Search PubMed⌕ Search

Biomedical subjects

S Horton

Publications and source records attributed to S Horton.

At least 37 records · Page 2Linked to original sources
PubMed1996

Breastfeeding promotion and priority setting in health.

An increase in exclusive breastfeeding prevalence can substantially reduce mortality and morbidity among infants. In this paper, estimates of the costs and impacts of three breastfeeding promotion programmes, implemented through maternity services in Brazil, Honduras and Mexico, are used to develop cost-effectiveness measures and these are compared with other health interventions. The results show that breastfeeding promotion can be one of the most cost-effective health interventions for preventing cases of diarrhoea, preventing deaths from diarrhoea, and gaining disability-adjusted life years (DALYs). The benefits are substantial over a broad range of programme types. Programmes starting with the removal of formula and medications during delivery are likely to derive a high level of impact per unit of net incremental cost. Cost-effectiveness is lower (but still attractive relative to other interventions) if hospitals already have rooming-in and no bottle-feeds; and the cost-effectiveness improves as programmes become well-established. At an annual cost of about 30 to 40 US cents per birth, programmes starting with formula feeding in nurseries and maternity wards can reduce diarrhoea cases for approximately $0.65 to $1.10 per case prevented, diarrhoea deaths for $100 to $200 per death averted, and reduce the burden of disease for approximately $2 to $4 per DALY. Maternity services that have already eliminated formula can, by investing from $2 to $3 per birth, prevent diarrhoea cases and deaths for $3.50 to $6.75 per case, and $550 to $800 per death respectively, with DALYs gained at $12 to $19 each.

Adult↗
PubMed1996

The Phoenix Indian Medical Center experience with laparoscopic cholecystectomy during pregnancy.

Since the advent of laparoscopic cholecystectomy, there has been concern about its efficacy in the pregnant patient. This article reports the largest series to date and adds to the growing evidence that the procedure can be safely performed and has the potential to decrease morbidity and mortality. At the Phoenix Indian Medical Center, we performed laparoscopic cholecystectomy in eight women in the second trimester and one in the first trimester of pregnancy, and we attempted it in one patient in her late second trimester. Intra-abdominal pressure was maintained at or below 15 mm Hg. Subsequently, all 10 patients had term vaginal deliveries. In the pregnant patient, laparoscopic cholecystectomy appears to be safe with no morbidity or mortality seen in this series. Early mobilization has the potential to decrease postoperative complications and shorten hospital stay.

Adolescent↗
PubMed1995

Support for bereaved relatives in ICU.

It is of paramount importance that nurses offer counselling to all bereaved relatives. Relatives' understanding of the statements made on death certificates must be ensured.

Adult↗
PubMed1993

Granulated round cell tumor of cats.

Morphologic and biologic features of five feline granulated round cell tumours were compared with those previously reported to be of globule leukocyte and large granular lymphocyte origin. The five cats ranged from 6 to 9 years of age and presented with nonspecific gastrointestinal signs. Four of the five cats were tested for feline leukemia virus and were negative by enzyme-linked immunosorbent assay. The neoplastic process involved the abdominal cavity in all cases, with a predilection for the distal small intestine and mesentery. The liver and peripheral and thoracic lymphoid tissues were also sporadically affected. Neoplastic round cells contained 0.5-1.5-microns eosinophilic cytoplasmic granules that were difficult to discern on causal observation with hematoxylin and eosin stain but were deep blue and easily visualized when stained with phosphotungstic acid-hematoxylin. In two cases, epithelium in the affected ileum and liver contained unusually large numbers of apparently normal globule leukocytes. Ultrastructurally, the tumor granules tended to cluster at one nuclear pole and were spindle to round in shape with variably dense contents. Some granules contained a dense "cap" at one end or internal crystalloid bars that distorted the granule membrane. The tumors reported herein are similar to all three of the previously reported feline granulated round cell tumors and probably have a common cellular origin.

Abdominal Neoplasms↗
PubMed1992

ECMO in newborn infants: the Melbourne experience.

At the Royal Children's Hospital, Melbourne, extracorporeal membrane oxygenation (ECMO) has been used in the treatment of newborn infants with life-threatening respiratory or cardiac failure since May 1989. The main indications for the use of ECMO are that the disease is reversible, the surviving infant is likely to be normal and there is an 80% likelihood of death without ECMO. Sixteen of 22 (73%) newborn infants have survived at least 6 months after ECMO. Fourteen of 16 (87.5%) infants receiving ECMO (who did not have a congenital diaphragmatic hernia) were functionally normal survivors; the other two infants died. Two of six infants with congenital diaphragmatic hernia who received ECMO were discharged and survived to have normal neurological and respiratory function at 6 month follow up. These results are similar to results from other centres internationally. It would appear that ECMO is a useful therapy for near-term newborn infants with otherwise fatal cardiorespiratory failure.

Australia↗
PubMed1992

Multimedia for clinical education in myocardial perfusion imaging.

Interactive multimedia has many advantages as a presentation medium for diagnostic imaging case studies, particularly for teaching digital imaging techniques such as myocardial perfusion imaging. Multimedia documents may incorporate interactive audiovisual presentations, sophisticated diagnostic images, anatomical illustrations, and text in medical instructional materials. The article describes a multimedia teaching atlas of SPECT and planar myocardial perfusion imaging delivered on Apple Macintosh II microcomputers, and discusses some of the advantages of delivering medical educational materials with interactive multimedia techniques.

Computer-Assisted Instruction↗
PubMed1991

Centrifugal pump left heart assist in pediatric cardiac operations. Indication, technique, and results.

Twelve children aged 6 days to 12 years had left or common atrial to aortic extracorporeal support with a centrifugal pump after cardiac operations. Left ventricular assist time ranged from 38 to 190 hours. Ten patients were successfully weaned from left ventricular assist device support; four hospital deaths occurred afterward. All six survivors were discharged from the hospital with improved left ventricular function. Although the follow-up time is short and the experience limited, we consider the centrifugal pump type of left ventricular assist device to be a potentially lifesaving treatment modality for selected pediatric patients having cardiac operations.

Cardiac Output, Low↗
PubMed1990

Use of anti-CD3 monoclonal antibody in the generation of effector cells from human solid tumors for use in cancer biotherapy.

Activated lymphocytes derived from tumor biopsies are very important as a source of biotherapy for cancer. The growth of lymphocytes requires periodic stimulation with specific antigen. In the case of tumor-derived lymphocytes, tumor cells in the biopsy can serve this function. This stimulation provides proliferative potential as well as functional specificity. Often, however, required numbers of viable tumor cells are not available for antigen dosing. In the present study, anti-CD3 antibody was used as a substitute for specific antigen in the generation of effector cells for biotherapy. Periodic stimulation of tumor-derived activated cells (TDAC) using anti-CD3 antibody immobilized on plastic tissue culture plates or PL-732 plastic bags resulted in continued proliferation of the TDAC. In addition, maintenance of cytotoxic activity was observed. In this study, we expanded lymphocytes from 15 tumor biopsies (five different tumor types) to therapeutic doses (greater than 5.0 X 10(10) TDAC). The average time for expansion was 70 days. Our studies showed upregulation of CD25 expression by 18 h. Proliferation of the TDAC occurred when cultures were supplemented with interleukin-2 (IL-2). The characteristics of anti-CD3 antibody-stimulated TDAC were similar to those reported before by our group using tumor biopsy for stimulation. This study provides evidence for the practical usefulness of anti-CD3 antibody stimulation of lymphocytes used in the biotherapy of cancer.

Antibodies, Monoclonal↗
PubMed1983

Cost-effectiveness and user characteristics of clinic based services for the treatment of diarrhea: a case study in Bangladesh.

This study compares the cost-effectiveness of three services for the treatment of diarrhea, in a rural area of Bangladesh. It also examines patterns of user composition, and how these depend on factors other than disease severity and incidence. The three services are a large hospital-style treatment center, an ambulance system bringing patients from greater distances, and a small treatment center staffed by paramedics. The results show that the long run average cost per patient is about +16 at the large center, with an additional +13 if the patient came by ambulance, compared to +3 at the small center. Corresponding costs per death averted were +1300, an additional +360, and +190 respectively. Previous studies have suggested that there is no more cost-effective alternative for the prevention of diarrhea, although in future home-based oral rehydration therapy may be a potential alternative. Each service exhibits use patterns suggesting that males and especially small boys receive preferential access to treatment. This bias is exacerbated as distance from the center increases, or if a fee is charged. The study concludes firstly that diarrhea treatment costs in clinics are relatively high, and secondly that unintended biases in service use should be an important consideration in service design.

Allied Health Personnel↗
PubMed1979

Autoimmune hemolytic anemia and the Kell blood groups.

Approximately one in 250 people with autoimmunity involving their red cells have IgG autoantibodies with specificity in the Kell blood groups. Red cells of these individuals have an acquired temporary weakening of their Kell antigens. Some of the patients also have allo-anti-K in their serum. This report presents a case in which an IgG autoantibody may define a new high-incidence red cell antigen related to the Kell blood groups. The patient's Kell blood group antigens are depressed, and his serum contains allo-anti-K. It is postulated that reduced red cell Kell antigenicity is caused by enzymatic degradation, possibly of bacterial origin, and that the acquired loss of Kell antigens, the Kell-specific autoimmune state, and the serum all0-anti-K, are all related aspects of one phenomenon.

Adult↗
PubMedDate not supplied

Correct coordination of neuronal differentiation events in ventral forebrain requires the bHLH factor MASH1.

MASH1 is a bHLH transcription factor specifically expressed in the developing nervous system that has an essential role in the formation of multiple neuronal lineages in the peripheral and central nervous systems. Here we demonstrate the requirement for MASH1 for normal development of ventral forebrain structures. MASH1 is expressed at high levels in the ventral telencephalon and specific regions within the ventral diencepharon. In the absence of MASH1, tissue morphology, proliferation, and gene expression within these forebrain regions is disrupted. The decreased incorporation of BrdU in the neuro-epithelium and the enlargement of the ventricles demonstrate a reduction in cell proliferation. A loss of anatomically distinct lateral and medial ganglionic eminences, and a disruption of axons traversing this region, indicate abnormalities in cell-type specification. The aberrant expression of Tuj-1, a marker of neuronal differentiation in the neuroepithelium, and Dlx, a marker of regional cell identity, in the ventricular zone in the MASH1 mutant brains suggest coordination of differentiation events is disrupted. In addition, the involvement of MASH1 in lateral inhibition processes that affect the development of these forebrain regions is implicated. Taken together, an essential role for MASH1 in the coordination of events required for correct cell-type specification and timing of differentiation during neural development in ventral forebrain regions is demonstrated.

Animals↗
PubMedDate not supplied

Examining interaction in language therapy.

Discussions around a 'theory of therapy' have prompted attempts to delineate the components of therapy for language impairment in aphasia. Here it is suggested that the therapy components associated with how language therapy is enacted need more precise specification, especially in relation to what is entailed by interaction between therapist and person with aphasia. Presented too is a system used for the analysis of interaction in language impairment therapy for aphasia and its possible applications are discussed. Components of the system are described and a sample analysis presented. The methodological difficulties entailed in making comparisons of therapy enactment are discussed. It is suggested furthermore that unless more is known about precisely defined interactions in therapy, it will be difficult to answer basic questions not only about how language therapy is being carried out, but also, subsequently, whether the ways in which therapy tasks are enacted have a significant impact on the outcome.

Aphasia↗
PubMedDate not supplied

Teaching and learning speech and language therapy skills: the effectiveness of classroom as clinic in speech and language therapy student education.

BACKGROUND: Terms such as 'clinical intuition' have often been applied to the practice of speech and language therapy. Various authors have aimed to make the process of therapy practice more explicit, and it is argued that recently developed descriptive/analytic frameworks have the potential to engender the critical mindset necessary for student speech and language therapists to become good reflective practitioners, with the potential for enhancing clinical education. AIMS: To investigate whether and how aspects of clinical skills education could be usefully addressed in an academic, as opposed to a clinical, setting. The study aimed to address the question of whether use of an interaction analysis system, in conjunction with video observation, and 'practice simulation' in a teaching-learning programme could be shown to have a positive impact on: (1) students' perceptions of their own understanding and practice of therapy, and their perceptions of themselves as self-reflective practitioners; and whether (2) this was borne out by students' ability to observe and interpret therapeutic interaction, as measured by (i) an objective written assessment; (ii) an objective video observation assessment; and (iii) assessment of their abilities in clinical practice. METHODS & PROCEDURES: Thirty-six students from City University took part in an experimental, placebo-controlled study using a deferred intervention design. Assessments designed to reflect changes resulting from the teaching-learning curriculum were carried out pre- and post-intervention with experimental and control groups. Quantitative and qualitative results were obtained. OUTCOMES & RESULTS: The intervention programme was found to have had a significant impact on students' perceptions of their understanding of therapy, but not on their perceptions of their practice of therapy. The experimental group scored significantly better on a written assessment of 'interpretation of therapy interaction', but were no better than the control group on a 'Video observation' assessment. Owing to attrition and the poor quality of videos submitted for assessment, it was not possible to measure changes in actual clinical practice. Qualitative feedback from the teaching-learning programme suggests that students generally found the approach to be beneficial. CONCLUSIONS: While there were some encouraging results, it is still uncertain whether addressing the actual practice of therapy in an academic setting gives 'added value' to the work carried out on clinical placements. However, there is no doubt that bringing this type of programme under the umbrella of an academic institution would greatly increase the consistency of teaching and the range of experiences available to students.

Adult↗