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Biomedical subjects

R Marshall

Publications and source records attributed to R Marshall.

At least 73 records · Page 4Linked to original sources

Opioid detoxification using naloxone.

A method of brief inpatient opioid detoxification using naloxone is described. Daily injections of naloxone were administered to 20 patients who were dependent on opioids until no physical withdrawal reaction occurred. A reducing regime of clonidine and diazepam was used to treat withdrawal symptoms. Seventy-five percent of patients successfully completed detoxification within 6 days. Withdrawal symptoms were minimal and rapidly declined during treatment. Unlike other techniques using opioid antagonists detoxification with daily naloxone injections requires minimal medical supervision, enables full participation in a daily relapse prevention programme and results in discharge from hospital without medication for symptomatic relief.

Journal Article↗

Paramedics, technicians, and survival from out of hospital cardiac arrest.

OBJECTIVE: To test the hypothesis that limited paramedic advanced life support skills afford no advantage in survival from cardiac arrest when compared with non-paramedic ambulance crews equipped with defibrillators in an urban environment; and to investigate whether separate response units delayed on scene times. METHODS: A prospective, observational study was conducted over 17 consecutive months on all adult patients brought to the accident and emergency (A&E) department of Glasgow Royal Infirmary having suffered an out of hospital cardiac arrest of cardiac aetiology. The main interventions were bystander cardiopulmonary resuscitation (CPR) and limited advance life support skills. MAIN OUTCOME MEASURES: Return of spontaneous circulation, survival to admission, and discharge. RESULTS: Of 240 patients brought to the A&E department, 19 had no clear record of whether a paramedic was or was not involved and so were excluded. There was no difference in survival between the two groups, although a trend to admission favoured non-paramedics. Paramedics spent much longer at the scene (P < 0.0001). Witnessed arrests (P = 0.01), early bystander CPR (P = 0.12), shockable rhythms (P = 0.003), and defibrillation (P < 0.0001) were associated with better survival. Intubation and at scene times were not associated with better survival. Delayed second response units did not prolong at scene times. CONCLUSIONS: The interventions of greatest benefit in out of hospital cardiac arrest are basic life support and defibrillation. Additional skills are of questionable benefit and may detract from those of greatest benefit.

Adolescent↗

Effect of milk fat content on flavor perception of vanilla ice cream.

The effects of milk fat concentration on flavor perception of vanilla ice cream (with 0.5 to 10% fat) were studied by sensory analyses. The percentage of free vanillin in the ice cream was determined by HPLC. The HPLC data showed that the amount of free vanillin decreased when fat content increased. Perceptions of vanilla flavor and sweetness were evaluated by a trained panel using time-intensity methodology. No significant difference was found in sweetness perception. Among 11 time-intensity parameters for vanilla flavor perception, the panel found a significant difference only in the time required to reach maximum vanilla intensity. However, free-choice profiling and a consumer preference panel showed, respectively, that, as fat content was increased, sensory quality improved, and overall preference increased.

Animals↗

Modal profiles for the Halstead-Reitan Neuropsychological Battery for Children.

Modal Profile Analysis was used to cluster students (aged 9 to 14 years) on 16 subtest scores from the Halstead-Reitan Neuropsychological Battery for Children (HRNB-C). This analysis produced eight modal profile types, all of which were replicated in multiple samples. An initial attempt to establish external validity indicated that the modal groups display dissimilar patterns of performance on independent variables. The present typology is compared to similar typologies developed with adult neuropsychological data. In sum, the current classification system provided less coverage than the adult typologies, but produced more unique or homogeneous modal groups. Discussion focuses on potential clinical and research uses of the modal HRNB-C profiles.

Journal Article↗

Multilaboratory comparison of in vitro tests for chromosome aberrations in CHO and CHL cells tested under the same protocols.

Different test results have been reported for the same chemicals in two in vitro chromosome aberration test systems, CHL cells tested by a Japanese protocol and CHO cells tested by the US National Toxicology Program [Sofuni et al., Mutat Res 241:173-213,1990]. Here, laboratories in Japan, the US and the UK tested 9 such chemicals in CHL and CHO cells using the same protocols and found all 9 positive in both cell types; differences in earlier conclusions with these chemicals were due mainly to test protocol, not to different sensitivities of the cells. The most important protocol difference is sampling time. Chemicals that were negative in the NTP series using a sampling time of 10 to 13 hours often produced positive results when retested here with a 20- to 24-hour sampling time. While positive results were obtained in both cell types, CHL cells sometimes had higher aberration levels and survived at higher doses than CHO cells would tolerate. This may reflect some intrinsic difference in sensitivity but may also be affected by factors such as cell cycle length and culture media (e.g., oxygen scavenging capacity). The collaboration reported here also contributed to a better understanding of scoring aberrations, especially "gaps"; there was good agreement on what types of aberrations should be included in the totals when scoring criteria were clearly defined, for example, many changes classified as "gaps" by the Japanese system were classified as "breaks" in the scoring systems used in the United States and the United Kingdom, and were appropriately included in total aberration counts.

Animals↗

Adverse effect of donor vasopressor support on immediate and one-year kidney allograft function.

BACKGROUND: This purpose of this study was to determine if there was a significant difference between the rates of acute tubular necrosis (ATN) and long-term graft survival in renal allografts procured from donors requiring inotropic support (DRIS) and those from donors not requiring inotropic support. METHODS: Eighty-two consecutive cadaveric renal transplant patients were prospectively followed in our local procurement area, the Delaware Valley Transplant Program. Forty-eight patients received organs from DRIS (> 10 mcg/kg per minute of dopamine, dobutamine, epinephrine, and norepinephrine alone or in combination), and 34 did not. RESULTS: Allografts from the non-DRIS group had an immediate function rate of 82.4% and a 1-year function rate of 91.2%. In comparison, the DRIS grafts had an immediate function rate of 58.3% and a 1-year function rate of 72.9%. These differences were statistically significant. The mean serum creatinine in the non-DRIS group was 1.46 +/- 0.58 mg/dl, whereas in the DRIS cohort it was 1.89 +/- 0.93 mg/dl. CONCLUSIONS: Kidneys transplanted from DRIS had significantly (1) poorer immediate function, (2) worse 1-year survival rates, and (3) higher serum creatinine at 1 year. We conclude that recipients receiving organs from donors requiring inotropic support are at a higher risk of developing ATN after surgery and experience reduced 1-year function.

Adolescent↗

The role of upper limb segment rotations in the development of racket-head speed in the squash forehand.

In the squash forehand drive, the contribution that each of the upper limb segment's anatomical rotations make to racket-head velocity towards the front wall (x-direction) during the forward swing and at impact were calculated. Eight squash players (3 females, 5 males) capable of hitting a high-performance squash forehand drive were filmed at a nominal rate of 300 Hz by two phase-locked Photosonics cameras. The three-dimensional displacement histories of 12 selected landmarks were then calculated using the direct linear transformation approach and three-dimensional individual segment rotations were calculated using vector equations. Internal rotation of the upper arm at the shoulder joint (46.1%), hand flexion at the wrist joint (18.2%) and forearm pronation at the radio-ulnar joint (12.0%) were the major contributors to the mean 30.8 m s-1 x-direction velocity of the centre of the racket-head at impact. Pronation of the forearm at the radio-ulnar joint and extension at the elbow joint both played a significant role in generating racket velocity in the period prior to impact.

Arm↗

Extended harvest times are not necessary for the detection of in vitro clastogens in regulatory cytogenetics studies.

The choice of harvest time in in vitro cytogenetics assays is a critical factor in determining the sensitivity of the assay for detecting clastogenic potential. As yet there is no harmonization of regulatory requirements in this aspect. It has been suggested that the use of extended harvest times can improve the sensitivity of detecting some chemicals which either induce cell cycle delay or produce lesions which induce chromosome aberrations at divisions subsequent to the first post-treatment mitosis. The incidence of such chemicals encountered in the routine testing of chemicals for regulatory submissions is not known. Therefore a large database of 550 chemicals tested in nine laboratories using standard regulatory protocols, including a late harvest time, was assessed for the incidence of chemicals uniquely positive only at a delayed harvest time. The number of such chemicals was very low ( < 0.2%) and the chromosome damage induced by these chemicals may not result from direct genotoxic mechanisms. Based on these data it is recommended that there is no need to include an extended harvest time in in vitro cytogenetics assays except where it might help to resolve an equivocal result.

Animals↗

Review of police inquiries to an accident and emergency department.

OBJECTIVE: To assess the workload generated by police inquiries to an accident and emergency (A&E) department and the adherence of medical staff to departmental guidelines relating to these inquiries. DESIGN: Prospective analysis of the number, nature, and timing of police inquiries and the information released by medical staff. SETTING: A&E department of an inner city teaching hospital. OUTCOME MEASURES: Number of personal and telephone requests for information from police; completion of a form of inquiry; record of patient consent for release of information. RESULTS: A daily average of 8.7 police inquiries were made, but in only 10% of cases was a form of inquiry completed. The patient's consent for release of information to the police was recorded in 4% of cases. CONCLUSIONS: Police inquiries generate a significant workload for an A&E department, often at clinically busy times. Medical staff need further education to ensure that patient confidentiality is respected while assisting the police with their investigations.

Confidentiality↗

The pharmacotherapy of hypochondriasis.

This article addresses the diagnosis and pharmacologic treatment of hypochondriasis. Diagnostic issues are reviewed briefly, focusing on the need for a thorough medical re-consideration of the patient's presenting symptoms. Because the diagnosis rests on the absence of a medical cause to account for the presence or intensity of the physical symptoms, neither self-report forms nor non-medically trained interviewers should be used to definitively make the diagnosis of hypochondriasis. We review the case reports and small uncontrolled series on the pharmacologic treatment of hypochondriasis, emphasizing the growing body of evidence suggesting particular efficacy for the serotonin reuptake inhibitors. Preliminary results from an ongoing placebo-controlled trial of hypochondriasis using fluoxetine are presented. While the controlled trial supports the open treatment data in revealing a high rate of improvement among patients completing treatment with fluoxetine, it also demonstrates that many patients respond to placebo as well. In conclusion, although the traditional nihilistic attitude regarding the possibility of successful treatment of hypochondriacs appears no longer warranted, the question remains open as to whether SSRIs have particular efficacy in patients with hypochondriasis or whether nonspecific treatment effects are the primary cause of improvement.

Humans↗

An outbreak of scabies in a school for children with learning disabilities.

An outbreak of scabies was detected in autumn 1992 at a school for children with learning disabilities. Because of the scale of the outbreak all the children at the school, and their contacts, were treated on one 'mass treatment day'. Scabies is still widely misunderstood and carries a social stigma, which makes investigation and control more difficult than it would otherwise be.

Age Factors↗

The urban traffic environment and the risk of child pedestrian injury: a case-crossover approach.

We conducted a case-crossover study to quantify the effects of traffic volume and speed on the risk of child pedestrian injury on the school-home journey. We identified 46 children injured as pedestrians on the school-home journey. For each case, we compared the traffic volume and speed on the road where the child was struck with the volumes and speeds on the other roads the child would usually cross. We found strong associations between pedestrian injury risk and high traffic volume [relative risk = 6.3; 95% confidence interval (CI) = 2.1-18.8] and high speed (relative risk = 3.6; 95% CI = 1.5-8.4). These results provide suggestions as to future applications of the case-crossover design.

Accidents, Traffic↗

Controversies of early discharge of infants from the well-newborn nursery.

A reduced hospital length of stay for normal newborns has become common, largely in an attempt to reduce hospital costs. Although evidence in the literature suggests that this is a safe practice, the overall quality of the studies is weak, and controversy exists regarding the advisability of this practice. A review of the rather modest literature and experience with shortened hospital stays lead us to conclude that early discharge of newborns is safe if it is but one component of a larger program designed to transfer portions of care traditionally provided in the hospital to pre- and postnatal care provided outside the hospital. The early discharge program developed at the Harvard Community Health Plan is presented as an example of such a program, with the hope that this model will provide a useful framework to those who are involved with shortened hospital maternity lengths of stay.

Community Health Services↗