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Biomedical subjects

R Freeman

Publications and source records attributed to R Freeman.

At least 163 records · Page 9Linked to original sources
PubMed1995

Preemptive ganciclovir therapy to prevent cytomegalovirus disease in cytomegalovirus antibody-positive renal transplant recipients. A randomized controlled trial.

OBJECTIVE: To determine whether preemptive ganciclovir therapy administered daily during antilymphocyte antibody therapy can prevent cytomegalovirus disease in renal transplant recipients who are positive for cytomegalovirus antibody. DESIGN: Randomized, controlled, multicenter trial. SETTING: 6 university-affiliated transplantation centers. PATIENTS: 113 renal transplant recipients who were positive for cytomegalovirus antibody. INTERVENTION: Patients were randomly assigned to receive either 1) ganciclovir, 2.5 mg/kg body weight administered intravenously on every day that antilymphocyte antibody therapy was administered or 2) no anticytomegalovirus therapy. MEASUREMENTS: Patients were observed for 6 months after completion of antilymphocyte antibody therapy for development of cytomegalovirus disease and cytomegalovirus viremia. RESULTS: Cytomegalovirus disease occurred in 14% of patients (9 of 64) who received preemptive ganciclovir therapy and in 33% of controls (16 of 49) (P = 0.018). Cytomegalovirus was isolated from buffy-coat specimens from 17% of patients (11 of 64) receiving preemptive ganciclovir and from 35% of controls (17 of 49) (P = 0.03). Controlling for the reason (induction or treatment of rejection) for using antilymphocyte antibodies in a Cox proportional hazards model, we found that preemptive ganciclovir still protected against cytomegalovirus disease (adjusted relative risk, 0.27; 95% CI, 0.12 to 0.64). No adverse events were attributed to preemptive ganciclovir therapy during or within 6 months of its administration. CONCLUSIONS: Preemptive ganciclovir therapy administered daily during courses of treatment with antilymphocyte antibodies reduced the excessive occurrence of cytomegalovirus disease in renal transplant recipients who were positive for cytomegalovirus antibody. This approach, which links the most potent immunosuppression to intensive antimicrobial therapy, allows preventive therapy to be given to those patients at greatest risk for developing infectious complications. These patients are likely to benefit most from the preventive strategy.

Adolescent↗
PubMed1995

Whirlpool baths in nursing homes: use, maintenance, and contamination with Pseudomonas aeruginosa.

Transmission of Pseudomonas aeruginosa wound infection was associated with the use of a whirlpool bath in a nursing home. The nursing home inspection unit asked for guidance on whirlpool baths in nursing homes and advice for proprietors about their use, cleaning, disinfection, and maintenance. Seventeen whirlpool baths in 16 nursing homes in two health districts were examined for the presence of P. aeruginosa. A survey was made of the use made of whirlpool baths, methods used to clean and disinfect them, and the occurrence of P. aeruginosa wound infection in users. P. aeruginosa were found in large numbers in water samples from all whirlpool baths after agitation. Only one of the 253 residents who used whirlpool baths was known to have a P. aeruginosa wound infection. The local nursing home inspection unit was advised that whirlpool baths could continue to be used in nursing homes but only by continent residents with intact skin. The bath should be cleaned and disinfected, preferably with hypochlorite, after each use; the bath should be more thoroughly cleaned and disinfected daily and the bath should be fully serviced at least once a year. Suspected or confirmed cases of P. aeruginosa infection in residents of nursing homes should be reported to the consultant in communicable disease control. The prevalence of known infection with P. aeruginosa was low in the residents of the nursing homes, but the unguided and unregulated use of whirlpool baths in nursing homes may present an infection hazard to residents who use the bath and to hospitals that admit residents from such nursing homes.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1995

Occupational stress and dentistry: theory and practice. Part I. Recognition.

Dental practice has been considered to be the most stressful of the health care professions. Increasingly dentists in general practice seem to experience more physical and mental ill health compared with other health professionals and this has been recognised to be a consequence of occupational stress. Occupational stress has been related to changes in clinical dental practice with many of the perceived causes being within the dentist's own control. Since dentists are faced daily with these potential occupational stressors one way of controlling stress is through its recognition. This paper highlights experiences common to all those in dental practice as a first step in reducing occupational stress.

Dental Care↗
PubMed1995

Occupational stress and dentistry: theory and practice. Part II. Assessment and control.

Since dentistry has been identified as being a stressful profession, dentists, with the help of the members of the dental team, must attempt to achieve a relatively stress-free working environment. In addition to recognising potential occupational stressors it is important for dentists to be able to assess their emotional responses to the practice of dentistry and to arrange their daily working lives in such a way as to reduce occupational stress. This paper examines the means by which dentists may assess occupational stress as well as person-centred and/or situation-centred strategies of coping with and controlling occupational stress in general dental practice.

Adaptation, Psychological↗
PubMed1995

Clinical pharmacology of estrogens: cardiovascular actions and cardioprotective benefits of replacement therapy in postmenopausal women.

The use of estrogens in postmenopausal women has been the subject of much controversy regarding hormone formulation, dosage, use in combination with progestins, duration of treatment, and contraindications. Estrogens have been prescribed to relieve menopausal symptoms for more than three decades. The hormones reduce the gynecologic and psychologic changes associated with menopause while inhibiting bone resorption and possibly reducing the risk of cardiovascular disease. Their use however has been complicated by an increased risk of endometrial cancer and possibly breast cancer. The use of estrogens as cardioprotective agents is discussed and the clinical experiences and the possible mechanisms of action are reviewed. The clinical pharmacology of estrogens and the various formulations that are available as monotherapy or in combination with progestins will also be reviewed.

Adult↗
PubMed1995

Clinical pharmacology of estrogens: cardiovascular actions and cardioprotective benefits of replacement therapy in postmenopausal women.

The use of estrogens in postmenopausal women has been the subject of much controversy regarding hormone formulation, dosage, use in combination with progestins, duration of treatment, and contraindications. Estrogens have been prescribed to relieve menopausal symptoms for more than three decades. The hormones reduce the gynecologic and psychologic changes associated with menopause while inhibiting bone resorption and possibly reducing the risk of cardiovascular disease. Their use however has been complicated by an increased risk of endometrial cancer and possibly breast cancer. The use of estrogens as cardioprotective agents is discussed and the clinical experiences and the possible mechanisms of action are reviewed. The clinical pharmacology of estrogens and the various formulations that are available as monotherapy or in combination with progestins will also be reviewed.

Adult↗
PubMed1995

Transfer function analysis of respiratory sinus arrhythmia: a measure of autonomic function in diabetic neuropathy.

Standard techniques measuring heart rate (HR) variability do not account for its dependence on the rate and depth of respiration or measure the time relationship between changes in lung volume and HR. We used transfer function analysis to determine the magnitude and time relationship of the HR response to a known change in lung volume in controls and diabetics. This technique demonstrated significant differences between controls and diabetics with varying degrees of autonomic dysfunction. Specifically, reduced supine vagal and increased supine sympathetic HR modulation was found with progression of the autonomic neuropathy. In response to postural change the normal diabetics displayed impaired sympathetic HR modulation. Transfer function analysis yields new insight into the sequence of changes that occur with diabetic autonomic neuropathy and provides an accurate, easily comprehensible measurement of respiratory induced HR variability.

Adult↗
PubMed1995

Resolution of batch variations in pyrolysis mass spectrometry of bacteria by the use of artificial neural network analysis.

A simple, but stringent, three group model of bacterial interstrain identity (two cultures of the same strain of Escherichia coli) and difference (a culture of a serologically distinct strain) was used in multiple serial weekly subcultures for five weeks to demonstrate the effect of both growth-related (phenotypic) and machine-related variation on pyrolysis mass spectra. An aliquot of serum from a single sample was included in each pyrolysis batch to distinguish machine drift from culture drift. Conventional principal component (PC) canonical variate (CV) analysis was successful within each pyrolysis batch but the variations between batches precluded the use of data from more than one batch in successful PCCV analysis. In contrast, artificial neural networks (ANNs) trained with data from one batch could be successfully used to identify groups in data from non-contemporaneous pyrolysis batches. Although the ANN method will require validation in more complex settings than this simple model, it is a promising approach to the problem of batch constraint in pyrolysis mass spectrometry.

Bacterial Typing Techniques↗
PubMed1995

The relationship between heart rate variability and measures of body habitus.

There is a well-recognized relationship between autonomic nervous system function and body habitus although few studies have addressed the role of the parasympathetic nervous system. A decrease in parasympathetic nervous-system-mediated heart rate variability in obesity may in part explain the mortality and morbidity that are associated with the obese state. We used multiple linear regression techniques to explore the relationship between measures of heart rate variability and anthropometric indices in 597 male participants in the Normative Aging Study. After adjustment for age and log10 heart rate, weight and body mass index were significant predictors of both the expiratory to inspiratory ratio (E/I ratio) and the difference between maximum and minimum heart rate (HRMax-Min). The abdomen-to-hip ratio and percentage body fat were not significant predictors of measures of heart rate variability. A one standard deviation change in the anthropometric index (weight, body mass index) resulted in a decrease in the E/I ratio of 0.010-0.014 and a decrease in the HRMax-Min of 0.486-0.715 beats/min. A change in the anthropometric index across the distribution (5-95 percentile) resulted in a decrease in the E/I ratio of 0.032-0.037 and a decrease in the HRMax-Min of 1.56-2.39 beats/min. These results indicate that heart rate variability and overall body size are correlated. This association could in part explain the mortality and morbidity that is associated with the obese state.

Adipose Tissue↗
PubMed1995

Prevention of prosthetic valve endocarditis.

Prosthetic valve endocarditis (PVE) has been traditionally divided into early (EPVE) and late (LPVE) forms, the division being made at 60 days after operation. Recent actuarial studies suggest that the risk of EPVE continues up to 12 months after operation. This new insight must increase the emphasis on perioperative prevention, including those measures taken at the time of operation, such as antibiotic prophylaxis, and particularly, the prevention of postoperative nosocomial bacteraemia which other recent studies suggest is a much more significant factor than previously appreciated. The application of DNA-based typing methods of the predominant causative organisms of EPVE [coagulase-negative staphylococci; (CNS)] can be increasingly expected to unravel the aetiology of EPVE and support more logical preventive measures. As with the prevention of native valve endocarditis, the prevention of LPVE currently relies on antibiotic prophylaxis at predictable times of bacteraemia. Epidemiological studies have shown that events currently recognized account for a very minor proportion of cases. The elucidation of the incidence, causes and potential preventive measures of the spontaneous bacteraemias responsible for most cases of LPVE remains a major task. The prevention of all forms of PVE is presently inadequate. Recent studies have not improved our abilities but have served to define areas in which existing measures should be re-emphasized and other areas in which more knowledge is urgently required.

Anti-Bacterial Agents↗
PubMed1995

Nosocomial enterococci: resistance to heat and sodium hypochlorite.

Six strains each of Enterococcus faecium and E. faecalis were investigated with respect to their resistance to heat and sodium hypochlorite. All enterococci survived the temperatures and holding times specified by the Department of Health (DoH) for the disinfection of 'foul and used' or 'infected' linen (65 degrees C for 10 min or 71 degrees C for 3 min). In addition, three strains (one E. faecium and two E. faecalis) could withstand 150 ppm available chlorine for 5 min, the treatment suggested by the DoH for the disinfection of heat labile materials. Further, our results showed that four strains of E. faecium were able to survive the British Standard for heat disinfection of bedpans (80 degrees C for 1 min). The significance of these findings with particular reference to the potential for enterococci to survive and disseminate in the hospital environment is discussed.

Cross Infection↗
PubMed1995

Direct milk excretion of Campylobacter jejuni in a dairy cow causing cases of human enteritis.

Consumption of milk contaminated with Campylobacter jejuni has been described as a cause of human enteritis. Although faecal contamination of milk with the organism has frequently been described, direct milk excretion of Campylobacter jejuni into milk has rarely been linked with cases of human infection. We describe the investigations undertaken following the isolation of Campylobacter jejuni from samples of unpasteurized milk prior to retail. Results of epidemiological investigations including typing of Campylobacter jejuni isolates using pyrolysis mass spectrometry, Penner and Lior serotyping, biotyping, phage typing and restriction fragment length polymorphism analysis provided convincing evidence implicating direct milk excretion of Campylobacter jejuni by one asymptomatic dairy cow as the source of the milk contamination and the cause of local cases of human enteritis.

Animals↗
PubMed1995

Sporadic isolates of Escherichia coli O157.H7 investigated by pyrolysis mass spectrometry.

Thirty-six encoded isolates of Escherichia coli. 32 of which were of serotype O157, were examined by pyrolysis mass spectrometry (PyMS). Thirty-one of the serotype O157 isolates possessed the flagellar antigen H7 and produced Verocytotoxin (VT), the other isolate serotyped as H45 and was non-toxigenic. Eighteen of the VT-producing E. coli (VTEC) isolates were from sporadic disease in residents of the Northern Region. Standard principal component (PC) and canonical variate (CV) analysis of the data distinguished only the four non-O157 isolates from the remainder which were indistinguishable by this approach. A similarity matrix based on differences between individual CV means distinguished a further ten isolates. The matrix correctly clustered 2 pairs of isolates from siblings and 4 isolates from an affected family. A further 5 clusters of 3 or more isolates and 6 pairs of isolates were defined. These groupings proved to be homogenous for toxin phenotype but occasionally entrained isolates of dissimilar phage type. However, in general, PyMS-derived clustering of apparently sporadic isolates accorded with geographical locations as determined by postcode. PyMS, which is a quick and high volume capacity phenotypic technique, may be a useful addition to existing methods in the investigation of the epidemiology of sporadic VTEC disease.

Escherichia coli↗
PubMed1995

Autonomic epilepsy.

Explore the source record for details and available documents.

Autonomic Nervous System Diseases↗
PubMed1995

Recovery and relapse in adolescents with bipolar affective illness: a five-year naturalistic, prospective follow-up.

OBJECTIVE: This study was a 5-year naturalistic prospective follow-up of 54 consecutive admissions of adolescents to a university inpatient service with a diagnosis of bipolar I affective illness. METHOD: Subjects received structured clinical evaluations every 6 months after entry to establish time to recovery and subsequent relapse. Regression models were used to identify predictors of differential course. RESULTS: Rate of recovery varied by polarity of episode at time of entry, with quick recovery observed in subjects with pure mania or mixed states, and a protracted index episode in subjects with pure depression. Multiple relapses were most often seen in subjects with mixed or cycling episodes at intake. CONCLUSIONS: Polarity of illness may have utility in identifying bipolar adolescents with a more recurrent illness. Comparison with adult data suggests that recurrence risks may vary as a function of age at onset or stage of the disease process.

Adolescent↗
PubMed1995

Prevention and government: health policy making in the United Kingdom and Germany.

The gap between rhetoric and reality in health policy making for disease prevention services is well recognized. I do not try once more to close the gap, but rather argue that the rhetoric of prevention is politically significant. Beginning with an account of prevailing explanations of prevention in policy making, I explore the idea that prevention has a pervasive legitimacy in health politics. This affords opportunities for instrumental policy making by government. To this end, I concentrate on the relationship between disease prevention and health care delivery, discussing in detail the association between prevention and health care reform. My arguments are based on case studies of policy making in Germany and the United Kingdom. I discuss implications for understanding the core interests of government, physicians, and users with respect to prevention in health policy making. The concluding section offers comparative commentary on the role of disease prevention in health sector restructuring.

Cross-Cultural Comparison↗