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Biomedical subjects

P Robinson

Publications and source records attributed to P Robinson.

320 records · Page 18Linked to original sources
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Multidisciplinary team interaction: summary and Action Plan.

INTRODUCTION: Multidisciplinary team interaction has become a commonplace phrase in the discussion of disaster response. Theme 6 explored multidisciplinary team interactions and attempted to identify some of the key issues and possible solutions to the seemingly intractable problems inherent in this endeavour. METHODS: Details of the methods used are provided in the introductory paper. The Cochairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. The Cochairs then presided over a workshop that resulted in the generation of a set of Action Plans that then were reported to the collective group of all delegates. RESULTS: Main points developed during the presentations and discussion included: (1) promotion of multidisciplinary collaboration, (2) standardization, (3) the Incident Command System, (4) professionalism, (5) regional disparities, and (6) psychosocial impact. DISCUSSION: Action plans recommended: (1) a standardized template for Needs Assessment be developed, implemented, and applied using collaboration with international organizations, focusing on needs and criteria appropriate to each type of event, and (2) team needs assessments be recognized for local responses and for determination of when international assistance may be required, for planning a command system, and for evaluating the psychosocial impact. CONCLUSIONS: There is a clear need for the development of standardized methods for the assessment of needs, development and implementation of a command structure, and for appreciation of regional differences and the psychosocial impact of all interventions.

Attitude of Health Personnel↗
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Methodologic issues in randomized trials of liaison psychiatry in primary care.

Most anxiety, depressive, and substance abuse disorders are treated exclusively in the primary care health system. However, recognition and treatment of these disorders in primary care is deficient. Psychopharmacologic and psychotherapeutic interventions have been developed and proven effective in randomized trials in specialty care. However, the results of successful trials of mental health interventions in specialty settings may not generalize to primary care settings because of epidemiologic differences in patients, differences in skills of providers, as well as differences in the very structure of care. The importance of the development of innovative randomized trials to improve recognition and treatment of mental illness in primary care is emphasized, as well as the methodologic problems inherent in carrying out these trials.

Humans↗
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Generalised granulomatous disease in a horse.

A 6-year-old gelding was referred with a 3-month history of recurrent fever, inappetance, lethargy and weight loss. On clinical examination major findings were depression, thin condition, thrombophlebitis, nodules on the scrotal skin, leukocytosis, hyperfibrinogenaemia and hyperglobulinaemia. Pleural fluid and areas of lung consolidation were seen on ultrasonographic examination of the thorax. A diagnosis of chronic respiratory disease was made. Initially there was a response to antibiotic therapy but the horse was presented 3 months later with continued weight loss, recurrent fever and multifocal skin lesions, characterised by scales, crusts and nodules, affecting the nasal bridge, jugular grooves, ventral neck, withers, scrotum, prepuce, and medial gaskins. Histological evaluation of skin biopsies indicated a granulomatous reaction. On ultrasonographic examination of the thorax multiple hypoechoic lesions consistent with granulomas were seen in both lungs. A diagnosis of generalised granulomatous disease was made. The horse was euthanased at the owner's request. On necropsy examination the main findings were multiple nodules of fibrotic granulomatous inflammation in the lung, heart, liver, gastrointestinal tract and mesenteric lymph nodes, supporting the diagnosis of generalised granulomatous disease.

Animals↗
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Increased phosphatidic acid and decreased lysophosphatidic acid in response to thrombin is associated with inhibition of platelet aggregation.

Thromboxane A2, produced from the arachidonic acid released from platelet phospholipids by phospholipase A2, stimulates platelet aggregation. It remains unresolved whether additional products of platelet phospholipase A2 might promote aggregation. To address this question, we have used aspirin-treated platelets to block thromboxane A2 formation and studied the influence of the phospholipase A2 inhibitor U10029A on platelet aggregation and secretion in response to thrombin. U10029A at 100 microM markedly inhibited platelet aggregation, but had no effect on platelet secretion. Since this concentration of U10029A effectively blocked lysophosphatidic acid (LPA) formation, LPA was added and found to substantially reverse the inhibitory effect of U10029A in these platelets. Furthermore, the action of U10029A was not due to inhibition of phosphatidate phosphohydrolase because U10029A, unlike propranolol, did not inhibit this enzyme. Although it is not possible to conclusively rule out an effect of U10029A in addition to its inhibition of phospholipase A2, our results reveal that a product of phospholipase A2 other than thromboxane A2 is important for platelet aggregation, but not for secretion in response to thrombin. Our data suggest that this product is LPA. Since the amount of phosphatidic acid (PA) increased dramatically concurrent with inhibition of platelet aggregation, it is safe to conclude that PA has no direct role to promote platelet aggregation in response to thrombin.

Arachidonic Acid↗
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Biosynthesis of collagen in isolated periodontal ligament.

This study showed that the excised periodontal ligament from humans and hamsters actively synthesizes protein, as measured by 14C-proline incorporation, when incubated in vitro for periods of 30 minutes to six hours. However, only a small percentage of the protein synthesized was collagen.

Adolescent↗
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Imported malaria treated in Melbourne, Australia: epidemiology and clinical features in 246 patients.

BACKGROUND: Imported malaria is increasing in nonendemic countries, including Australia. The objective of this study was to describe the epidemiology and clinical features of travelers with imported malaria presenting to a specialist infectious diseases hospital. METHODS: A retrospective case series of 246 consecutively admitted inpatients with laboratory confirmed malaria. The main outcome measures were the proportion of patients infected with each malaria species, and relationship between species and country of birth, area of acquisition, adequacy of chemoprophylaxis, clinical features, laboratory investigations, and treatment. RESULTS: Plasmodium vivax caused 182 (68.9%) episodes, Plasmodium falciparum caused 71 (26.9%), Plasmodium ovale caused 5 (1.9%), and Plasmodium malariae 1 (0.4%). Fifty-six percent of patients reported chemoprophylaxis use. People born in a country with endemic malaria (36.6%) were less likely to have used chemoprophylaxis. Malaria was most commonly acquired in Papua New Guinea and Southeast Asia. The median times to diagnosis after return to Australia for P. falciparum and P. vivax infections were 1 and 9 weeks respectively. The longest interval between last arrival in Australia and presentation with P. falciparum malaria was 32 weeks. Fever (96%), headache (74%), and a tender or palpable spleen (40%), were the most common clinical features. Diarrhea was more common in P. falciparum, and rigors in P. vivax infections. Thrombocytopenia (71%), abnormal liver function tests and an elevated C-reactive protein (85%) were common. Six patients had severe falciparum malaria but no deaths occurred during the study period. CONCLUSION: Malaria remains a health threat for those traveling in endemic areas and is associated with failure to use chemoprophylaxis appropriately. Nonspecific clinical features may lead to delayed diagnosis and misdiagnosis. Malaria should be suspected in the febrile traveler, regardless of birthplace, prophylaxis, symptomatology, or the time that has elapsed since leaving the malarious area.

Adult↗
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The policy context.

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Clinical Nursing Research↗
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Delipidified cell components of Mycobacterium leprae and its applications.

Delipidified cell components (DCC) of Mycobacterium leprae obtained as an insoluble material consist of several proteins. This preparation, DCC, has ability to differentially bind to sera from lepromatous leprosy patients and antibodies to this complex get reduced as patients improve under chemotherapy. The antigenic complex has no ability to bind to proteins of sera from normal healthy individuals or tuberculoid leprosy patients. The DCC is antigenic and is recognised by immune deficient cells of lepromatous leprosy patients, leading to lymphocyte proliferation, production of Interleukin II and interferon gamma, and resulting in activation of the phagocytes to initiate killing of endocytosed M.leprae through reactive oxygen intermediates, primarily superoxide. The DCC has also immunomodulatory properties to protect mice against M.leprae infection. Experiments with mice and isolated peripheral blood cells from patients have indicated the probable molecular mechanism of immunomodulation by DCC.

Adjuvants, Immunologic↗
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Antiplatelet therapy and carotid plaque hemorrhage and its clinical implications.

UNLABELLED: One hundred and fifty-four carotid endarterectomy plaques were studied to determine the correlation of multiple intraplaque hemorrhages to (1) carotid symptoms, (2) the percentage of carotid stenosis, and (3) the preoperative antiplatelet therapy. The plaques were evaluated histopathologically for the presence of multiple hemorrhages. The data were analyzed using the chi 2 test. Multiple hemorrhages were noted in 60.4% and single or not hemorrhage in 39.6% of patients with hemispheric symptoms. In patients with nonhemispheric symptoms, 9.4% had multiple hemorrhages and 90.6% has single or no hemorrhages; 89.4% plaques with multiple hemorrhages had stenosis greater than 75% in contrast to 37.5% in plaques with single or no hemorrhage; and 62.5% with single or no hemorrhage had stenosis of less than 75% (p less than 0.001). In patients receiving antiplatelet therapy, 80.1% of plaques with multiple hemorrhages were removed, in contrast to 19.7% from patients not receiving antiplatelets (p less than 0.001). IN CONCLUSION: Multiple intraplaque hemorrhages were seen more often in patients with hemispheric symptoms and are associated with more critical carotid stenosis. Preoperative antiplatelet therapy increases the incidence of repeated plaque hemorrhages; therefore, we question the validity of this therapy in certain patients with carotid disease.

Arterial Occlusive Diseases↗
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Indications and complications of carotid endarterectomy as performed by four different surgical specialty groups.

The results of 518 carotid endarterectomies (CEA) performed by four surgical specialty groups were evaluated for complications and categorized according to their presentations. Nineteen surgeons performing CEA were classified into four groups: general surgeons (GS), general vascular surgeons (GVS), cardiovascular surgeons (CVS), and neurosurgeons (NS). The stroke and combined stroke and death rates respectively by the four groups were 6.1% and 6.1%; 3.2% and 3.5%; 6.5% and 8.7%; and 6.5% and 6.5%. The indications of CEA varied among the groups. Asymptomatic stenosis constituted 10.6%, 16.0%, 19.0%, and 0% of the total CEA performed by the groups respectively; nonhemispheric transient ischemic attacks (TIA) constituted 3.0%, 18.4%, 8.7%, and 0%; hemispheric TIA constituted 77.3%, 58.1%, 63.0% and 90.3%; and stroke constituted 9.1%, 7.5%, 8.7% and 9.7%. When CEA for asymptomatic stenosis and nonhemispheric TIA were combined, the stroke rate was 22.2% for the GS group; 1.6% for the GVS group; and 15.4% for the CVS group. In conclusion, the overall stroke rate was close for the four groups at 6.1%, 3.2%, 6.5% and 6.5% respectively. However, asymptomatic and nonhemispheric TIA patients had significantly lower complication rates when operated on by the GVS group in contrast to the other groups (1.6% for the GVS in contrast to 22.2% for the GS and 15.4% for the CVS). The GVS and CVS groups operated more frequently on asymptomatic and nonhemispheric TIA patients than the GS and NS groups.

Adult↗
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Pincer mouthstick.

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Humans↗