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Biomedical subjects

S Read

Publications and source records attributed to S Read.

At least 73 records · Page 4Linked to original sources
PubMed1993

Dopamine regulates D2 receptor gene expression in normal but not in tumorous rat pituitary cells.

Abnormalities of dopamine D2 receptors may be implicated in the development of some pituitary tumours. Previously we have identified dopamine D2 receptor gene expression both in normal rat pituitaries and in dopamine resistant GH3 rat pituitary tumour cells. In this study we have examined the effect of dopamine on D2 receptor gene expression in these cells using a probe specific for both D2 receptor isoforms. Normal rat pituitary cells were maximally stimulated by 100 nM dopamine at which concentration D2 receptor mRNA concentrations were 400% greater than that measured in controls. No increase in D2 receptor gene expression was observed in GH3 pituitary tumour cells.

Animals↗
PubMed1993

Nurse triage in theory and in practice.

'Nurse Triage' refers to the formal process of early assessment of patients attending an accident and emergency (A&E) department by a trained nurse, to ensure that they receive appropriate attention, in a suitable location, with the requisite degree of urgency. The benefits claimed for nurse triage include better patient outcomes, through clinical management reaching those in greatest need of it first. A recent study of nurse triage in a British A&E department failed to demonstrate the benefits claimed: patients undergoing triage were delayed, especially those in the most urgent groups. No differences were noted between the two study groups in levels of satisfaction with the A&E process. The results brought forth criticism from all quarters. In this paper the points made by the critics are considered, and an attempt to answer them is made.

Clinical Nursing Research↗
PubMed1993

Differences in priorities assigned to patients by triage nurses and by consultant physicians in accident and emergency departments.

STUDY OBJECTIVES: To investigate whether the greater urgency assigned to accident and emergency patients by triage nurses than by accident and emergency doctors was uniform across all patient groups. DESIGN: Patients attending an accident and emergency department between 8.00 am and 9.00 pm over a six week period were assessed prospectively for degree of urgency by triage nurses, and retrospectively for urgency by one of two consultant accident and emergency doctors. Patients were grouped according to their clinical mode of presentation. SETTING: An accident and emergency department of a district general hospital in the Midlands, UK, in 1990. PATIENTS: 1213 patients who presented over six weeks. MEASUREMENTS AND MAIN RESULTS: As might be expected, patients' conditions were assessed as being more urgent prospectively than retrospectively. This finding, however, was not uniform across all patient groups. Nurses' assessments of urgency tended to favour children and patients who presented with eye complaints and gave less priority to medical cases, particularly those with cardiorespiratory symptoms. CONCLUSIONS: These findings have implications for all those involved in the organisation of triage systems and in the training of nurses in accident and emergency departments. It is essential that judgements on how urgently patients need to be seen are made in a completely objective manner.

Age Factors↗
PubMed1992

Evaluation of nurse triage in a British accident and emergency department.

OBJECTIVE: To compare formal nurse triage with an informal prioritisation process for waiting times and patient satisfaction. SETTING: Accident and emergency department of a district general hospital in the midlands in 1990. DESIGN: Patients attending between 8:00 am and 9:00 pm over six weeks were grouped for analysis according to whether triage was operating at time of presentation and by their degree of urgency as assessed retrospectively by an accident and emergency consultant. PATIENTS: 5954 patients presenting over six weeks. MAIN OUTCOME MEASURES: Time waited between first attendance in the department and obtaining medical attention, and patient satisfaction measured by questionnaire. RESULTS: Complete data on waiting time were collected on 5037 patients (85%). Only 1213 of the 2515 (48%) patients presenting during the triage period were seen by a triage nurse. Patients in the triage group waited longer than those in the no triage group in all four retrospective priority categories, though differences were significant for only the two most urgent categories (difference in median waiting time 10.5 (95% confidence interval 3.5 to 14) min for category 1 and 8.5 (3 to 12) min for category 2). Responses to the patient satisfaction questionnaire were similar in the two groups except for the question relating to anxiety relating to pain. CONCLUSIONS: This study fails to show the benefits claimed for formal nurse triage. Nurse triage may impose additional delay for patient treatment, particularly among patients needing the most urgent attention.

Adolescent↗
PubMed1992

Cellular immunity of patients with recurrent or refractory vulvovaginal moniliasis.

Cellular immunity was studied in 73 patients with recurrent vaginal moniliasis and 37 healthy controls, by skin testing with the multitest CMI kit and Candida antigen, with measurement of lymphoblastic transformation to phytohemagglutinin, antigens of Candida albicans, mumps, and streptokinase. Eighteen patients (24.7%) had a hypoergic or anergic response to Candida antigen on skin testing versus two controls (5.4%), p = 0.01. Overall, the patient's lymphoblastic proliferation to mitogen and various antigens was not significantly different from that of the controls. However, a subgroup of younger women (19 to 29 years old) had impaired responses to Candida antigen when compared with age-matched controls, 58% versus 17%, p less than 0.005. Most women with current vaginal moniliasis had normal cellular immunity.

Adult↗
PubMed1992

Piloting an evaluation of triage.

This paper takes a broad view of the work involved in pilot studies of evaluation research. Drawing on their experience of preparation for a field experiment in a British Accident and Emergency department, which was to evaluate the effectiveness of a nurse triage system, the authors stress the importance of careful observation of the system to be studied, in the environment in which it is to be studied. In addition, the usual evaluations of research instruments which comprise formal pilot studies are included.

Emergency Nursing↗
PubMed1992

Rapid DNA fingerprinting to control for specimen errors in HIV testing by the polymerase chain reaction.

Variable-number-tandem-repeats (VNTRs) are highly polymorphic and provide informative genetic markers for distinguishing between individuals. We have used PCR amplification of VNTR locus pMCT118 to identify mislabelled specimens submitted for HIV PCR testing. The method is rapid, can be applied to large numbers of samples and eliminates the need for radioactive probes. DNA samples (10 ng) are amplified for 25 cycles using fluorescence-labelled oligonucleotide primers (blue dye). An aliquot of the PCR product is then combined with an internal lane size standard (labelled with a red dye), electrophoresed through a 2% agarose gel on an automated fluorescence DNA fragment analyser and the size and quantity of the fragments determined automatically relative to the internal standard. Fifteen alleles, ranging in size from 398 tp 709 bp were readily identified in a random sampling of DNA from 63 unrelated HIV-infected patients. Fragment size was reproducible and corresponded to alleles containing from 16 to 35 repeats of a 16 bp unit. VNTR genotyping will prove useful for resolving discordant results due to specimen mix-up and ensuring that the correct samples have been analyzed.

Alleles↗
PubMed1992

Zidovudine for chemoprophylaxis after occupational exposure to HIV-infected blood: an economic evaluation.

Three approaches to the management of health care workers (HCWs) following percutaneous exposure to blood of previously unknown serological status were compared using cost-effectiveness analysis. In strategy A, all HCWs are offered zidovudine as soon as possible after exposure. The decision is made within 72 hours to (1) continue therapy with the drug for 4 weeks if the patient's blood is positive for human immunodeficiency virus (HIV) on testing or (2) discontinue therapy and follow-up if the patient's blood is HIV-negative. Strategy B is similar to A except that zidovudine is not offered. In strategy C the patient's blood is not tested and zidovudine is not offered. The results indicate that for every 100 HCWs managed with strategies A, B, and C, the total costs in Canadian dollars (Can $1.00 = U.S. $0.85) are $47,910, $38,849, and $110,834, respectively. The incremental cost per case of AIDS prevented by A relative to B is $300,140, and that prevented by A relative to C is -$6,244,000 (i.e., A results in savings relative to C).

Cost-Benefit Analysis↗
PubMed1992

Detection of incident HIV infection by PCR compared to serology.

In order to determine the most sensitive method for the early detection of HIV infection, polymerase chain reaction (PCR) and serology were compared using matched peripheral blood mononuclear cells (PBMC) and serum samples taken sequentially at 3-month intervals on 17 HIV seroconverters. All samples from the time of enrollment in the study to the time of seroconversion were studied. [There were only two of the 17 cases where PCR and antigen positivity preceded EIA detectable seroconversion.] Initially, one of these cases was found to be PCR positive 11 months prior to seroconversion, however DNA fingerprinting techniques indicated that the early positive specimen did not belong to the subject in question. In a single subject, PCR was negative at the time of serologic evidence of infection but was positive at the next sampling 3 months later. In the remaining 14 cases, PCR was positive at the same sample time as full or partial seroconversion as determined by three EIA screening tests and Western blot. EIA antibody screen tests showed variability in detection of early HIV antibodies. We found no evidence for prolonged HIV infection prior to seroconversion. PCR offers little if any advantage over serology in the early detection of HIV infection in adults.

AIDS Serodiagnosis↗
PubMed1991

Hepatitis B and human immunodeficiency virus infection in street youths in Toronto, Canada.

Hepatitis B and human immunodeficiency virus are transmitted by venereal contact or by the sharing of used needles during drug use. A questionnaire was administered to street youths admitting to prostitution and to a group denying prostitution, as well as to sexually active adolescents who lived with their family and were attending an adolescent medical clinic. The age, gender, race, number of sexual partners, condom use, illicit drug use, anal intercourse and admission to prostitution were recorded for each of the subjects. Serology was obtained for hepatitis B markers and human immunodeficiency virus antibody. Multiple regression analysis was performed to determine the factors which might predict hepatitis B serologic status. A single subject, who admitted to prostitution, was found to be human immunodeficiency virus-seropositive. Seven of 43 (16%) admitted prostitutes compared with 1 of 44 (2%) other street youth and none of 27 controls demonstrated anti-hepatitis B surface antibodies. The higher rate of seropositivity in admitted prostitutes was statistically significant (P less than 0.0097). Two seropositive prostitutes had IgM hepatitis B core antibody suggesting recent infection. Two factors, number of partners (P less than 0.0007) and practice of anal intercourse (P less than 0.05), were identified in the multiple regression analysis as predictive of seropositivity. Thus adolescents who live on the street are at increased risk for becoming infected with hepatitis B virus. The difficulty in ensuring vaccine coverage in this population would support calls for including hepatitis B vaccination as part of childhood immunization.

Adolescent↗
PubMed1989

Cyclosporine-induced deterioration in patients with AIDS.

Eight patients with AIDS (acquired immune deficiency syndrome) but free of life-threatening infection were treated with the immunosuppressive drug cyclosporine for a mean of 53.9 days. The serum cyclosporine levels were maintained in the desired therapeutic range. All eight patients experienced severe toxic symptoms, which necessitated discontinuation of cyclosporine therapy in six. The serum levels of creatinine, urea and potassium rose during treatment and fell after therapy was stopped. The total leukocyte count, hemoglobin level, platelet count, total T-cell count, and T4- and T8-cell counts all fell markedly during treatment. The total leukocyte count, platelet count, and T4- and T8-cell counts rose after therapy was stopped, but the hemoglobin level remained low. No patient experienced resolution of symptoms during therapy, and the condition of all patients improved after treatment was stopped. The results of this pilot study indicate that cyclosporine does not alleviate, and may worsen, the symptoms and laboratory findings in patients with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Factors influencing erythrocyte choline concentrations.

Choline concentrations in human erythrocytes increase after freezing and thawing, during incubation in Krebs-phosphate for 30 min or on storage at 0 degrees C for 3-24 hr. The increase is prevented by protein precipitation by 10% perchloric acid, 10% zinc hydroxide, 10% sodium tungstate or boiling in water. It is not prevented by EDTA (10 mM) and is increased by oleate (5 mM). We suggest that the increase is due to the action of phospholipase D on erythrocyte phospholipids.

Calcium↗