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Biomedical subjects

R Thompson

Publications and source records attributed to R Thompson.

At least 127 records · Page 7Linked to original sources
PubMed1995

Do transition grants help rural hospitals?

Congress introduced the Rural Health Care Transition (RHCT) Grant Program in 1989 to assist financially troubled, small rural hospitals. This article discusses grant effects on the second cohort of hospitals to complete their 3-year grants. Although three-quarters of the grantees implemented all or most of their goals, 11 percent could not implement a viable project. Grantees added or upgraded 523 services with the help of their grants, especially outpatient and social services, most of them financially self-supporting. Except among the largest hospitals, there was no evidence that the grants improved grantee finances. Management appeared unaffected by the grants.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1995

A comparative breastfeeding study in two contrasting areas.

An apparent decline in breastfeeding rates motivated health visiting staff within Hillingdon Community Health Trust to undertake a research project on infant feeding practice. Margaret Buckell and Rosemary Thompson describe a study to measure intent to breastfeed, breastfeeding initiation rates and feeding outcomes in two contrasting areas of Hillingdon, an outer London borough, and to identify areas for further work to improve breastfeeding levels.

Breast Feeding↗
PubMed1995

Participative decision making: multidisciplinary team involvement in unit design.

This article describes the multidisciplinary team's input into the design and construction of an Epilepsy Monitoring Unit. The unit construction was a collaborative effort of a multidisciplinary team based in part on patient input as well as economic and efficiency factors. The Unit has resulted in long term rewards for both patients and staff. Patients benefit from the friendly environment created and staff benefits are due to the increased efficiency of the unit--working smarter not harder and the knowledge that staff nurses were an integral part of the planning process of this highly successful project.

Decision Making, Organizational↗
PubMed1994

The influence of increased health care costs on general practitioner consultations and prescription collection.

AIM: Increased health service charges have led to concern that some patients may be unable to meet these costs, which could compromise their care. Increased costs may affect general practitioner attendance, and/or the collection of a prescription. This study examines both of these factors. METHODS: Between 18 August and 14 September 1992, questionnaires were sent to the consenting patients of 19 general practitioners from the Hutt Valley requesting information regarding the general practice (GP) visit and the prescription. The information included the reason for the GP visit, whether there was any delay and its duration, the reason for any delay, the cost of the visit and whether a prescription was received. Data regarding the prescription included the cost and whether all, some, or none of the items were uplifted, and whether the patient had a community service card. RESULTS: 489 (86%) returned completed questionnaires and 426 received a prescription. Of these, 164 were group 1 community service card holders; one was a group 2 community service card holder; 186 were group 3; 59 did not specify their group; 18 had a chronic-user card. Forty percent (194 patients), delayed going to their doctor, 118 by more than 3 days. The most common reasons for delay were hope that their condition may improve spontaneously and the cost of the consultation or prescription. Possession of a community service card was a significant factor in delay with group 3 (high wage earners) more likely to delay than group 1 (p < 0.0005). Only two patients did not present their prescription. Ninety-three percent of those receiving a prescription presented for dispensing within 24 hours. Ninety-two percent of patients paid for all their prescription items. CONCLUSIONS: Delay in obtaining treatment is common and occurs primarily at the general practitioner consultation. It primarily affects those individuals who were classified as group 3, the group that has taken the burden of recent health service charges increases.

Adolescent↗
PubMed1994

Sexual differentiation of brain and behavior in the zebra finch: critical periods for effects of early estrogen treatment.

In order to determine the critical period(s) during which estrogen alters sexually dimorphic behavior and neuroanatomy in zebra finches (Poephila guttata), nestlings were injected daily with 20 micrograms estradiol benzoate (EB) during posthatching week 1, week 2, week 3, or weeks 1, 2, and 3. At 7 months of age, birds were implanted with testosterone propionate and tested with female partners for singing, dancing, and copulatory mounting. Brains were subsequently processed for morphometry, and the volumes of the song system nuclei HVC, area X, and RA and the soma sizes and densities of neurons in RA were determined. Males given EB during week 1 failed to mount. Females given EB during week 1 were fully masculinized with respect to dancing and RA neuron soma size and density, and were partially masculinized with respect to song nuclei volumes and singing. Treatment beginning after week 1 was ineffective or less effective for all measures. Only for RA neuron measures was treatment for all three weeks more effective than week 1 treatment. Thus the first post-hatching week is the most influential period of those tested for effects of exogenous estrogen on sexual differentiation in this species, and is a period during which both masculinization of females and demasculinization of males is possible.

Animals↗
PubMed1994

The anti-infarct effect of an adenosine A1-selective agonist is diminished after prolonged infusion as is the cardioprotective effect of ischaemic preconditioning in rabbit heart.

Our aim was to determine whether adenosine A1 receptor-mediated protection could be maintained for a prolonged period of time by a continuous infusion of an A1-selective agonist. To produce myocardial infarction a branch of the left coronary artery of rabbit hearts was occluded for 30 min and reperfused for 3 h. Infarct size was determined with tetrazolium staining. Prior to the 30 min ischaemia, rabbits were subjected to one of the following six protocols: (1) 6 h i.v. saline infusion; (2) 6 h i.v. CCPA (0.043 mg/kg/h) infusion; (3) 72 h saline infusion; (4) 72 h CCPA infusion; (5) 72 h CCPA infusion plus preconditioning with 5 min ischaemia followed by 10 min reperfusion; (6) 72 h saline infusion plus preconditioning. The 6 h CCPA infusion group had significantly smaller infarct sizes than the 6 h vehicle group. 16.2 +/- 2.9% infarction of the ischaemic region v 39.5 +/- 2.6%, P < 0.01. Infarction in the 72 h CCPA infusion group (37.7 +/- 2.7%) was the same as in the 72 h vehicle group (35.2 +/- 3.1%). Ischaemic preconditioning could not limit infarct size in 72 h CCPA animals (%infarction; 29.1 +/- 4.6%) but did protect animals given vehicle for 72 h (8.4 +/- 1.2%, P < 0.01). After 72 h infusion of CCPA, both the cardioprotective effect of adenosine A1-selective agonist and ischaemic preconditioning were attenuated. These findings indicate that: (1) the myocytes become desensitized to the protective effect of CCPA with prolonged exposure; and (2) ischaemic preconditioning is no longer protective when tachyphylaxis to CCPA occurs.

Acetylcholine↗
PubMed1994

Computer assisted recognition and quantitation of the effects of airborne chemicals acting at different areas of the respiratory tract in mice.

The pattern and timing of a normal breath in unanesthetized mice was analyzed from measurement of inspiratory and expiratory airflows (VI and VE). Airflow was measured via a differential pressure transducer, attached to a pneumotachograph, which itself was attached to a body plethysmograph into which a mouse was placed. The analog voltage from the differential pressure transducer was digitized and stored for analysis on a microcomputer. Criteria were developed to classify each breath as normal (N) or belonging into one of seven abnormal categories. The abnormal categories were arrived at by computer analysis, recognizing specific modifications of the normal pattern into patterns of: sensory irritation of the upper respiratory tract (S), airflow limitation within the conducting airways of the lungs (A) or pulmonary irritation at the alveolar level (P). Combinations of these effects, i.e., S+A, P+A, P+S and P+S+A were also recognized. Computer analysis of each breath also permitted quantitative evaluation of the degree of S, A or P abnormalities. To induce each type of effect we used inhalation exposures to 2-chlorobenzylchloride, carbamylcholine or propranolol. We propose that this approach will permit rapid evaluation of the possible effects of airborne chemicals at three levels of the respiratory tract, with the classification of the type of effect easily obtained in an objective way using well defined criteria, followed by quantitation of the degree of each effect.

Administration, Inhalation↗
PubMed1994

The influence of Maloprim chemoprophylaxis on cellular and humoral immune responses to Plasmodium falciparum asexual blood stage antigens in schoolchildren living in a malaria endemic area of Mozambique.

We examined the impact of chemoprophylaxis on the cellular and humoral immune responses to polypeptides of the asexual Plasmodium falciparum blood stage antigens, the glutamate rich protein GLURP and Pf155/RESA, both of which in previous field studies have been identified as potentially protective antigens. The study was carried out in the Escola Primária de Lingamo, a primary school in a suburban area of Maputo, Mozambique. A cohort of 392 schoolchildren (aged 7-12 years) was randomly allocated to two equal groups, one receiving chemoprophylaxis with dapsone/pyrimethamine (Maloprim), the other receiving placebo every week from December 1989 to November 1990. The groups were then followed until November 1991 without chemoprophylaxis. Cellular responses to immunodominant epitopes from Pf155/RESA and GLURP, and to non malaria antigens C. albicans and PPD, were assessed by lymphocyte proliferation assays in vitro. Anti-GLURP and anti-Pf155/RESA antibodies were detected by enzyme-linked immunosorbent assay (ELISA) and erythrocyte membrane immunofluorescence (EMIF), and total anti-P. falciparum antibodies were measured by indirect fluorescent antibody test (IFAT). Immunological reactivities were evaluated every six months, at the end of the rainy season and at the end of the dry season, both during the period of chemoprophylaxis and during the follow-up. The antibody response rate to the GLURP was lower in the Maloprim group than in the placebo group during the intervention phase. The lymphoproliferative response rate to the malaria antigens was significantly lower at the end of the rainy season than at the end of the dry season, but the difference between the experimental group and the control group of schoolchildren was not statistically significant. These results suggest that the antibody responses to the GLURP molecule and partly to the Pf155/RESA antigen in this study population were shortlived and dependent on frequent boostering, but whether these antigens play a role in the development of natural clinical immunity remains open. In the experimental group of schoolchildren weekly chemoprophylaxis successfully reduced the parasite rate during the rainy season from 43% to 4%, and during the dry season from 18% to 0%. Chemoprophylaxis may therefore have a useful role in combination with another partially effective malaria control measure such as insecticide-impregnated bed nets or a malaria vaccine.

Animals↗
PubMed1994

Reduced muscle protein breakdown in septic rats following treatment with interleukin-1 receptor antagonist.

1. The role of interleukin-1 (IL-1) in sepsis-induced muscle proteolysis was assessed by treating septic rats with recombinant IL-1 receptor antagonist (rIL-1ra). 2. In initial experiments, we tested the effectiveness of IL-1ra in preventing muscle proteolysis induced by administration of IL-1. 3. When normal rats were treated with rIL-1 alpha (three intraperitoneal doses of 100 micrograms/kg body weight each over 16 hr), total and myofibrillar muscle protein breakdown rates, measured as release of tyrosine and 3-methylhistidine, respectively, by incubated extensor digitorum longus muscles, were significantly increased. 4. This metabolic response to IL-1 alpha was completely abolished by rIL-1ra, administered as three intraperitoneal doses of 3 mg/kg body weight each over 16 hr. 5. In subsequent experiments, sepsis was induced in rats by cecal ligation and puncture (CLP); non-septic rats were sham-operated. 6. Treatment of septic rats over 16 hr with a total dose of 25 mg/kg body weight of rIL-1ra reduced, but did not normalize, the increased muscle protein breakdown rates seen during sepsis. 7. When the dose of rIL-1ra was more than doubled and given as a constant infusion at a rate of 4.2 mg/kg body weight/hr for 16 hr, the increased rate of muscle proteolysis in septic rats was normalized. 8. The present study offers the first direct evidence that IL-1 is involved in the regulation of muscle proteolysis during sepsis.

Animals↗
PubMed1994

Prevention of nosocomial pneumonia.

Prevention of nosocomial pneumonia becomes an achievable goal only to the extent that the mechanisms of infection are known. It is likely that there is variation among microorganisms, patients, type of care and intensive care, and practices that determines the relative efficacy of preventive measures. Certain procedures appear to be universally required and include adequate reprocessing of ventilation equipment and infection control measures in patient care. In contrast, many factors may affect the role of the stomach as a cause of nosocomial pneumonia, including enteral feeding procedures and gastric acidity. Differences in results between studies of preventive measures may reflect uncontrolled practice factors, which make the measures either more or less important. Selective decontamination of the digestive tract is a measure with potentially serious consequences, primarily cost and microbial resistance, and should be undertaken with care probably in selected high-risk patients. Other recommendations such as the use of sucralfate, which is effective in prevention of bleeding without clear side effects, are probably worth instituting based on existing evidence. The primary need may be for better reprocessing of equipment or hand washing and sterile gloves, or it may be several changes at once. Certainly an array of preventive measures is necessary, and there is probably no single procedure likely to solve such a complex problem. Use of the collective findings of many investigators needs to be made and strategies applied to each patient and setting. There has been a marked increase in our knowledge of nosocomial pneumonia, and effective measures for prevention are available. Application of these measures widely should reduce the frequency of respiratory complications. The microbiologic tools to compare bacterial isolates have been developed, and the course of events preceding infection of the patient can be demonstrated. The role of equipment, environment, other patients, personnel, colonization sites, and other factors can now be examined. Future studies should control for the many known factors that may predispose to nosocomial pneumonia to make the results meaningful. This would include definition of infection, patient risk factors, identification of microorganisms, details of enteral nutrition, type of stress ulcer prophylaxis, exposure to antimicrobial agents, and institutional resistance patterns. In some studies, surveillance cultures and molecular epidemiology techniques would be required. Large controlled multicenter studies are necessary to determine the significance of the results of promising smaller studies.(ABSTRACT TRUNCATED AT 400 WORDS)

Cross Infection↗
PubMed1994

Estimating the covariance structure of traits during growth and ageing, illustrated with lactation in dairy cattle.

Quantitative variation in traits that change with age is important to both evolutionary biologists and breeders. We present three new methods for estimating the phenotypic and additive genetic covariance functions of a trait that changes with age, and illustrate them using data on daily lactation records from British Holstein-Friesian dairy cattle. First, a new technique is developed to fit a continuous covariance function to a covariance matrix. Secondly, this technique is used to estimate and correct for a bias that inflates estimates of phenotypic variances. Thirdly, we offer a numerical method for estimating the eigenvalues and eigenfunctions of covariance functions. Although the algorithms are moderately complex, they have been implemented in a software package that is made freely available. Analysis of lactation shows the advantages of the new methods over earlier ones. Results suggest that phenotypic variances are inflated by as much as 39% above the underlying covariance structure by measurement error and short term environmental effects. Analysis of additive genetic variation indicates that about 90% of the additive genetic variation for lactation during the first 10 months is associated with an eigen-function that corresponds to increased (or decreased) production at all ages. Genetic tradeoffs between early and late milk yield are seen in the second eigen-function, but it accounts for less than 8% of the additive variance. This illustrates that selection is expected to increase production throughout lactation.

Aging↗
PubMed1994

Leiomyosarcoma in leiomyomatosis of the small intestine.

Multiple leiomyomata of the small intestine are rare. We report one such case where a leiomyosarcoma had arisen from a leiomyoma in the small intestine 8 years after presentation. The possible origin of the leiomyomata is discussed and it is concluded that small intestinal leiomyomatosis should be regarded as a premalignant condition.

Adult↗
PubMed1994

Clinical audit of health visitor interventions in child accident prevention.

The Health of the Nation strategy has set a target for reducing the death rate from accidents among children aged under 15 by at least 33 per cent by 2005. Accidents are included because they present a major health issue. Maureen Carson and Rosemary Thompson describe the part played by health visitors in the Norwich Community Health Services strategy to cut child accident rates, and the important role of the hospital paediatric liaison health visitor.

Accident Prevention↗
PubMed1993

Prescribing for childhood asthma in the Wellington area: comparison with international guidelines.

AIMS: An international paediatric asthma consensus group has outlined the rational approach to the treatment of childhood asthma. We have examined the prescription of asthma treatment to children in Wellington to assess to what extent these guidelines have been adopted by general practitioners. METHODS: During the period 1 May-11 June 1991, the prescriptions for 228 asthmatic children, dispensed at 30 randomly selected pharmacies in the greater Wellington area, were reviewed. RESULTS: Eighty-four per cent of the children were prescribed beta 2 adrenoceptor agonists. Of these, 80% of those under five years, and 27% over five years of age, received these agents by the oral route. In almost half, these drugs were prescribed on a regular basis. Fifty-two per cent of patients were prescribed some form of antiinflammatory therapy (inhaled or oral steroids, ketotifen or sodium cromoglycate). Only 2% received sodium cromoglycate. CONCLUSION: Although approximately half of these children received some form of antiinflammatory therapy, the minimal use of sodium cromoglycate, and high frequency of regular scheduled beta 2 adrenoceptor agonist use, suggests that the guidelines for asthma management in children may not have been widely adopted by primary care physicians in Wellington.

Adolescent↗