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Biomedical subjects

R Hughes

Publications and source records attributed to R Hughes.

At least 73 records · Page 4Linked to original sources
PubMed2000

Disease management for diabetes mellitus: impact on hemoglobin A1c.

OBJECTIVE: To describe outcomes associated with a health maintenance organization (HMO)-sponsored disease management program for diabetes. STUDY DESIGN: Descriptive study that compared outcomes of patients with diabetes before and after entry into a disease management program. PATIENTS AND METHODS: The study was conducted in a mixed-model HMO with 275,000 members. The disease management program included a Steering Committee, clinical guidelines, primary care site-based diabetes education, coverage of glucose meters and strips, simplified outcomes reporting, and support of clinical leadership. Data were obtained for 5332 continuously enrolled patients who voluntarily entered the disease management program; 3291 patients (61.7%) received 3 months or more of follow-up, and 663 (12.4%) received 1 year or more of follow-up. The primary outcomes were change from baseline of mean hemoglobin A1c (HbA1c) and medication use after 3 months and 1 year of follow-up. RESULTS: The mean baseline HbA1c for all program participants was 8.51% (standard deviation [SD] = 1.86%). At 3 months of follow-up, the mean HbA1c value for 2794 of 3291 participants (84.0%) had decreased to 7.41% (SD = 1.33%; P = .0001). At 1 year of follow-up, the HbA1c value, available for 605 of 663 patients (91.3%), had decreased from a mean baseline value of 8.76% (SD = 1.87%) to 7.41% (SD = 1.24%; P = .0001). Among 663 patients with 1 year of follow-up, insulin use increased from 30.0% to 31.6%, and sulfonylurea use decreased from 40.7% to 33.8%. Troglitazone and metformin use increased from 7.7% and 23.8%, respectively, to 16.4% and 28.8%, respectively. CONCLUSIONS: Our data suggest that a multifaceted disease management program for diabetes can result in significant short-term improvements in glycemic control in the managed care setting. While the improvement in the HbA1c was accompanied by an increase in the use of insulin, troglitazone, and metformin, we suggest the influence of disease management on glycemic control among our participants was significant and should be considered in future studies in this area.

Adolescent↗
PubMed2000

Protein degradation in the large intestine: relevance to colorectal cancer.

Colorectal cancer is the second most common form of cancer death in Western countries. Diet has been implicated in the aetiology of this disease. Epidemiological evidence suggests that diets high in meat and fat and low in fermentable carbohydrate increase colorectal cancer risk. One mechanism that could explain the association with meat is increased colonic protein metabolism due to increased protein intake from high meat diets. Products of colonic protein degradation and metabolism include ammonia, phenols, indoles and amines which have been shown to exert toxic effects in vitro and in animal models. These compounds are present in faecal samples suggesting that they may exert gut mucosal effects. Human studies have shown that colonic protein metabolism via the gut microflora is responsive to dietary protein as faecal ammonia and urinary phenolic compound concentrations increase in response to increased intake of protein rich foods. Other toxic metabolites from dietary protein precursors such as N-nitroso compounds and sulphides are also formed. Recent work has shown that diets high in meat, fat and low in fibre increase human faecal water genotoxicity. It is likely that metabolites from colonic protein metabolism contribute to this increase in genotoxicity during high meat intakes.

Adult↗
PubMed1999

Delay in the application of the cover glass is a potential source of error with the Makler Counting Chamber.

OBJECTIVE: To determine the effect of delaying the application of the cover glass of a Makler Counting Chamber (Sefi Medical Instruments, Haifa, Israel) on the apparent concentration of sperm or Dynabeads (Dynal Pty Ltd, Carlton, Victoria, Australia). DESIGN: Systematic alteration of the time taken to apply the cover glass. SETTING: Comprehensive infertility service. PATIENT(S): Fresh semen from a patient or washed sperm from a donor. INTERVENTION(S): For the Makler Counting Chamber, a 5-microL drop of the sperm or bead suspension was placed in the center of the lower platform and the cover glass was applied either immediately (0 seconds) or after a delay of 5, 10, or 30 seconds. MAIN OUTCOME MEASURE(S): The concentration of beads or sperm counted using an Improved Neubauer Hemocytometer or a Makler Counting Chamber. RESULT(S): There was a progressive increase in sperm concentration with a longer delay in applying the cover glass when sperm was suspended in either seminal plasma or culture medium. Repeating the experiments with Dynabeads resuspended in phosphate-buffered saline, serum, or seminal plasma showed the same trend, although the suspension of beads in serum seemed to settle the least over the first 10 seconds. CONCLUSION(S): Delay in the application of the cover glass is a potential source of error with the Makler Counting Chamber and should be avoided.

Female↗
PubMed1999

Outcome of electroclinical, electrographic, and clinical seizures in the newborn infant.

Three seizure types have been described in the neonate: electroclinical, electrographic, and clinical only. Controversy still exists about whether the episodic abnormal movements seen in some infants, which are not accompanied by simultaneous ictal discharges on the EEG, are true seizures. Twenty-four infants with seizures were studied, 17 had purely electrographic and/or electroclinical seizures, seven had clinical-only seizures; six of these seven had clonic seizures, without facial manifestations or autonomic change. The three seizure types were investigated using video-EEG and a Griffiths neurodevelopmental assessment was performed in each seizure group. Of the seven infants with clinical-only seizures, six had clonic seizures with a normal background EEG, neuroimaging studies and neurodevelopmental follow-up assessment were normal in five. In the remaining 17 infants with electrographic and/or electroclinical seizures, seizure discharges were often associated with ocular phenomena, apnoea, or tonic posturing, and the background EEG was abnormal in all but one subject. Neurodevelopmental follow-up assessments revealed a poor outcome (14 of 17) in this group. In otherwise healthy infants, purely clonic seizures involving only the limbs may be a benign phenomenon and an EEG should be obtained to avoid unnecessary treatment. Infants with seizures superimposed on an abnormal background EEG pattern had a poor outcome.

Anticonvulsants↗
PubMed1999

Comparison of the solution conformations of a cell-adhesive peptide LBE and its reverse sequence EBL.

T-cell adhesion is mediated by an ICAM-1/LFA-1 interaction; this interaction plays a crucial role in T-cell activation during immune response. LBE peptide, which is derived from the beta-subunit of LFA-1, has been shown to inhibit ICAM-1/LFA-1-mediated T-cell adhesion. In this work, we studied the solution conformations of LBE peptide and its reverse sequence (EBL) by NMR, CD and molecular dynamics simulations. Reverse peptides have been used as controls in biological studies. The effect of reversing the sequence of LBE to EBL peptides on their respective conformations is important in understanding their biological properties in vitro or in vivo. The NMR studies for these peptides were carried out in water and in TFE/water solvent systems. In 40% TFE/water, both peptides exhibited helical conformation. CD studies suggested that the LBE exhibits 30% helical conformation, while the EBL exhibits 20% helical conformation. From the NMR and MD simulation studies, it was evident that the peptides exhibited a stable helical conformation; a stable helical structure was found at Leu6 to Leu15 for LBE and at Gly9 to Leu17 for EBL. The helical conformations of LBE and EBL may be in equilibrium with other possible conformers; the other conformers contain loop and turn structures. Both peptides bind to divalent cations because the LBE is derived from the cation-binding region of the LFA-1. This study shows that reversing the peptide sequence did not alter the secondary structure of the corresponding sequence. Hence, caution must be exercised when using reverse peptides as controls in biological studies. This report will improve our ability to design a better inhibitor of ICAM-1/LFA-1 interaction.

Amino Acid Sequence↗
PubMed1999

Antiganglioside antibodies in Guillain-Barré syndrome after a recent cytomegalovirus infection.

OBJECTIVE: To study the association between anti-ganglioside antibody responses and Guillan-Barré syndrome (GBS) after a recent cytomegalovirus (CMV) infection. METHODS: Enzyme linked immunosorbant assay (ELISA) was undertaken on serum samples from 14 patients with GBS with recent cytomegalovirus (CMV) infection (CMV+GBS) and 12 without (CMV-GBS), 17 patients with other neurological diseases (OND), 11 patients with a recent CMV infection but without neurological involvement, 11 patients with recent Epstein-Barr virus (EBV) infection but without neurological involvement, and 20 normal control (NC) subjects. RESULTS: IgM antibodies were found at 1:100 serum dilution to gangliosides GM2 (six of 14 patients), GM1 (four of 14), GD1a (three of 14) and GD1b (two of 14) in the serum samples of the CMV+GBS patients, but not in those of any of the CMV-GBS patients. IgM antibodies were also found to gangliosides GM1, GD1a, and GD1b in one of 11 OND patients, to ganglioside GM1 in one of 11 non- neurological CMV patients, and to ganglioside GD1b in one of 20 NC subjects. Some patients with EBV infection had IgM antibodies to gangliosides GM1 (five of 11), GM2 (three of 11), and GD1a (two of 11). However, the antibodies to ganglioside GM2 had a low titre, none being positive at 1:200 dilution, whereas five of the CMV+GBS serum samples remained positive at this dilution. CONCLUSION: Antibodies to ganglioside GM2 are often associated with GBS after CMV infection, but their relevance is not known. It is unlikely that CMV infection and anti-ganglioside GM2 antibodies are solely responsible and an additional factor is required to elicit GBS.

Adolescent↗
PubMed1999

An analysis of breastfeeding initiation in Tasmania by demographic and socioeconomic factors for the period 1981-1995.

Breastfeeding initiation and duration trend data is an important component of infant health and nutrition monitoring and surveillance systems. It is also an important basis for identifying breastfeeding promotion needs, prioritising target groups and strategies and in evaluating the effectiveness of breastfeeding promotion efforts. A collation and analysis of available Tasmanian breastfeeding initiation data was undertaken in order to help direct statewide breastfeeding promotion planning and evaluation and to begin the development of a minimum data set for statewide breastfeeding monitoring and surveillance. Perinatally collected breastfeeding initiation data (breastfeeding at discharge from hospital) was analysed against available demographic and socioeconomic variables and compared with initiation rates from interstate Australian populations. Data suggest that breastfeeding initiation rates in Tasmania have been static over the 15 years to 1995 (a three percent increase from 1981 to 1995) and that the associations between breastfeeding initiation and occupational classification, maternal age and parity in Tasmania are consistent with those reported elsewere. Whilst caution needs to be applied to between-population comparisons, breastfeeding initiation rates in Tasmania appear to be considerably lower than that reported in other states. This suggests relatively greater efforts are required to influence breastfeeding initiation. Further research is required to investigate reasons for this difference.

Adult↗
PubMed1999

A sensitive immunoslot-blot assay for detection of malondialdehyde-deoxyguanosine in human DNA.

As part of a large programme on food risk assessment, we have become Interested in the endogenous production of genotoxic agents from dietary precursors. Malondialdehyde (MDA), a product of lipid peroxidation and prostaglandin biosynthesis, is mutagenic in bacterial and mammalian systems. MDA reacts with DNA, and the major adduct (M1-dG) has been detected in healthy human liver and leukocyte DNA. Analytical methods used so far for the detection of M1-dG have not been applied to large numbers of individuals or a large variety of samples. Often, only a few micrograms of DNA from human tissues are available for analysis, and a very sensitive assay is needed to detect background levels of M1-dG in very small amounts of DNA. In this paper, we describe the development of an immunoslot-blot (ISB) assay for the measurement of M1-dG in 1 microgram of DNA. The limit of detection of the assay is about 5 adducts per 10(8) bases. The advantages of ISB over other assays for DNA adduct detection, such as the possibility of analysing 1 microgram DNA per sample and the fact that it is less time-consuming and laborious, mean that it can be more easily used for routine analysis of large numbers of samples in biomonitoring. A series of human samples was analysed, and levels of 0.3-6.43 M1-dG per 10(7) normal bases were detected in 42 gastric biopsy samples and 0.7-16.65 M1-dG per 10(7) normal bases in 28 samples of leukocyte DNA. In an initial study in five human volunteers on standardized diets, the levels of M1-dG in leukocyte DNA changed in relation to meat, vegetable and tea intake.

Biomarkers↗
PubMed1998

FQHC (Federally Qualified Health Center): harnessing the incentives of cost reimbursement.

Community health centers (CHCs) are federally supported primary care providers to the low-income and uninsured. The federally qualified health center (FQHC) legislation requires states to pay CHCs for Medicaid services on the basis of reasonable cost. The statute generated controversy, particularly in a time when, for most providers, cost-related reimbursement has given way to fixed payments and managed care. This article examines the impact of FQHC on revenue and utilization of CHCs, using data for 328 centers that were in continuous operation between 1989 (the year the legislation was enacted) and 1992, the first year of full implementation. During this period, the CHCs Medicaid revenue grew rapidly. FQHC is estimated to account for under one third of the total increase, while inflation and growth in utilization due to expanded Medicaid eligibility are estimated to account for the other two thirds. At the same time, the change to cost-related reimbursement had a significant increase in total service users and Medicaid recipients receiving care from CHCs. Although some expected that cost-reimbursement would lead to inflationary increase in utilization, this did not occur. There was no statistically significant relationship between the change in payment methodology and changes in encounters per user. The experience of FQHC indicates that, for safety net providers of primary care, cost-related reimbursement is not "inherently inflationary." Results of this study raise the question of whether payment within constraints, but bearing relationship to cost, is not an appropriate approach to developing primary care capitation rates for these providers--and assuring maintenance of the safety net for the uninsured.

Community Health Centers↗
PubMed1997

Upper airway edema after carotid endarterectomy: the effect of steroid administration.

The objective of this study was to evaluate the effect of preoperative steroid administration on the site and extent of upper airway edema after carotid endarterectomy. The design was a randomized, prospective, double-blind controlled trial. Thirty-eight patients undergoing elective carotid endarterectomy (17 patients were in the steroid-treated group and 21 in the control group) were administered either 16 mg of dexamethasone or saline placebo prior to surgery. Computed tomograms (CT) scans of the neck were performed on the patients preoperatively and 24 h postoperatively. Measurements were taken from the CT scans of the airway transverse and anterior-posterior diameters at the levels of the hyoid bone, arytenoid cartilage, and cricoid cartilage. No postoperative neck hematomas were seen on the CT scans. Although neck edema was observed postoperatively, the upper airway dimensions were not statistically significantly different between the steroid and the control groups. We conclude that steroid administration immediately preoperatively has no clinical effect in reducing edema formation in the upper airway postcarotid endarterectomy.

Aged↗