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Biomedical subjects

M Smith

Publications and source records attributed to M Smith.

At least 235 records · Page 13Linked to original sources
PubMed2000

The content and accessibility of sex education information on the Internet.

The objective of this study was to describe Web sites with sex education material and assess the accessibility of specific information on the Internet. First, the authors conducted a review of Web sites using specific sex education keywords. Second, 27 undergraduate students were asked to locate information on proper condom use and sexually transmitted disease (STD) symptoms. The time, number of search attempts, and number of clicks needed to identify each piece of information were recorded. The authors identified 41 sites with sex education material from almost 6 million pages yielded by the keywords. Sixty-three percent of the 1,556 most compatible pages were categorized as pornography. The students found the information on condom use and STD symptoms in an average of 4 minutes, using fewer then six clicks and two searches. The authors concluded that general information on sex education is difficult to locate on the Internet and often lacks essential elements, but accurate and useful information on specific topics can be more easily obtained.

Adolescent↗
PubMed2000

Predicting place of discharge from hospital for patients with a stroke or hip fracture on admission.

OBJECTIVES: To determine the predictive power of patient and service characteristics on place of discharge following hospital admission for an acute stroke and for hip fracture. METHODS: Prospective cohort of 440 acute stroke and 572 hip fracture patients aged 65 years or over admitted from home to six district general hospitals and associated community hospitals, three in the North and three in the South of England. RESULTS: Age, marital status, living arrangements, mental health status at admission, pre-admission self-rated disability, pre-admission use of home-care services, post-admission staff assessments of functional dependency as measured by Barthel Index and of confusion as measured by the modified Crichton Royal Behavioural Rating Scale and nursing staffs' expectation of place of discharge are all significantly related to place of discharge for stroke and hip fracture participants. Logistic regression correctly predicted discharge destination for 87% of stroke patients from data available at time of admission and 83% of hip fracture patients. Of the 30% of stroke patients discharged to an institution, the model correctly predicted 73%. However, of the 19% of hip fracture patients discharged to an institution, only 28% were correctly predicted. CONCLUSIONS: Data about older patients admitted to hospital with an acute condition should be routinely collected by hospital staff to inform clinical management and to permit risk-adjusted audit.

Aftercare↗
PubMed2000

Goal-setting in rehabilitation: report of a workshop to explore professionals' perceptions of goal-setting.

OBJECTIVE: To explore the views of therapists, nurses and doctors working in a variety of rehabilitation settings on the goal-setting process. METHODS: Sixteen rehabilitation staff from three different settings attended a goal-setting workshop in which the difficulties associated with goal-setting were described with their potential solutions. RESULTS: Five difficulties with goal-setting were identified. (1) Formal goal-setting was felt to be an activity unusual for many of the patients although intrinsic to the activity of many professional groups. (2) Goal-setting is often insensitive to people's roles in the community. (3) Goal-setting in the hospital environment does not transfer easily to the community. (4) External factors (e.g. staff turnover) over which staff felt they had little control were important in the success of a goal-setting programme. (5) Goals tend to be formulated and owned by the team, rather than the patient. CONCLUSIONS: Goal-setting is a very satisfactory activity for the team but to be as successful for the patient their needs must be acknowledged. People with mild disability and a short inpatient stay have different needs to those with acute onset severe permanent disability and those with chronic or progressive disability admitted from the community. Comparison of both process and outcome effects of different types of goal-setting is an area for future study.

Activities of Daily Living↗
PubMed2000

Phase I, dose-finding, and pharmacokinetic study of raltitrexed combined with oxaliplatin in patients with advanced cancer.

PURPOSE: To determine the maximum-tolerated dose (MTD) and the dose-limiting toxicities (DLTs) of the raltitrexed plus oxaliplatin combination regimen, to explore its safety and pharmacokinetics, and to assess its antitumor activity in patients with advanced solid tumors. PATIENTS AND METHODS: Forty-eight patients received the combination of raltitrexed plus oxaliplatin. Raltitrexed was administered as a 15-minute infusion followed by oxaliplatin as a 2-hour infusion 1 hour later, repeated every 3 weeks. Seven dose levels were explored, ranging from 2 to 3.75 mg/m(2) and from 85 to 130 mg/m(2) for raltitrexed and oxaliplatin, respectively. The pharmacokinetics of both raltitrexed and oxaliplatin was assessed at the last three dose levels. RESULTS: Forty-six patients were assessable for toxicity. Severe toxicities usually occurred from dose level V (raltitrexed 3 mg/m(2) and oxaliplatin 130 mg/m(2)). This combination was not myelosuppressive, eliciting only sporadic grades 3 and 4 neutropenia and/or thrombocytopenia without complications. There was no alopecia. DLTs were asthenia and nausea/vomiting, despite systematic antiemetic prophylaxis. Dose level VI (raltitrexed 3.5 mg/m(2) and oxaliplatin 130 mg/m(2)) was deemed to be the MTD. Eight confirmed partial responses were observed: six patients with malignant mesothelioma (both pretreated and nonpretreated), one with fluorouracil-refractory pancreatic carcinoma, and one with renal carcinoma. Evaluation of the pharmacokinetics of both drugs did not suggest any drug interaction. CONCLUSION: The combination of raltitrexed and oxaliplatin given as consecutive short infusions every 3 weeks seems to be an acceptable regimen that allows a dose-intensity as high as the sum of the recommended doses of each agent given alone. The dose recommended for further phase II studies is raltitrexed 3 mg/m(2) and oxaliplatin 130 mg/m(2) every 3 weeks. Promising antitumor activity has been observed in patients with malignant mesothelioma.

Adult↗
PubMed2000

Comparison of a new foam mattress with the standard hospital mattress.

This study evaluates pressure ulcer incidence rates and comfort perceptions in 100 subjects admitted to a district general hospital. Subjects were divided into two groups, Group A using the standard hospital mattress (Transfoam), which had been in use in the hospital for three years, and Group B using the study mattress (Transfoamwave), which was new at the beginning of the trial. Due to the low observed incidence of pressure ulcers, it has not been possible to determine whether there is a difference in the clinical performance of the mattresses. Both appear to provide similar levels of comfort. Seat cushions were provided for each trial subject but staff failed to make good use of them, which suggests that more education is required in this area.

Aged↗
PubMed2000

Herpes simplex virus-mediated gene delivery to the rodent visual system.

PURPOSE: To determine the types of cells in the visual system of the mouse and rat that can express a transgene delivered by an attenuated replication competent Herpes simplex virus-1 (HSV-1) vector. METHODS: C57/BL6 x BALB/C mice and Albino rats were treated with 1 x 10(7) pfu of the HSV-1 ribonucleotide reductase mutant (hrR3) expressing the Escherichia coli lacZ gene. The hrR3 virus was delivered by topical application to the cornea, intravitreal (IV) injection, intracameral injection (IC), or stereotactic injection into the visual cortex (VC). At specified times postinfection, animals were killed and tissues were removed, fixed, sectioned, and stained with X-gal or hematoxylin and eosin for histochemical and histopathologic examination. RESULTS: Topical delivery after corneal scarification in both mouse and rat resulted in lacZ expression in 25% of the corneal epithelial cells and 25% of the retinal pigment epithelium (RPE) cells. Topical application without concurrent scarification also resulted in transgene delivery to 20% of the RPE cells of the rat but not the mouse. IV injection resulted in expression primarily in RPE cells, with up to 100% of the cells expressing lacZ in the mouse and rat. Other cells expressing the transgene included ciliary body (CB) and optic nerve cells. Up to 25% of the retinal ganglion cells in the rat expressed lacZ, but only rarely in mice. IC delivery in rats resulted in expression in trabecular meshwork, CB cells, RPE, and iris epithelium. Injection into area 17 of the rat VC resulted in efficient labeling of the VC neurons and neurons in the lateral geniculate nucleus without any evident pathology or inflammation. Neither inflammation nor disease pathology was observed in either the mouse or rat after any route of delivery. CONCLUSIONS: It was demonstrated that the hrR3 HSV-1 virus can deliver a functioning gene to several cell types in the eye and neurons in the VC and that the virus can move via retrograde transport to nuclei that project to the VC.

Animals↗
PubMed2000

Depression, psychomotor retardation, negative symptoms, and memory in schizophrenia.

OBJECTIVE: The purpose of this study was to examine the relations between depression, psychomotor retardation, and negative symptoms in schizophrenia as well as the specific contribution of each of these factors to memory impairment. BACKGROUND: It has been suggested that depression overlaps with negative symptomatology in schizophrenia. The relation between psychomotor retardation and negative symptomatology has been unclear. METHOD: The Hamilton Depression Rating Scale, The Positive and Negative Symptom Scale for Schizophrenia, and Scale for the Assessment of Negative Symptoms were used to assess depressive and negative symptomatology in a sample of patients with schizophrenia. Verbal memory performance was assessed by a free recall test. Two indices of processing speed were measured. Correlations among variables were computed. RESULTS: Depression score was correlated with the avolition item from the Scale for the Assessment of Negative Symptoms and with both measures of processing speed. Negative symptomatology was unrelated to processing speed. Memory performance was correlated with depression score, slowing of processing speed, and avolition. Its correlation with depression score and processing speed remained significant when the other factors were partialled out. CONCLUSIONS: Memory performance in schizophrenia may be affected by lack of motivation, psychomotor retardation, and depression. It is suggested that negative symptoms could be split between a volitional component linked to depression and cognitive efficiency and an emotional component unrelated to them.

Adult↗
PubMed2000

A prototype haptic lumbar puncture simulator.

Lumbar punctures (LP) are complex, precise procedures done to obtain cerebro-spinal fluid from a patient for diagnostic purposes. Incorrect techniques resulting from inadequate training or supervision can result in sub-optimal outcomes. As tactile feedback is crucial for a successful lumbar puncture, this procedure serves as an ideal candidate for the development of a haptic training simulator. The intent of this project is to engineer a force feedback LP simulator that provides a safe method of training students (medical students, residents, or trained physicians) for an actual LP procedure on a patient.

Computer Graphics↗
PubMed2000

Vitamin B12 deficiency and incontinence in older people.

OBJECTIVES: To investigate the relationship between urinary incontinence and Vitamin B12 deficiency in community-living older people using standard serum cobalamin levels as well as the metabolites methylmalonic acid (MMA) and total homocysteine (HCYS). DESIGN: A prospective cross-sectional study of community-living older people. PARTICIPANTS: Independent and cognitively normal adults (mean age=72 years, range=65-89 years) living in the community. One hundred and nineteen volunteers were recruited at group meetings, activity groups, and through the use of posters. MEASUREMENTS: Information on urinary continence was provided by the participant during a systematic medical history, and was defined as any amount of uncontrolled leakage of urine. Vitamin B12, methylmalonic acid and homocysteine levels were determined in all subjects. MAIN RESULTS: We found no significant differences between the continent and incontinent group in regard to their serum Vitamin B12 (OR=1.34, CI: 0.39-4.58, p=.424), methylmalonic acid levels (OR=0.71, CI: 0.24-2.10, p=.386), or total homocysteine levels (CI: 0.29-4.54, p=.535). CONCLUSIONS: In our study continence was not significantly affected by the B12 status of the subject; neither serum B12 levels or the metabolites MMA and HCYS (reflecting B12 function) were significantly different in the continent group versus the incontinent one.

Aged↗
PubMed2000

[Pulmonary aspergillosis complicating chronic septic granulomatosis. Treatment with itraconazole and gamma interferon].

A 20-year-old patient suffering from chronic granulomatous disease developed pulmonary aspergillosis with thoracic wall invasion. Treatment with itraconazole combined with 3-weekly injections of interferon gamma (INF gamma) improved the patient's general state of health within two months. Functional signs resolved totally and x-ray images continued to improve for 6 months. INF gamma was withdrawn after 11 months and was replaced with cotrimoxasole. Itraconazole was continued in a long-term regimen. Four years after onset of treatment, the clinical status of the patient remained satisfactory, and the radiological aspect was unchanged. Pulmonary aspergillosis affects up to 40% of patients suffering from chronic granulomatous disease. Mortality is high, to the order of 25%. The classical treatment is based on amphotericin B, but this case points out the significant contribution of itraconazole as first-line therapy. This antimycotic has been suggested for prophylaxis. The combined use of INF gamma can be discussed due to the uncertainties about its long-term effects and because of the requirement for 3-weekly injections. High cost is another important consideration.

Adult↗