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Biomedical subjects

M Watson

Publications and source records attributed to M Watson.

305 records · Page 17Linked to original sources
PubMedDate not supplied

Understanding the experience of prophylactic bilateral mastectomy: a qualitative study of ten women.

Prophylactic bilateral mastectomy represents a new and controversial cancer prevention strategy for women at high-risk of familial breast cancer, the psychosocial implications of which are yet to be fully explored. A qualitative methodology was therefore adopted to provide a discovery-orientated study of the perspectives of ten women who had undergone prophylactic mastectomy and the views of eight of their partners. Each participant was interviewed with the aim of exploring the personal experiences of surgery, factors associated with psychological adjustment and the impact on the family. Data were transcribed and systematically analysed using Grounded Theory. Themes emerging from participants' accounts formed seven significant categories that represented women's key experiences: (i) deciding; (ii) telling; (iii) experiencing surgery and recovering; (iv) maintaining womanliness; (v) processing the loss; and (vi) moving on. The importance of the social context in women's experience and difficulties of isolation/eliciting support were also highlighted: (vii) isolation and being supported. A core category of 'Suffering and countering multiple loss' considered central to women's experience, integrated the seven significant categories and provided further conceptualisation of women's experience. Implications for clinical practice are highlighted.

Adaptation, Psychological↗
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Development of a disease specific questionnaire to supplement a generic tool for QoL in colorectal cancer.

The need for disease-specific quality of life measures is highlighted in the literature. The psychometric properties of a supplementary disease-specific quality of life questionnaire developed for use with a generic Quality of Life tool in colorectal cancer patients are explored. Originally developed and tested in a German sample, the English translation was tested on a cohort of UK colorectal cancer patients. Relevance and acceptability was previously established in Germany. A rigorous factor analysis ascertained the underlying structure of two factors with a number of single items that were retained as clinically important symptom indicators. In considering validity, four conditions were assessed: Reliability using Cronbach's alpha; Construct validity by comparing patient subgroups; Clinical Validity, by testing the hypothesis that some patient subgroups experience worse quality of life; Construct Reliability using second order factor analysis with the EORTC QOLQ-C30 scales, confirming that the factors retained provide an excellent measure of physical discomfort and a good measure of physical well being. Two other such questionnaires were developed in parallel with this one and reported in the literature (FACT-C and QOLQ-CR38). However, this questionnaire provides a useful alternative tool for use in clinical trials of colorectal cancer treatments alongside a core QoL questionnaire especially when brevity is an important consideration.

Colorectal Neoplasms↗
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Deletion of the NF2 region in both meningioma and juxtaposed meningioangiomatosis: case report supporting a neoplastic relationship.

We report a case of juxtaposed atypical meningioma and meningioangiomatosis (MA) in an 8-year-old boy with no clinical stigmata or family history of neurofibromatosis. We studied the proliferative activity and genetic changes in the two lesions in an attempt to define their biologic and pathogenetic relationships. The MIB-1 index was 11% in the meningioma and <1% in the MA, indicating increased proliferative activity in the meningioma. Fluorescence in situ hybridization was done for two chromosomal regions commonly deleted in meningiomas. There was loss of the neurofibromatosis 2 locus (22q12) in both the meningioma and MA. Conversely, the region of 1p32 was not deleted. Our results indicate that both the meningioma and MA arose from the same clonal process, with the meningioma probably undergoing additional, but undefined, genetic alterations that confer upon it a more proliferative potential. This loss of 22q12 in the MA raises doubt about the presumed hamartomatous nature of MA.

Antigens, Nuclear↗
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Vancouver workshop: overview and synthesis.

Investigators from the six PICES member nations conducted a May, 1999 interdisciplinary research assessment of Vancouver Harbour, BC, Canada. Sediment contaminants were analyzed at several sites along an assumed pollution gradient extending eastward into the harbour from the relatively less-impacted Howe Sound area (located outside and seaward, to the west). Subsets of a few representative benthic biota (English sole for general contaminants; specific mollusks for TBT) at the sampling sites were concurrently assessed for specific tissue contaminants. Measurements of biotic response to contaminants-across a wide spectrum of biological and ecosystem organization, and ranging from selected biomarkers and tissue responses, to observations at the organism and community level-were likewise conducted. Parameters examined included: P-450 expression, EROD induction and histopathologic assessment of toxicopathic liver lesions in English sole; prevalence and frequency of imposex in neogastropods; perturbations in benthic community responses to pollutants; tissue assays of various bivalve shellfish species for PSP. Results affirmed a consistent east-to-west trend in declining contaminant-associated effects, across a range of biological assessments, thus providing strong evidence that these effects are pollution-related. Specific findings revealed a significant distortion of benthic community structure along the pollution gradient, as well as biomarker evidence of histological and biochemical stress in English sole from central and inner harbour sites. Although the study reaffirms prior assumptions that various species of neogastropods have been extirpated from the harbour, most likely from the antifoulant uses of tributyltin, some of the adverse impacts from TBT may be declining. Also noted were strong biochemical inferences that sediments in the relatively "uncontaminated" Howe Sound, may well contain significant P450-inducing pollutants which were not included as analytes in the design of this limited and preliminary assessment. During the brief sampling period, PSP contamination did not appear to be a significant issue for the harbour.

Animals↗
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The pH and titratable acidity of a range of diluting drinks and their potential effect on dental erosion.

OBJECTIVES: To investigate, in vitro, the potential dental effects of diluting juices by measuring their acidity levels and to examine the effect dilution has on the potential erosive properties of the drinks. METHODS: Four commonly available diluting drinks were assessed for both pH and titratable acidity at a variety of dilutions, reflecting the range of concentrations over which such drinks may be consumed. Predetermined dilutions of citric acid and hydrochloric acid, with similar pH values to those of the drinks, were used as positive control acidic solutions. The pH measurements throughout the study were made using a pH electrode connected to an Orion EA940 IonAnalyser. RESULTS: All four drinks demonstrated a high degree of resistance to a rise in pH, indicating high intrinsic buffering capacity. The measured pH changed very little with increasing dilution ratio when compared to the citric and hydrochloric acid controls, even when considered extremely dilute. In contrast, the titratable acidity of each of the drinks reduced proportionally with increasing dilution, thereby reducing considerably its erosive potential. CONCLUSIONS: While dilution had very little effect on the measured pH values, the titratable acidity reduced as the drink became more dilute. Since there appears to be a direct relationship between dilution and titratable acidity, the erosive potential of diluting juices may be reduced substantially by the addition of water. It remains unlikely, however, that the drinks would ever be consumed at a 'safe' level of dilution due to diminished taste and colour.

Beverages↗
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Acute osteomyelitis and septic arthritis in children.

OBJECTIVE: To review the clinical presentation, clinical management and organisms responsible for acute haematogenous osteomyelitis (AHO) and septic arthritis (SA) in the post Haemophilus influenzae type B (Hib) vaccine era and to evaluate current Australian antibiotic guidelines for these conditions. METHODS: A retrospective chart review of children less than 16 years of age presenting to The Children's Hospital at Westmead in the period from January 1998 to July 2002 with an ICD discharge code consistent with AHO or SA. RESULTS: During the 4 1/2-year period 120,511 children were admitted to The Children's Hospital at Westmead. There were 102 cases of AHO and 47 cases of SA during this time. An organism was identified either by blood culture or tissue biopsy in 45% of children with AHO and 38% with SA. Staphylococcus aureus was the most common identifiable causative organism accounting for 76% of isolated organisms in AHO and 39% of isolated organisms in SA. Methicillin-resistant S. aureus (MRSA) was responsible for 9% of AHO and 6% of SA cases. There were no cases due to Haemophilus influenzae or Kingella kingae during the study period. The majority (66%) of children with AHO were managed non-operatively with intravenous and then oral antibiotics. Thirty-five (34%) children had operative treatment to drain pus. In contrast, 74% of the patients with SA had one or more surgical procedures performed to drain pus from involved joints. CONCLUSIONS: Staphylococcus aureus remains the most common organism causing AO and SA; however, community-acquired methicillin-resistant strains are now occurring. Haemophilus influenzae is no longer a common cause of SA. Our study supports the current Australian antibiotic guidelines that recommend flucloxacillin alone as the empiric treatment of choice of both AHO and SA in children fully immunised against Hib. However the possibility of community-acquired MRSA should be considered, particularly in high risk groups such as indigenous Australian children or children from regional areas with a high rate of community-acquired MRSA.

Acute Disease↗
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Gene expression patterns in advanced human cervical cancer.

The purpose of this study was to evaluate gene expression patterns in human cervical tumors by extent of lymph node metastases at diagnosis. Pretreatment whole-body fluorodeoxyglucose-positron emission tomography (FDG-PET) imaging was performed in eight patients with invasive squamous cell carcinoma of the cervix to evaluate the extent of lymph nodes metastases. Pretreatment tumor tissue samples were subjected to laser-capture microdissection, and isolated RNA was linearly amplified and hybridized to Affymetrix Human U95A GeneChip microarrays. Molecular FDG-PET imaging revealed that three patients had lymph node involvement in the supraclavicular region and five patients did not. Microarray data were segregated into two groups based on the extent of regional lymph node involvement. Supervised clustering analysis identified 75 of about 12,000 gene transcripts represented on the array whose average expression was at least threefold different. We identified 12 of the 75 transcripts that demonstrated a statistically significant difference in expression between the two patient groups (P < 0.05). Five transcripts were upregulated and seven downregulated. Both overall and cause-specific survivals were different between these two patient groups (P= 0.006). This limited data set identified candidate biomarkers of extent of lymph node metastases that correlated with poor survival outcome.

Adult↗
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'The ten pound note test': suggestions for eliciting improved responses in the severely brain-injured patient.

The severely brain-injured patient may demonstrate a limited repertoire of responses. Anecdotal accounts suggest that stimuli of personal relevance, or of an unusual or innovatory nature, may sometimes elicit more meaningful responses. Two cases of severe acquired brain injury are described, in whom overall levels of responsiveness had been very low since coma ended. The use of stimuli with personal relevance provoked strong responses and presaged further behavioural change. The implications are discussed.

Activities of Daily Living↗
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The development of new techniques in the assessment and monitoring of recovery from severe head injury: a preliminary report and case history.

The case of a 19-year-old male who sustained a severe brain injury is described. This patient was initially given a very gloomy prognosis, leading to poor expectations for recovery. Additionally, like many such patients in the United Kingdom, he was cared for by a ward team who were without specialized training in head injury rehabilitation. Despite these factors the patient went on to make a good recovery. The issues of specialized care and the need for more appropriate patient assessment procedures are raised. The MRC Head Injury Assessment Project is described.

Activities of Daily Living↗
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Salt in the bath.

Explore the source record for details and available documents.

Baths↗
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Comparison of costs to the health sector of comprehensive and episodic health care for sickle cell disease patients.

Of 391 patients with sickle cell disease known to the health care facilities of the University of South Alabama, 194 patients used these facilities in 1989. In that year, 33.5 percent of patients seen at the University of South Alabama did not attend the Comprehensive Health Care Clinics developed for sickle cell patients. There were major differences in the patterns of use and in health care costs among sickle cell patients who attended the Comprehensive Health Care Clinics and those who did not. Patients not using these clinics, although they accounted for only 33.5 percent of the total patients, constituted 71.4 percent of visits to the emergency rooms and 42.3 percent of inpatient admissions. Patients enrolled in the Comprehensive Health Care Clinics used emergency rooms and inpatient units less frequently (P < 0.0001 and P = 0.0006, respectively) and were responsible for significantly smaller health care costs in each category (P < 0.0300). Evaluation of factors responsible for differences in the use patterns and patient education to improve use of comprehensive health care services should be considered.

Adult↗