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Biomedical subjects

R Freeman

Publications and source records attributed to R Freeman.

At least 37 records · Page 2Linked to original sources
PubMed1999

The role of the dental nurse in general practice.

Dental nurses have reported dissatisfaction with their work which is associated with feelings of lack of control and being undervalued. This paper examines some of the possible reasons behind job dissatisfaction with illustrations from a pilot study conducted in general dental practice.

Attitude of Health Personnel↗
PubMed1999

Atypical anorexia nervosa: separation from typical cases in course and outcome in a long-term prospective study.

OBJECTIVE: To assess differences in long-term course and outcome between typical and atypical cases of anorexia nervosa. METHOD: A naturalistic, longitudinal prospective design was used to assess recovery, relapse, and onset of binge eating over 10 to 15 years in patients ascertained through a university-based specialty treatment program. Atypical anorexia nervosa was distinguished from the diagnostically prototypic form of the disorder based on the continuous absence of morbid fear of weight gain and body size distortion during the inpatient phase of treatment. Patients were assessed semiannually for 5 years then annually thereafter until the final visit. RESULTS: Compared to pure cases of anorexia nervosa, atypical cases were less likely to drop weight after discharge, recovered more rapidly, and had lower cumulative risk for developing binge eating. CONCLUSION: It has been argued recently that weight phobia and body image disturbance should not be viewed as critical to the diagnosis of anorexia nervosa. This study shows that the absence of these particular symptoms in patients presenting with malnutrition secondary to extreme dietary restriction predicts a less malignant course and outcome compared to typical cases of anorexia nervosa. These course differences suggest that the division of patients into typical versus atypical diagnostic subtypes may be nosologically valid and clinically useful.

Adult↗
PubMed1999

Suppression of radiation damping in high-resolution NMR.

The radiation damping field induced by an intense NMR line can be counterbalanced by a DANTE sequence of small flip angle pulses of opposite phase applied during the free induction decay. The transient NMR signal is acquired, one complex data point at a time, in the intervals between these DANTE pulses. As the intense signal decays, reducing the radiation damping field, the flip angles of the DANTE pulses are reduced at a matching rate. An experimental test on an aqueous solution of d-glucose demonstrates a reduction in linewidth at half height from 13.5 to 0.8 Hz, revealing a weak doublet response previously hidden under the broad water line.

Glucose↗
PubMed1999

Reduced intrapatient variability of cyclosporine pharmacokinetics in renal transplant recipients switched from oral Sandimmune to Neoral.

Sixty-six renal transplant patients maintained on Sandimmune, the traditional formulation of cyclosporine, participated in an open-label, sequential trial to compare intrapatient variability in drug exposure before and after a switch to Neoral. Three 12-hour cyclosporine pharmacokinetic profiles were obtained over approximately 6 weeks while patients were receiving Sandimmune. Patients were then switched to Neoral, with the dose adjusted as necessary to maintain target trough blood cyclosporine concentrations. At approximately 4 and 6 weeks postconversion, 2 additional pharmacokinetic profiles were obtained. Key pharmacokinetic variables analyzed were area under the concentration-time curve (AUC), maximum concentration (Cmax), and predose trough concentration (C0). Intrapatient variability in drug exposure for dose-normalized mean AUC, Cmax, and C0 was significantly reduced with Neoral, with 50 (76%), 57 (86%), and 45 (68%) patients experiencing reduced variability in AUC, Cmax, and C0, respectively (P < 0.001). Additionally, the total exposure to cyclosporine was more predictable from the trough level of cyclosporine with Neoral; the relationship between AUC and C0 was 0.81 for Neoral at both pharmacokinetic profiling time points but ranged from 0.49 to 0.69 for the 3 Sandimmune time points. The large reductions in intrapatient variability of pharmacokinetic variables for cyclosporine provided by Neoral indicate an improvement in the consistency of drug exposure, which may translate into important clinical benefits.

Adult↗
PubMed1999

Pyrolysis mass spectrometry analysis of free-living and symbiotic cyanobacteria.

The potential of pyrolysis mass spectrometry to distinguish closely related cyanobacterial strains was assessed by using the technique to compare symbiotic cyanobacteria isolated from the hornwort Phaeoceros laevis and free-living cyanobacterial strains at the same field site. The same strains had previously been compared using polymerase chain reaction-based DNA fingerprinting techniques (West & Adams 1997, Appl. Environ. Microbiol. 63: 4479-4484). Many of the strains were grouped identically by the two techniques, although there were some differences, possibly resulting from the ability of these cyanobacteria to develop a range of specialised cell types having different chemical compositions to the vegetative cells. Although growth conditions were chosen to suppress cellular differentiation, this may not always have been completely successful. With careful control of growth conditions pyrolysis mass spectrometry has considerable potential as an additional tool for the phenetic comparison of cyanobacterial strains. It has the advantage that analysis is directly derived from whole cells, and hence is simpler and cheaper than DNA-based methods, although it does require the growth of axenic strains. The technique may be particularly useful in the study of some of the more cryptic unicellular and non-heterocystous filamentous cyanobacterial groups, in which the lack of cellular differentiation should minimise any variability in the chemical composition of cells.

Bacterial Typing Techniques↗
PubMed1999

Rapid detection of methicillin-resistant staphylococci by multiplex PCR.

A multiplex PCR was developed to detect the coagulase gene (coa; pathognomic of Staphylococcus aureus) and the mecA gene (characteristically encoding for methicillin resistance in staphylococci) in a single, rapid test. Suitable primers for the gene targets and an internal, amplification control were incorporated into a multiplex PCR assay, which was then optimized on a capillary air thermal cycler to improve the turnaround time of the test to approximately 1.5 hours. The assay was evaluated with 111 fresh clinical isolates of staphylococci. The multiplex PCR correctly distinguished between isolates of S. aureus, which were sensitive to methicillin (MSSA) and those resistant to it (MRSA). It also correctly differentiated between similar isolates of coagulase negative staphylococci (MSSE and MRSE respectively). It was concluded that this multiplex PCR was a rapid and reliable method for the detection of methicillin-resistant staphylococci.

Coagulase↗
PubMed1999

No effect of adjunctive fluoxetine on eating behavior or weight phobia during the inpatient treatment of anorexia nervosa: an historical case-control study.

A six-week open label clinical trial investigated the response to fluoxetine in adolescents hospitalized for treatment of anorexia nervosa. Patients were drawn from consecutive admissions to a specialty treatment service and received fluxoetine as an add-on to their multidisciplinary treatment regimen beginning three weeks to one month postintake. Global clinical severity ratings of eating behavior and weight phobia were obtained at baseline and then at biweekly intervals. These ratings were compared to those obtained from matched historical case-controls who received an identical course of inpatient therapy but without adjunctive pharmacotherapy. Analyses failed to show any beneficial or detrimental effect of fluoxetine on these clinical measures. We conclude that fluoxetine has no robust additive or synergistic therapeutic benefit when measured against the effects of intensive, multidisciplinary inpatient therapy.

Adolescent↗
PubMed1999

The importance of orthostatic intolerance in the chronic fatigue syndrome.

Chronic fatigue syndrome (CFS) or myalgic encephalomyelitis is a clinically defined syndrome characterized by persistent or relapsing debilitating fatigue for longer than 6 months in the absence of any definable medical diagnosis. The cause of this syndrome is unknown. Symptoms of orthostatic intolerance, such as disabling fatigue, dizziness, diminished concentration, tremulousness, and nausea, are often found in patients with CFS. In this review, we critically evaluate the relationship between orthostatic intolerance and CFS. Particular emphasis is placed on clinical diagnosis, laboratory testing, pathophysiology, and therapeutic management. It is hoped that this review will provide a stimulus for further study of this complex and disabling condition.

Autonomic Nervous System↗
PubMed1999

Assessing the generalizability of OSCE measures across content domains.

PURPOSE: To assess the degree to which OSCE measures generalize across multiple administrations to the same students. METHODS: Students' scores from three OSCEs at one institution were correlated to determine the generalizability of the scoring systems across course domains. RESULTS: Analysis revealed that while checklist scores showed quite low correlations across examinations from different domains (ranging from 0.14 to 0.25), global process scores showed quite reasonable correlations (ranging from 0.30 to 0.44), with the correlations for global scores being significantly higher than those for checklist scores in all three comparisons. CONCLUSION: These data would seem to confirm the intuitions about each of these measures: the checklist scores are highly content-specific, while the global scores are evaluating a more broadly based set of skills. Implications for the use of these scales are discussed.

Clinical Clerkship↗
PubMed1999

ABC medium, a new chromogenic agar for selective isolation of Salmonella spp.

We describe a new chromogenic agar medium, ABC medium (alphabeta-chromogenic medium), which includes two substrates, 3, 4-cyclohexenoesculetin-beta-D-galactoside and 5-bromo-4-chloro-3-indolyl-alpha-D-galactopyranoside, to facilitate the selective isolation of Salmonella spp. This medium exploits the fact that Salmonella spp. may be distinguished from other members of the family Enterobacteriaceae by the presence of alpha-galactosidase activity in the absence of beta-galactosidase activity. A total of 1, 022 strains of Salmonella spp. and 300 other gram-negative strains were inoculated onto this medium. Of these, 1,019 (99.7%) strains of Salmonella spp. produced a characteristic green colony, whereas only 1 strain (0.33%) of non-Salmonella produced a green colony. A total of 283 stool samples were cultured onto desoxycholate citrate (DC) agar and ABC medium by direct inoculation and after selective enrichment in selenite broth. Overall, the sensitivity and specificity were superior for ABC medium (100 and 90.5%, respectively) than for DC agar (88 and 26.9%, respectively). We conclude that ABC medium offers a high degree of specificity for the detection of Salmonella spp. in stool samples.

Agar↗
PubMed1999

System identification of closed-loop cardiovascular control mechanisms: diabetic autonomic neuropathy.

We applied cardiovascular system identification (CSI) to characterize closed-loop cardiovascular regulation in patients with diabetic autonomic neuropathy (DAN). The CSI method quantitatively analyzes beat-to-beat fluctuations in noninvasively measured heart rate, arterial blood pressure (ABP), and instantaneous lung volume (ILV) to characterize four physiological coupling mechanisms, two of which are autonomically mediated (the heart rate baroreflex and the coupling of respiration, measured in terms of ILV, to heart rate) and two of which are mechanically mediated (the coupling of ventricular contraction to the generation of the ABP wavelet and the coupling of respiration to ABP). We studied 37 control and 60 diabetic subjects who were classified as having minimal, moderate, or severe DAN on the basis of standard autonomic tests. The autonomically mediated couplings progressively decreased with increasing severity of DAN, whereas the mechanically mediated couplings were essentially unchanged. CSI identified differences between the minimal DAN and control groups, which were indistinguishable based on the standard autonomic tests. CSI may provide a powerful tool for assessing DAN.

Adult↗
PubMed1999

Human studies of recombinant human nerve growth factor and diabetic peripheral neuropathy.

Recombinant human nerve growth factor (rhNGF) is the first neurotrophin to be investigated in clinical trials of diabetic peripheral neuropathy (DPN). To date, the drug has been administered to 60 healthy volunteers and 209 patients with DPN in phase I and II studies. Results from phase I have demonstrated rhNGF to be safe and generally well tolerated in doses up to 1.0 microg/kg given intravenously or subcutaneously for up to 12 doses. Doses investigated in phase II were 0.1 or 0.3 microg/kg s.c. 3 days a week for 6 months. Preliminary results from this trial suggest that rhNGF specifically improves the function of small-fibre sensory peripheral neurons, which is consistent with its postulated mode of action. Two pivotal 12-month phase III trials are underway in diabetic patients with symptomatic peripheral neuropathy to confirm the therapeutic effects of rhNGF. Results from these trials are expected in 2000.

Adult↗