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Biomedical subjects

R Smith

Publications and source records attributed to R Smith.

At least 19 recordsLinked to original sources
PubMed1992

Using a mock trial to make a difficult clinical decision.

Many clinical decisions have to be taken with inadequate scientific information. Reaching a consensus among experts has been tried as one response to this problem. Another, described here, is to use legal process to dissect a difficult question. In this case a mock trial--using barristers, expert witnesses, and a jury--was conducted on whether bone marrow transplantation should be offered to all children with symptomatic sickle cell disease. Transplantation seems to offer about a 90% cure rate for a condition that may kill 15% of children before they reach 20. But transplantation carries a 10% risk of death or severe disability, and doctors cannot predict which children will suffer severely from their sickle cell disease and which will suffer little or nothing. The jury eventually reached a majority decision that transplantation should not be offered now to all symptomatic children.

Anemia, Sickle Cell↗
PubMed1992

Audit and research.

Explore the source record for details and available documents.

Health Services Research↗
PubMed1992

Solution structure of endothelin-3 determined using NMR spectroscopy.

The aqueous solution structure of the 21-residue vasoactive peptide hormone endothelin-3 has been determined using high-resolution NMR spectroscopy. A total of 177 proton-proton distance measurements and 5 chi 1 dihedral angle constraints derived from NMR spectra were used to calculate the structure using a combination of distance geometry and dynamical simulated annealing calculations. The calculations reveal a highly ordered, compact conformation in which a helical region extending from K9 to C15 lies in close apposition with the C-terminal hexapeptide; this interaction seems to be largely driven by hydrophobic interactions. Structure-activity studies are interpreted in terms of the conformational features of the calculated endothelin-3 structure.

Amino Acid Sequence↗
PubMed1992

Prevalence of HIV among childbearing women and women having termination of pregnancy: multidisciplinary steering group study.

OBJECTIVE: To determine the prevalence of HIV among pregnant women, in particular those whose behaviour or that of their partners put them at "low risk" of infection. DESIGN: Voluntary named or anonymous HIV testing of pregnant women during 21 months (November 1988 to July 1990). SUBJECTS AND SETTING: All women who planned to continue their pregnancy and attended clinics serving the antenatal populations of Edinburgh and Dundee. All women admitted for termination of pregnancy to gynaecology wards serving the pregnant populations of Dundee and outlying rural areas. MAIN OUTCOME MEASURES: Period prevalence of HIV antibody positivity. RESULTS: 91% of antenatal clinic attenders and 97% of women having termination of pregnancy agreed to HIV testing on a named or anonymous basis. HIV period prevalences for antenatal clinic attenders and women having termination of pregnancy tested in Dundee were 0.13% and 0.85% respectively, and for antenatal clinic attenders tested in Edinburgh 0.26%. For those at "low risk" rates for antenatal clinic attenders and women having termination of pregnancy in Dundee were 0.11% and 0.13%, and for antenatal clinic attenders in Edinburgh 0.02%. In Dundee HIV prevalence among women having a termination of pregnancy (0.85%) was significantly greater than that among antenatal clinic attenders (0.13%). CONCLUSIONS: HIV infection is undoubtedly occurring among women at "low risk," and it is clear that a policy of selective testing of those at only "high risk" is inadequate for pregnant women living in areas of high prevalence such as Edinburgh and Dundee. Moreover, when studying pregnant populations in such areas there is the need to include those having a termination of pregnancy.

Abortion, Induced↗