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Biomedical subjects

S Dawson

Publications and source records attributed to S Dawson.

At least 109 records · Page 6Linked to original sources
PubMed1994

Acute arthritis of cats associated with feline calicivirus infection.

Twelve specific pathogen-free cats were infected either by intra-articular inoculation or by contact exposure to one of two strains of feline calicivirus (FCV), either F65, a field strain originating from an outbreak of lameness in a group of cats, or a vaccine strain. Following either route of exposure, both strains induced signs typical of FCV infection including oral and nasal ulceration, conjunctivitis and ocular discharge. These signs were of equal severity for both virus strains, but overall, following either route of infection, F65 induced more severe disease than the vaccine strain, with marked pyrexia, lethargy and lameness. Vaccine virus only induced a relatively mild lameness following intra-articular inoculation. Gross pathological and histopathological lesions were seen in some of the joints, but again changes were more severe in the F65-exposed cats. Virus was isolated from both normal and affected joints from both groups of F65-exposed cats, and from a joint from each cat inoculated intra-articularly with vaccine virus. Mild transient lameness was also seen in one of two control cats inoculated intra-articularly, but no pathological changes were seen or virus isolated from joints. A cDNA probe used in RNA dot blot hybridisation experiments was found to be specific and more sensitive than virus isolation in detecting FCV in selected tissues. This may be useful in future studies on the pathogenesis of FCV disease and in studies on viral persistence in FCV carriers.

Acute Disease↗
PubMed1994

Quality paraprofessional home care.

Home care aides are often said to be the core of the caregiving team, but their treatment and compensation may leave something to be desired. These paraprofessionals are the front-line workers in home care; for clients to perceive home care as quality care, the job of the home care worker itself must be restructured.

Caregivers↗
PubMed1994

Better jobs, better care: building the home care work force.

This paper focuses on providing quality care in the paraprofessional home care industry. Despite government policies that have encouraged home-based care for 20 years, home health care still remains relegated to second-class status by the rest of the health care industry. Home care is unique because it relies primarily on paraprofessional care delivered by a home care aide working alone, essentially as a guest in the client's home. The resulting interpersonal dynamic between patient and caregiver--which develops far from the eyes of the primary physician, regulators, and third-party payers--is one unlike any other patient-caregiver relationship in the health care system. The quality of care received by the client is linked directly to the quality of the paraprofessional's job: "good jobs" are prerequisite for "good service." Good jobs, however, are not enough. They must be supported by paraprofessional agencies that add real value to the home care service. Part I We define quality home care as meeting the client's needs. Unfortunately, since home care is provided in dispersed, minimally supervised settings, measuring quality of service is very difficult. For this reason, we suggest that it is the front-line employee--the home care aide who is present for hours every visit--who can best determine if the client's needs are being met, and who is best positioned to respond accordingly. Part II To best meet client needs, paraprofessional home care must be built around the home care aide. This requires that home care aides (1) be carefully selected during the hiring process, (2) be well trained, and (3) be empowered with considerable responsibility and capacity to respond to the daily needs of the clients. This Model, one that emphasizes the front-line employee, is in full keeping with the "total quality management" innovations that are currently reorganizing America's service industries. Unfortunately this model is not typically reflected in current paraprofessional home health care practice. Part III Building the home care service around home care aide requires redesigning the paraprofessinal's job in 5 ways: 1. Make work pay, by providing a minimum of $7.50 per hour and a decent benefits package.(ABSTRACT TRUNCATED AT 400 WORDS)

Health Services Needs and Demand↗
PubMed1994

UCLA liver transplantation: analysis of the first 1,000 patients.

Graft and patient survival rates for Black patients were higher than for any group. This may be due to the younger age distribution among Black transplant recipients versus other races at UCLA. Graft and patient survival for Asian patients were significantly lower than for any other group. However, this result was not totally accounted for by the rapid recurrence of disease in hepatitis B patients. Patients with a positive flow cytometry crossmatch had significantly lower first and second graft survival rates due to early graft loss. Patients with PRA of more than 10% had a higher proportion of positive flow crossmatches. However, as a group, patients with more than 10% PRA did not demonstrate decreased graft survival. Consideration should be given to prospectively flow crossmatching the more than 10% PRA group. Patients with zero-DR mismatches had better survival than patients with one- and 2-DR mismatches. Prospective HLA matching in OLT patients is not currently done.

Adolescent↗
PubMed1993

Typing of feline calicivirus isolates from different clinical groups by virus neutralisation tests.

One hundred and thirteen isolates of feline calicivirus originating from seven different clinical groups were typed by virus neutralisation tests using eight different cat antisera. The clinical groups comprised 'healthy' cats, cases of acute oral/respiratory disease, chronic stomatitis, acute febrile lameness syndrome, vaccine reactions (clinical disease seen within 21 days of vaccination) and vaccine breakdowns (clinical disease seen more than 21 days after but within one year of vaccination). Isolates from the vaccine reaction cases were grouped into those associated with acute oral/respiratory disease alone and those associated with the lameness syndrome, and the latter group was further subdivided according to the vaccine used. Two groups appeared significantly different from others with some of the antisera. Thus the lameness vaccine reaction isolates associated with vaccine B were significantly different from the isolates from all the other clinical groups, including other lameness isolates, with a number of the antisera. In addition, the chronic stomatitis isolates were significantly different from those from the 'healthy' and the acute oral/respiratory disease groups with one or two of the antisera. Eighty-five to 88 per cent of the isolates were neutralised by antisera raised against F9 or F9-like vaccine strains at a dilution of 1 in 2. Twenty antibody units of such antisera neutralised 42 to 80 per cent of the isolates. A bivalent antiserum raised against a vaccine F9 strain and field strain LS015 neutralised 96 per cent of the isolates at a dilution of 1 in 2, and 20 antibody units neutralised 68 per cent of isolates. Antisera to field strain F65 neutralised all the remaining isolates at a dilution of 1 in 2 and 44 per cent of the remaining isolates at a dilution of 20 antibody units. Therefore, strains LS015 and F65 may be of use in the production of a polyvalent feline calicivirus vaccine, together with the widely used strain F9.

Animals↗
PubMed1993

Investigation of vaccine reactions and breakdowns after feline calicivirus vaccination.

The clinical and epidemiological features of feline calicivirus associated vaccine reactions and breakdowns were investigated. Twenty per cent of 123 vaccine reactions were associated with acute oral/respiratory disease alone, and 80 per cent were associated with lameness either alone or in association with other clinical signs. Feline calicivirus was isolated from oropharyngeal swabs from 69 per cent of the vaccine reaction cases. Twenty-four of 31 vaccine breakdowns were associated with acute oral/respiratory disease and only seven with lameness; the virus was isolated from 28 of the 31 breakdowns. Some of the viruses isolated from the vaccine reactions were compared with the appropriate vaccine virus in virus neutralisation tests; the majority appeared to be different from the vaccine virus and were presumably field viruses. However, some appeared more similar to the vaccine virus and the majority of these were associated with lameness after the first vaccination.

Animals↗
PubMed1993

Induction of CYP2B1 and 3A1, and associated monoxygenase activities by tamoxifen and certain analogues in the livers of female rats and mice.

Previous studies suggest long-term feeding of tamoxifen (Z-1-[4-(2-dimethylamino-ethoxy)phenyl]1,2-diphenyl-1-butane) to rats gives rise to liver tumours, while mice are resistant. The effects of tamoxifen on cytochrome P450 isoenzymes and associated monoxygenase activities in the livers of female Fischer rats and C57Bl/6 and DBA/2 mice have been compared. Total microsomal cytochrome P450 was not induced in the livers of rats given tamoxifen (45 mg/kg daily for 4 days) and was in fact significantly reduced after 3 days treatment. In contrast, there was a 30-60-fold increase in the metabolism of benzyloxy- and pentoxyresorufins to resorufin. Ethoxyresorufin O-deethylase was induced only 2.5-fold. The regio- and stereo-specific hydroxylation of testosterone following tamoxifen pretreatment of rats showed a general time- and dose-dependent induction. 6 beta- and 16 alpha-hydroxylation of testosterone together with oxidation to androstenedione were increased 2-3-fold while 2 beta-hydroxylation was induced only marginally, suggesting that tamoxifen produces a mixed pattern of induction with a significant phenobarbitone-like component. No induction of the 2 beta- or 6 beta-hydroxylation pathway occurred in either mouse strain. In rats, immunoblotting experiments with polyclonal antibodies raised against CYP2B1 or 3A1 showed that tamoxifen pretreatment resulted in 2-3-fold increases in both CYP2B1, 2B2 and 3A1 proteins, relative to controls. Immunohistochemistry of rat liver sections showed a centrilobular localization of these induced proteins. Similar patterns of induction as measured by immunoblotting experiments and testosterone hydroxylation were seen following the administration of structurally related analogues, toremifene and droloxifene (3-hydroxytamoxifen), thought to be non-carcinogenic in the rat. No induction of these monooxygenase activities was seen in C57Bl/6 mice and only small increases in benzyloxy and pentoxyresorufin metabolism were in DBA/2 mice. It is suggested that the induction of cytochrome P450-dependent activities by tamoxifen may result in accelerated liver metabolism of this drug with important implications for the disposition of tamoxifen in vivo and also for its metabolic conversion to genotoxic metabolite(s). The difference in inducibility of cytochrome P450-dependent monooxygenase activities between rats and mice offers a plausible and testable hypothesis that the difference in tamoxifen metabolism between the two species may contribute to their carcinogenic response to tamoxifen.

Animals↗
PubMed1993

Radiographic progression of hospital referred osteoarthritis of the hip.

Various factors have been considered important in the rate of progression of osteoarthritis of the hip, though few data are available from large longitudinal studies. One hundred and thirty six patients referred to hospital (85 women, 51 men; mean age 65 years, range 29-86 years) with osteoarthritis of the hip (192 affected hips) were followed up for a median of 27 (range 3-72) months. One hundred and six patients (144 affected hips) were reviewed for a minimum of one year (median 28, range 12-72 months). Fifty three per cent of all osteoarthritic hips required an operation at a median of 14 (range 3-48) months from entry. All radiographs before and after entry were examined (median four films for each patient over a median of three years, range 0.5-19 years). Hips showing rapid radiographic progression on prospective films more often had superior migration, or an atrophic bone response; those with no progression more often had an indeterminate, medial, or axial migration pattern, protrusio or mild osteoarthritis at presentation. A higher occurrence of rapid progression was seen in women, in those of older age at symptom onset, and in hips with a higher Kellgren grade at entry; men more often showed no progression. Age at presentation, body mass index, symptom duration, or presence of chondrocalcinosis, hand osteoarthritis/nodes, or Forestier's disease did not influence progression. This study supports the contention that, at the time of hospital referral, certain patient characteristics and radiographic features at the hip may help to identify those at high risk of rapidly progressive hip osteoarthritis.

Adult↗
PubMed1993

A program to assist sensory-impaired patients.

The recent enactment of the Americans with Disabilities Act challenges health care institutions to provide facilities and services to persons with a variety of disabilities. A hospital-wide Sensory Assistance Program was developed and implemented to identify and assist patients with visual, hearing, or speech impairments. Preliminary evaluation of the program indicates very positive patient and staff approval and acceptance and minimal cost outlays to the institution.

Academic Medical Centers↗
PubMed1993

Acute lymphoid leukemia. No evidence of consistent chemotherapy-induced intestinal malabsorption.

PURPOSE: The impact of chemotherapeutic agents on intestinal functional integrity was assessed in 16 consecutive children treated for acute lymphoid leukemia (ALL) and in remission on maintenance therapy. PATIENTS AND METHODS: Measurements of height, weight, nutrient intake, fecal fat, D-xylose absorption, and lactose absorption were obtained at diagnosis and every 6 months during therapy. RESULTS: At diagnosis all children were age appropriate for height and weight. A decrease in height velocity occurred in 73% at 12 months and 29% at 24 months. A reduced weight velocity was seen in 40% at 12 months and 14% at 24 months. Nutrient intake was more than two thirds the recommended nutrient intake (RNI) for energy in 70% of the children and > 100% RNI for protein in all but one child. Gastrointestinal investigations at diagnosis were normal, and no child had symptoms suggestive of malabsorption. Fecal fat excretion was abnormal in only one child, after therapy-induced pancreatitis, and returned to normal with pancreatic enzyme supplementation. D-xylose absorption became abnormal in two children at 6 months on therapy, normalized at 12 months, and remained normal on further evaluations. Intestinal lactose absorption was abnormal in four of 12 children. CONCLUSIONS: These results suggest that habitual nutrient intake is adequate and that there is no generalized malabsorption in children during treatment for ALL that might interfere with their overall nutritional status. However, mild to moderate alteration in intestinal functional integrity may occur transiently in some children.

Adolescent↗
PubMed1993

An assessment of global health status in survivors of acute lymphoblastic leukemia in childhood.

PURPOSE: Progressive improvement in survival rates of children with cancer demands an appraisal of the "cost of cure." Much information is available on the frequency and severity of individual late effects in long-term survivors, but there are few data on multiple sequelae in individual patients or on global morbidity burdens. PATIENTS AND METHODS: To address this issue, we developed a multiattribute health status classification system. This consists of three to five levels of function within each of seven attributes: sensation, mobility, emotion, cognition, self-care, pain, and fertility. The system was applied to survivors of acute lymphoblastic leukemia (ALL). RESULTS: Overall burdens of morbidity were greater in those who had had "high-risk" disease than in children treated less intensively for "standard-risk" ALL. Deficits in emotional and cognitive status were especially common (alone and in combination). These were more prevalent in younger patients and exhibited a dose relationship to cranial irradiation. CONCLUSIONS: Such appraisals of morbidity must be compared with prevalence rates in the general population.

Activities of Daily Living↗
PubMed1993

The Kingston Project. II. The effects of high energy supplement and metronidazole on malnourished children rehabilitated in the community: anthropometry.

Malnourished children (mean age 1.2 years) referred from public health clinics to a paediatric metabolic ward in Kingston, Jamaica, were enrolled for treatment in a community-based health care project and were randomly allocated to one of two groups. The first group was treated at home with metronidazole and then for 6 months using the standard health care provided from local clinics by community health aides. The second group was given the same drug and home treatment, but in addition received a high energy supplement of 3.31 MJ daily for 3 months. We have previously shown a significant advantage in both weight and height gain for a group given the same supplement in contrast with standard health care controls (Heikens et al., 1989, Eur. J. Clin. Nutr. 43, 145-160), and in this study test the addition of a drug treatment aimed at reducing malabsorbtion due to a possible microbial overgrowth of the small bowel in malnourished children. This paper reports anthropometric findings showing significant benefits from both the drug and nutritional treatments. Greatest gains were by the group given both treatments, but the group given the antibiotic treatment, without energy supplementation, also made better growth recovery than did controls. Only 8% of the children treated with metronidazole failed to respond to community-based intervention and were admitted to hospital, compared with 19% for the other groups (P < 0.05). These findings support targetted high-energy supplementation for the rehabilitation of moderately malnourished children receiving health clinic care, and suggest further that such programs should include antibiotic treatment directed at SBBO.

Analysis of Variance↗
PubMed1993

The Kingston Project. III. The effects of high energy supplement and metronidazole on malnourished children rehabilitated in the community: morbidity and growth.

In the Kingston Project malnourished children referred from public health clinics to a metabolic ward were treated at home using community health aides within the existing health service. We have previously provided anthropometric results showing significantly greater gains in weight and length for groups given a high energy supplement (3.31 MJ daily) for 3 months during treatment, and greatest gains for a group treated with metronidazole at the beginning of supplementation [Heikens et al., Eur. J. Clin. Nutr. 43, 145-160 (1989); 47, 160-173 (1993)]. We now present findings on morbidity and relate these to the separate interventions and to growth velocities. Although referral was solely on nutritional criteria, 65% of the sample were found to have additional illnesses at enrollment. During the study period (6 months) upper respiratory tract infections (URTI) were the commonest illness in all groups; there were significantly more gastroenteric infections in the group given the supplement, but not the antibiotic, treatment; the children who received only the standard health service care were ill more often and for longer periods than children in the other groups. Diarrhoea, fever and dysentery prevalences were all found to relate significantly to weight velocity, and although prevalences differed between treatment groups, the detrimental effect on velocity was similar whichever the group.

Child, Preschool↗