoma cruzi infected mice affects the characteristics of the sciatic nerve action potential (SNAP) depending on the parasite strain. Sera from mice infected with the reticulotropic/neurotropic RA strain with reactivity against sciatic nerve (RA/Ne+ sera) induced delays on latency and diminished amplitudes 4 days after injection. Sera from mice infected with the myotropic CA-I strain failed to affect SNAP. Purified immunoglobulin (Ig)G from RA/Ne+ also diminished the amplitude of SNAP. Deposits of IgG labelling axonal fibres and/or myelin sheaths were detected in nerves injected with RA/Ne+ sera. No major histological damage or parasite DNA was found in those nerves. The SNAP changes after sera injection were similar to those observed in mice injected with trypomastigotes in the epineurum 17 days before and in chronically infected animals. This investigation suggests that autoantibodies triggered as a consequence of T. cruzi infection are able to mediate, at least in part, the electrophysiological abnormalities observed in PNS during the course of Chagas' disease.
Action Potentials↗
The long-term results of Anderson-Hynes pyeloplasty.
OBJECTIVES: To examine the durability of open pyeloplasty for pelvi-ureteric junction obstruction. PATIENTS AND METHODS: The records of 56 Anderson-Hynes pyeloplasties undertaken by two surgeons between 1981 and 1994 were examined. Attempts were made to trace all patients and for them to undergo diuretic renography to examine the current status of the operated renal unit. RESULTS: In all, 41 evaluable patients were identified; 24 agreed to return for reassessment. The mean (range) time from surgery was 10.6 (6-19) years. The results showed an improvement over the preoperative split renal function in 19 patients (79%) and an improvement in drainage in 23 (96%). CONCLUSIONS: The Anderson-Hynes pyeloplasty is an excellent procedure for treating pelvi-ureteric junction obstruction, and produces a lasting improvement in function and drainage in most patients. It is the 'gold standard' against which newer techniques should be compared.
Adolescent↗
Shaping the interprofessional agenda: a study examining qualified nurses' perceptions of learning with others.
This paper presents the findings of a survey of post-qualified nursing students undertaking an interprofessional studies programme in a higher education institution. The total population of students surveyed included nurses, midwives, social workers and youth and community workers. However, the findings presented here centre on the data generated from the nurses. The participants made a retrospective evaluation of their educational experiences through focus groups and the use of a semi-structured questionnaire. Out of a potential 36 nurses, 32 (88%) participated in the evaluation. Overall, the nurses appraised their learning positively, although the qualitative data highlighted the complexity of the experience and the importance of skillful facilitation. Learning to work collaboratively entails more than learning about the practical roles of other occupations; it includes an understanding of the knowledge bases, aspirations and values that underpin those roles. The paper contributes to current debates about the most effective ways to prepare nursing students to work interprofessionally. It highlights the importance of evaluating the experiences of those taking part in interprofessional initiatives. This is a distinctive departure from much nursing research in the field in that it gives a voice to participants and identifies how their voice may shape interprofessional policy agendas.
Attitude of Health Personnel↗
Influence of recipient-bed isolation on survival rates of skin-flap transfer in rats.
The effect of recipient-bed isolation with artificial barriers on skin-flap survival, compared to flap transfer without bed isolation, was evaluated in a modified rat epigastric skin-flap model. The pattern of blood flow in the raised flap with a proximal axial portion and distal random portion was confirmed by laser Doppler flowmetry. Forty rats were divided into four groups. Three of the groups had one of three different artificial barriers-silicone, polypropylene, or gelatin sponge. In each of these three groups, one of the artificial barriers was placed between the flap and its recipient bed after flap replacement. The flaps without bed isolation (Group 4) were used as controls. The survival area was measured 7 days postoperatively. Results demonstrated that necrosis in the groups with silicone and polypropylene barriers was significantly higher than in the controls. Histologically, neovascularization was shown in the flaps without artificial barriers. Foreign-body reactions were observed in the flaps with bed isolation and among these, severe inflammation and congestion were seen in the flaps with polypropylene isolation. In this study, the authors demonstrated that the random portion of a rat skin flap could survive partially through imbibition of plasma and the ingrowth of new vessels from the recipient bed. This neovascularization can be prevented by recipient-bed isolation with an artificial barrier. Bed isolation with a silicone sheet is suggested for use in the study of rat skin-flap survival.
Animals↗
Proliferation and release of IL-5 and IFN-gamma by peripheral blood mononuclear cells from cat-allergic asthmatics and rhinitics, non-cat-allergic asthmatics, and normal controls to peptides derived from Fel d 1 chain 1.
BACKGROUND: In general, T cells from normal, nonatopic individuals respond to aeroallergens with synthesis and release of IFN-gamma. In contrast, release of T(H)2-type cytokines by activated lymphocytes is a feature of allergic rhinitis and atopic asthma. OBJECTIVE: The purpose of this study was to determine differences in T-cell recognition of epitopes within allergenic sequences, in terms of proliferation and cytokine production, in subjects with atopic asthma compared with subjects with allergic rhinitis and normal controls. METHODS: Proliferative responses and IL-5/IFN-gamma release patterns from PBMCs from cat-allergic asthmatic, cat-allergic rhinitic, and non-cat-allergic asthmatic subjects and nonatopic normal controls were determined in primary cultures. Cells were challenged with 7 overlapping peptides spanning chain 1 of the major cat allergen, Fel d 1. RESULTS: The 4 groups did not differ with respect to the ability to mount proliferative responses to Fel d 1 peptides. In all groups, the IFN-gamma responses were predominantly to the amino terminus peptides. Cat-allergic and non-cat-allergic asthmatic subjects (and not cat-allergic rhinitic subjects and normal controls) made IL-5 responses to most of the Fel d 1 peptides, the result being a mixed (T(H)0) cytokine response at the N-terminus and a restricted (T(H)2) response at the C-terminus. CONCLUSION: Proliferative and IL-5/IFN-gamma responses of T cells from asthmatic and atopic rhinitic subjects and normal controls to allergen peptides can be dissociated. Furthermore, differing cytokine responses to peptides derived from a single antigen suggest that certain domains of the molecule might preferentially induce IL-5 rather than IFN-gamma and as a result could be more important in disease pathogenesis.
Adult↗
Anatomic validation of a novel method for left ventricular volume and mass measurements with use of real-time 3-dimensional echocardiography.
Assessment of left ventricular (LV) volumes and mass is a critical element in the evaluation of patients with cardiovascular disease. However, most non-invasive methods used for the quantitative measurements of LV volume and mass have important intrinsic limitations. Real-time 3-dimensional echocardiography (RT3D echo) is a new technique capable of acquiring volumetric images without cardiac or respiratory gating. The purpose of this study was to develop and validate a system for rapid LV volume and mass measurements with the use of RT3D echo images. To this end, in 11 explanted sheep hearts, the left ventricle was instrumented with a latex balloon and filled with known volumes of saline solution. Two independent observers made volume calculations from images acquired with RT3D echo. In addition, 21 open-chest sheep were imaged with RT3D echo for LV mass calculation. Anatomic LV mass was determined after removing the heart. A strong correlation was observed between the actual LV volumes and those calculated from the RT3D echo images (r = 0.99; y = 1.31 + 0.98x; standard error of the estimate = 2.2 mL). An analysis of intraobserver and interobserver variabilities revealed high indexes of agreement. A strong correlation was observed between actual LV mass and that calculated from RT3D echo images (r = 0.94; y = 14.4 + 0.89x; standard error of the estimate = 8.5 gm). Thus RT3D echo images allow rapid and accurate measurements of LV volume and mass. This technique may expand the use of cardiac ultrasonography for the quantitative assessment of heart disease.
Animals↗
Noninvasive assessment of left ventricular isovolumic contraction and relaxation with continuous wave Doppler aortic regurgitant velocity signals: an in vivo validation study.
The purpose of this study was to provide fundamental in vivo validation of a method with the use of aortic regurgitant (AR) jet signals recorded with continuous wave (CW) Doppler for assessing left ventricular (LV) isovolumic contraction and relaxation. Preliminary studies have suggested that analysis of CW Doppler AR velocity signals permits the estimation of LV positive and negative dP/dt. We studied 19 hemodynamically different states in 6 sheep with surgically induced chronic aortic regurgitation. CW AR velocity spectra and high-fidelity LV and aortic pressures were recorded simultaneously. Rates of LV pressure rise and fall (RPR and RPF) were calculated by determining the time interval between points at 1 m/s and 2.5 m/s in the deceleration and acceleration slopes of the CW Doppler AR velocity envelope (corresponding to a pressure change of 21 mm Hg). RPR and RPF calculated by CW Doppler analysis for each state were compared with the peak positive dP/dt and negative dP/dt, obtained from the corresponding high-fidelity LV pressure curve, respectively. The LV peak positive and negative dP/dt derived by catheter ranged from 817 to 2625 mm Hg/s and from 917 to 2583 mm Hg/s, respectively. Multiple regression analysis showed that Doppler RPR correlated well with catheter peak positive dP/dt (r = 0.93; mean differences, -413 +/- 250 mm Hg/s). There was also good correlation and agreement between Doppler RPF and the catheter peak negative dP/dt (r = 0.89; mean difference, -279 +/- 239 mm Hg/s). Both Doppler-determined RPR and RPF underestimated their respective LV peak dP/dt. CW Doppler AR spectra can provide a reliable noninvasive estimate of LV dP/dt and could be helpful in the serial assessment of ventricular function in patients with aortic regurgitation.
Animals↗
Quantification of aortic regurgitation by real-time 3-dimensional echocardiography in a chronic animal model: computation of aortic regurgitant volume as the difference between left and right ventricular stroke volumes.
BACKGROUND: The accuracy of conventional 2-dimensional echocardiographic and Doppler techniques for the quantification of valvular regurgitation remains controversial. In this study, we examined the ability of real-time 3-dimensional (RT3D) echocardiography to quantify aortic regurgitation by computing aortic regurgitant volume as the difference between 3D echocardiographic-determined left and right ventricular stroke volumes in a chronic animal model. METHODS: Three to 6 months before the study, 6 sheep underwent surgical incision of one aortic valve cusp to create aortic regurgitation. During the subsequent open chest study session, a total of 25 different steady-state hemodynamic conditions were examined. Electromagnetic (EM) flow probes were placed around the main pulmonary artery and ascending aorta and balanced against each other to provide reference right and left ventricular stroke volume (RVSV and LVSV) data. RT3D imaging was performed by epicardial placement of a matrix array transducer on the volumetric ultrasound system, originally developed at the Duke University Center for Emerging Cardiovascular Technology. During each hemodynamic steady state, the left and right ventricles were scanned in rapid succession and digitized image loops stored for subsequent measurement of end-diastolic and end-systolic volumes. Left and right ventricular stroke volumes and aortic regurgitant volumes were then calculated and compared with reference EM-derived values. RESULTS: There was good correlation between RT3D left and right ventricular stroke volumes and reference data (r = 0.83, y = 0.94x + 2.6, SEE = 9.86 mL and r = 0.63, y = 0.8x - 1.0, SEE = 5.37 mL, respectively). The resulting correlation between 3D- and EM-derived aortic regurgitant volumes was at an intermediate level between that for LVSV and that for RVSV (r = 0.80, y = 0.88x + 7.9, SEE = 10.48 mL). RT3D tended to underestimate RVSV (mean difference -4.7 +/- 5.4 mL per beat, compared with -0.03 +/- 9.7 mL per beat for the left ventricle). There was therefore a small overestimation of aortic regurgitant volume (4.7 +/- 10.4 mL per beat). CONCLUSION: Quantification of aortic regurgitation through the computation of ventricular stroke volumes by RT3D is feasible and shows good correlation with reference flow data. This method should also be applicable to the quantification of other valvular lesions or single site intracardiac shunts where a difference between right and left ventricular cavity stroke volumes is produced.
Animals↗
Vascular reactivity in men and women of reproductive age.
OBJECTIVE: This study was undertaken to document vascular reactivity in both phases of normal menstrual cycles and anovulatory cycles of women receiving oral contraceptives and to compare vascular reactivity of women in the follicular phase of the normal menstrual cycle with that of men of a similar age group. STUDY DESIGN: Forearm blood flow was measured with plethysmography in 15 women with ovulatory cycles during the follicular and luteal phases of the normal cycle, at equivalent times in 14 women receiving oral contraceptives, and in 15 age-matched men. Changes in forearm blood flow, an index of vascular reactivity, were measured during a randomly ordered brachial artery infusion schedule of norepinephrine, sodium nitroprusside, angiotensin II, and Nomega-monomethyl-L -arginine and were analyzed with repeated measures analysis of variance. RESULTS: Forearm blood flow responses were similar in the two phases of the normal cycle. Responses were similar between women with ovulatory cycles and users of oral contraceptives, apart from a significantly greater response to angiotensin II in the oral contraceptive group during the medication phase than during the withdrawal phase (P =.027). Basal forearm blood flow was higher in men than in women (7 +/- 1.6 vs 5 +/- 1.4 mL/100 mL per minute; P =.015), and men demonstrated a significantly greater vasoconstrictor response to norepinephrine (P <.05) than did women. CONCLUSION: Vascular reactivity is similar in the two phases of the normal menstrual cycle, but women who use oral contraceptives have an exaggerated response to angiotensin II during the medication phase. Men demonstrate greater vascular reactivity to norepinephrine than do women, perhaps because of the lack of estrogen-mediated protective effects and increased adrenergic activity.
Adult↗
Twenty-four-hour automated blood pressure monitoring as a predictor of preeclampsia.
OBJECTIVE: The purpose of this study was to determine the predictive ability of parameters of 24-hour ambulatory blood pressure monitoring for the development of preeclampsia or gestational hypertension in women who are already considered at risk for these disorders. STUDY DESIGN: One hundred twenty-two pregnant women who were considered high risk for the development of preeclampsia underwent 24-hour ambulatory blood pressure monitoring between 18 and 30 weeks gestation, while their condition was normotensive according to routine mercury sphygmomanometry. One hundred sixty-four healthy primigravid women who were considered at usual risk for preeclampsia underwent the same tests as a parallel study. Routine blood pressure, awake and sleep average blood pressure, and 24-hour mean average blood pressure were entered into multiple logistic regression as predictors of either preeclampsia or gestational hypertension; significant variables were then tested by a series of receiver operator curves. RESULTS: Eight percent of usual risk and 45% of high risk women experienced the development of preeclampsia or gestational hypertension. In both groups, the average routine mercury blood pressure and awake, sleeping, and 24-hour ambulatory blood pressure monitoring-derived blood pressure were significantly higher in women who later experienced the development of preeclampsia or gestational hypertension. In usual risk women, 24-hour systolic blood pressure of >or=115 mm Hg and sleeping systolic blood pressure of >or=106 mm Hg were predictive of later preeclampsia or gestational hypertension, but sensitivities were low (77% and 54%, respectively). In high risk women, sleeping diastolic blood pressure of >or=62 mm Hg and sleeping mean arterial pressure of >or=79 mm Hg were predictive of preeclampsia or gestational hypertension, but again sensitivities were low (70% and 65%, respectively). CONCLUSION: Awake and sleeping blood pressure are higher in midpregnancy in women who later experience the development of preeclampsia or gestational hypertension. Twenty-four-hour ambulatory blood pressure monitoring provides a noninvasive method of selecting some of these women, but this test has a sensitivity no better than that of other predictive tests, even in women at high risk for preeclampsia.
Adult↗
A critical review of rural medical workforce retention in Australia.
The problem of how best to recruit and retain doctors in rural and remote communities has led governments to adopt a range of medical workforce incentives, including retention grants. A comprehensive literature survey suggests that medical workforce retention has been poorly distinguished from other supply issues such as recruitment, and that its determinants and the process leading to retention are poorly understood. Such a knowledge gap is likely to limit the effectiveness of retention incentives. This article reports the results of this literature review, and advances a conceptual framework as the basis for ongoing research and evaluating how best to deliver effective retention interventions.
Australia↗
The practitioner as policy analyst: a study of student reflections of an interprofessional course in higher education.
Health and welfare practitioners in the United Kingdom have experienced and continue to experience considerable turbulence as services and occupational boundaries undergo restructuring. To a significant extent such turbulence is driven by policies that promote interprofessional agendas. This paper reports on an evaluation of a higher education programme that adopted a social policy approach to the analysis of interprofessional working. The retrospective views were sought of nursing, midwifery, social work and community and youth work post-qualifying students with use of semi-structured questionnaires and focus groups. Although difficulties were encountered with the political science focus to the programme, overall the participants very positively evaluated the opportunity to engage in policy analysis in a shared learning environment. Given the highly politicised, complex and shifting environment of interprofessional working, it is suggested that the study lends support to the argument that 'policy acumen' is a central skill for contemporary health and welfare practitioners. The paper, therefore, starts to explore issues of particular relevance for educationalists involved in developing frameworks for interprofessional programmes particularly in higher education.
Education, Continuing↗
Is it possible to decrease antibiotic prescribing in primary care? An analysis of outcomes in the management of patients with sore throats.
OBJECTIVES: The aim of this study was to assess whether it was possible to change clinical practice through the introduction of an evidence-based protocol for the management of sore throats. The impact of the changed clinical practice on patients was also assessed. METHOD: An observational study was carried out comparing management of patients with sore throats in a semi-rural general practice (14 000 patients), before and after the introduction of an evidence-based protocol, using a multidisciplinary approach. All patients over the age of 2 years presenting with sore throats as their chief presenting complaint were included in the study which ran for two 6-month periods: February-July 1997 (n = 435) and February-July 1998 (n = 350). Antibiotic prescribing rates, consultation and reconsultation rates, duration of sore throat, analgesia requirements and satisfaction were assessed. RESULTS: Antibiotic prescribing was significantly reduced in period 2 (56% compared with 19%). Consultation rates decreased by 19% in period 2. Median number of days to recovery of sore throats was the same in both groups. Reconsultation rates and dissatisfaction rates were the same in both groups. CONCLUSION: Using a multidisciplinary approach, it is possible to reduce antibiotic prescribing for sore throats significantly without adversely affecting outcome.
Anti-Bacterial Agents↗
Risperidone olanzapine drug outcomes studies in schizophrenia (RODOS): health economic results of an international naturalistic study.
We report the health economic data from the Risperidone Olanzapine Drug Outcomes studies in Schizophrenia (RODOS) programme. Details of the efficacy and tolerability data from RODOS are available in a companion paper. The population analysed during RODOS consisted of 1901 patients with diagnoses of schizophrenia or schizoaffective disorder. The mean +/- SD daily dose of olanzapine treatment was 14.5 +/- 5.1 mg compared to 5.3 +/- 2.6 mg for risperidone. Use of concomitant neuroleptics (risperidone, 65%; olanzapine, 62%; P = 0.2) and other concomitant drugs (risperidone, 76%; olanzapine, 73%; P = 0.2) was similar in both groups. The mean +/- SD total costs of all inpatient drugs was significantly (P < 0.001) higher for olanzapine (US$ 297.5 +/- 305.1) than risperidone (US$159.9 +/- 183.3). Although this difference in the average total costs in part reflects the longer treatment duration for olanzapine compared to risperidone (34 days versus 31 days), the cost difference remained when looking at costs on a daily basis. The mean +/- SD daily cost of all inpatient drugs was also significantly (P < 0.001) higher for olanzapine (US$7.7 +/- 4.0) than for risperidone (US$ 4.6 +/- 2.9). These findings were very consistent across all nine countries. The results from RODOS suggest that treatment costs are significantly higher with olanzapine than with risperidone without any clinical benefit to offset this.
Adult↗
Multiple micronutrient deficiencies in a child fed an elemental formula.
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Ascorbic Acid Deficiency↗