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Biomedical subjects

S Williams

Publications and source records attributed to S Williams.

At least 343 records · Page 19Linked to original sources
PubMed1997

Informed consent: patients' and junior doctors' perceptions of the consent procedure.

The important task of obtaining informed consent is often left to the most junior member of the surgical team, whose understanding of the surgical procedures involved may be limited. Little is known about patients' and junior doctors' satisfaction with the consent procedure, which was studied with the use of questionnaires. The vast majority of patients (95%) were satisfied with the explanation given to them prior to obtaining consent although 45% thought that the doctor who signed the consent form would be performing the surgery. Thirty-seven per cent of the junior doctors questioned admitted to obtaining consent for procedures of which they had little understanding. The majority of both junior doctors and patients felt that the surgeon performing surgery should sign the consent form. Junior doctors cannot be expected to obtain informed consent for procedures they do not fully understand and patients's; expectations must be taken into consideration if the seemingly inexorable rise in medico-legal litigation is to be halted.

Attitude of Health Personnel↗
PubMed1997

A method to estimate prevalence of iron deficiency and iron deficiency anemia in adolescent Jamaican girls.

A method is presented to estimate a cutoff for hemoglobin concentration appropriate for estimating the prevalence of iron deficiency anemia in poor Jamaican girls 13-14 y of age. Iron deficiency was determined from a three-variable model of iron status (serum ferritin, erythrocyte protoporphyrin, and mean corpuscular volume). The most appropriate hemoglobin cutoff was considered the one that minimized misclassification of iron deficiency: that yielding the maximum kappa coefficient for correctly classifying iron deficiency between 100 and 120 g/L, at 1-g/L intervals. By using this method, a hemoglobin cutoff of 107 g/L was considered most appropriate. This cutoff and the other indicators were used to estimate prevalence of iron deficiency and iron deficiency anemia in the Jamaican girls: 7.6% and 4.3%, respectively. This approach should be appropriate for determining hemoglobin cutoffs for iron deficiency anemia in other populations.

Adolescent↗
PubMed1997

Enteral feeding in the home environment.

Nutritional status has a major influence on wound healing, immunity, and quality of life for home care patients. This article presents the rationale, guidelines, and troubleshooting strategies home care nurses can use in caring for patients receiving enteral nutrition.

Community Health Nursing↗
PubMed1997

Sunburn and sun protection among young children.

OBJECTIVE: To examine the extent of sun exposure, sun protection and experience of sunburn among young New Zealand children on summer weekends. METHODS: In a telephone survey of 1243 respondents, those with children in the household were asked about sun exposure and protection for the youngest child in the family. Information was obtained for 285 children aged from infancy to 10 years. RESULTS: Over 90% of the children were reported to be outside on the preceding Saturday and/or Sunday; 7% of those outside experienced some degree of sunburn. The worst burning was on the face, head, neck or ears. On either day about half the children were wearing sunscreen and 60% were wearing a hat. Parental use of sun protection was the strongest predictor of sun protection among the children. CONCLUSIONS: While reports of sun protection among young children were encouraging, many children in the community are still at high risk of sunburn. Efforts to promote sun protection as a family responsibility may reduce the experience of burning among the young.

Adolescent↗
PubMed1997

The use of tobacco, alcohol and other drugs by young Aboriginal people in Albany, Western Australia.

This paper describes patterns of tobacco, alcohol and other drug use among Aboriginal people aged 8 to 17 years in the town of Albany, Western Australia. Of a total of 110 young Aboriginal people residing in the town at the time of the study, 105 were interviewed by two trained Aboriginal research assistants using interview schedules that included questions based on the national guidelines for the comparability of studies of drug use among young people. The most commonly used drugs were tobacco, alcohol and cannabis. Use of other substances was usually experimental, The majority (57 per cent) of this population had not used any drugs, 13 per cent made some use of alcohol and/or tobacco, 15 percent were polydrug users, and 15 per cent were frequent polydrug users. Use of drugs increased with age: 48 per cent of those aged 15 to 17 were frequent polydrug users. Tobacco consumption was greater and alcohol use less than that reported among Western Australian secondary school children of comparable age.

Adolescent↗
PubMed1997

Sun behaviour and perceptions of risk for melanoma among 21-year-old New Zealanders.

This study investigated perceived risk of melanoma, sunscreen use and frequency of sunburn in a large sample of young New Zealanders. A self-report questionnaire was administered to a sample of 909 21-year-olds to survey their perception of how sun behaviours affect their risk of getting melanoma, how often they get sunburn, how often they use sunscreen and what factors would get them to use sunscreen more often. Knowledge of melanoma was high, but myths concerning 'safe tanning' persisted. Many young adults believed that sunbathing regularly using a sunscreen and obtaining a good base tan from gradual sun exposure decreased their risk of getting melanoma. They were unsure about the use of artificial sun beds and if their use would increase or decrease their risk. Males and females differed significantly on many aspects of their sun behaviour. Most used sunscreen only 'sometimes' and its use was linked to knowledge of melanoma and perceptions of risk. The best way to modify the sun behaviour of young adults is to target both their knowledge of melanoma risk factors and their perceptions of risk.

Adult↗
PubMed1997

A monoclonal antibody to Borrelia burgdorferi flagellin modifies neuroblastoma cell neuritogenesis in vitro: a possible role for autoimmunity in the neuropathy of Lyme disease.

Although Borrelia burgdorferi is found at the site of many manifestations of Lyme disease, local infection may not explain all features of the disease. Previous work has demonstrated that the organism's flagellin cross-reacts with a component of human peripheral nerve axon, heat shock protein 60. The cross-reacting epitope is identified by a single anti-B. burgdorferi flagellin monoclonal antibody, H9724. We now report that the spontaneous and peptide growth factor-stimulated in vitro neuritogenesis of SK-N-SH neuroblastoma cells and other neural tumor cell lines is suppressed by H9724. In contrast, changes induced by exposure of these cells to optimal and suboptimal concentrations of cyclic AMP, phorbol ester, or retinoic acid are not affected by H9724. H9724 does not decrease cell viability or the ability of the cells to anchor to the culture plate or extracellular matrix and does not block nerve growth factor binding to the cells. These findings are compatible with the premise that antiaxonal antibodies formed during the immune response to B. burgdorferi flagellin might modify axonal function in vivo and play a role in the pathogenesis of neurologic features of Lyme disease. A humoral immune response predicated on molecular mimicry could explain persistent or ongoing neurologic dysfunction occurring after elimination of the organism by appropriate antibiotic therapy.

Antibodies, Bacterial↗
PubMed1997

Patients telephoning A&E for advice: a comparison of expectations and outcomes.

OBJECTIVE: To investigate the expectations of patients when they phone the accident and emergency (A&E) department, how this relates to the advice they receive, the action they subsequently take, and their satisfaction with the service. SETTING: The study was undertaken at an inner city hospital in south east London. METHODS: 597 calls to the department were documented during the study period, and callers for whom a phone number had been recorded were followed up by structured interviews carried out by a trained interviewer within 72 h of the call. Up to three attempts were made to contact each patient. The interviews were conducted at various times of the day to avoid excluding people with different work or social patterns. RESULTS: The interviewer was able to contact 203 patients within 72 h of their call to the A&E department. Of these 197 (97%) agreed to participate. Almost two thirds stated that when they phoned A&E they anticipated receiving self care advice; 11% expected to be advised to see or contact their general practitioner. Only a quarter of callers stated that they had expected to be told to attend A&E. There was disagreement between the advice that nurses documented as having been given, the advice the caller recalled receiving, and the action the patient subsequently took. Even so, 107 (55%) callers were very satisfied and 62 (32%) were satisfied, while 11 (6%) were dissatisfied with the telephone consultation; 15 (8%) were unsure. In all, 170 (87%) thought the advice they received was helpful. CONCLUSIONS: Understanding the reasons why patients phone A&E departments and their expectations should contribute to developing more responsive and effective services.

Counseling↗
PubMed1997

The costs and effects of cervical and breast cancer screening in a public hospital emergency room. The Cancer Control Center of Harlem.

OBJECTIVES: This study assessed the cost-effectiveness of cervix and breast cancer screening in a public hospital emergency room. METHODS: Age-eligible women with nonurgent conditions and without recent screening were offered screening by a nurse. A decision analysis compared the costs and outcomes of emergency room screening and standard hospital screening efforts. RESULTS: The undiscounted cost-effectiveness results for establishing new programs were $4050 (cervical cancer), $403,203 (breast cancer), and $4375 (joint cervix and breast cancer) per year of life saved. If screening is added to an existing program, results are more favorable ($429, $21,324, and $479 per year of life saved for cervix, breast, and joint screening, respectively). Results were most sensitive to volume and probability of receiving treatment after an abnormal screen. CONCLUSIONS: Emergency room screening was cost-effective for cervical cancer; breast cancer screening was relatively expensive given the low number of women reached. More intensive recruitment and follow-up strategies are needed to maximize the cost-effectiveness of such programs.

Breast Neoplasms↗
PubMed1997

Natural cycles.

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Holistic Health↗
PubMed1997

Ex vivo expansion of megakaryocyte progenitors: effect of various growth factor combinations on CD34+ progenitor cells from bone marrow and G-CSF-mobilized peripheral blood.

Prolonged thrombocytopenia resulting from inadequate megakaryocyte (MK) progenitor cell reconstitution is a serious complication of hematopoietic cell-supported high-dose chemotherapy (HDC). In this situation, the infusion of MK progenitors that are expanded ex vivo could be clinically beneficial. In this study we investigated the ability of various growth factor combinations to generate MK progenitors. CD34+ cells derived from bone marrow (BM) and granulocyte colony-stimulating factor (G-CSF)-mobilized peripheral blood (PB) from 17 patients with breast cancer, lymphoma, or myeloma were cultured unpertubed for 10 days in a serum-free liquid culture system that contained recombinant growth factors. Five different growth factors combinations were evaluated: Stem cell factor (SCF), interleukin (IL)-3, IL-6 + G-CSF (combination 1); SCF, megakaryocyte growth and development factor (MGDF) + G-CSF (combination 2); SCF + MGDF (combination 3); MGDF alone (combination 4); and SCF, IL-3, IL-6, G-CSF + MGDF (combination 5). PB CD34+ cells yielded significantly higher numbers of CD41+ MK progenitors than BM CD34+ cells with any of the growth factor regimens assayed. PB CD34+ cells (2x10[5]) at day 0 generated 1.2 to 1.3x10(6) CD41+ cells by day 10 when cultured in the presence of growth factor combinations 1, 2, or 3. In contrast, 2x10(5) BM CD34+ cells produced 5x10(5) CD41+ cells after 9 days in the presence of combination 1, whereas lower numbers of CD41+ cells were generated in cultures with combinations 2 and 3 (2.3x10[5] and 4.2x10[4], respectively). The addition of MGDF to cultures that were grown with combination 1 for 5 days increased the number of CD41+ cells (1.7-fold increase in PB-derived cultures, 1.6-fold increase in BM-derived cultures). Treatment with MGDF alone resulted in higher frequencies of MK progenitors than those obtained in cultures with combined growth factors (79% in PB-derived cultures, 25% in BM-derived cultures), but because total cell growth was attenuated, absolute numbers of MK progenitors were lower (7x10(5) in PB-derived cultures, 7x10(4) in BM). Morphological analysis of immunocytochemically identified megakaryocytic cells revealed mononuclear cells as the predominant cell type in all of the cultures. During the 10-day culture period, PB-derived MK progenitors did not show notable maturation, even under the influence of MGDF, whereas in BM-derived cultures MGDF induced a significant shift to binuclear cells and stage I MK after day 5. Phenotypic analysis of cell surface markers showed that the majority of cultured megakaryocytic cells coexpressed CD34 and platelet glycoproteins (GPs), also indicating an immature stage of development. The ex vivo proliferative activity of CD34+ cells and their potential to develop into the megakaryocytic lineage demonstrated considerably high interpatient variations. There was no correlation between platelet recovery following HDC with hematopoietic cell support and the magnitude of GP+ cell expansion ex vivo, suggesting the feasibilty of MK expansion ex vivo in patients with prolonged thrombocytopenia posttransplantation. In summary, these data indicate that GCSF-mobilized CD34+ PBPCs are more effectively expanded ex vivo into the megakaryocytic lineage than are CD34+ BMPCs. CD34+/GP+ MK progenitors may be an appropiate cell population for transplantion as prophylaxis or treatment of prolonged thrombocytopenia. The efficacy of this procedure will be tested prospectively in a clinical trial.

Adult↗
PubMed1997

Natural cycles.

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Astrology↗
PubMed1997

Natural cycles.

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Astrology↗
PubMed1997

Natural cycles.

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Astrology↗
PubMed1997

The challenges of improving discharge planning in Sweden and the UK: different but the same.

Discharge of older people from hospital has been an area of concern for over 20 years. The present emphasis on rapid throughput of patients in acute care settings is likely to exacerbate existing problems. Improving current practice will mean addressing a number of complex issues to do with communication between agencies and professions. Despite different welfare systems, many of the challenges of discharge planning are shared in different countries. This paper describes attempts to involve patients and carers in discharge planning in Sweden and the UK and identifies a number of areas which require attention if the ideals of patient and carer empowerment are to be achieved.

Aged↗