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Biomedical subjects

M McKee

Publications and source records attributed to M McKee.

At least 181 records · Page 10Linked to original sources
PubMed1995

Mortality league tables: do they inform or mislead?

OBJECTIVE: To examine certain methodological issues related to the publication of mortality league tables, with particular reference to severity adjustment and sample size. DESIGN: Retrospective analysis of inpatient hospital records. SETTING: 22 hospitals in North West Thames health region for the fiscal year 1992-3. SUBJECTS: All admissions with a principal diagnosis of aortic aneurysm, carcinoma of the colon, cervical cancer, cholecystectomy, fractured neck of femur, head injury, ischaemic heart disease, and peptic ulcer. MAIN MEASURES: In hospital mortality rates adjusted by disease severity and calculated on the basis of both admissions and episodes. RESULTS: The numbers of deaths from specific conditions were often small and the corresponding confidence intervals wide. Rankings of hospitals by death rate are sensitive to adjustment for severity of disease. There are some differences that cannot be explained using routine data. CONCLUSIONS: Comparison of crude death rates may be misleading. Some adjustment for differences in severity is possible, but current systems are unsatisfactory. Differences in death rates should be studied, but because of the scope for manipulating data, this should be undertaken in a collaborative rather than a confrontational way. Any decision to publish league tables of death rates will be on political rather than scientific grounds.

Adolescent↗
PubMed1995

[Public health in the XXI century].

To understand what will happen in the future one must draw on the experience of those from the past who have tried to predict what is happening now. The paper develops a taxonomy of visionaries of futurologist; the advocates of historical determinism, who come from both the left, such as Marx, and the right, such as Toffler and Fukuyama; the scientist, ranging from Leonardo da Vinci to Arthur C. Clarke, and the pragmatists, who seek to learn from evidence and the experience of others. These will be examined in turn and the frequent failings of the first three will be illustrated. Drawing on experience in a variety of European countries it will be concluded that our best hope is to learn from each other and from empirical evidence. The article will conclude with a review of some of the challenges which are either predictable but being ignored or totally unpredictable.

History, Modern 1601-↗
PubMed1995

Identification of an extensive system of nitric oxide-producing cells in the ciliary muscle and outflow pathway of the human eye.

PURPOSE: Nitric oxide (NO) is an important intracellular and intercellular regulator in nerve tissue as well as in vascular endothelium, smooth muscle, and certain other cell types. In the ocular anterior segment, studies in rat have revealed a comparatively restricted distribution of the NO synthetic enzyme, NO synthase (NOS-1). Recent physiological studies, however, have shown that NO-mimicking nitrovasodilators can alter intraocular pressure in monkeys through an action (at least in part) on outflow resistance. The current studies, which determine the sites of NO synthesis in the human outflow pathway, were performed to provide an anatomic and biochemical explanation for these observations. METHODS: The occurrence and distribution of sites of ocular NO production in postmortem human eyes were determined using the isozyme-independent NO-indicator marker, NADPH-diaphorase (NADPH-d), together with direct biochemical assay and immunocytochemical localization of specific NO synthase (NOS) isoforms. RESULTS: The ciliary muscle (CM) and outflow pathway of normal human eyes were found to be substantially enriched in NADPH-d, the majority of which, by immunological analysis, consisted not of NOS-1 (brain or bNOS) but rather of NOS type 3 (endothelial cell or ecNOS). Biochemical analysis confirmed the NADPH-dependent production of NO and, unlike the primarily soluble distribution of bNOS, activity was found in both particulate and soluble fractions. NO reactivity was enriched in major sites of outflow resistance (trabecular meshwork and Schlemm's canal) as well as in collecting channels and was particularly prominent in the CM, especially in the anatomically distinct longitudinal subgroup of CM fibers that insert near (and may normally play a role in regulating resistance in) the trabecular meshwork. CONCLUSION: The human outflow pathway and CM are enriched sites of NO synthesis. These sites are anatomically distributed in such a manner as to suggest that one possible role for NO in the anterior segment may be to modulate outflow resistance either directly at the level of the trabecular meshwork, Schlemm's canal and collecting channels, or indirectly through alteration in the tone of the longitudinal CM.

Adolescent↗
PubMed1995

Alterations of ocular nitric oxide synthase in human glaucoma.

PURPOSE: The authors recently reported that sites of outflow resistance and regulation in the human eye are highly enriched in the endothelial isoform of nitric oxide (NO) synthase (ecNOS). In vasculature, ecNOS activation is associated with altered vascular resistance and, in the stomach, defects in NO are associated with pathologic gastric hypertension. Because human glaucoma sometimes is associated with an increase in intraocular pressure and resistance changes in the aqueous outflow pathway (OP), the authors have investigated the possibility that alterations in NO or defects in NO-synthesizing tissues might exist in glaucomatous eyes. METHODS: Occurrence, distribution, and extent of sites of ocular NO production in the anterior segments of 16 normal eyes (10 patients) and 17 eyes (12 patients) with a history of primary open-angle glaucoma (POAG) were determined using the NO-indicator marker, NADPH-diaphorase (NADPH-d), which is known to colocalize with ecNOS immunoreactivity. Analysis of NADPH-d reactivity in tissues was combined with examination of overall cell distribution and use of neuron-specific markers. RESULTS: The ciliary muscle (CM) and OP of glaucomatous eyes showed marked differences in the amount and distribution of NADPH-d and alterations in gross structure. NADPH-d reactivity was decreased in trabecular meshwork (TM) and Schlemm's canal, and there was a marked reduction of anterior longitudinal CM fibers that insert near (and may normally regulate resistance in) the TM. CONCLUSION: Abnormalities in NO or NO-containing cells occur in POAG. These abnormalities may be causally related to glaucoma or may be a manifestation of the disease or its treatment. In either case, such alterations, together with recent pharmacologic studies showing that NO-mimicking nitrovasodilators alter IOP, indicate that NO has relevance to the course, treatment, or both, or some forms of this disease.

Aged↗
PubMed1995

Atrial natriuretic peptide modulates sodium and potassium-activated adenosine triphosphatase through a mechanism involving cyclic GMP and cyclic GMP-dependent protein kinase.

Prior studies indicate that the natriuretic effects of atrial natriuretic peptide (ANP) are due, in part, to an inhibition of the passive movement of sodium ions from tubular lumen through apical cation channels into renal tubular epithelium. The present work demonstrates that ANP also exerts a potent inhibitory effect on the active pumping of sodium ions by renal tubular sodium and potassium-activated adenosine triphosphatase (Na, K-ATPase). This action of ANP is relatively long lasting, is due to a change in enzyme Vmax and is specific for ouabain-sensitive activity. Enzyme modulation occurs with an EC50 for ANP of 0.1 nM, is independent of intracellular [Na+] and is associated with an increase in tissue cyclic GMP (cGMP), but not cyclic AMP (cAMP). Modulation of Na, K-ATPase by ANP is mimicked by 8-bromo-cGMP and okadaic acid (OA) and is blocked by KT 5823, a selective inhibitor of cGMP-dependent protein kinase (PKG), but not by KT 5720, a selective inhibitor of cyclic AMP-dependent protein kinase (PKA), which suggests that the action of ANP on the sodium pump involves cGMP-mediated changes in protein phosphorylation. Regulation of renal Na, K-ATPase activity also occurs with nitric oxide-generating compounds, such as nitroglycerin and sodium nitroprusside (SNP). However, the ability of ANP to modulate Na, K-ATPase does not appear to involve this latter pathway because the effects of ANP on the sodium pump cannot be blocked by either N omega-nitro-L-arginine, an inhibitor of NO synthase, or hemoglobin, which blocks NO through binding.(ABSTRACT TRUNCATED AT 250 WORDS)

Alkaloids↗
PubMed1995

Development of public health training in Hungary--an exercise in international co-operation.

Following the fall of Communism, the countries of Central and Eastern Europe have been restructuring their health systems. Restructured medical education is vital to, and has been supported by, the European Union TEMPUS (Trans-European Mobility Scheme for University Studies) scheme. An example is a three-year project in Hungary to develop undergraduate and postgraduate medical education in public health. The project team (CNPHH) included representatives from all Hungarian medical schools and universities in Western Europe and Canada. The project involved assessing the needs of the Hungarian departments and developing a strategy involving transfer of skills in modern public health and educational methods, study visits and courses in Hungary and at Western universities, and capital funding. The project provides a model for others wishing to develop or restructure their education at national or local levels. This paper describes the methods used, outcomes achieved, and lessons learned.

Curriculum↗
PubMed1994

Nitric oxide, cGMP, and hormone regulation of active sodium transport.

The inter- and intracellular regulator nitric oxide (NO) has been suggested to play a role in the modulation of cellular excitability, but the mechanism(s) by which this occurs remain unclear. Using the kidney as a model system, we report here evidence that NO, produced in response to various hormones and cytokines, can effect long-term alterations in the activity of the membrane sodium pump. This regulation of Na, K-ATPase, which occurs in a system of NO-containing renal tubules, involves cGMP and cGMP-dependent protein kinase. Na, K-ATPase can also be regulated by alterations of cGMP initiated through NO-independent factors, such as atriopeptin, and in nonrenal tissues, such as cerebellum. Regulation of the membrane sodium pump by NO and cGMP, therefore, represents a mechanism for hormonal modulation of ion gradients, not only in kidney but also in other organs, including brain, where NO and cGMP play a prominent role in cellular function.

Amino Acid Oxidoreductases↗
PubMed1994

Survey of clinical pharmacy services in United Kingdom National Health Service hospitals.

The extent to which clinical pharmacy services are provided in National Health Service (NHS) hospitals in the United Kingdom was studied by means of a questionnaire. Questionnaires inquiring whether and to what extent certain clinical pharmacy services were provided were mailed to all NHS hospital pharmacies in 1992. The questionnaires also requested information about the hospital and the number and qualifications of pharmacists employed. The results were compared with those of a survey of pharmaceutical services in the United States. Of 508 questionnaires mailed, 416 usable responses were returned. Services commonly provided were inpatient drug therapy monitoring (96%), clinical trials support (92%), formulary management (89%), participation in drug and therapeutic committees (97%), and an on-site drug information center (60%). Services infrequently provided were therapeutic drug monitoring (21%), medication history-taking (16%), and a 24-hour on-site pharmacist (10%). Several services were associated with pharmacies that employed many pharmacists, pharmacists with advanced education, or specialist clinical pharmacists and pharmacies located in medical school teaching hospitals. U.K. hospital pharmacies provided fewer patient-oriented services and more drug information, therapy monitoring, and pharmacist education services than U.S. hospital pharmacies. Provision of clinical pharmacy services in the United Kingdom was associated with employment of many pharmacists, pharmacy clinical specialists, and pharmacists with advanced education.

Clinical Trials as Topic↗
PubMed1994

Product evaluation and process improvement.

This article discusses how a systematic approach to product selection and evaluation can assist health care personnel. This model considers four tenets: (1) quality, (2) cost, (3) safety, and (4) practitioner choice. An algorithm is utilized to serve as a visual guide for the introduction, trial, and selection of equipment and products. In addition to considering the four tenets, the article discusses the value of an integrated team approach and the importance of involving the staff in the decisions.

Attitude of Health Personnel↗
PubMed1994

Evaluation of the Sonksen picture test for detection of minor visual problems in the surveillance of preschool children.

The Sonksen Picture Test (SPT) for surveillance of vision in preschool children was evaluated in 842 children, aged 21 to 60 months, from nine health districts in England, Wales and Scotland. The failures and controls were refracted and examined for squint; the Sheridan-Gardiner seven-letter chart (SGLC) was also used with children of > or = 42 months. The SPT was quicker to administer than the SGLC, with median times of one and five minutes, respectively. 98 per cent of children of all ages completed the SPT, whereas 10 per cent of those over 42 months were unable to complete the SGLC. The test method that has been established is developmentally appropriate for this age-group, more so than optotype tests. It is a binocular test that is quick, cheap and simple to administer, and is available to children under five years.

Child, Preschool↗
PubMed1994

Characteristics of bulimic women with and without alcohol abuse.

We compared the characteristics of hospitalized women with bulimia nervosa alone (N = 19) and with bulimia nervosa plus alcohol abuse (N = 13) using standard measures of depression, eating disorders, general psychiatric symptomatology, and temperament. Bulimic women with alcohol abuse had significantly higher lowest past weight, but did not differ from women with bulimia alone on age, age of onset of bulimia, current weight, and highest past weight. There were no differences in clinical symptoms of bulimia, depression, or general psychiatric symptomatology. On Cloninger's Tridimensional Personality Questionnaire (TPQ), bulimic women with alcohol abuse scored significantly higher on Total Novelty Seeking, on the Novelty Seeking Subscale Disorderliness, and on the Reward Dependence Subscale Attachment. Implications for understanding the relation between bulimia and substance abuse are discussed.

Adolescent↗
PubMed1994

Reconstruction after malunion and nonunion of intra-articular fractures of the distal humerus. Methods and results in 13 adults.

We reviewed the results of 13 adults of secondary reconstruction of malunited and ununited intraarticular distal humeral fractures. Their average age was 39.7 years, and preoperatively all had pain, loss of motion and functional disability; the average arc of motion was only 43 degrees and the average flexion contracture was 45 degrees. Nine patients had ulnar neuropathy. Elbow reconstruction, at an average of 13.4 months after the original injury, included osteotomy for malunion or debridement for nonunion, realignment with stable fixation and autogenous bone grafts, anterior and posterior capsulectomy and ulnar neurolysis. The elbows were mobilised 24 hours postoperatively. There were no early complications and all nonunions and intra-articular osteotomies healed. After a mean follow-up of 25 months, the average arc of motion was 97 degrees with no progressive radiographic degeneration. Ulnar nerve function improved in all cases and clinical assessment using the Morrey score showed two excellent, eight good and three fair results. Reconstruction of intra-articular malunion and nonunion of the distal humerus in young active adults is technically challenging, but can improve function by restoring the intrinsic anatomy of the elbow.

Adolescent↗
PubMed1993

Coronary artery surgery: are women discriminated against?

OBJECTIVE: To determine whether the sex differences in access to cardiac surgery observed in the United States exist in the United Kingdom. DESIGN: Retrospective analysis of routinely collected data. SETTING: South West Thames and North West Thames regional health authorities. SUBJECTS: 8564 patients discharged from hospital with a principal diagnosis of coronary heart disease in 1987-8 in South West Thames region and 15243 discharges in North West Thames region in 1990-1. MAIN OUTCOME MEASURES: Performance of angiography or coronary artery bypass surgery. RESULTS: In all age groups and among patients with a principal diagnosis of either angina or chronic ischaemia men were significantly more likely than women to undergo revascularisation in both regions. Using multiple logistic regression to control for potential clinical and demographic confounders, the male to female odds ratio for revascularisation among all cases was 1.59 (95% confidence interval 1.25 to 2.03) in South West Thames region and 1.47 (1.32 to 1.63) in North West Thames region. CONCLUSION: There appears to be a systematic difference in the treatment received by men and women in the United Kingdom. The reasons for this are uncertain.

Adult↗