The diffusion of telemedicine: theory into practice.
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Attitude of Health Personnel↗
Biomedical subjects
M Reid
Publications and source records attributed to M Reid.
Human D(IIIa) erythrocytes: RhD protein is associated with multiple dispersed amino acid variations.
As a partial D antigen of the Rh blood group system, the D category IIIa phenotype occurs mainly in Blacks, but its molecular basis has not been defined. Here we describe studies of the D category D(IIIa) and VS+ red blood cells (RBC) from two unrelated probands by Southern blot, cDNA PCR, and nucleotide sequencing. Rh haplotyping by Sph I restriction fragment length polymorphisms indicated that the two probands carried Dce/dCe and Dce/DcE genotypes, respectively. Sequence analysis of Rh cDNAs showed that their erythroid cells expressed both D and CE transcripts. Nevertheless, the D transcripts were found to contain four nucleotide changes scattered in three exons: nt455 A-to-C (exon 3), nt602 C-to-G (exon 4), nt 654 C-to-G (exon 5), and nt667 T-to-G (exon 5). These variations resulted in the following amino acid substitutions characteristic of RhCE polypeptides: 152 Asn-to-Thr, 201 Thr-to-Arg, 218 Ile-to-Met, and 223 Phe-to-Val. The 152Thr and 223Val residues were predicted to reside in proximity to the third and fourth extracellular loops, respectively. Together, these results establish a correlation of the four amino acid changes in the RhD protein with the expression of D(IIIa) as a partial D antigen on the RBC membrane. Since the varied nucleotides identified in D(IIIa) all pre-exist in CE, they are likely to have originated from CE by templated micro-conversion event(s). The identification of a specific nt736 C-to-G transversion in CE in the two probands suggests that 245Val may involve the expression of VS antigen.
Amino Acids↗
Relative effects of carbohydrates and protein on satiety -- a review of methodology.
There is some evidence that the effects of carbohydrates and protein may differ with respect to satiety. This may depend in part on the different methods of preparing these nutrients for administration. Additional factors such as timing, different delays, differential metabolism and expectations of ingested foods may contribute to different outcomes of experiments investigating the satiating effects of macronutrients. Here, studies of the relative satiating effects of carbohydrates and protein are discussed followed by a methodological discussion of the reviewed studies. Finally, suggestions for methodological improvements are given which should allow future studies to investigate more clearly the mechanisms underlying satiety.
Animals↗
Urea kinetics varies in Jamaican women and men in relation to adiposity, lean body mass and protein intake.
OBJECTIVE: We have measured urea kinetics in normal adult men and women of different body composition to determine whether adiposity is associated with differences in the rate of urea production or endogenous urea hydrolysis. DESIGN: Urea kinetics were determined from the excretion of [15N15N]urea in urine over a period of 48 h following a single oral dose of [15N15N]urea, in nine lean and nine obese women and in seven light and seven heavy males while they were consuming their habitual diets. Urinary 5-L-oxoproline was measured as an index of glycine metabolic status. SETTING: The studies were carried out in the research ward of the Tropical Metabolism Research Unit, University of the West Indies. RESULTS: Successful studies were completed in eight obese and five lean women and in six heavy and five light men. When compared with lean women, in obese women the rate of urea production and hydrolysis was significantly greater and this difference could not be accounted for by the greater fat-free mass alone, and was in part associated directly with the increase in fat mass. The rate of urea production and hydrolysis was greater in heavy men than in light men, a difference which was attributed to an increase in dietary protein. In obese women and heavy men there was a significantly higher rate of excretion of 5-L-oxoproline in urine when compared with lean women and lean men respectively. CONCLUSION: This paper highlights the difficulty in identifying an appropriate reference with which to express results in people of different body composition. In obese women urea production and the hydrolysis of urea are increased, in part related to the increased fat-free mass, but also related to the increased fat mass itself. In obese women and men on high protein diets the greater rate of hydrolysis urea may be a reflection of an increased demand for the synthesis of non-essential amino acids, especially glycine.
Adult↗
Oesophageal ECG in a child for burns surgery.
Continuous monitoring of heart rate and rhythm are regarded as minimal standards of monitoring during anaesthesia. However, when the thoracic area is exposed for surgery as for debridement of burns and split skin grafting then placement of surface electrodes for electrocardiographic (ECG) monitoring is not possible. We report the intraoperative use of an old technique, oesophageal ECG (OesECG) in a child presenting for major burns surgery. The positioning of the probe, electrical safety and P-QRS morphology, are discussed.
Burns↗
The KEL24 and KEL14 alleles of the Kell blood group system.
BACKGROUND: The Kell blood group system consists of at least 21 antigens, which may be classified into five sets of alleles and at least 10 independently expressed antigens. The molecular basis of four of the five sets of alleles has been described; point mutations in KEL leading to amino acid substitutions characterize the alleles. In this study, the point mutation associated with the remaining allele, KEL14/KEL24, was determined. STUDY DESIGN AND METHODS: The 19 exons of KEL were amplified from genomic DNA by a polymerase chain reaction (PCR) procedure. The PCR products were sequenced. DNA sequences from unrelated KEL:14,24 and KEL:-14,24 individuals were compared to the DNA sequence of the common KEL:14,-24 phenotype. RESULTS: DNA from the KEL:14,24 person yielded both G and C at nt 659, indicating an Arg and Pro polymorphism in amino acid residue 180 of Kell protein. DNA from the KEL:-14,24 person had a G659C mutation in exon 6, indicating an Arg180Pro substitution. The G659C change introduces an Hae III restriction enzyme site, which was used to confirm the base mutations by restriction fragment length polymorphism analysis of the PCR products. CONCLUSION: A G659C mutation, predicting an Arg180Pro change in Kell protein, is associated with the KEL14/KEL24 allele.
Alleles↗
Randomised controlled trial of an aggressive nutritional regimen in sick very low birthweight infants.
AIMS: To improve energy intake in sick very low birthweight (VLBW) infants; to decrease growth problems, lessen pulmonary morbidity, shorten hospital stay, and avoid possible feeding related morbidity. Morbidity in VLBW infants thought to be associated with parenteral and enteral feeding includes bronchopulmonary dysplasia, necrotising enterocolitis, septicaemia, cholestasis and osteopenia of prematurity. METHODS: A prospective randomised controlled trial (RCT) comparing two types of nutritional intervention was performed involving 125 sick VLBW infants in the setting of a regional neonatal intensive care unit. Babies were randomly allocated to either an aggressive nutritional regimen (group A) or a control group (group B). Babies in group B received a conservative nutritional regimen while group A received a package of more aggressive parenteral and enteral nutrition. Statistical analysis was done using Student's t test, the Mann-Whitney U test, the chi 2 test and logistic regression. RESULTS: There was an excess of sicker babies in group A, as measured by initial disease severity (P < 0.01), but mean total energy intakes were significantly higher (P < 0.001) in group A at days 3 to 42 while receiving total or partial parenteral nutrition. Survival and the incidences of bronchopulmonary dysplasia, septicaemia, cholestasis, osteopenia and necrotising enterocolitis were similar in both groups. Growth in early life and at discharge from hospital was significantly better in babies in group A. There were no decreases in pulmonary morbidity or hospital stay. CONCLUSION: Nutritional intake in sick VLBW infants can be improved without increasing the risk of adverse clinical or metabolic sequelae. Improved nutritional intake resulted in better growth, both in discharge, but did not decrease pulmonary morbidity or shorten hospital stay.
Bacterial Infections↗
Use of GUM services and information and views held by first time service users in a large UK city: implications for information provision.
The aim of this study was to examine the relationship between information and views held by service users before obtaining help from a genitourinary medicine (GUM) service and the accessibility and use of the service, and to determine potential intervention measures for change. A structured questionnaire was completed by 292 first-time GUM service users in a large UK city in 1994. Overall 94 (57.7%) of 163 male service users and 59 (48.4%) of 122 female service users had some information about the service before seeking help, although this difference was not significant. Only 92 (31.5%) knew the service was open-access. The main source of information was through general practitioners (GPs), with personal contact as the second most common information source. Two hundred and fifteen (73.6%) used the service within 2 weeks of needing help and 104 (35.6%) of these felt there was delay, but reporting delay was not associated with having information about the service. The majority indicated feeling nervous and/or embarrassed about using the service. Female service users were significantly more likely to feel nervous or embarrassed than male service were (P < 0.05). Service users were significantly more likely to feel nervous when they had no information about the service than if they knew something about the service (P < 0.01). Most service users regarded the service as dealing with sexually transmitted infections (STIs), and most intended to use the service for this reason. However, whilst many service users indicated knowledge about non-STI services, including HIV counselling and testing, relatively few intended to use these services. Most service users (269, 92.1%) were in favour of increased availability information about GUM clinics mainly through written media but also through GPs. The results of this study show a clear need to project increased awareness and information about this GUM service so as to encourage use of the range of services available and promote more positive feelings about using the service. Information in written media as well as through other health professionals may be of benefit. Further work is needed to study the effect of information provision in influencing the large number of potential service users to make use of sexual health services.
Counseling↗
Nursing facilities and NCQA (National Committee for Quality Assurance) standards: a vital connection.
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Accreditation↗
The disappearance of birth: language versus reality in modern childbirth.
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Attitude to Health↗
A new experimental model: the vascular pedicled cutaneous flap over the mid-dorsum of the rat.
The cutaneous vascular anatomy of the mid-dorsum in the rat and its role in flap design was studied in the rat. The investigation consisted of anatomic dissection, methylene blue injection into the axial artery, and flap harvesting in live animals. Dissection and injection revealed that the mid-dorsum of the rat derives its blood supply largely from the 10th intercostal artery, here referred to as the middle dorsal artery, which originates from the lateral aspect of the thoracic aorta. The cutaneous vascular territory of the middle dorsal artery was defined as follows: the medial border, midline of the dorsum; the lateral border, midaxillary line; the cephalic border, a line joining the medial and lateral borders midway between the level of the axilla proximally and 1 cm above the base of the rib cage distally; and the caudal border, a line drawn midway between the latter point proximally and the anterior superior iliac spine distally. Both unilateral and bilateral vascular pedicled island cutaneous flaps were harvested in living rats based on and exceeding the vascular territory delimited by methylene blue injection. Flaps limited to this territory with intact middle dorsal arteries showed total survival, while oversized flaps underwent partial necrosis peripherally. Because of its simplicity, reliability, and consistent vascularity, this flap has potential applications in the study of flap hemodynamics.
Animals↗
Medical genetic services in 31 countries: an overview.
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Consumer Behavior↗
Randomised, controlled trial of efficacy of midwife-managed care.
BACKGROUND: Midwife-managed programmes of care are being widely implemented although there has been little investigation of their efficacy. We have compared midwife-managed care with shared care (ie, care divided among midwives, hospital doctors, and general practitioners) in terms of clinical efficacy and women's satisfaction. METHODS: We carried out a randomised controlled trial of 1299 pregnant women who had no adverse characteristics at booking (consent rate 81.9%). 648 women were assigned midwife-managed care and 651 shared care. The research hypothesis was that compared with shared care, midwife-managed care would produce fewer interventions, similar (or more favourable) outcomes, similar complications, and greater satisfaction with care. Data were collected by retrospective review of case records and self-report questionnaires. Analysis was by intention to treat. FINDINGS: Interventions were similar in the two groups or lower with midwife-managed care. For example, women in the midwife-managed group were less likely than women in shared care to have induction of labour (146 [23.9%] vs 199 [33.3%]; 95% CI for difference 4.4-14.5). Women in the midwife-managed group were more likely to have an intact perineum and less likely to have had an episiotomy (p = 0.02), with no significant difference in perineal tears. Complication rates were similar. Overall, 32.8% of women were permanently transferred from midwife-managed care (28.7% for clinical reasons, 3.7% for non-clinical reasons). Women in both groups reported satisfaction with their care but the midwife-managed group were significantly more satisfied with their antenatal (difference in mean scores 0.48 [95% CI 0.41-0.55]), intrapartum (0.28 [0.18-0.37]), hospital-based postnatal care (0.57 [0.45-0.70]), and home-based postnatal care (0.33 [0.25-0.42]). INTERPRETATION: We conclude that midwife-managed care for healthy women, integrated within existing services, is clinically effective and enhances women's satisfaction with maternity care.
Adult↗
A new low-incidence antigen in the Kell blood group system: VLAN (KEL25).
A multilaboratory investigation has identified a new low-incidence antigen "VLAN' on the red cells of a blood donor. The VLAN antigen is destroyed by 2-aminoethylisothiouronium bromide treatment of the donor's red cells suggesting an association with the Kell system. Monoclonal antibody-specific immobilization of erythrocyte antigen analysis with anti-VLAN and with several mouse monoclonal antibodies directed at epitopes on the Kell glycoprotein gave positive results, indicating that the VLAN antigen is located on the Kell glycoprotein. The VLAN red blood cells have the common Kell phenotype: KEL:-1,2,-3,4,5,-6,7,-10,11,12,13,14,-17,18,19,-21,22,-23,-24. Additional serologic data indicate that the VLAN antigen is not part of any other ISBT blood group system, collection or series. A family study showed that the VLAN antigen is inherited since the red cells of two sisters and one niece of the propositus are also VLAN+. The ISBT Working Party on Terminology for Red Cell Surface Antigens has assigned VLAN to the Kell blood group system as KEL25 (number for computer listings 006025).
Antigens↗
Point mutations characterize KEL10, the KEL3, KEL4, and KEL21 alleles, and the KEL17 and KEL11 alleles.
BACKGROUND: The Kell blood group system is complex, consisting of five sets of alleles and expressing high- and low-incidence antigens and at least 11 other independently expressed antigens. The molecular basis of two sets of alleles: KEL1 (K) and KEL2 (k) and KEL6 (Jsa) and KEL7 (Jsb) have been elucidated as single-base mutations leading to amino acid changes. The molecular basis for the KEL3 (Kpa), KEL4 (Kpb), and KEL21 (Kpc) alleles, the KEL11(Cote) and KEL17(Wka) alleles, and for KEL10 (UIa) is now reported. STUDY DESIGN AND METHODS: Genomic DNA from unrelated individuals with KEL:3,-4,-21 [Kp(a+b-c-)], KEL:-3,-4,21 [Kp(a-b-c+)], KEL:17,-11, and KEL:10 (UIa) phenotypes was amplified by polymerase chain reaction (PCR) with primers for the 19 exons of KEL. The PCR products were sequenced and compared to the DNA sequences of a common Kell system phenotype, KEL:-3,4,-21,-17,-10. Base mutations found were confirmed by restriction fragment length polymorphism analysis in which DNA of unrelated persons with similar red cell phenotypes was used. RESULTS: In all cases, single-base mutations were responsible for the expression of the various antigens. In KEL3 (Kpa), KEL4 (Kpb), and KEL21 (Kpc), point mutations at the same codon in exon 8, encoding amino acid residue 281, distinguish the three genes. KEL4 has the CGG codon for arginine, KEL3 has the TGG codon for tryptophan, and KEL21 has the CAG codon for glutamine. KEL17 has a T1025C mutation in exon 8, encoding a valine-to-alanine amino acid change at residue 302. KEL10 has an A1601T mutation in exon 13, encoding a glutamic acid-to-valine change at residue 494. In all cases, the point mutations created restriction enzyme sites, and PCR-based restriction fragment length polymorphisms confirmed that these point mutations occurred in unrelated persons with the same red cell phenotype. CONCLUSION: Single-base substitutions characterize the KEL3, KEL21, KEL17, and KEL10 genes. The allelic relationship of KEL3, KEL4, and KEL21 was confirmed because the mutations occur in the same codon, expressing different amino acids. PCR-based restriction fragment length polymorphisms can be used to distinguish genotypes.
Alanine↗
Attitudes towards termination for fetal abnormality: comparisons in three European countries.
Attitudes towards termination for a range of genetic conditions were studied in health professionals and lay people in three European countries: Germany, Portugal and the UK. The health professionals consisted of geneticists in all countries and additionally obstetricians from Portugal and the UK. The lay persons consisted of pregnant women, and male and female non-medical university employees. In all, more than 1,700 study participants completed questionnaires. Overall, health professionals were more likely than the lay persons to report that they would opt for termination following diagnosis of a fetal abnormality. Differences were found between countries and study groups. German respondents were least likely to report that they would undergo termination in the case of a fetal abnormality while Portuguese respondents were most likely to report that they would undergo a termination. Further studies are needed to determine first the extent to which differences between health professionals and lay samples reflect a difference in perception of disability, including tolerance of having a child with a disability; and second, whether such differences result in health professionals presenting termination of pregnancy in a way that is not concordant with patients' value systems.
Abortion, Induced↗
Genetic recombination at the human RH locus: a family study of the red-cell Evans phenotype reveals a transfer of exons 2-6 from the RHD to the RHCE gene.
The human RH locus appears to consist of two structural genes, D and CE, which map on the short arm p34-36 of chromosome 1 and specify a most complex system of blood-group genetic polymorphisms. Here we describe a family study of the Evans (also known as "D..") phenotype, a codominant trait associated with both qualitative and quantitative changes in D-antigen expression. A cataract-causing mutation was also inherited in this family and was apparently cotransmitted with Evans, suggesting a chromosomal linkage of these two otherwise unrelated traits. Southern blot analysis and allele-specific PCR showed the linkage of Evans with a SphI RFLP marker and the presence of a hybrid gene in the RH locus. To delineate the pattern of gene expression, the composition and structure of Rh-polypeptide transcripts were characterized by reverse transcriptase-PCR and nucleotide sequencing. This resulted in the identification of a novel Rh transcript expressed only in the Evans-positive erythroid cells. Sequence analysis showed that the transcript maintained a normal open reading frame but occurred as a CE-D-CE composite in which exons 2-6 of the CE gene were replaced by the homologous counterpart of the D gene. This hybrid gene was predicted to encode a CE-D-CE fusion protein whose surface expression correlates with the Evans phenotype. The mode and consequence of such a recombination event suggest the occurrence, in the RH locus, of a segmental DNA transfer via the mechanism of gene conversion.
Adult↗
Knowledge of lymphoedema among primary health care teams: a questionnaire survey.
Lymphoedema usually develops following surgery or radiotherapy for cancer, but can also occur in advanced malignant disease or be primary in origin. Lower limb lymphoedema may present particular difficulties in diagnosis, treatment and management. All types of lymphoedema can seriously impair quality of life for those affected. This study aimed to determine the level of knowledge among primary health care team members concerning the identification and management of patients at risk of developing lymphoedema, the current treatment options available for patients with established lymphoedema, and the awareness of local services available within the Cambridge Health District. A postal questionnaire survey obtained an 84.3% response rate. Many primary health care professionals were not aware of some important issues in the prevention and management of lymphoedema. This information proved useful in enabling the specialist service to develop appropriate educational initiatives.
Clinical Competence↗