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Biomedical subjects

R Hall

Publications and source records attributed to R Hall.

At least 73 records · Page 4Linked to original sources
PubMed1998

An approach to the treatment of psychogenic parasitosis.

BACKGROUND: Patients with psychogenic parasitosis typically seek help from nonpsychiatric physicians and can be difficult and time-consuming to treat. Pimozide has been promoted as the treatment of choice but is not indicated for every patient presenting with this symptom. Our purpose was to develop a realistic treatment protocol for the nonpsychiatric physician faced with these patients. METHODS: Using what is known about this problem through review of the literature and our own experience with 20 patients, a practical treatment strategy is suggested. RESULTS: It is proposed that dermatologists and primary care professionals seeing these patients determine (1) whether or not the patient's belief in infestation is shakable and (2) whether or not the patient is depressed, in order to chose a therapeutic plan. CONCLUSIONS: Dermatologists and psychiatrists can work together to develop treatment protocols that minimize risk and maximize therapy for patients with psychogenic parasitosis.

Adult↗
PubMed1998

The impact of rubella immunisation on the incidence of rubella, congenital rubella syndrome and rubella-related terminations of pregnancy in South Australia.

OBJECTIVES: To describe the impact of rubella immunisation on the incidence of rubella, congenital rubella syndrome and rubella-related terminations of pregnancy in South Australia, and to identify factors associated with a re-emerging problem. DESIGN AND METHODS: A population-based descriptive study using data from South Australian notifications of disease, births and terminations of pregnancy, the rubella immunisation programme, antenatal rubella antibody screening and paediatric hospital case records. SETTING: South Australia (population 1.48 million people; 20,000 births per year). MAIN OUTCOME MEASURES: Incidence of rubella (age-sex specific), congenital rubella syndrome and rubella-related terminations of pregnancy; antenatal rubella sero-positive rates; rubella immunisation uptake rates. RESULTS: Rubella notification rates in 1990-1996 were significantly higher for males than females for ages 15-34 years. There were five cases of congenital rubella syndrome notified in 1980-1996 compared with at least 20 confirmed or compatible cases in 1965-1979. Rubella-related terminations of pregnancy are now rare, with the last termination for maternal rubella being in 1993. The antenatal rubella sero-positive rate in 1995 was 96.7%, but was significantly lower among Asian women born overseas (78.6% among those 30 years or older). Vaccination uptake rates in schoolgirls decreased between 1990 and 1994 (91.2% to 86.9%). CONCLUSIONS: Since the introduction of rubella immunisation, the incidence of rubella infection among women of reproductive age, and of rubella-related terminations, has fallen. Congenital rubella syndrome has not been notified since 1990 but its risk persists with a recent increase in rubella notifications, a fall in school immunisation rates, a relatively low antenatal sero-positive rate among older Asian women born overseas and the trend towards giving birth at older ages. Effective immunisation programmes must be maintained, particularly in schools and for young children and migrant women.

Abortion, Induced↗
PubMed1998

Calcium- and hydroxyapatite-binding properties of glucuronic acid-rich and iduronic acid-rich glycosaminoglycans and proteoglycans.

This study describes the interaction of a small chondroitin sulphate proteoglycan and the glycosaminoglycans chondroitin 4-sulphate, dermatan sulphate and heparan sulphate with hydroxyapatite. All macromolecules possessed a high affinity, with the iduronic acid-rich dermatan sulphate and heparan sulphate displaying higher adsorption maxima than the glucuronic acid-rich chondroitin 4-sulphate. At similar concentrations, dermatan sulphate produced a 30% inhibition of hydroxyapatite-induced crystal growth, whilst chondroitin 4-sulphate yielded 50% inhibition. Estimation of the calcium binding capacity of these glycosaminoglycans using equilibrium dialysis indicated that chondroitin 4-sulphate bound five times more calcium than dermatan sulphate at a calcium concentration similar to that of serum. The data indicate a possible important role for chondroitin 4-sulphate in dentinogenesis where it is the dominant glycosaminoglycan, since it could act as a capture point for calcium ions during mineralisation, with the leucine-rich domain of its parent proteoglycan acting as anchor points to type I collagen.

Adsorption↗
PubMed1998

Remifentanil and propofol total intravenous anaesthesia for thymectomy in myasthenia gravis.

We report a case of trans-sternal thymectomy for myasthenia gravis using a non relaxant, total intravenous technique with propofol and remifentanil. This afforded excellent control of heart rate and pressor responses during surgery while allowing early return of spontaneous ventilation and extubation within nine minutes of termination of anaesthesia. Advantages and disadvantages of this approach versus relaxant and volatile techniques are discussed with particular reference to preservation of neuromuscular function.

Adolescent↗
PubMed1998

The measurement of intervention effects in developmental phonological disorders.

The effectiveness of speech and language therapy for developmental phonological disorders has typically been measured in terms of the diminution of the application of phonological processes. Often substantial amounts of intervention and time may be needed to show up such changes. Shorter and more clinically realistic intervention regimes can result in small but significant changes in speech production which represent positive developments in the phonological system. In order to measure progress in this sort of therapy a sensitive instrument of measurement is required. In this paper we describe a research measurement tool, the probe scoring system, which was designed to detect small changes in the child's phonological system following therapy and contrast it to some of the instruments selected for use in other efficacy studies. The potential for wider clinical application is also considered.

Child↗
PubMed1997

Systolic and diastolic effects of variable atrioventricular delay in patients with complete heart block and normal ventricular function.

This study was designed to demonstrate the effects of varying the atrioventricular delay (AVD) on ventricular diastolic filling dynamics and the resultant stroke volume in patients with complete heart block and normal cardiac function. We studied 7 patients with normal cardiac function in whom a dual chamber pacemaker had been implanted because of complete heart block. Doppler and M-mode echocardiography was performed at 70, 100, 140, 180, and 220 ms, AVD with the device in DDD mode at a rate of 80 beats/min. The effects of these variable intervals on the contribution of the E and A waveform to the diastolic filling, on the stroke volume, and on the systolic intervals were evaluated. Optimization of this interval, with a 19% increase in stroke volume was achieved in the group of patients at an AVD of 140 ms. When considered individually, the AVD associated with the largest stroke volume, was 100 ms in 2 patients and 140 ms in the remaining 5. At this individual optimal AVD the ventricular septal contraction occurred 31 +/- 14 ms, before the end of the transmitral flow. The optimal AVD is, therefore, the one which synchronizes the ventricular and atrial systole so that the first ventricular septal contraction occurs after the peak of the A wave, just before the end of the transmitral flow. Because of the different functional cardiovascular status of the single patient, this parameter should be individualized; this can be clinically important as it may lead, in this patient population, to an improvement of the stroke volume up to 42%.

Adult↗
PubMed1997

Concurrent outbreaks of Salmonella Typhimurium in South Australia.

The Communicable Disease Control Branch of the South Australian Health Commission received 45 laboratory notifications of Salmonella between 23 December 1996 and 17 January 1997. A rapid screening test, undertaken by the Institute of Medical and Veterinary Sciences, Adelaide, was the first indication that this was more than one outbreak, prompting the establishment of separate investigations. Three Salmonella Typhimurium (S. Typhimurium) phage types were subsequently identified. Investigations are continuing into an outbreak of S. Typhimurium phage type (PT) 64, while investigations failed to identify any association between four cases of PT 44. As of 12 February 1997, 71 notifications had been confirmed as S. Typhimurium PT 135. Epidemiological investigations found this outbreak was associated with consumption of bread rolls with a meat filling distributed through local Asian grocery stores from a home-based manufacturer. The product was voluntarily withdrawn and there have been no new cases of PT 135.

Bacterial Typing Techniques↗
PubMed1997

Postoperative elevation of creatine kinase (CK-MB): does it contribute to diagnosis of myocardial infarction?

PURPOSE: This retrospective study sought to determine the benefit of measurement of changes in plasma creatine kinase-myocardial band (CK-MB) levels in elective postoperative high risk surgical patients beyond that obtained from the surface 12 lead ECG. METHODS: The charts of 111 patients admitted to the surgical intensive care unit (SICU) of a tertiary level university teaching hospital were reviewed. They were screened using predetermined definitions of myocardial infarction (MI) (as reflected by changes in the 12 lead surface ECG (Minnesota code) or elevations in CK-MB) for complications such as pulmonary oedema, congestive heart failure, arrhythmias, or cardiogenic shock. Four groups were identified based on changes in the ECG indicative of MI (Present-ECG+ or Absent-ECG-) and elevations of CK-MB (Present-CKMB+ or Absent-CKMB-) and compared for the incidence of complications. RESULTS: No patient with ECG- findings had a complication. Fifteen patients with ECG+ findings were identified and all had complications. Fourteen of these patients had CKMB+ results. In contrast, 29 patients with CKMB+ results alone (i.e., ECG-) had no complications. CONCLUSION: Clinically important (i.e., requiring therapeutic intervention) postoperative myocardial infarction was detected by ECG changes. The benefit of determining changes in CK-MB was minimal from a therapeutic perspective.

Adult↗
PubMed1997

Comparison of the Bard BTA test with voided urine and bladder wash cytology in the diagnosis and management of cancer of the bladder.

OBJECTIVES: To compare the Bard BTA test, a simple latex-agglutination test for cancer of the bladder (BC) that can be performed in less than 3 minutes in the urologist's office, with voided urine or bladder wash cytology in the diagnosis of subjects suspected of having BC on the basis of symptoms or recent abnormal cystoscopy or intravenous urography. METHODS: The study was performed at three medical centers in 414 subjects (147 female and 267 male; mean age 60 years), 345 of whom (83%) had no prior history of BC. The cytologic examinations were performed by pathologists unaware of the results of the BTA test. RESULTS: Cystoscopy or cystoscopy and biopsy revealed BC in 71 subjects (17%). The overall sensitivities of the BTA test and cytology were 70% and 25%, respectively. The specificities of the BTA test and cytology in the 337 subjects without BC were 90% and 100%, respectively. The sensitivities of the BTA test by tumor grade were 17%, 64%, and 92% for grades 1, 2, and 3, respectively; those of cytology were 17%, 14%, and 44%. Regression analysis suggests that tumor grade but no other study variable explains the sensitivity of the BTA test. CONCLUSIONS: The BTA test is considerably more sensitive than cytology in the detection of BC. For urologists who use cytology in the diagnosis and follow-up of patients with BC, the BTA test may replace cytology.

Adolescent↗
PubMed1997

Evaluation and follow-up of patients with N1-3 M0 or NXM1 prostate cancer in phase III trials.

OBJECTIVES: The aim of this discussion is to review the design and conduct of phase III trials in metastatic prostate cancer, to seek ways of improving their study design, accuracy, relevance to clinical practice, acceptability to patients, and ease of participation by clinicians. We also aim to try to set uniform definitions for the evaluation of the different endpoints used in clinical trials on metastasized prostate cancer. METHODS: The work was started by correspondence between the participants in the group for the year before the consensus meeting. Two comprehensive questionnaires were circulated and the answers were distributed to all the members of the group. The statements were finalized during the consensus meeting. RESULTS: There were some differing opinions concerning the methods of evaluation of endpoints for follow-up, such as time to tumor progression and time to treatment failure. After the consensus conference, there were no major disagreements within the group. CONCLUSIONS: The aim of phase III trials is to influence clinical management. To obtain a credible result they require a sound statistical basis with appropriate power and encompassing patients from small urologic practices as well as large or academic institutions. However, deviation from routine practice may affect the accrual rate, and the trial procedure should therefore be as similar as possible to routine management. Trials inevitably involve extra work and cost. Both should be kept to a minimum to encourage participation and hasten a timely conclusion. It is mandatory to create uniform ways of designing and evaluating clinical trials in prostate cancer.

Clinical Trials, Phase III as Topic↗
PubMed1997

Baseline quality of life of patients with advanced prostate cancer. European Organization for Research and Treatment of Cancer (EORTC), Genito-Urinary Tract Cancer Cooperative Group (GUT-CCG)

Quality of life (QoL) is now commonly studied in prostate cancer. However, little is known about the appropriateness of the various QoL instruments in this group of patients. The purpose of this work was to study the baseline QoL assessment of patients with prostate cancer who were randomised into three EORTC phase III studies. The three trials included locoregional prostate cancer patients, poor prognosis metastatic patients and hormone resistance patients, respectively. In the three trials, patients were asked to complete a questionnaire assessing their physical and psychosocial functioning and their symptom levels. These questionnaires included questions from the EORTC QLQ-C30 (version 1): the physical functioning, role functioning, global health/QoL scales and a single pain item. The psychometric properties of the scales were assessed and an analysis was performed to investigate if differences existed in the scale scores between the three groups of patients, 638 baseline questionnaires were available for patients entered into the three trials. The Gutman coefficients of reproducibility and scalability were 0.94 and 0.71, respectively, for the physical functioning scale and 0.97 and 0.90, respectively, for the role functioning scale. The Cronbach's alpha reliability coefficients were 0.68, 0.48 and 0.90 for the physical functioning, role functioning and global health/QoL scales, respectively. The four scales were able to distinguish clearly between the patient populations under study. The physical functioning, role functioning, global health/QoL scales and the single pain item scale from the EORTC QLQ-C30 (version 1) are valid measures when used in the setting of prostate cancer.

Activities of Daily Living↗
PubMed1997

Headaches and neck pain in farmers.

The prevalence of headache and neck pain in farmers was determined by use of a questionnaire. Information about activities which increased the symptoms and about the treatments sought was also recorded. Results showed that 77.7% of farmers experienced neck pain and 79.2% experienced headache. Driving a tractor was the activity which was most frequently described as increasing symptoms in both conditions. While driving a tractor, farmers are exposed to whole-body vibration and assume a rotated neck posture. The contribution of these factors to the development of headache and neck pain is discussed.

Adult↗
PubMed1997

Aggregative adherence fimbria II, a second fimbrial antigen mediating aggregative adherence in enteroaggregative Escherichia coli.

Enteroaggregative Escherichia coli (EAEC) has been implicated as an agent of pediatric diarrhea in the developing world. We have shown previously that EAEC adheres to HEp-2 cells by virtue of a plasmid-encoded fimbrial adhesin designated aggregative adherence fimbria I (AAF/I), the genes for which have been cloned and sequenced. However, not all EAEC strains express AAF/I. Using TnphoA mutagenesis, we have characterized a novel fimbria (designated AAF/II) which mediates HEp-2 adherence of the human-pathogenic strain 042. AAF/II is 5 nm in diameter and does not bind AAF/I antiserum, as determined by immunogold transmission electron microscopy. TnphoA identified a gene (designated aafA) which bears significant homology to aggA, the fimbrial subunit of AAF/I (25% identity and 47% similarity at the amino acid level). When hyperexpressed and purified by polyhistidine tagging, the AafA protein assembled into 5-nm-diameter filaments which bound anti-AAF/II antiserum. The cloned aafA gene complemented a mutation in the aggA gene to confer fimbrial expression from the AAF/I gene cluster, manifesting phenotypes characteristic of AAF/II but not AAF/I. The aafA mutant did not adhere to human intestinal tissue in culture, suggesting a role for AAF/II in intestinal colonization. By using DNA probes for AAF/I and AAF/II derived from fimbrial biosynthesis genes, we show that AAF/I and AAF/II are each found in only a minority of EAEC strains, suggesting that still more EAEC adhesins exist. Our data suggest that AAF adhesins represent a new family of fimbrial adhesins which mediate aggregative adherence in EAEC.

Adhesins, Escherichia coli↗
PubMed1997

Stress fracture of the tibia after arthrodesis of the ankle or the hindfoot.

We studied twelve patients who had a stress fracture of the tibia and one patient who had a stress fracture of the fibula after arthrodesis of the ankle or the foot. A second stress fracture subsequently developed in two patients. All but two patients were managed non-operatively, and the fractures healed uneventfully. One patient who was managed operatively had a below-the-knee amputation to treat a painful non-union of a tibial fracture, and the other had interlocking intramedullary nailing for a displaced fracture. All but one of the arthrodesis sites had fused before the stress fracture occurred. All of the stress fractures that occurred after arthrodesis of the ankle were in the middle and distal aspects or the distal aspect of the tibia, while those that occurred after triple arthrodesis were in the distal aspect of the fibula or the medial malleolus. Although six of the thirteen patients still had uncorrected alignment and deformity after the arthrodesis, optimum alignment after the arthrodesis did not preclude the occurrence of a stress fracture. We conclude that stress fracture must be considered in the differential diagnosis of pain months or even years after solid fusion at the site of an ankle or triple arthrodesis.

Adult↗
PubMed1996

As mammography use increases, are some providers omitting clinical breast examination?

OBJECTIVE: To explore use of clinical breast examination (CBE) among women receiving mammography. METHODS: A retrospective cohort analysis of 100 women aged 50 years or older with at least one bilateral mammogram. Chart review documented demographic information, severity of illness, and performance of CBE (from 1 year prior to 18 months after the mammogram). RESULTS: The mean age of the 100 women was 63 years. They were predominantly unmarried (60%), nonwhite (58%), and not currently employed (57%). Three quarters (76%) had mammography and CBE (comprehensive screening), while the remaining 24% had mammography only. Sociodemographic factors did not differ for women with and without comprehensive screening (P>.1). However, patients of female providers were more likely to receive comprehensive screening than patients of male providers. Specifically, 95% of women seen by female attending physicians or fellows had comprehensive screening vs 67% for male attending physicians or fellows and 61% for residents (P=.008). CONCLUSIONS: Mammography may be replacing CBE especially among patients of male providers. Interventions targeted to these providers could help improve the use of CBE and mammography.

Aged↗
PubMed1996

Conservation of neutralizing determinants between the sporozoite surface antigens of Theileria annulata and Theileria parva.

The sporozoite surface antigens SPAG-1 of Theileria annulata and p67 of Theileria parva are postulated to contain determinants necessary for host cell invasion and/or recognition and are both being considered as candidates for inclusion in subunit vaccines. Preliminary data suggest that these are related molecules. In this paper we describe the investigation of the relationship between these sporozoite antigens further by analysis of the immunological cross-reactivity using Mabs and sera raised against each antigen. The cross-reactions were examined by carrying out Western blots, IFA tests, and in vitro sporozoite neutralization assays. In addition, sequence comparison data which clearly establish that these surface antigens are encoded by related genes are presented. The regions of SPAG-1 identified as containing cross-reactive epitopes recognized by p67 antiserum correlated to regions of high predicted homology between p67 and SPAG-1, which are located at their respective N- and C-termini. Furthermore, p67 and SPAG-1 were found to contain cross-reactive determinants responsible for neutralization of sporozoite infectivity in vitro, and at least some of these were located in the C-termini of both molecules. The relevance of these findings to the possible roles for these molecules in host cell invasion is discussed.

Amino Acid Sequence↗
PubMed1996

Effectiveness of a consultation intervention to promote tobacco control policies in Northwest Indian tribes: integrating experimental evaluation and service delivery.

A quasi-experimental replication of an intervention for promoting tobacco control policies in Northwest Indian tribes is described and the process of intervention including issues of collaboration among research institutions and Indian organizations is discussed. The policy intervention was evaluated using a pretest-posttest design wherein 20 tribes that had served as wait-list controls now received the intervention. The intervention comprised a tribal representative attending a kickoff orientation; follow-up visits to the tribes; distribution of tobacco policy workbooks; and phone call consultations. Policy status and stringency were assessed by means of telephone interviews with two key contacts per tribe, and by a count of enacted policies. There were significant pre-post changes in the primary outcome measure, a composite summary score of tobacco policy stringency, and changes were also reflected in enacted policies. The intervention effects observed were similar to those found in the prior randomized trial and suggest a robust, disseminable intervention. Much of the success achieved was attributed to the role of an Indian organization in planning the project and implementing the intervention and evaluation protocols.

Follow-Up Studies↗