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Biomedical subjects

S Mason

Publications and source records attributed to S Mason.

At least 37 records · Page 2Linked to original sources
PubMed2003

Screening and follow up assessment in three cases of auditory neuropathy.

Three children with auditory neuropathy are described. Two were detected via a targeted neonatal hearing screening programme based on auditory brain stem response testing, and one via the routine Health Visitor Distraction Test. Auditory neuropathy is an important but poorly understood disorder which has implications on planning future hearing screening policy and management of hearing impairment.

Evoked Potentials, Auditory, Brain Stem↗
PubMed2003

Prehospital use of paracetamol among children attending the accident and emergency department.

OBJECTIVES: To identify patterns of prehospital administration of paracetamol to children who were perceived to be feverish by their carers. METHODS: A prospective cohort study of carers of children attending a paediatric accident and emergency (A&E) department. Carers of children completed a questionnaire to identify domestic patterns of paracetamol use. Data were collected on temperature of the child in the A&E department, administration of antipyretics in the A&E department, diagnosis, and disposal from the A&E department. RESULTS: Seventy five adults attending the A&E department consented to involvement. Sixty five of the children were feverish on arrival in the A&E department. Twenty one children (32.3%) had not received paracetamol before attending. There was a significant relation between knowledge of the antipyretic properties of paracetamol and administration (chi(2)=5.0, p<0.05). There was a significant correlation between fever and administration of paracetamol in the A&E department (chi(2)=23.7, p<0.01), however, 15 feverish patients (24.6%) were not treated. CONCLUSIONS: Most carers administer paracetamol appropriately in the prehospital setting. Administration correlates significantly with knowledge of its benefits. There is scope for education of carers and A&E department staff in the in the appropriate use of antipyretics such as paracetamol.

Acetaminophen↗
PubMed2003

Discharge from triage: modelling the potential in different types of emergency department.

OBJECTIVE: To assess the potential for patients to be assessed and discharged directly from triage in an emergency department (ED). METHODS: Modelling was undertaken by collection of retrospective electronic data from four different EDs. Serial removal of groups was undertaken using data from coding systems related to patients details of admission/treatment/investigations and procedure undertaken. The final group left were analysed for ambulance usage, prior primary care consultation, and age group. RESULTS: 29.4% patients were discharged after clinical assessment but without any specific treatment or investigation. It was seen that of the patients who can be considered for discharge from triage, 15.5% were brought to the ED by ambulance, 3.5% were patients who had already consulted primary care, and 11% were children. CONCLUSIONS: This study suggests that a large percentage of patients seen in EDs may not require the extra facilities of that department. There is potential for a large number to be discharged within a few minutes of arrival if appropriate assessment skills are available at first contact. This may require more senior assessment than is currently used. This study has not assessed safety of such a system or the times of day when it is best deployed.

Adult↗
PubMed2003

Developing a community paramedic practitioner intermediate care support scheme for older people with minor conditions.

INTRODUCTION: The Department of Health document Reforming emergency care stated that new initiatives need to be developed to improve the care and assessment of patients. The Audit Commission has suggested that ambulance services should be allowed to decide who should be sent to each type of emergency and treat some patients at home. AIMS: This scheme explores a new way of providing clinical assessment of older patients in their homes or in care homes within Sheffield. It sets out to provide a very patient centred model of care by providing community based clinical assessment for patients presenting to the emergency services with minor acute conditions. Scope, development, and structure of scheme: The scheme trains paramedic practitioners in the assessment and treatment of minor conditions to emergency nurse practitioner level. It consists of a three week full time theory based course and a 45 day period of supervised clinical practice based in the emergency department, minor injury unit, care of the elderly falls clinic, and with community services. Subsequently, the competence of the practitioners is assessed. Service delivery: The service will be activated by a 999 call between 0800 to 2000 each day. It is anticipated that between 25% to 50% of patients eligible to receive the service will be assessed and treated within the home. This approach to providing emergency care is untested and the frequency of use, patient acceptability, safety, and cost effectiveness are unknown, therefore rigorous assessment is essential through a randomised controlled trial.

Aged↗
PubMed2002

The cost-effectiveness of population Helicobacter pylori screening and treatment: a Markov model using economic data from a randomized controlled trial.

BACKGROUND: Economic models have suggested that population Helicobacter pylori screening and treatment may be a cost-effective method of reducing mortality from gastric cancer. These models are conservative as they do not consider that the programme may reduce health service peptic ulcer and other dyspepsia costs. We have evaluated the economic impact of population H. pylori screening and treatment over 2 years in a randomized controlled trial and have incorporated the results into an economic model exploring the impact of H. pylori eradication on peptic ulcer disease and gastric cancer. METHODS: Subjects between the ages of 40 and 49 years were randomly invited to attend their local primary care centre. H. pylori status was evaluated by (13)C-urea breath test and infected individuals were randomized to receive omeprazole, 20 mg b.d., clarithromycin, 250 mg b.d., and tinidazole, 500 mg b.d., for 7 days or identical placebos. Economic data on health service costs for dyspepsia were obtained from a primary care note review for the 2 years following randomization. These data were incorporated into a Markov model comparing population H. pylori screening and treatment with no intervention. RESULTS: A total of 2329 of 8407 subjects were H. pylori positive: 1161 were randomized to receive eradication therapy and 1163 to receive placebo. The cost difference favoured the intervention group 2 years after randomization, but this did not reach statistical significance (11.42 ponds sterling per subject cost saving; 95% confidence interval, 30.04 ponds sterling to -7.19 pounds sterling; P=0.23). Analysis by gender suggested a statistically significant dyspepsia cost saving in men (27.17 ponds sterling per subject; 95% confidence interval, 50.01 pounds sterling to 4.32 pounds sterling; P=0.02), with no benefit in women (-4.46 per subject; 95% confidence interval, -33.85 pounds sterling to 24.93 pounds sterling). Modelling of these data suggested that population H. pylori screening and treatment for 1,000,000 45-year-olds would save over 6,000,000 pounds sterling and 1300 years of life. The programme would cost 14, 200 pounds sterling per life year saved if the health service dyspepsia cost savings were the lower limit of the 95% confidence intervals and H. pylori eradication had only a 10% efficacy in reducing mortality from distal gastric cancer and peptic ulcer disease. CONCLUSIONS: Modelling suggests that population H. pylori screening and treatment are likely to be cost-effective and could be the first cost-neutral screening programme. This provides a further mandate for clinical trials to evaluate the efficacy of population H. pylori screening and treatment in preventing mortality from gastric cancer and peptic ulcer disease.

Adult↗
PubMed2002

The psychological burden of injury: an 18 month prospective cohort study.

OBJECTIVES: To determine the prevalence of post-trauma psychological problems among a cohort of male accident and emergency department patients admitted to hospital. To identify the changes in their psychological symptoms over an 18 month follow up period. METHODS: A prospective cohort study of male accident and emergency department patients who were admitted for treatment of an injury. Baseline interview recorded demographic details and accident details. Standardised questionnaires measured baseline psychological state and personality type. Follow up at six weeks, six months, and 18 months after injury was by face to face interview or postal questionnaire and recorded progress since injury, and documented psychological status through the use of standardised questionnaires to detect psychiatric disorder and symptoms of post-traumatic stress disorder (PTSD). RESULTS: 210 male patients were recruited into the study. Psychiatric disorder was identified in 47.6% of responders at six weeks, and 43.4% at six months after injury. This improved significantly at 18 months. PTSD symptoms were moderate in 25%-30% and severe in 5%-14% and did not change significantly over the study period. A significant relation was found between previous psychiatric history and psychological symptoms at 18 months after injury. No relation was identified between injury severity and psychological status after injury. CONCLUSION: This study finds a high prevalence of psychological distress in male accident and emergency department patients after injury. Although some symptoms resolve over the follow up period, a proportion remain and may be related to previous psychiatric history. There was no relation identified between severity of injury and psychological morbidity.

Adolescent↗
PubMed2001

Anion binding with two polyammonium macrocycles of different dimensionality.

A comparative study of the binding of nitrate and sulfate with a polyammonium monocycle L(1), (3,6,9,17,20,23-hexaazatricyclo[23.3.1.1(11,15)]-triaconta-1(29),11,13,15(30),25,27-hexaene), and the corollary bicycle L(2), (1,4,12,15,18,26,31,39-octaazapentacyclo-[13.13.13.1(6,10).1(20,24).1(33,37)]-tetratetraconta-6,7,9,20(43),21,23,33(42),34,36-nonaene), is reported. Potentiometric studies indicated negligible binding for L(1) and nitrate, but high affinity was observed for sulfate (log K(H5L(SO4)/H5L-SO4) = 3.53(1), log K(H6L(SO4)/H6L-SO4) = 4.36(1)). Stronger binding was observed for the cryptand L(2) with both nitrate and sulfate (log K(H6L(NO3)/H6L-NO3) = 3.11(5), log K(H7L(NO3)/H7L-NO3) = 3.55(5); log K(H6L(SO4)/H6L-SO4) = 4.43(1), log K(H7L(SO4)/H7L-SO4) = 4.97(5)). Five crystal structures are reported: the nitrate (1) and sulfate (2) salts of L(1), the free base (3) of L(2), and the nitrate (4) and tosylate (5) salts of L(2). Structural results for L(1) indicate relatively planar monocycles with cis and trans orientations of the phenyl groups for 2 and 1, respectively, with the anions above and below the monocycle rings. For L(2), key features include an encapsulated water and intricate water network in 3, two encapsulated and four external nitrates and two external water molecules in 4, and six external tosylates with sulfonate groups pointing into the cavity and eight external waters in 5.

Aza Compounds↗
PubMed2001

Vasopressin versus epinephrine for inhospital cardiac arrest: a randomised controlled trial.

BACKGROUND: Survival rates for cardiac arrest patients, both in and out of hospital, are poor. Results of a previous study suggest better outcomes for patients treated with vasopressin than for those given epinephrine, in the out-of-hospital setting. Our aim was to compare the effectiveness and safety of these drugs for the treatment of in-patient cardiac arrest. METHODS: We did a triple-blind randomised trial in the emergency departments, critical care units, and wards of three Canadian teaching hospitals. We assigned adults who had cardiac arrest and required drug therapy to receive one dose of vasopressin 40 U or epinephrine 1 mg intravenously, as the initial vasopressor. Patients who failed to respond to the study intervention were given epinephrine as a rescue medication. The primary outcomes were survival to hospital discharge, survival to 1 h, and neurological function. Preplanned subgroup assessments included patients with myocardial ischaemia or infarction, initial cardiac rhythm, and age. FINDINGS: We assigned 104 patients to vasopressin and 96 to epinephrine. For patients receiving vasopressin or epinephrine survival did not differ for hospital discharge (12 [12%] vs 13 [14%], respectively; p50.67; 95% CI for absolute increase in survival 211.8% to 7.8%) or for 1 h survival (40 [39%] vs 34 [35%]; p50.66; 210.9% to 17.0%); survivors had closely similar median mini-mental state examination scores (36 [range 19-38] vs 35 [20-40]; p50.75) and median cerebral performance category scores (1 vs 1). INTERPRETATION: We failed to detect any survival advantage for vasopressin over epinephrine. We cannot recommend the routine use of vasopressin for inhospital cardiac arrest patients, and disagree with American Heart Association guidelines, which recommend vasopressin as alternative therapy for cardiac arrest.

Aged↗
PubMed2001

High-frequency ventilation design and equipment issues.

Various technical approaches to high-frequency ventilation are available. Of these, HFOV is used most commonly. As high-frequency ventilation becomes increasingly used in the care of adult patients, the technical issues related to this therapy will become increasingly important.

Animals↗
PubMed2001

Clinical features in women with polycystic ovaries: relationships to insulin sensitivity, insulin gene VNTR and birth weight.

OBJECTIVE: Polycystic ovaries are a common ultrasound finding, yet few of these women have many clinical features of polycystic ovary syndrome. Clinical presentation may relate to degree of insulin resistance, common polymorphism at the insulin gene VNTR, and birth weight. We therefore examined the relationship between insulin sensitivity, insulin gene VNTR genotype, birth weight and presence of polycystic ovaries/features of polycystic ovary syndrome in a normal population study. DESIGN AND PATIENTS: In 224 young women recruited as normal volunteers, ovarian morphology was determined by transabdominal ultrasound and features of polycystic ovary syndrome were identified on clinical and biochemical examination. Insulin sensitivity was estimated from fasting glucose and insulin levels using the homeostasis model. Insulin gene VNTR genotypes were determined in women and their parents. MEASUREMENTS AND RESULTS: Thirty-three per cent (74/224) had polycystic ovaries on ultrasound. These women had higher birth weights (P = 0.004), higher insulin sensitivity (P = 0.02) and higher leptin levels for body mass index (P = 0.04) than women with normal ovaries. However among women with polycystic ovaries, increasing severity of clinical phenotype (based on number of features of: menstrual irregularity, acne, hirsutism, serum testosterone > 3 mmol/l and LH > 10 IU/l) was associated with decreasing insulin sensitivity (P < 0.0001) and related to paternally transmitted insulin gene VNTR class III alleles (P = 0.03). CONCLUSION: Women with polycystic ovaries on ultrasound have increased insulin sensitivity and possible leptin resistance, which could predispose to future weight gain. However, in these women the appearance of clinical features of polycystic ovary syndrome is related to insulin resistance and insulin gene VNTR class III alleles.

Adolescent↗
PubMed2001

Psychologic morbidity and health-related quality of life of patients assessed in a chest pain observation unit.

STUDY OBJECTIVES: We sought to measure psychologic morbidity and health-related quality of life among patients attending the hospital with acute chest pain both at presentation and 1 month after rigorous assessment for cardiac disease. METHODS: Consecutive patients undergoing assessment on the chest pain observation unit of a large, urban emergency department were asked to complete 3 questionnaires: the Short Form-36 Health Survey (SF-36), the Euroqol Health Utility Questionnaire, and the Hospital Anxiety and Depression Scale. The same questionnaires were mailed 1 month later, along with a questionnaire documenting subsequent pain and reassurance. RESULTS: At enrollment (n=166), 32 (19%) participants (95% confidence interval [CI] 15% to 26%) were experiencing moderate levels of anxiety, and 21 (13%, 95% CI 8% to 19%) were experiencing moderate levels of depression. Health utility and all SF-36 dimensions of quality of life were substantially below age-adjusted normal values. One month after assessment (n=110), only the Pain dimension score of SF-36 had significantly improved. Most scores were unchanged, and the Physical Role and Mental Health dimension scores of SF-36 had significantly deteriorated. Seventy (64%) patients (95% CI 54% to 72%) had further pain after discharge. Despite these findings, 98 (86%) patients (95% CI 78% to 91%) responded that their assessment was "completely reassuring" or "quite reassuring." CONCLUSION: Patients with acute, undifferentiated chest pain have substantial psychologic morbidity and impairment of quality of life. Although patients respond that they are reassured by chest pain observation unit assessment, anxiety and depression remain prevalent and quality of life remains impaired 1 month after assessment.

Acute Disease↗
PubMed2001

Is it in a neonate's best interest to enter a randomised controlled trial?

Clinicians are required to act in the best interest of neonates. However, it is not obvious that entry into a randomised controlled trial (RCT) is in a neonate's best interest because such trials often involve additional onerous procedures (such as intramuscular injections) in return for which the neonate receives unproven treatment or a placebo. On the other hand, neonatology needs to develop its evidence base, and RCTs are central to this task. The solution posited here is based on two points. First, "best interest" is not equivalent to "the best possible interest" only to "best interest within a certain realm". The realm of deliberation when asking the title question is the neonate's health. Deliberating in this realm may involve the exclusion from consideration of some factors that might be thought relevant (such as parental wealth). Furthermore, circumstances may dictate the need to deliberate on other factors that might be thought irrelevant (such as health care resources). Second, deciding on a neonate's best interest does not involve "putting oneself in its shoes". Rather, it involves asking in what it has an interest, or stake. These will include some things in which we all, as human beings, have a stake, such as medical progress. Putting these two points together, in the realm of health the answer to whether RCT entry is in a neonate's best interest is usually very finely balanced. Where this is the case, it is reasonable to invoke a broader notion of best interest and include a broader range of elements in which the neonate has a stake, including medical progress. In this way RCT entry can, usually, be said to be in a neonate's best interest.

Child Advocacy↗
PubMed2001

Identification of a novel psoriasis susceptibility locus at 1p and evidence of epistasis between PSORS1 and candidate loci.

The pathogenesis of all forms of psoriasis remains obscure. Segregation analysis and twin studies together with ethnic differences in disease frequency all point to an underlying genetic susceptibility to psoriasis, which is both complex and likely to reflect the action of a number of genes. We performed a genome wide analysis using a total of 271 polymorphic autosomal markers on 284 sib relative pairs identified within 158 independent families. We detected evidence for linkage at 6p21 (PSORS1) with a non-parametric linkage score (NPL)=4.7, p=2 x 10(-6) and at chromosome 1p (NPL=3.6, p=1.9 x 10(-4)) in all families studied. Significant excess (p=0. 004) paternal allele sharing was detected for markers spanning the PSORS1 locus. A further three regions reached NPL scores of 2 or greater, including a region at chromosome 7 (NPL 2.1), for which linkage for a number of autoimmune disorders has been reported. Partitioning of the data set according to allele sharing at 6p21 (PSORS1) favoured linkage to chromosomes 2p (NPL 2.09) and 14q (NPL 2.0), both regions implicated in previous independent genome scans, and suggests evidence for epistasis between PSORS1 and genes at other genomic locations. This study has provided linkage evidence in favour of a novel susceptibility locus for psoriasis and provides evidence of the complex mechanisms underlying the genetic predisposition to this common skin disease.

Age of Onset↗
PubMed2001

Oral care clinical trials at Hill Top Research.

Oral health care products generally require laboratory or clinical testing prior to being introduced to the market. Companies that develop such products have three options for such testing--their own facilities, dental schools, or clinical research organizations (CROs). Laboratory or clinical trials involving subjects can be conducted to test claims of safety and efficacy as well as cosmetic and therapeutic claims. CROs, which conduct such research on a fee-for-service basis in an independent environment, are an attractive alternative in many cases.

Clinical Trials as Topic↗
PubMed2000

Some practical issues in the design, monitoring and analysis of a sequential randomized trial in pressure sore prevention.

A sequential double blind (assessor and patient) triangular design was used to compare the incidence of pressure sores following elective major surgery among patients lying on a standard foam mattress with those on a dry visco-elastic polymer pad during their operation. A total of 446 patients were recruited into the trial between 1994 and 1996. Interim analyses were carried out after 181 patients were entered into the trial and then subsequently after approximately every 100 patients recruited. The trial unexpectedly reached a stopping boundary at the first interim analysis, however the Independent Data Monitoring Committee recommended continuation of the trial. They were concerned that there was a need for a larger definitive trial and about an apparent treatment by centre interaction. They required a substudy to be undertaken to further validate the subjective endpoint, and that further sensitivity analyses of the main trail endpoint should be carried out in the second interim analysis. The trial was stopped at the third interim analysis when again a stopping boundary was crossed indicating that the gel pad was associated with significantly fewer pressure sores than the standard mattress (log odds ratio -0.7, (95 per cent confidence interval (CI), -1.28, -0.11), p=0.02) (estimate CI, p-value adjusted for group sequential conduct). The design, monitoring and analysis of this trial will be presented as an example of the practical problems or non-problems encountered for the local hospitals, for the trials unit, for the data monitoring committee and for the funding committee.

Beds↗