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Biomedical subjects

R J Taylor

Publications and source records attributed to R J Taylor.

At least 91 records · Page 5Linked to original sources
PubMed1996

Pancreas allograft rejection: correlation of transduodenal core biopsy with Doppler resistive index.

PURPOSE: To determine the usefulness of sonographically obtained resistive indexes (RIs) in the diagnosis of pancreas allograft rejection. MATERIALS AND METHODS: Findings were studied from 78 transduodenal pancreas allograft biopsies that were ultrasound-guided and cystoscopically directed. The 78 biopsies included 40 that were compared directly with baseline RI data. Biopsies were categorized by result and correlated with concurrent RIs (including 26 RIs obtained within 24 hours of biopsy) with the chi2 test for categoric variables and the Student t test for continuous variables. Sensitivity, specificity, and positive and negative predictive values were calculated with standardized formulas. RESULTS: The mean RIs between the no rejection, mild acute rejection, and moderate acute rejection groups were not statistically significantly different; however, the mean RI associated with chronic rejection was statistically significantly higher (P < .05) than that in the other groups. The sensitivity, specificity, and positive and negative predictive values of either an elevated RI (> 0.70) or greater than 10% increase in the RI above the baseline value in the diagnosis of acute rejection were approximately 50%. CONCLUSION: Neither the absolute level of the RI nor the relative increase was correlated with acute rejection proved at biopsy. Changes in RIs after pancreas transplantation were a poor indicator of acute rejection, but the absolute value of the RI was elevated in cases of chronic rejection.

Adult↗
PubMed1996

General practice blood pressure recording in Scotland: variations in the classification of hypertension.

A questionnaire concerning blood pressure assessment, as part of health promotion activity, was circulated to all 770 Gpass practices in Scotland producing a 64.6% response rate. The results reveal a wide range in both the systolic and diastolic levels chosen to classify blood pressure as normal, borderline raised or raised. Practices are using a variety of values to indicate hypertension when considering systolic and, to a lesser extent, diastolic pressure. The variations found suggest that both over and under treatment are a significant risk to patients. The introduction of the 1993 health promotion regulations means that practices are required to actively target their practice population for blood pressure assessment and appropriate intervention. We suggest that this process will be enhanced if doctors are encouraged to adopt the established guidelines for the classification of blood pressure or general practice computer software is adopted to offer blood pressure protocol support.

Adolescent↗
PubMed1996

Do physicians' perceptions of drug costs influence their prescribing?

This study examines general practitioner (GP) attitudes towards and knowledge of prescribing costs, and the influence of these 2 factors in the doctor's demand for drugs. The main emphasis of the study is on the influence of perceived cost of drugs on prescribing habits. A postal questionnaire was sent to all 273 GP principals in the Grampian region of Scotland. This questionnaire assessed GPs' attitudes and knowledge with respect to prescribing costs. Information was also collected on the prescribing habits of 176 of these GPs. This information was linked to look at the influence GPs' knowledge of drug costs has on their actual prescribing behaviour. Three drug groups were studied: ulcer-healing drugs, pain-killers and penicillins. The results showed that although most GPs agreed that costs should be borne in mind when prescribing medicines, their actual knowledge of the drug costs was often inaccurate. Furthermore, for certain therapeutic groups, prescribing habits are influenced by GPs' perceptions of drug costs. This implies that GPs are not as averse to considering costs as is often assumed, and that giving GPs better information about drug costs might promote more rational prescribing.

Attitude of Health Personnel↗
PubMed1996

Expression of human cytochrome P4501A1 (CYP1A1) in Saccharomyces cerevisiae inhibits cell division.

1. Saccharomyces cerevisiae cells, genetically engineered to express human cytochrome P4501A1 (CYP1A1), have a mean doubling time of 5.8 h, which is considerably slower than that of control yeast cells that have undergone the same transformation process but with a plasmid lacking CYP1A1 cDNA (3.3 h). 2. A smaller reduction in the rate of cell division is observed in yeast cells expressing the closely related human P450, CYP1A2. No reduction is seen with plaice CYP1A, despite similar levels of P450 expression and enzyme activity (ethoxyresorufin O-deethylation) and no inhibition of growth is observed with yeast cells expressing higher levels of human CYP2D6. 3. Repeated culture of cells from a single CYP1A1 transformant colony results in a gradual loss of P450 expression and of CYP1A1-associated enzymatic activity over a 5-6 week period. In contrast, expression of human CYP2D6 by a single transformant colony is stable for at least 6 months. 4. The loss of CYP1A1 activity from transformed cells is accompanied by a return to normal growth rate, similar to that of control cells. 5. Inhibition of CYP1A1 enzyme activity during culture, by either type I (alpha-naphthoflavone), type II (ellipticine) or mechanism-based (1-(1'propynyl)pyrene) CYP1A inhibitors, does not affect growth rate, suggesting that some other property of human CYP1A1 protein is responsible for the growth inhibition observed.

Cell Division↗
PubMed1996

Radiolabeled iododeoxyuridine: safety evaluation.

UNLABELLED: The emphasis of radiolabeled iododeoxyuridine (*IUdR) research at our institution to date has been to assess its safety as a potential therapeutic agent. Toward this goal, we have performed preclinical and clinical studies, using various routes of administration, to detect adverse changes in normal tissues in both humans and animals. As IUdR is rapidly dehalogenated by the liver, the intravenous route is unlikely to be successful in therapeutic efforts. We have therefore focused our attention on more "protected" routes: intra-arterial and intravesicular administration. METHODS: Studies were performed in farm pigs after multiple administrations of [125I]IUdR into the aorta, carotid artery and bladder. IUdR and metabolites were measured in venous blood samples at appropriate time intervals after administration, after which histologic examination of tissues was performed. Studies in human have been performed after intra-arterial administration of [123I]IUdR in patients with liver metastases and intravesicular administration in patients with bladder carcinoma, initially using [123I]IUdR and currently using both [123I]IUdR and [125I]IUdR. Blood samples for pharmacokinetics and metabolite analysis and tissue for autoradiography (when feasible) have been obtained. RESULTS: To date, no evidence of adverse effects on normal tissue or alteration of hematologic or metabolic indices have been seen in pigs or humans. When instilled in the bladder, there is little leakage of IUdR in the circulation. CONCLUSION: When [125I]IUdR is used as a therapeutic agent, we anticipate little or no effect on normal tissues.

Administration, Intravesical↗
PubMed1996

Medicine--a healing or a dying art?

That medicine is a science is the popular belief, and this has been reinforced by the advent of 'evidence-based medicine', which assumes that scientific proof is required to support medical practice. However, the view of science implied is a narrow one, foreign both to pure scientists and to artists, and the art of medicine is devalued by the approach. There are both important differences and important similarities between science and the arts. The arts should contribute to evidence-based practice and education along with science, and have a role in many aspects of medical practice.

Art↗
PubMed1996

Completeness and accuracy of morbidity and repeat prescribing records held on general practice computers in Scotland.

BACKGROUND: A high proportion of Scottish general practices use a standard computer software package (GPASS, general practice administration system for Scotland), and thus, Scotland is uniquely placed to amalgamate primary care data on a national scale. Practices, however, vary widely in the nature and extent of data entered on computer and a major limitation on the use of the collected data is the absence of information on the completeness and accuracy of the computer database. AIM: This study set out to assess the quality of morbidity and repeat prescribing records held on computer by general practices in Scotland. METHOD: Forty-one practices, with above average levels of morbidity data recorded on computer, were selected on a geographic basis in relation to the national population distribution. Within each practice, 250 patients aged 45-64 years were selected at random. Data relating to 19 diagnoses, six surgical procedures and 40 repeat prescription drugs were extracted from the computer records of these patients and compared with information held on patients' paper records and supplied by patients in response to a postal questionnaire. The completeness and accuracy of computer entries were assessed in terms of sensitivity and positive predictive value, respectively. RESULTS: For the 5567 patients for whom all three sources of data (validated computer records, paper records and questionnaire responses) were available, sensitivity (completeness) of morbidity recording had median values of 0.67 for diagnoses, 0.93 for surgical procedures and 0.75 over all conditions examined. Practices varied both in the completeness of recording of each condition and in their overall performance. The predictive value (accuracy) of morbidity data was uniformly high for all conditions examined (median 1.00). For repeat prescription drugs, recording on GPASS was both complete and accurate. CONCLUSION: The recording of morbidity data on GPASS for 45-64-year-old patients in a selected group of 41 highly-computerized practices is about 75% complete and highly accurate. For national morbidity studies, it seems likely that amalgamated data from the best GPASS practices will be as complete and accurate as the morbidity statistics currently derived from hospital-based activities in Scotland.

Drug Prescriptions↗
PubMed1996

Mesenteric arteriovenous fistula after vascularized pancreas transplantation resulting in graft dysfunction.

Mesenteric arteriovenous fistula (AVF) is an unusual complication after vascularized pancreas transplantation. We report the case of a patient who developed a mesenteric AVF in the transplanted mesenteric bundle which resulted in severe and protracted endocrine insufficiency necessitating reinstitution of insulin therapy. This was reversible with surgical correction of the AVF. This complication should be included in the differential diagnosis of pancreas allograft dysfunction.

Adult↗
PubMed1996

Morbidity and prescribing patterns for the middle-aged population of Scotland.

BACKGROUND: As part of a large national survey of morbidity recording on general practice computers, morbidity and prescribing data were collected from three separate sources for more than 10,000 patients aged 45-64 years, randomly selected from 41 Scottish general practices. AIM: To amalgamate the three sources of data to provide estimates of prevalence rates for a range of common chronic diagnoses, and of medication rates for associated repeat prescription drugs. METHOD: Forty-one Scottish general practices were selected on a geographic basis in relation to the national population distribution. Within each practice, 250 patients aged 45-64 years were selected at random. Data relating to 19 diagnoses and 40 repeat prescription drugs were extracted from the computer records of these patients and compared with information held on patients' paper records and supplied by patients in response to a postal questionnaire. After assessing the completeness and accuracy of computer-held information, the three sources of data were amalgamated according to agreed protocols. RESULTS: Lifetime prevalence rates are presented for each diagnosis, broken down by sex and age group. Differences in rates between the sexes, and with change in age, were in the expected direction for all diagnoses, and were matched by corresponding differences in entitlements to repeat prescription drugs. Comparison of these lifetime rates with published prevalence rates indicates a latent pool of morbidity within the community, which ranges from 1.0 to 10.0 times the annual prevalence rate for different conditions. CONCLUSION: The amalgamated data provide an estimate of lifetime prevalence rates for the range of conditions examined. They complement conventional morbidity statistics and have potential value in allowing the underlying management costs of specific chronic conditions to be evaluated.

Chronic Disease↗
PubMed1995

Experience with protocol biopsies after solitary pancreas transplantation.

The early detection of allograft rejection remains elusive after solitary pancreas transplantation (PTX). We have previously described a modified technique of cystoscopic transduodenal PTX biopsy using the Biopty gun under ultrasound guidance. During the last 2 years, we performed 24 solitary PTXs with prospective protocol biopsy monitoring as well as biopsies performed whenever clinically indicated. The study group included 17 pancreas transplants alone, 6 sequential pancreas after kidney transplants, and 1 sequential pancreas after liver transplant. Five patients received pancreas retransplants. A total of 92 cystoscopically directed core PTX biopsies were performed, including 50 protocol biopsies (mean 2.1 per patient). Protocol biopsies were performed at 1 month (19), 2 months (3), 3 months (20), 6 months (7), and 12 months (1) after PTX. Adequate PTX tissue for histopathologic examination was obtained in 49 cases (98%). Biopsy findings included no rejection (34), mild rejection (13), pancreatitis (1), and cytomegalovirus infection (1). Overall, 15 of the 49 evaluable biopsies (31%) had significant histopathologic findings. All but 1 of the cases of mild rejection were treated with bolus steroids. Eight of these patients subsequently developed recurrent biopsy-proven rejection within 2 months; 5 grafts were subsequently lost to rejection between 3 and 13 months after PTX. Three biopsy complications occurred: 1 hematoma, 1 pancreatitis, and 1 ileus. Patient survival is 96% and PTX graft survival (complete insulin independence) is 75% after a mean follow-up of 15 months. In the remaining 42 clinically indicated biopsies, 3 were insufficient, 8 showed no rejection, and 31 (79%) had rejection. In half of these cases, the rejection was graded as moderate to severe. In conclusion, prospective monitoring with protocol PTX biopsies may result in the earlier detection of allograft rejection and have a direct effect on improving results after solitary PTX.

Adolescent↗
PubMed1995

Mortality in the New South Wales coal industry, 1973-1992.

OBJECTIVE: To study the mortality of coalminers in New South Wales (NSW) between 1973 and 1992. DESIGN AND PARTICIPANTS: An inception cohort of all male coal industry employees who entered the industry between 1 January 1973 and 31 December 1992 was constructed from the records of Joint Coal Board medical examinations. This cohort was matched with the NSW Death Register to determine the number and causes of deaths in cohort members. RESULTS: The cohort consisted of 23,630 men; 491 died during the study period. The standardised mortality ratio (SMR) for all causes of death was 0.76; that is, after age correction, coalminers have a 24% lower mortality than the general NSW population. Deaths from cancer were lower than expected, and there was a 27% lower mortality from respiratory disease. However, a substantial excess of non-motor-vehicle accidents (SMR, 1.60) was found. Most of these deaths can be attributed to occupation, and some to specific incidents. These excess death rates are confined to underground miners; open cut miners have a substantially lower rate than the general population. CONCLUSIONS: A "healthy worker" effect may explain the lower overall mortality. Although "black lung" is no longer a problem, accidents are still common in underground coalmining. The major expansion of open cut mining in recent years has improved the situation.

Accidents, Occupational↗