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Biomedical subjects

M McCarthy

Publications and source records attributed to M McCarthy.

At least 307 records · Page 17Linked to original sources
PubMed1992

Relationship between the number of partners in a general practice and the number of different drugs prescribed by that practice.

The objective of this study was to assess whether practice size, as measured by the number of doctors, had any bearing on the range of drugs prescribed. All practices in the northern and western health boards in Northern Ireland were included in the study--a total of 132 practices (362 doctors) serving a population of 628,249. Prescribing data, obtained from the Department of Health and Social Services (Northern Ireland) information technology unit database, were analysed retrospectively for the month of January 1989. The number of different preparations prescribed in each of 22 therapeutic groups were counted. Hence a measure of the range of prescribing was assessed. A significant correlation was found between the number of different preparations prescribed and the number of general practitioners working in the practice. However, no correlation was found between the number of different drugs prescribed and the mean prescribing cost per patient or the mean list size of the doctors in each practice. The use of a practice prescribing policy was found to have no influence on the range of drugs prescribed, nor on the prescribing costs. The inference is that formal therapeutic policies may be difficult to implement within group practices. These results are of importance to general practitioners since the greater the number of different drugs prescribed the greater will be the risk of side effects and dangerous interactions.

Drug Costs↗
PubMed1992

Futility of yearly heart biopsies in patients undergoing heart transplantation.

Three hundred thirty-eight endomyocardial biopsies, performed as part of the routine annual evaluation at 1 or more years after transplantation in 211 patients, were reviewed. In only two instances (0.6%) were the histologic findings suggestive, but not pathognomonic, of acute rejection. Both patients were treated for rejection and are doing well at 4 and 6 years postoperatively. On the basis of the results of this study, we believe that routine yearly heart biopsies in asymptomatic patients are not necessary for long-term care of patients after heart transplantation, and we believe they should be performed only if there is clinical suspicion of rejection or as part of a research protocol.

Actuarial Analysis↗
PubMed1991

A controlled clinical trial of E5 murine monoclonal IgM antibody to endotoxin in the treatment of gram-negative sepsis. The XOMA Sepsis Study Group.

OBJECTIVE: To assess the efficacy of adjunctive monoclonal antibody antiendotoxin immunotherapy in patients with gram-negative sepsis. DESIGN: Double-blind, randomized, placebo-controlled trial. SETTING: Thirty-three university-affiliated centers, including Veterans Affairs, community, and municipal hospitals. PATIENTS: Hospitalized adults with signs of gram-negative infection and a systemic septic response. INTERVENTION: Patients were assigned to receive either 2 mg/kg of a murine monoclonal antibody directed against gram-negative endotoxin (E5) or placebo. A second infusion was administered 24 hours later. MAIN OUTCOME MEASURES: Mortality over the 30-day study period, resolution of organ failures, and safety. RESULTS: Four hundred eighty-six patients were enrolled. Three hundred sixteen had confirmed gram-negative sepsis (54% bacteremic, 46% nonbacteremic). The survival difference was not statistically significant for all patients. Among patients with gram-negative sepsis who were not in shock at study entry (n = 137), E5 treatment resulted in significantly greater survival (relative risk, 2.3; P = .01). Resolution of individual organ failures was more frequent among these patients, occurring in 19 (54%) of 35 patients in the E5 group vs eight (30%) of 27 in the placebo group (P = .05). Four reversible allergic reactions occurred among 247 patients (1.6%) receiving E5. No other toxicity was identified. CONCLUSIONS: Treatment with E5 antiendotoxin antibody appears safe. It reduces mortality and enhances the resolution of organ failure among patients with gram-negative sepsis who are not in shock when treated.

Aged↗
PubMed1991

Treatment of breast cancer in two teaching hospitals: a comparison with consensus guidelines.

We compared the initial treatment of 383 patients with breast cancer in two central London teaching hospitals during 1986 with the guidelines of the King's Fund Consensus Conference for breast cancer treatment held in London the same year. The majority of patients (68%) received lumpectomy and 18% received mastectomy. Lumpectomy was followed by radiotherapy for 95% of cases but 30% of mastectomy patients also received radiotherapy. Only 42% of the patients had surgical sampling of the axillary nodes. Cytotoxic chemotherapy was recorded for 27% women under 50, but also for 16% women age 50 or more. Tamoxifen was given to 58% of women aged 50 or more, but also to 26% of women under 50. We conclude that there are discrepancies between consensus guidelines and clinical practice. Further study is needed to determine whether these variations are clinically important, and whether similar variations exist elsewhere in Europe.

Breast↗
PubMed1991

Pedal cyclists, crash helmets and risk.

As a rate per million kilometres travelled, the 'risk' of cycling appears to be high in relation to other forms of transport. Yet, in absolute numbers, there are far fewer cyclist deaths than pedestrian or motor vehicle occupant deaths, and most deaths and serious injuries to pedal cyclists are caused by other road users--principally motor vehicles. The large majority of pedal cyclist deaths are due to head injuries after collision with a motor vehicle. It is therefore commonly proposed that cyclists should wear crash helmets for their own 'safety'. Helmets may protect against fall injuries, but current models are not designed to withstand the impact of collisions with motor vehicles. Evidence for the benefit of pedal cyclists wearing helmets is limited: the existing studies cannot exclude the possibility of different risk-taking behaviour, either by cyclists or by motor vehicle drivers, for helmet wearers compared with non-wearers. A public health policy towards reducing pedal cyclist deaths should seek prevention of accidents, rather than protection from their consequences. Cycling in greater safety would reduce the 'risk' per kilometre travelled, but more cycling might not reduce total cyclist deaths or injuries--because of greater exposure. The 'risk' of cycling--the risk of injury or death--is a complex mix of exposure, 'danger' of the environment, and the perceived risk affecting our precautionary preventive behaviour.

Accident Prevention↗
PubMed1991

Infection of human neural cell aggregate cultures with a clinical isolate of cytomegalovirus.

Human neural cell aggregate cultures were prepared from dissociated fetal brain tissue and maintained in rotation culture. After 35 days in culture, aggregates had the histologic appearance of dense, immature, neural cells in a tightly packed neuropil. Electron microscopy revealed ultrastructural features suggestive of immature neurons and neuroglia. In addition, neuron-specific enolase and glial fibrillary acidic protein associated with radial glial cells were detected within the aggregates by immunoperoxidase staining. When infected with a laboratory-adapted strain of cytomegalovirus (CMV), [AD169], cells containing large, bizarre, nuclei and CMV-induced intranuclear inclusion bodies were dispersed throughout the aggregates at 16 days postinfection. In situ hybridization using a CMV-specific DNA probe and electron microscopy confirmed the presence of virus sequences as well as virus particles at histologic sites of cytopathology. In sharp contrast, aggregate cultures infected with a CMV strain recovered from the retina of an acquired immune deficiency syndrome (AIDS) patient with CMV retinitis and encephalitis displayed distinct foci of cytopathology at 23 days postinfection, a pattern not observed in CMV [AD169]-infected aggregates. Our findings suggest that human neural cell aggregates represent a a promising multicellular non-neoplastic culture system in which to study the replication of human neurotropic viruses within neural tissue.

Brain Diseases↗
PubMed1991

Functional scoring of multi-trauma patients: who ends up where?

To help map the continuum from injury to return to full function, the Functional Independence Measure (FIM) was used in an acute care setting to identify and track disability, to focus rehabilitative efforts during the acute phase of care, and to help demonstrate what is truly important in getting patients back to full functional status. A total of 109 patients were assessed over a 13-month period. FIM scores were based on a patient's ability to routinely perform certain tasks in 18 areas of function and ranged from 1 to 7. The change in FIM scores from admission to discharge was used to determine those patients to be discharged home and those patients to be discharged to a rehabilitation facility. We conclude that the FIM is a very useful tool that produced a very good measure of a patient's total function, tracked progress or lack of it through acute hospitalization, and correctly categorized and quantitated dysfunction (both cognitive and physical) as discharge planning was being done.

Activities of Daily Living↗
PubMed1991

Monoclonal antibody-defined epitope map of expressed rubella virus protein domains.

An expanded library of murine monoclonal antibodies (MAbs) was generated by infecting BALB/C mice with the Therien strain of rubella virus (RV) and selecting secreting hybrids by enzyme-linked immunosorbent assay (ELISA) using purified virion targets. A panel of plasmids containing specified RV cDNA fragments was also constructed by using a variety of strategies with pGE374- and pGE374-derived expression vectors. Hybrid RecA-RV-beta-galactosidase (LacZ)- or RecA-RV-truncated LacZ-containing proteins collectively representing the entire open reading frame of the structural proteins of RV were overexpressed in Escherichia coli. Bacterial lysates were then probed by ELISA with selected MAbs and by immunoblot following separation by electrophoresis under denaturing conditions. With this approach, MAbs that appeared to react with linear determinants defined epitopes localized within the following domains: MAbs C-1, C-2, and C-8 bind epitopes within the predicted amino-terminal 21 amino acids of the capsid region C9 to C29; MAb C-9 binds to a domain bounded by C64 and C97; MAbs E2-1 through E2-6 bind to the E2 glycoprotein backbone region from E2(1) to E2(115); MAbs E1-18 and E1-20 bind to the E1 glycoprotein region from E1(202) to E1(283). MAb E1-18 neutralizes RV infectivity; MAb E1-20 neutralizes infectivity and modestly inhibits hemagglutination. Analyses with selected synthetic peptides have confirmed several of the molecular domains deduced with the expressed proteins. These plasmid constructions and peptides have proven useful in beginning to unravel the molecular organization of several antigenic sites of this human pathogen.

Animals↗
PubMed1991

The role of HTLV in HIV-1 neurologic disease.

We performed a serologic survey for antibodies to HTLV-I/II in the course of a longitudinal study of the neurologic complications of HIV-1 infection. Nine (3.7%) of 242 HIV-1 seropositive subjects and none of 60 HIV-1 seronegative control subjects had antibodies to HTLV-I/II by ELISA. Western blot and polymerase chain reaction confirmed the presence of HTLV-I in 2 subjects and HTLV-II infection in 2 others. Both HIV-1/HTLV-I coinfected subjects and 1 HIV-1/HTLV-II coinfected subject had a slowly progressive myelopathy clinically identical tropical spastic paraparesis/HTLV-I-associated myelopathy (TSP/HAM). The presence of a myelopathy resembling TSP/HAM in the coinfected subjects suggests that HIV-1 may enhance the expression of neurologic disease caused by HTLV. Patients with a progressive myelopathy occurring in association with HIV-1 infection should be serologically tested for the presence of HTLV. Establishing dual infection has therapeutic and prognostic import as 1 of the HIV-1/HTLV-I subjects substantially improved with corticosteroids and the HIV-1/HTLV-II subject with myelopathy had a marked improvement in the absence of therapeutic intervention.

Adult↗
PubMed1991

Community HIV/AIDS teams.

This paper describes a consecutive series of 103 patients with HIV and AIDS related illnesses who were referred to, and remained in, the care of two community teams. The characteristics of the patients are outlined and the early experiences of the teams are described. The findings of this study should assist doctors and nurses caring for patients with HIV and AIDS related illnesses in the community, and provide valuable data for service planners.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Anger attacks in depressed outpatients and their response to fluoxetine.

"Anger attacks" are spells of anger that are inappropriate to the situation and have physical features resembling panic attacks. The Anger Attacks Questionnaire, designed to assess these attacks, was administered to 79 consecutive patients (25 men and 54 women, mean age 38.8 +/- 10.3 years) diagnosed as having major depression with the Structured Clinical Interview for DSM-III-R. Of these 79 depressed patients, 34 (13 men and 21 women) reported having anger attacks according to our criteria. The prevalence of anger attacks in a group of 31 younger depressed patients (48%) was significantly higher (p = .048) than that of 29 normal controls (21%) of similar age. Of the 79 depressed patients, 19 (7 men, 12 women) were treated openly with fluoxetine at 20 mg/day for at least 8 weeks. At pretreatment, 9 patients (47%) had reported anger attacks, only 3 (16%) continued to report them after treatment, and the difference was statistically significant (p less than .05).

Adult↗
PubMed1991

Hypochloremic metabolic alkalosis from ingestion of a chloride-deficient infant formula: outcome 9 and 10 years later.

In 1978 and 1979 two infant formulas, Neo-Mull-Soy and Cho-Free, were found to be deficient in chloride. The Centers for Disease Control received reports that hypochloremic metabolic alkalosis (HMA) had developed in 141 children as a result of exposure to these formulas. Thirty-five of these children were examined at 9 and 10 years of age and compared with a group of 32 children who were exposed to the chloride-deficient formulas but were not reported to experience HMA and a group of 61 children who received chloride-sufficient soy formulas in infancy. The control children were matched to the HMA children on sex, race, age, and maternal education. Growth characteristics, performance on the Wechsler Intelligence Scale for Children-Revised (WISC-R), the Boston Naming Test, the Rey-Osterrieth Test, the Clinical Evaluation of Language Fundamentals-Revised (CELF-R), and subtests from several other speech and language tests were compared across the groups. After adjustment for family income and the level of the father's education, significantly lower scores were observed in the HMA children on the WISC-R Arithmetic subtest (mean = 10.5) compared with the soy control children (mean = 12.0, P less than .05) and on the WISC-R Coding subtest (mean = 9.0) compared with the soy control children (mean = 10.8, P less than .01). All the WISC-R subtest scores were, however, within the normal range. Although no significant differences occurred on the CELF-R between groups, the risk of an HMA child falling below the range expected for a standard population was increased on the CELF-R Composite Total, Receptive, and Expressive Language scores: risk ratios = 2.14, 2.14, and 3.03 respectively. Significant differences were observed between the children exposed, both HMA and non-HMA children, and the soy control children for behavioral problems as determined by the Achenbach Childhood Behavioral Checklist. It is concluded that as a group, children with documented HMA appear to have recovered from their growth failure and have normal cognitive development. They may, however, be at risk for deficits in language skills that require expressive language abilities.

Alkalosis↗
PubMed1990

Palliative care: views of patients and their families.

OBJECTIVE: To investigate the current problems and needs of terminally ill cancer patients and their family members, and to discover their views of hospital, community, and support team services. DESIGN: Prospective study of patients and families by questionnaire interviews in the patients' homes. SETTING: Inner London and north Kent (London suburbs). SUBJECTS: 65 Patients, each with a member of their family or a career. MAIN OUTCOME MEASURES: Ratings of eight current problems and ratings and comments on three services-hospital doctors and nurses, general practitioners and district nurses, and the support team staff-obtained after a minimum of two weeks' care from palliative care support teams. RESULTS: Effect of anxiety on the patient's nearest career. and symptom control were rated as the most severe current problems by both patients and families; a few patients and families identified other severe problems. Families' ratings of pain control, symptom control, and effect of anxiety on the patient were significantly worse than the patients' ratings (p less than 0.05). Support teams received the most praise, being rated by 58 (89%) patients and 59 (91%) of family members as good as excellent. General practitioners and district nurses were rated good or excellent by 46 (71%) patients and 46 (71%) family members, but six (9%) in each group rated the service as poor or very bad, and ratings in the inner London district were significantly worse than those in the outer London district. Hospital doctors and nurses were rated good or excellent by 22 (34%) patients and 35 (54%) of family members, and 14 (22%) patients and 15 (23%) family members rated this service as poor or very bad. Negative comments referred to communication (especially at diagnosis), coordination of services, the attitude of the doctor, delays in diagnosis, and difficulties in getting doctors to visit at home. Family members were more satisfied with the services than were patients. CONCLUSIONS: Palliative care needs to include both the patient and family because the needs of the family may exceed those of the patient. Support teams and some hospital and community doctors and nurses met the perceived needs of dying patients and families, but better education and organisation of services are needed.

Adult↗
PubMed1990

Enhancement of [3H]muscimol binding to brain synaptic membranes by progesterone and related pregnanes.

Progesterone (a delta 4-3 keto-pregnane) as well as a series of pregnanes enhanced [3H]muscimol binding to rat cerebral cortex membranes. This effect was increased by preincubation in the presence of the drugs, progesterone being effective only after a 30 min preincubation. The effect of progesterone was dose-dependent from 1 nM to 100 microM reaching a maximum of 140% over control. Its 20 alpha and 20 beta reduced metabolites (20 alpha- and 20 beta-OH-4-pregnen-3-one) had no effect. Ring A reduction in either the 5 alpha or 5 beta position resulted in steroids (5 alpha- and 5 beta-pregnane-3,20-di-one) producing moderate but consistent facilitation of binding (30-40% increase at 10 microM). The presence of a hydroxyl group in C3 had variable results in the potency of pregnanes to facilitate muscimol binding. Pregnanes with a 3 beta-OH group showed weaker activity than those having a 3 alpha-OH group, 5 alpha-pregnan-3 alpha-ol-20-one being the most potent (100% stimulation). Pregnenolone, a delta 5-3 beta-OH-pregnane, was only effective at low concentrations (10 nM to 10 microM). Scatchard analysis of [3H]muscimol binding in the presence of progesterone and 5 alpha-pregnan-3 alpha-ol-20-one revealed that the observed effect was due to an increase in binding sites rather than to a change in affinity.

Animals↗