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Biomedical subjects

S Jones

Publications and source records attributed to S Jones.

At least 127 records · Page 7Linked to original sources
PubMed2001

Pediatric Prevention Network: a multicenter collaboration to improve health care outcomes.

Nosocomial infections and antimicrobial resistance are major causes of mortality and morbidity and have become a major public health focus. To date, most national and international nosocomial infection surveillance and prevention activities have been focused on adults, despite the fact that pediatric patients are at high risk for nosocomial infections because of their immature immune systems and prevalent device usage. In 1997 the Hospital Infections Program at the Centers for Disease Control and Prevention and the National Association of Children's Hospitals and Related Institutions partnered to establish a Pediatric Prevention Network. Infection control professionals and their hospital administrators at all children's hospitals were invited to participate. The objectives of the network are to establish baseline infection rates; design, implement, and evaluate prevention interventions; establish benchmark rates and best practices; and serve as a site for multicenter studies to improve outcomes for hospitalized children. This network serves as a model for quality improvement systems in health care.

Child↗
PubMed2001

Infection control programs at children's hospitals: a description of structures and processes.

BACKGROUND: Infection control (IC) structures and processes determine the effectiveness of surveillance efforts to prevent infections in health care settings. METHODS: A survey was sent to 56 children's hospitals collaborating in the Pediatric Prevention Network (PPN). RESULTS: Completed surveys were returned from 48 hospitals. Responsibility for the IC program resided with the medical director (21%); vice president for patient care (18%); quality improvement director (17%); other senior hospital administrator (15%); or other hospital personnel (18%). Forty-two hospitals had an IC committee; 32 had antimicrobial restriction/control policies; and 21 had an antimicrobial restriction/control task force or committee. Components of antimicrobial restriction programs included infectious disease specialist approval, restricted formularies, selective susceptibility test reporting, and staff education programs. Many methods were used to detect infections, including microbiology laboratory reports (100%); record reviews (98%); informal reports from providers (90%); and readmission reviews (77%). CONCLUSIONS: Children's hospitals vary widely in how they design and implement their IC functions. These variations influence adverse event detection and nosocomial infection rate calculations. If medical errors, including nosocomial infections, are to be detected and hospital rates compared, standardized methods to collect, analyze, and report data are needed. The PPN has initiated activities to standardize surveillance and IC practices in participating hospitals.

Anti-Bacterial Agents↗
PubMed2001

Similarities and differences in eyewitness testimonies of children who directly versus vicariously experience stress.

This study tested questions of ecological validity by comparing the eyewitness testimonies of children directly experiencing a painful inoculation experience those of children in a yoked-control group who vicariously experienced the inoculation onwith videotape. The study involved 86 5-year-olds, divided between 2 groups: the experiential and yoked control. The experiential group was followed through a health department with a video camera as they received diphtheria, pertussis, tetanus (DPT), and oral polio inoculations. They were tested immediately, 20 min later, and 1 month later. Each child in the yoked-control group merely watched the videotape of his or her counterpart in the experiential group, made similar ratings of pain, and was given the same tests and suggestions. Stress and personal experience affected items congruent with the stressor to produce flashbulb-like memories, with slower rates of forgetting for some items, such as nurse identifications, and greater suggestibility for other items, such as estimates of needle size. These and the apparently conflicting results in the literature were said to make sense when personally experienced stress was viewed from S.-A. Christianson's (1992) interactive perspective rather than as a single ubiquitous variable.

Attitude to Health↗
PubMed2001

Management of older patients with hypertension in primary care: improvement on the rule of halves.

OBJECTIVES: the benefits of treatment of hypertension in older people are well-established but implementation of this knowledge may be sub-optimal. We have determined recent primary care management of older people with hypertension. METHODS: we examined health records (n = 6986) of a 1 in 7 sample of patients aged 65-80 years from a random sample of practices (n = 51) in the former Northern Region of the UK, stratified by health authority, for the previous 6 years. We recorded documented risk factors, diagnosis of hypertension, three most recent blood pressure readings, current drug therapy and previous blood pressure lowering therapy, and presence of coexistent pathology. RESULTS: blood pressure was defined as hypertensive (> or = 160/> or = 90 mmHg; one or both values above these limits), normotensive or undetermined using a validated algorithm. In 30% of patients, blood pressure status was undetermined. Thirty-five percent of subjects were found to be hypertensive. Of these, 70% were receiving antihypertensive treatment but only 30% of treated patients had controlled (< 150 and 90 mmHg) and 13% well controlled (< 140 and 85 mmHg) blood pressure. In all, 14% of older hypertensive patients were detected, treated and had their hypertension controlled. There were significant differences between practices in the proportion of hypertensive patients treated (P < 0.001) and in the proportion of hypertensive patients whose blood pressure was controlled (P < 0.01). CONCLUSIONS: treatment of hypertension in older people in primary care has improved in terms of detection and treatment but in only one-third of patients is high blood pressure controlled. There remain important opportunities for prevention of stroke and myocardial infarction in this age group through achieving improved blood pressure control.

Aged↗
PubMed2001

Second-hand smoke at work: the exposure, perceptions and attitudes of bar and restaurant workers to environmental tobacco smoke.

OBJECTIVES: To investigate the knowledge of, and perceptions, attitudes and exposure to second-hand smoke (SHS) of staff in the New Zealand hospitality industry. METHOD: Face-to-face interviews with bar staff, waiters, and bar and eating-place managers and owners in Wellington during the 1999-2000 summer. An analysis was made of the 1999 New Zealand Electoral Roll to find the number of those most exposed to SHS. RESULTS: 435 interviews with full data recovery were completed at 364 locations; 59% of interviewees were exposed to SHS, including 77% of those at licensed premises. More than half of those exposed to workplace smoke reported irritation from SHS to their throat or lungs. Less than a third were aware of the risk of strokes from SHS. Three-quarters of interviewees wanted some sort of smoking restriction in bars. CONCLUSIONS: The majority of interviewees were at risk of premature death and disease because of exposure to workplace smoke, and had an incomplete knowledge of the dangers to which they were exposed. More than 5,000 similar workers in New Zealand appear to share this risk. IMPLICATIONS: This industry needs legislation to make it smoke free.

Adolescent↗
PubMed2001

Mitochondrial enteropathy: the primary pathology may not be within the gastrointestinal tract.

BACKGROUND: Mitochondrial DNA (mtDNA) defects are an important cause of disease. Although gastrointestinal symptoms are common in these patients, their pathogenesis remains uncertain. AIM: To investigate the role of the mtDNA defect in the production of gastrointestinal dysfunction. PATIENT: A 20 year old woman who presented at 15 years of age with recurrent vomiting and pseudo-obstruction, who did not respond to conservative management and ultimately had subtotal gastrectomy and Roux-en-y reconstruction. She subsequently presented with status epilepticus and was found to have a mitochondrial respiratory chain disorder due to a pathogenic mtDNA point mutation (A3243G). METHODS: Resected bowel was studied using light and electron microscopy and mtDNA analysed from both mucosal and muscular layers using polymerase chain reaction generated RFLP analysis. RESULTS: Histological and electron microscopic studies revealed no morphological abnormalities in the resected stomach, and molecular genetic analysis failed to identify the genetic defect in either the mucosal or muscle layers. CONCLUSION: This study suggests that in some individuals with gastrointestinal symptoms associated with established mitochondrial DNA disease, the primary pathology of the mitochondrial enteropathy lies outside the gastrointestinal tract.

Adolescent↗
PubMed2001

Association of the interleukin 1 receptor antagonist gene with ulcerative colitis in Northern European Caucasians.

BACKGROUND AND AIMS: An association between the allele 2 of the interleukin 1 receptor antagonist gene variable number tandem repeats polymorphism in intron 2 and ulcerative colitis was first reported in 1994. Subsequent studies in Caucasian Northern European patients have not confirmed this, although trends towards an association were observed. The lack of statistical significance could reflect inadequate power. In this study the association was reassessed in a large independent set of well characterised Caucasian patients and a meta-analysis of reported patient series was performed. PATIENTS AND METHODS: A total of 320 patients with endoscopically and histologically confirmed ulcerative colitis (124 pancolitis, 196 left sided and distal disease) and 827 ethnically matched controls were genotyped at polymorphic sites in the interleukin 1 receptor antagonist gene. Carriage rates were compared using chi(2) statistics. A meta-analysis of this and seven previous studies in North European Caucasian patients was performed using the Mantel-Haenszel chi(2) test. RESULTS: Patients had a significantly increased carriage rate of allele 2 compared with controls (52% v 45%; odds ratio 1.3 (95% confidence interval (CI) 1.01-1.7); p=0.04). The allele 2 carriage rate was highest in extensive colitis (carriage rate 56%; odds ratio 1.5 (95% CI 1.1-2.3) p=0.02) and in individuals who had undergone colectomy (carriage rate 55%; odds ratio 1.5 (95% CI 0.95-2.4); p=0.08). Meta-analysis of all eight studies showed a significant association between carriage of allele 2 and ulcerative colitis (odds ratio 1.23 (95% CI 1.04-1.45); p=0.01). CONCLUSIONS: The association of the interleukin 1 receptor antagonist gene polymorphism with ulcerative colitis is confirmed. The association is minor and confers only a small risk to an individual but will contribute a high attributable risk in a population due to the high allelic frequency. Accurate phenotypic characterisation defines more homogeneous subsets of patients, such as those with extensive disease, in whom the association is greater.

Adolescent↗
PubMed2001

Undergraduate community health nursing education in a neighborhood settlement house.

Undergraduate community health nursing faculty are continually challenged to find appropriate clinical placements. Prior to using an inner-city neighborhood settlement house as a clinical site, traditional public health and home-care agencies provided clinical placements for senior baccalaureate nursing students. The settlement house had several programs but did not have a traditional nursing department. A 14-item questionnaire was developed to examine student (N = 30) perceptions of the opportunities for course objectives to be met and student attitudes and beliefs regarding the settlement-house placement. The majority of the students agreed that the learning experiences at the settlement house provided opportunities to meet course objectives. Findings indicated that students who considered the neighborhood safe are more apt to recommend the clinical placement to other students (p < .01). Those students who believe that professional nursing services can help improve the health of people who live in the inner city are more apt to say, "This experience changed my beliefs regarding people who live in an inner-city neighborhood" (p < .01).

Attitude of Health Personnel↗
PubMed2001

Glutamate does not play a major role in controlling bone growth.

Bone cells express glutamate-gated Ca2+-permeable N-methyl-D-aspartate (NMDA) receptors and GLAST glutamate transporters. Blocking NMDA receptors has been reported to reduce the number of bone resorption pits produced by osteoclasts, and mechanical loading alters GLAST transporter expression, which should change the extracellular glutamate concentration and NMDA receptor activation. Thus, by analogy with the brain, glutamate is postulated to be an important intercellular messenger in bone, controlling bone formation and resorption. We found that activating or blocking NMDA receptors had no effect on bone formation by rat osteoblasts in culture. The number of resorption pits produced by osteoclasts was reduced by the NMDA receptor blocker MK-801 but not by another blocker AP-5, implying that this effect of MK-801 is unrelated to its glutamate-blocking action. By contrast, MK-801, AP-5, and NMDA had no consistent effect on the volume of pits. In mice with GLAST glutamate transporters knocked out, no differences were detected in mandible and long bone size, morphology, trabeculation, regions of muscle attachment, resorption lacunae, or areas of formation versus resorption of bone, compared with wild-type siblings. These data suggest that glutamate does not play a major role in controlling bone growth.

2-Amino-5-phosphonovalerate↗
PubMed2001

Prevalence of hepatitis C among injection drug users in England and Wales: is harm reduction working?

OBJECTIVES: This study sought to establish the prevalence of hepatitis C antibodies (anti-HCV) and hepatitis B antibodies (anti-HBc) among injection drug users in England and Wales. METHODS: A voluntary cross-sectional survey collected oral fluid samples and behavioral information; 2203 injectors were recruited through drug agencies, and 758 were recruited in the community. RESULTS: Prevalence was 30% for anti-HCV, 21% for anti-HBc, and 0.9% for HIV antibodies. Anti-HCV prevalence rates were significantly greater among those with longer injecting careers, those in older age groups, those residing in London, those recruited in drug agencies, those positive for anti-HBc, and those with a previous voluntary HIV test. CONCLUSIONS: Anti-HCV prevalence rates among injectors in England and Wales, where comprehensive harm reduction programs exist, are lower than rates in other industrialized countries.

Adult↗
PubMed2001

Low proliferative rate of invasive node-negative breast cancer predicts for a favorable outcome: a prospective evaluation of 669 patients.

This study was designed to compare outcome in terms of disease-free survival (DFS) in women with histologically negative axillary lymph nodes and documented low proliferative rate cancer to other well-defined prognostic factors including type of adjuvant treatment. Between 1988 and 1998, we studied 669 patients with invasive node-negative breast cancer up to 5 cm in size and low proliferative rate measured by flow cytometry to determine S-phase fraction (SPF) or by histochemistry (Ki67/MIB1). At a median follow-up of 53 months, 5-year DFS for the entire group was 94% and did not differ significantly by type of systemic adjuvant treatment: none (133 patients, 95% DFS), tamoxifen (441 patients, 94% DFS), or chemotherapy with doxorubicin and cyclophosphamide (95 patients, 92% DFS). In a multivariate prognostic factor analysis, only tumor size was significant; 5-year DFS was 96% for T1N0 cancer versus 89% for T2N0 cancer (P = 0.01). We have prospectively confirmed that a low rate of proliferation as measured by SPF or MIB1 determination confers an excellent prognosis in invasive node-negative breast cancer up to 5 cm in size, regardless of adjuvant treatment.

Adult↗
PubMed2001

Tension-free vaginal tape and percutaneous vaginal tape sling procedures.

PURPOSE: Midurethral synthetic sling procedures for treatment of stress urinary incontinence (SUI) are gaining increased attention from surgeons specializing in female pelvic reconstructive techniques seeking successful patient outcomes through reproducible simplicity. This report describes the procedural steps and methods used to maximize the potential for successful outcomes using techniques of midurethral synthetic sling placement. Reported complications and surgical outcomes are reviewed with respect to patient selection and minimizing the potential for morbidity and mortality as long-term clinical experience is accumulated. MATERIALS AND METHODS: Tension-free vaginal or transvaginal tape (TVT) and the recently introduced percutaneous vaginal tape (PVT) are two new procedural choices for placement of synthetic sling material at the midurethra. Both procedures use sling material composed of polypropylene mesh, a nonabsorbable synthetic material, placed at the level of the midurethra via an antegrade (PVT, using a percutaneous ligature carrier) suprapubic approach or retrograde (TVT, using vaginal trocars) vaginal approach. Patient selection, procedural techniques, and methods described are based on observations obtained or reported from clinical experience. Outcomes and complications for TVT are derived from a literature review of all published articles in Index Medicus from 1996 to 2000. RESULTS: The experience with TVT for the last 5 years is encouraging. At 3-year follow-up for TVT, reported cure rates for SUI range from 80% to 95%. A multitude of worldwide reports on PVT with shorter follow-up support the findings of the TVT experience. Reproducible findings with midurethral synthetic slings are the short operative times recorded for the sling procedure, ease of technical performance, minimal patient discomfort, and a high rate of early return of normal voiding function. The rate of complications such as obstructive voiding or de novo instability (0-15%) and urinary retention necessitating a secondary procedure (2-4%) appear to be equal to the rates of contemporary competing technologies and procedures for treatment of SUI. CONCLUSIONS: Preliminary reports and the experience at our institution suggest that the techniques of midurethral synthetic sling placement of TVT and PVT are reproducible, easy to master, and minimally invasive with respect to tissue handling. Although complications with all anti-incontinence procedures exist, understanding the anatomical considerations and methodology of these unique procedures should minimize patient morbidity, avoid patient mortality, and produce a high rate of durable success.

Female↗
PubMed2001

Development of antibodies to topical bovine thrombin after abdominal hysterectomy. A case report.

BACKGROUND: Topical thrombin spray is frequently used as a hemostatic agent in surgery, particularly following cardiovascular, orthopedic and neurologic surgery. Acquired coagulation factor inhibitors to thrombin and factor V may develop following gynecologic surgery with repeat topical thrombin use. CASE: A 45-year-old woman underwent total abdominal hysterectomy/bilateral salpingo-oophorectomy. Her past medical history included idiopathic thrombocytopenic purpura and Marfan's syndrome and past surgery included splenectomy and aortic valve replacement with a three-vessel coronary artery bypass graft. She was converted from Coumadin (DuPont Pharmaceuticals, Wilmington, Delaware) to heparin preoperatively, and heparin was stopped six hours before surgery, with normalization of her prothrombin time (PT) and partial thromboplastin time (PTT). Topical bovine thrombin spray was applied to the surgical field in anticipation of early resumption of heparin anticoagulation. Seven days after surgery, after recovering from some acute bleeding problems, the patient began to have elevation of her PT in spite of being off Coumadin for 10 days. Her PT and international normalized ratio (INR) continued to rise, reaching peak values of 31.4 and 6.99, respectively. A mixing study did not correct the problem, confirming the presence of coagulation inhibitors. The patient was given intravenous immunoglobulins and corticosteroids, and her PT/PTT and INR values slowly normalized. CONCLUSION: Acquired coagulation factor may develop following gynecologic surgery with topical thrombin use. This potential complication should be strongly considered in any patient prior to using topical bovine thrombin, especially those with a prior exposure or history of surgical procedures in which bovine thrombin is commonly used.

Abdomen↗
PubMed2001

Estrogen increases CD40 ligand expression in T cells from women with systemic lupus erythematosus.

OBJECTIVE: To examine the in vitro effects of estrogen on CD40 ligand (CD40L) expression in peripheral blood T cells isolated from patients with systemic lupus erythematosus (SLE) and normal controls. METHODS: T cells from female patients with SLE and controls were cultured in serum-free medium without and with 2-fluoroestradiol. Some T cells were activated by further culture on anti-CD3 coated plates. Calcineurin was activated in some T cells by culture in ionomycin. Cell surface CD40L was quantitated by FACS analysis. mRNA expression was measured using semiquantitative PCR. RESULTS: Lupus T cells cultured in medium containing 2-fluoroestradiol showed a significant (p = 0.04) increase in the amount of CD40L on the cell surface, but not in the number of positive cells, compared to the same T cells cultured without estradiol. Estradiol did not significantly change CD40L expression on the surface of T cells from normal women. In addition, the difference in cell surface CD40L between T cells cultured without and with estradiol was significantly greater (p = 0.048) on SLE than on normal T cells. Culture of SLE T cells in medium containing 2-fluoroestradiol followed by T cell receptor (TCR) activation for 2 h using anti-CD3 resulted in a significant (p = 0.04) estrogen dependent increase in CD40L mRNA. The estrogen dependent increases in SLE T cell CD40L mRNA and cell surface protein were blocked by the estrogen receptor antagonist ICI 182,780. SLE and normal T cells pretreated with estradiol and cultured with ionomycin for 2 h to activate calcineurin showed no significant differences in CD40L mRNA. CONCLUSION: These results suggest that estradiol, working through the estrogen receptor, stimulates the expression of CD40L in unstimulated and activated SLE T cells. Estradiol effects may be exerted on multiple regulatory steps that control CD40L expression. The estrogen dependent increase in CD40L expression could hyperstimulate SLE T cells and thereby contribute to the pathogenesis of SLE.

Adult↗