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Biomedical subjects

N Palmer

Publications and source records attributed to N Palmer.

34 records · Page 2Linked to original sources
PubMed1998

An investigation of antibiotic prescribing by general dental practitioners: a pilot study.

PURPOSE OF STUDY: This pilot study was designed to investigate how general dental practitioners prescribe antibiotics. METHODS: A total of 200 prescriptions were selected at random from 1775 prescriptions dispensed in 55 pharmacies across a Liverpool district. The type of antibiotic prescribed, the duration, frequency and dose were analysed. The legibility and any other errors or omissions were also noted. RESULTS: The legibility of the prescriptions was good with very few errors or omissions from the patient details. Seven different types of antibiotics were used with amoxycillin being the most frequently prescribed (64.5%), followed by metronidazole (21.5%). Penicillin, erythromycin, clindamycin, tetracycline and cephradine were the other antibiotics prescribed. There was a wide variation in the duration, frequency and doses prescribed. CONCLUSION: The results of this pilot study show that many practitioners prescribe antibiotics for inappropriately long periods and with inconsistent frequency and duration.

Anti-Bacterial Agents↗
PubMed1997

Genomic sequence of a Lyme disease spirochaete, Borrelia burgdorferi.

The genome of the bacterium Borrelia burgdorferi B31, the aetiologic agent of Lyme disease, contains a linear chromosome of 910,725 base pairs and at least 17 linear and circular plasmids with a combined size of more than 533,000 base pairs. The chromosome contains 853 genes encoding a basic set of proteins for DNA replication, transcription, translation, solute transport and energy metabolism, but, like Mycoplasma genitalium, it contains no genes for cellular biosynthetic reactions. Because B. burgdorferi and M. genitalium are distantly related eubacteria, we suggest that their limited metabolic capacities reflect convergent evolution by gene loss from more metabolically competent progenitors. Of 430 genes on 11 plasmids, most have no known biological function; 39% of plasmid genes are paralogues that form 47 gene families. The biological significance of the multiple plasmid-encoded genes is not clear, although they may be involved in antigenic variation or immune evasion.

Biological Transport↗
PubMed1997

Resilience in adult children of alcoholics: a nonpathological approach to social work practice.

Imperative for social work practice is the need to examine practice frameworks that may inadvertently label variations in cultural expression, ways of navigating stress and threat of harm or social oppression, or periods of reassembly in negative or pathological terms. This article reviews research that explored another way of viewing adult children of alcoholics (ACOAs), because of the epistemology of pathology that grounds research and practice in the area of alcoholism. Using the Differential Resiliency Model (DRM) developed by the author, the study examined qualitative data to obtain a nonpathological approach to understanding the resilience of ACOAs. The DRM can help practitioners provide more timely and appropriate support and services that complement the survival and growth needs of individuals and families. A case example illustrates the use of the model.

Adult↗
PubMed1994

Emergency department patients who leave without seeing a physician: the Toronto Hospital experience.

STUDY OBJECTIVES: To determine why emergency department patients leave without being seen by a physician and whether they receive alternate medical care. DESIGN: A prospective, cross-sectional study of patients who left without being seen. Charts were reviewed for population demographics, presenting complaints, and clinical acuity rating. Follow-up was achieved within 6 weeks through mailed survey questionnaires and telephone interviews. SETTING: Two inner-city EDs of the Toronto Hospital, a quaternary care facility. PARTICIPANTS: All 423 patients who registered for care and left without being seen during a 16-week period from January to May 1991. RESULTS: Of 23,933 registered patients, 423 (1.4%) left without being seen. Follow-up was achieved on 39% of patients (165 of 423). Sixty-seven percent of those who left (284 of 423) had low acuity ratings. Of the 165 survey respondents, 107 (65%) left between 30 minutes and 2 hours after registration. The major reasons cited for leaving included prolonged waiting time (99 of 165, 60%), perceived difficulties with hospital staff (46 of 165, 28%), and pressing commitments elsewhere (45 of 165, 27%). Ninety-two percent (152 of 165) believed they should be evaluated by a physician within 1 hour of presentation. Forty-eight percent (80 of 165) sought further medical attention within 24 hours. Personal physicians (65 of 165, 39%) and other EDs (29 of 165, 18%) were the most common sources of further medical care. CONCLUSION: The majority of survey respondents had a low acuity rating and left because of prolonged waiting times. Most of these patients sought alternate medical care through their personal physician or other EDs.

Adolescent↗
PubMed1988

Congenital anomalies associated with rhabdomyosarcoma: an autopsy study of 115 cases. A report from the Intergroup Rhabdomyosarcoma Study Committee (representing the Children's Cancer Study Group, the Pediatric Oncology Group, the United Kingdom Children's Cancer Study Group, and the Pediatric Intergroup Statistical Center).

Congenital anomalies were identified in 37 of 115 (32%) children and adolescents autopsied with rhabdomyosarcoma. An analysis of sex, age, site, and histology of cases with or without congenital anomalies showed no significant differences. Of the 45 identified anomalies, 14 were considered major and 31 minor. The distribution of the anomalies by system included central nervous (9), genitourinary (10), gastrointestinal (13), and cardiovascular systems (4). Ten patients had complex or miscellaneous anomalies. There was one child with each of the following: Rubinstein-Taybi syndrome, neurofibromatosis, single horseshoe kidney, hemihypertrophy, and Arnold-Chiari malformation. Aniridia was not noted in any case of rhabdomyosarcoma. Individuals with rhabdomyosarcoma have an increased incidence of genitourinary anomalies similar to that in Wilms' tumor. Recent molecular genetic investigations have suggested that rhabdomyosarcoma, Wilms' tumor, and hepatoblastoma share a common pathogenetic mechanism involving chromosome 11. The uniquely increased association of central nervous system anomalies with rhabdomyosarcoma and absence of aniridia would support a different gene locus operative on chromosome 11 for individuals with rhabdomyosarcoma compared to Wilms' tumor. Extensive epidemiologic studies now in progress in patients with rhabdomyosarcoma should provide the incidence of congenital anomalies and potential linkage with prenatal events.

Cardiovascular Abnormalities↗
PubMed1988

Improving the quality of data in randomized clinical trials: the COMPACT computer package. COMPACT Steering Committee.

One crucial component for a successful clinical trial is that the data gathered have a high level of reliability and completeness. This paper reviews some problems of data management and describes the computer package COMPACT which has been developed to deal with such problems. The package allows range and consistency checks and can monitor complex follow-up schedules. A unique feature of the package is a PROBLEMS file which has use both for identification of queries about the data and of patients with particular characteristics of interest. The ability to monitor drug dosages and to signal deviations from the protocol is of particular value. COMPACT has the syntax necessary to create a 'flat' file for transfer to statistical packages for analysis, and the variable description files for SAS, SPSS and MINITAB. The package is written in standard FORTRAN which enables transfer to different types of mini and micro computer systems.

Clinical Trials as Topic↗
PubMed1985

Q-fever. The liver and bone marrow pathology.

Eighteen liver and seven bone marrow biopsies from 44 patients with clinically and serologically proven Q-fever seen during a recent outbreak were studied. Highly distinctive fibrin-ring granulomas were found in seven liver and four bone marrow specimens. Lipid or nonspecific granulomas often containing neutrophils and variable numbers of giant cells were noted in 13 livers and seven bone marrows. A wide variety of nongranulomatous histological changes, frequently including steatosis and nonspecific "reactive" hepatitis, were seen in the liver biopsies. Identifiable rickettsiae were not present in tissue sections studied by microbiologic stains or electron microscopy. The histological response pattern to Coxiella infection is varied, and Q-fever should always enter the differential diagnosis of a granulomatous disease encountered in liver and bone marrow specimens.

Animals↗
PubMed1983

The association of aniridia and Wilms' tumor: methods of surveillance and diagnosis.

The association between aniridia and Wilms' tumor (WT) is well known. The availability of data on a large number of WT patients entered on the first and second National Wilms' Tumor Studies provided the opportunity to review which examination had been most effective in detecting the presence of WT in patients being followed with aniridia. The records of 1287 patients were available and 13 or 1% had known aniridia. The details of the prediagnostic studies were available in 9/13 patients. Those nine patients had been examined regularly by IVP at intervals of 3-12 months prior to the discovery of the WT, but in only one was the unsuspected WT detected by these means. In the remaining eight patients, the tumor was discovered by palpation in six and suspected because of hematuria in two. It is concluded that repeated IVP's are not a satisfactory method to diagnose a WT at an early stage and newer radiodiagnostic studies, such as ultrasonography, will probably prove more effective.

Child, Preschool↗
PubMed1983

Renal cell carcinoma in children.

Data from four pediatric hospitals concerning 20 children treated for renal cell carcinoma (RCC) from 1964-1978 were reviewed. Median age of the patients (pts) was 11.8 years (range, 14 months-19 years). Twelve were male and eight female; 17 were white and three black. Most patients presented with pain and hematuria with or without a palpable mass. An intrarenal tumor was detected at IV urography (17 pts), arteriography (2 pts), or at surgery (1 pt). Treatment consisted of nephrectomy in 15 pts, renal biopsy (4 pts), or no surgery (1 pt), followed by chemotherapy (5 pts), radiation therapy (1 pt), or both (7 pts). Ten pts died of distant metastases at a median of one year (range, 0.2 to two years) after diagnosis. The other 10 pts (50%) survive free of relapse at a median of 4 years (range, two to ten years) from diagnosis. Proportions surviving free of recurrent disease two or more years by National Wilms' Tumor Study (NWTS) Group were 5/5 in Group I, 3/7 in Group II, 1/3 in Group III, and 1/5 in Group IV; by age at diagnosis, 6/6 in those under 11 years old and 4/14 in those 11 or older; and by type of surgery, 10/15 who had nephrectomy and 0/5 with limited or no surgery. The data indicate that radiation and chemotherapy had only minor if any influences on relapse-free survival. We conclude that (1) RCC in children is similar to its counterpart in adults; (2) RCC has a worse prognosis than Wilms' tumor except for the earliest stage; (3) nephrectomy alone is adequate treatment for Group I RCC, and (4) young age (less than 11 years old) may be prognostically favorable.

Adenocarcinoma↗
PubMed1981

The treatment of Wilms' tumor: results of the Second National Wilms' Tumor Study.

One-hundred-eighty-eight children up to 16 years of age were randomized in the second National Wilms' Tumor Study (NWTS) with tumors that were confined to the kidney and that had been totally excised (Group I). Most fared well whether treated for six or for 15 months with both actinomycin D (AMD) and vincristine (VCR). No postoperative radiation therapy (RT) was given. The two-year relapse-free survival (RFS) and two-year survival rates were 88 and 95%, respectively. Two-hundred-sixty-eight randomized patients with more advanced local lesions (Groups II and III) and 57 with distant metastases (Group IV) had postoperative RT and were scheduled for 15 months treatment with either AMD and VCR (Reg. C) or AMD plus VCR plus Adriamycin (Reg. D). The 77% two-year RFS rate for Reg. D was significantly different from the 63% with Reg. C. As in the first NWTS, patients with tumors of unfavorable histology (UH) had a significantly worse prognosis than those with favorable histology (FH), as did those with positive nodes. Survival rates at two years were 54% for UH vs. 90% for FH, and 54% vs. 82% for those with and without lymph node involvement.

Adolescent↗
PubMedDate not supplied

MR assessment of spinal metastases using the late 26 sequence.

Ninety-two patients with suspected spinal involvement by systemic cancer underwent MR examinations using both conventional and phase-contrast (LATE 26) spin-echo pulse sequences. MR imaging was considered positive for metastatic disease in 73 cases. Implants were extradural in 69 patients and intradural in 4 patients. Nineteen cases had no MRI evidence of metastases and the abnormalities suspected were shown to be due to either inflammatory or degenerative changes. MR appearances during and after chemo- and/or radiotherapy were studied in 5 patients. The impact of the LATE 26 sequence in the assessment of metastatic spinal disease is evaluated.

Adult↗
PubMedDate not supplied

The use of carbon-loaded thermoluminescent dosimeters for the measurement of surface doses in megavoltage x-ray beams.

To determine the absorbed dose to the skin of patients undergoing radiotherapy with megavoltage radiations, it is necessary for the dose to be measured at shallow depths. This report assesses the suitability of carbon-loaded thermoluminescent dosimeters (manufactured by Vinten Instruments Limited) for this purpose. Measurements have been made of the effective measurement depth of the dosimeters, the linearity with dose, and the variation of sensitivity within a batch. The variation of surface dose with incident angle of radiation for 5-MV x rays has been measured using these disks; the results are compared with results obtained using a thin-windowed ionization chamber.

Humans↗