Evaluating preterm breastfeeding training.
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Adult↗
Biomedical subjects
Peter Jones
Publications and source records attributed to Peter Jones.
Breastfeeding and returning to work.
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Adult↗
Negative betahCG: positive ectopic pregnancy.
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Abdomen, Acute↗
Minor physical anomalies in schizophrenia: is age a confounding factor?
Minor physical anomalies (MPAs) occur more frequently in a range of developmental disorders. They are also more frequent in schizophrenia supporting a neurodevelopmental aetiology of the illness. Contemporary MPA scales are yet to be validated for the effects of age. It is hypothesised that the effects of ageing may be confounding when these scales are applied to an elderly population. The distribution of MPAs in a normal elderly population was compared with younger subjects. Fifty subjects over the age of 60, and 50 subjects below the age of 60, with no known major mental illness, were evaluated. MPAs were assessed using a modified Lane scale [Psychol. Med. 27 (1997) 1155]. Elderly subjects showed an excess of absent trichions due to alopecia (p=0.004) short and broad palates (p=0.01) and greater ear protrusion (p=0.004) relative to young subjects. The differences reported are probably due to hair loss, edentulousness and growth of the auriculocephalic angle with age. These findings question the validity of studies of MPAs in schizophrenia that do not control for age.
Age Factors↗
Binuclear manganese compounds of potential biological significance. 1. Syntheses and structural, magnetic, and electrochemical properties of dimanganese(II) and -(II,III) complexes of a bridging unsymmetrical phenolate ligand.
Reactions of the unsymmetrical phenol ligand 2-(bis(2-pyridylmethyl)aminomethyl)-6-((2-pyridylmethyl)(benzyl)aminomethyl)-4-methylphenol with Mn(OAc)(2).4H(2)O or Mn(H(2)O)(6)(ClO(4))(2) in the presence of NaOBz affords the dimanganese(II) complexes 1(CH(3)OH), [Mn(2)(L)(OAc)(2)(CH(3)OH)](ClO(4)), and 2(H(2)O), [Mn(2)(L)(OBz)(2)(H(2)O)](ClO(4)), respectively. On the other hand, reaction of the ligand with hydrated manganese(III) acetate furnishes the mixed-valent derivative 3(H(2)O), [Mn(2)(L)(OAc)(2)(H(2)O)](ClO(4))( 2). The three complexes have been characterized by X-ray crystallography. 1(CH(3)OH) crystallizes in the monoclinic system, space group P2(1)/c, with a = 10.9215(6) A, b = 20.2318(12) A, c = 19.1354(12) A, alpha = 90 degrees, beta = 97.5310(10) degrees, gamma = 90 degrees, V = 4191.7 A(3), and Z = 4. 2(H(2)O) crystallizes in the monoclinic system, space group P2(1)/n, with a = 10.9215(6) A, b = 20.2318(12) A, c = 19.1354(12) A, alpha = 90 degrees, beta = 97.5310(10) degrees, gamma = 90 degrees, V = 4191.7 A(3), and Z = 4. 3(H(2)O) crystallizes in the monoclinic system, space group P2(1)/c, with a = 11.144(6) A, b = 18.737(10) A, c = 23.949(13) A, alpha = 90 degrees, beta = 95.910(10) degrees, gamma = 90 degrees, V = 4974(5) A(3), and Z = 4. Magnetic measurements revealed that the three compounds exhibit very similar magnetic exchange interactions -J = 4.3(3) cm(-)(1). They were used to establish tentative magneto-structural correlations which show that for the dimanganese(II) complexes -J decreases when the Mn-O(phenoxo) distance increases as expected from orbital overlap considerations. For the dimanganese(II,III) complexes, crystallographic results show that the Mn(II)-O(phenoxo) and Mn(III)-O(phenoxo) bond lengths are inversely correlated. An interesting magneto-structural correlation is found between -J and the difference between these bond lengths, delta(Mn)(-)(O) = d(Mn)()II(-)(O) - d(Mn)()III(-)(O): the smaller this difference, the larger -J. Electrochemical studies show that the mixed-valence state is favored in 1-3 by ca. 100 mV with respect to analogous complexes of symmetrical ligands, owing to the asymmetry of the electron density as found in the analogous diiron complexes.
Crystallography, X-Ray↗
Differences in the regulation of adipose tissue and liver lipogenesis by carbohydrates in humans.
We assessed the contributions of human liver and adipose tissue de novo lipogenesis (DNL) to triacylglycerol (TAG) synthesis. Volunteers were fed a high-energy, high-carbohydrate diet (HC, n = 5) or a normocaloric diet (NC, n = 10). NC subjects remained in the fasting state (Study 1, n = 5) or received oral glucose (Study 2, n = 5) throughout the test (12 h). HC subjects remained in the fasting state (Study 3). They ingested deuterated water and [U-13C]acetate to trace lipogenesis. Adipose tissue fatty-acid (FA) synthase (FAS), acetyl-CoA carboxylase 1 (ACC1), and SREBP-1c mRNA were measured. Plasma TAG-FA was labeled by 13C and deuterium showing active liver lipogenesis, which was stimulated (P < 0.05) by oral glucose and HC diet. Adipose tissue TAG had no detectable 13C enrichment in any test, showing no significant incorporation of TAG-FA provided by liver lipogenesis, but were labeled by deuterium in all tests, showing active DNL in situ; however, rough quantitative estimates showed that adipose DNL was minimal (<1 g), and poorly stimulated by oral glucose or HC diet. mRNA levels were not increased by the HC diet. Adipose DNL is active in humans, but contributes little to TAG stores and is less responsive than liver DNL to stimulation by carbohydrates.
Acetyl-CoA Carboxylase↗
The World Federation of Hemophilia: 40 years of improving haemophilia care worldwide.
In 2003, the World Federation of Hemophilia marks its 40th anniversary. Established in 1963 by Frank Schnabel, a person with hemophilia from Montreal, Canada, the WFH has grown into its role as an independent, not-for-profit representative of the global haemophilia community. Since then, its biannual world congresses have provided an opportunity to exchange information on research and treatment. Today, more than 3,000 delegates attend these congresses. Until the early 1990s, the WFH's other major function was the International Hemophilia Training Centre programme, offering training fellowships and workshops to medical and paramedical staff from developing countries. In 1982, AIDS was reported in people with haemophilia who had received tainted blood products. The WFH developed task forces and committees to monitor safety and supply issues and set up the Global Forum on the Safety and Supply of Treatment Products. In the mid-1990s, twinning programmes were established for treatment centres and national haemophilia organizations. Twinning facilitates the exchange of training, coaching, and expertise. In the late 1990s, the WFH expanded and began working with local organizations and health authorities in a number of countries to improve the diagnosis and care of persons with hemophilia. The federation currently has ongoing projects in 25 developing countries. On World Hemophilia Day, April 17, 2003, the WFH launched the Global Alliance for Progress (GAP) in haemophilia which aims to double the number of people with haemophilia diagnosed and receiving treatment in up to 40 developing countries over a 10-year period.
Acquired Immunodeficiency Syndrome↗
Percent change in wound area of diabetic foot ulcers over a 4-week period is a robust predictor of complete healing in a 12-week prospective trial.
OBJECTIVE: To assess the ability of the 4-week healing rate to predict complete healing over a 12-week period in a large prospective multicenter trial of diabetic patients with foot ulceration. RESEARCH DESIGN AND METHODS: We examined the change in ulcer area over a 4-week period as a predictor of wound healing within 12 weeks in patients who were seen weekly in a prospective, randomized controlled trial. RESULTS: Wound area measurements at baseline and after 4 weeks were performed in 203 patients. The midpoint between the percentage area reduction from baseline at 4 weeks in patients healed versus those not healed at 12 weeks was found to be 53%. Subjects with a reduction in ulcer area greater than the 4-week median had a 12-week healing rate of 58%, whereas those with reduction in ulcer area less than the 4-week median had a healing rate of only 9% (P < 0.01). The absolute change in ulcer area at 4 weeks was significantly greater in healers versus nonhealers (1.5 vs. 0.8 cm(2), P < 0.02). The percent change in wound area at 4 weeks in those who healed was 82% (95% CI 70-94), whereas in those who failed to heal, the percent change in wound area was 25% (15-35; P < 0.001). CONCLUSIONS: The percent change in foot ulcer area after 4 weeks of observation is a robust predictor of healing at 12 weeks. This simple tool may serve as a pivotal clinical decision point in the care of diabetic foot ulcers for early identification of patients who may not respond to standard care and may need additional treatment.
Diabetic Foot↗
Efficacy and safety of plant stanols and sterols in the management of blood cholesterol levels.
Foods with plant stanol or sterol esters lower serum cholesterol levels. We summarize the deliberations of 32 experts on the efficacy and safety of sterols and stanols. A meta-analysis of 41 trials showed that intake of 2 g/d of stanols or sterols reduced low-density lipoprotein (LDL) by 10%; higher intakes added little. Efficacy is similar for sterols and stanols, but the food form may substantially affect LDL reduction. Effects are additive with diet or drug interventions: eating foods low in saturated fat and cholesterol and high in stanols or sterols can reduce LDL by 20%; adding sterols or stanols to statin medication is more effective than doubling the statin dose. A meta-analysis of 10 to 15 trials per vitamin showed that plasma levels of vitamins A and D are not affected by stanols or sterols. Alpha carotene, lycopene, and vitamin E levels remained stable relative to their carrier molecule, LDL. Beta carotene levels declined, but adverse health outcomes were not expected. Sterol-enriched foods increased plasma sterol levels, and workshop participants discussed whether this would increase risk, in view of the marked increase of atherosclerosis in patients with homozygous phytosterolemia. This risk is believed to be largely hypothetical, and any increase due to the small increase in plasma plant sterols may be more than offset by the decrease in plasma LDL. There are insufficient data to suggest that plant stanols or sterols either prevent or promote colon carcinogenesis. Safety of sterols and stanols is being monitored by follow-up of samples from the general population; however, the power of such studies to pick up infrequent increases in common diseases, if any exist, is limited. A trial with clinical outcomes probably would not answer remaining questions about infrequent adverse effects. Trials with surrogate end points such as intima-media thickness might corroborate the expected efficacy in reducing atherosclerosis. However, present evidence is sufficient to promote use of sterols and stanols for lowering LDL cholesterol levels in persons at increased risk for coronary heart disease.
Animals↗
Early intervention in psychosis.
The article describes the development of guidelines for the management of first episode psychosis, over the first few years of the illness. Such guidelines advocate the use of low dose medication (be this with typical or atypical anti-psychotics) as well as psychological techniques, and assertive case management. The paper will review the development of these guidelines, describe them, and suggest outcome measures for the treatment of first and early episodes.
Humans↗
Continuous versus interrupted perineal repair with standard or rapidly absorbed sutures after spontaneous vaginal birth: a randomised controlled trial.
BACKGROUND: Trauma to the perineum is a serious and frequent problem after childbirth, with about 350000 women each year in the UK needing sutures for perineal injury after spontaneous vaginal delivery, and many millions more worldwide. We compared the continuous technique of perineal repair with the interrupted method, and the more rapidly absorbed polyglactin 910 suture material with the standard polyglactin 910 material. METHODS: 1542 women who had a spontaneous vaginal delivery with a second-degree perineal tear or episiotomy were randomly allocated to either the continuous (n=771) or interrupted (771) suturing method, and to either the more rapidly absorbed polyglactin 910 suture material (772) or standard polyglactin 910 material (770). Primary outcomes were pain 10 days after delivery and superficial dyspareunia 3 months postpartum. Analysis was by intention to treat. FINDINGS: At day 10, three women had dropped out of the study. Significantly fewer women reported pain at 10 days with the continuous technique than with the interrupted method (204/770 [26.5%] vs 338/769 [44.0%], odds ratio 0.47, 95% CI 0.38-0.58, p<0.0001). Occurrence of pain did not differ significantly between groups assigned the more rapidly absorbed material or standard material (256/769 [33.3%] vs 286/770 [37.1%], 0.84, 0.68-1.04, p=0.10). Women reported no difference in superficial dyspareunia at 3 months for the continuous vs the interrupted method (98/581 [16.9%] vs 102/593 [17.2%], 0.98, 0.72-1.33, p=0.88) or the more rapidly absorbed versus standard material (105/586 [17.9%] vs 95/588 [16.2%], 1.13, 0.84-1.54, p=0.42). Suture removal was done less with the more rapidly absorbed material than with standard suture material (22/769 [3%] vs 98/770 [13%], p<0.0001), and with the continuous versus interrupted method (24/770 [3%] vs 96/769 [12%], p<0.0001). INTERPRETATION: A simple and widely practicable continuous repair technique can prevent one woman in six from having pain at 10 days. Also, the more rapidly absorbed polyglactin 910 material obviates need for suture removal up to 3 months postpartum for one in ten women sutured.
Adult↗
Managing Obstetric Emergencies and Trauma (MOET) structured skills training in Armenia, utilising models and reality based scenarios.
BACKGROUND: Mortality rates in Western Europe have fallen significantly over the last 50 years. Maternal mortality now averages 10 maternal deaths per 100,000 live births but in some of the Newly Independent States of the former Soviet Union, the ratio is nearly 4 times higher. The availability of skilled attendants to prevent, detect and manage major obstetric complications may be the single most important factor in preventing maternal deaths. A modern, multidisciplinary, scenario and model based training programme has been established in the UK (Managing Obstetric Emergencies and Trauma (MOET)) and allows specialist obstetricians to learn or revise the undertaking of procedures using models, and to have their skills tested in scenarios. METHODS: Given the success of the MOET course in the UK, the organisers were keen to evaluate it in another setting (Armenia). Pre-course knowledge and practice questionnaires were administered. In an exploratory analysis, post-course results were compared to pre-course answers obtained by the same interviewer. RESULTS: All candidates showed an improvement in post-course scores. The range was far narrower afterwards (167-188) than before (85-129.5). In the individual score analysis only two scenarios showed a non-significant change (cord prolapse and breech delivery). CONCLUSION: This paper demonstrates the reliability of the model based scenarios, with a highly significant improvement in obstetric emergency management. However, clinical audit will be required to measure the full impact of training by longer term follow up. Audit of delays, specific obstetric complications, referrals and near misses may all be amenable to review.
Armenia↗
The relationship between predisposing factors, premorbid function and symptom dimensions in psychosis: an integrated approach.
BACKGROUND: Increasing evidence suggests psychosis may be more meaningfully viewed in dimensional terms rather than as discrete categorical states and that specific symptom clusters may be identified. If so, particular risk factors and premorbid factors may predict these symptom clusters. AIMS: (i) To explore, using principal component analysis, whether specific factors for psychotic symptoms can be isolated. (ii) To establish the predictors of the different symptom factors using multiple regression techniques. METHOD: One hundred and eighty-nine inpatients with psychotic illness were recruited and information on family history, premorbid factors and current symptoms obtained from them and their mothers. RESULTS: Seven distinct symptom components were identified. Regression analysis failed to identify any developmental predictors of depression or mania. Delusions/hallucinations were predicted by a family history of schizophrenia and by poor school functioning in spite of normal premorbid IQ (F = 6.5; P < 0.001); negative symptoms by early onset of illness, developmental delay and a family history of psychosis (F = 4.1; P = 0.04). Interestingly disorganisation was predicted by the combination of family history of bipolar disorder and low premorbid IQ (F = 4.9; P = 0.003), and paranoia by obstetric complications (OCs) and poor school functioning (F = 4.2; P = 0.01). CONCLUSION: Delusions and hallucinations, negative symptoms and paranoia all appeared to have a developmental origin though they were associated with different childhood problems. On the other hand, neither mania nor depression was associated with childhood dysfunction. Our most striking finding was that disorganisation appeared to arise when a familial predisposition to mania was compounded by low premorbid IQ.
Adolescent↗
MOET: Bangladesh--an initial experience.
OBJECTIVES: To summarize the quantitative and qualitative immediate assessments of the Managing Obstetric Emergencies and Trauma (MOET) course and to examine the individual changes in score obtained for each of the scenarios. METHODS: Students' knowledge before and after the course was evaluated with a standardized comprehensive questionnaire. RESULTS: All candidates showed an improvement in postcourse, compared to precourse, scores. In the individual score analysis only one scenario showed a non-significant change. The majority of other scenarios showed highly significant improvement between the two scores. CONCLUSION: This paper summarises the development of the first MOET course to be run outside the UK. It demonstrates the reliability of the model-based scenario foundation with a highly significant improvement in knowledge about obstetric emergency management. Further evaluation of longer term practice changes is now required.
Clinical Competence↗
Measuring disability and mortality following relocation within the NHS.
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Aged↗
Randomised, cross-over, placebo controlled trial of magnesium citrate in the treatment of chronic persistent leg cramps.
BACKGROUND: Nocturnal leg cramps are common and distressing. The only treatment of proven effectiveness is quinine, but this has a number of side effects. Magnesium salts have been shown to reduce leg cramp distress in pregnancy. This study tests whether magnesium citrate is effective in the treatment of leg cramps in non-pregnant individuals by conducting in a randomised, double-blind, cross-over placebo-controlled trial. MATERIAL/METHODS: Volunteers suffering regular leg cramps were recruited. Magnesium citrate equivalent to 300 mg magnesium and matching placebo were given for 6 weeks each. The number of cramps recorded in the cramp diary during the final 4 weeks of magnesium and placebo treatment, severity and duration of cramps and the participants' subjective assessment of effectiveness were analysed. RESULTS: In subjects who started with placebo (n=29) the median (95% CI) number of cramps was 9 (6-17) on placebo and 5 (4-8) on magnesium. For the group starting with magnesium (n=17) the median no of cramps was 9 (5-13) on magnesium and 8 (4-14) on placebo. There was no significant carry-over effect (p=0.88), but a highly significant period effect (p=0.008). There was a trend towards less cramps on magnesium (p=0.07). There was no difference in cramp severity and duration between the groups. Significantly more subjects thought that the treatment had helped after magnesium than after placebo 36 (78%) and 25 (54%) respectively, (p=0.03). Diarrhoea was recorded as a side effect of magnesium. CONCLUSIONS: The results suggest that magnesium may be effective in treatment of nocturnal leg cramps. Further evaluation is recommended.
Aged↗
CARDIOGENIC ACUTE RENAL FAILURE (CARF) FOLLOWING OPEN-HEART SURGERY.
Although previous reports have attributed acute renal failure (ARF) following cardiovascular surgery to acute tubular necrosis (ATN), little emphasis has been placed on renal failure due to congestive heart failure (CARF). Of 100 cases of ARF studied prospectively over an 18-month period, 36 occurred after open-heart surgery. Nineteen of these cases were associated with heart failure. The remaining 17 had ATN as manifested by high urinary sodium, low urine/plasma creatinine, and abnormal urinary sediment. At the onset of CARF, intravascular volume expansion was universally present, and oliguria with pulmonary edema was common. Urinary chemistries were (mean +/- SD): sodium (mEq/L) 8 +/- 7, U/P creatinine 72 +/- 45, and FENa (%) 0.1 +/- 0.1. Therapy consisted of digoxin, furosemide (F), vasopressors (V), and, when indicated, intraaortic balloon counterpulsation. Survivors of CARF responded more frequently to F and required less V. Ultimately, survival depended upon improvement in cardiac performance. All oliguric ATN patients failed to respond to F. Mortality for the CARF group was 52%. In contrast, 82% of the oliguric ATN group expired, whereas overall ATN mortality was 60%. Cardiogenic acute renal failure is a frequent cause of ARF after open-heart surgery in our institution. It is characterized by prerenal urinary chemistries, has a high mortality, and may be reversible.
Journal Article↗
Prospective, randomized, controlled, single-blind trial of the costs and consequences of systematic nutrition team follow-up over 12 mo after percutaneous endoscopic gastrostomy.
OBJECTIVES: We assessed the economic and clinical implications of systematic long-term nutrition team follow-up of patients after percutaneous endoscopic gastrostomy. METHODS: We designed a prospective, randomized, controlled, single-blind trial in a large district hospital and its catchment area. All adult patients referred for a gastrostomy were eligible and randomized into two groups. The intervention group had regular follow-up by the nutrition team (weekly in hospital, monthly after discharge) with appropriate support and advice for patient, carer, and primary care professionals. The control group had no specific nutrition team input (as is often current practice). Endpoints to the study were 12 mo, elective removal of tube, or death. The primary outcome was total health care costs. Secondary outcomes were complications, length of stay, readmissions, nutritional status, and quality of life. RESULTS: One hundred twelve patients were recruited. Eleven died before the start of the trial, leaving 47 in the intervention group and 54 in the control group. They were well matched for age, sex, and underlying diagnosis. Overall, the health care costs were 13,330 sterlings per patient in the intervention group compared with 16,858 pound sterlings in the control group (two-tailed, P = 0.27), a saving of 21% per patient. The intervention group had shorter lengths of stay, fewer and briefer readmissions, earlier removal of gastrostomy (where appropriate), shorter duration of feeding, and less demand for general practitioners and district nurse inputs. Nutritional status and quality of life were similar. CONCLUSIONS: Regular systematic nutrition team follow-up for gastrostomy-fed patients does not increase costs and may improve quality of care.
Aged↗