Search PubMed⌕ Search

Biomedical subjects

T Smith

Publications and source records attributed to T Smith.

At least 415 records · Page 23Linked to original sources
PubMed1995

Family involvement in multidisciplinary team evaluation: professional and parent perspectives.

For many children and families, a multidisciplinary team evaluation is their introduction to special education systems. Increasingly, federal guidelines mandating parent involvement in all aspects of service provision have meant that parents are being asked to participate as part of the evaluation team. If families and professionals are to serve as partners in the evaluation process, mutual respect and understanding of one another's perspectives will be crucial. This paper uses survey data from 39 parents and 81 professionals to examine the various expectations and perceptions brought by participants to the assessment process. Results indicated that there is substantial variability of perceptions among parents and professionals about the nature of child assessment and their respective roles in it. Implications for research and practice are discussed, along with techniques for involving families in the assessment process in more meaningful ways.

Adolescent↗
PubMed1995

Immunological markers of childhood fevers in an area of intense and perennial malaria transmission.

In order to describe presumed paediatric malaria on a cell-immunological basis, the soluble receptors of IL-2 (sIL-2R) and tumour necrosis factor (sTNF-R55 and sTNF-R75) were quantified in highly exposed young Tanzanian children. Sera were obtained from 66 acute and 72 reported febrile patients during health post consultations and follow-ups and from 68 community controls. Levels of sIL-2R, sTNF-R55 and sTNF-R75 were significantly elevated during fever attacks, especially in very young children. Soluble TNF-R75 levels were most stable and those of sTNF-R55 least. Levels of sTNF-R55 were related to the magnitude of fever and thus appeared to reflect attack severity. Levels of sTNF-R75 were highly significantly associated with parasite density, indicating that this response is malaria-specific. The present study indicates that sTNF-R75 levels could become a useful immunological tool in malaria intervention studies, as they reflect changes in malaria-specific immune responses. Future studies should validate this potential in different endemic settings.

Age Factors↗
PubMed1995

Antisense vasopressin oligonucleotides: uptake, turnover, distribution, toxicity and behavioral effects.

The uptake, turnover, distribution, toxicity and behavioral effects of antisense vasopressin oligonucleotides were investigated to define how these compounds interact with neural tissue to inhibit translation of a target mRNA. Both phosphorothioate modified and unmodified oligonucleotides are rapidly taken up by mammalian neural tissue. Turnover of the unmodified oligonucleotide was found to be fast (t1/2 < 1 h) relative to the phosphorothioate modified oligonucleotide (t1/2 = 12 h). The phosphorothioate vasopressin antisense oligonucleotide suppressed vasopressin synthesis in vivo at concentrations below the toxic threshold of approximately 5 microM. Intracranial injections of phosphorothioate antisense oligonucleotide into the region of the SON in vivo, resulted in a small decrease in vasopressin mRNA and a compensatory drinking response within the first 24 h, consistent with a deficit in vasopressin translation with kinetics similar to those observed in vitro. Water intake returned to normal by the second day indicating relatively rapid clearance of the oligonucleotide and minimal side effects. Although the mechanisms of accumulation and details of the molecular interactions are still unknown, our observation of preferential uptake and/or retention of oligonucleotide within a subset of neurons in vitro suggests some process of selective targeting. Thus, low concentrations of oligonucleotides targeted to the untranslated 5' end of vasopressin mRNA can be effective for the acute and reversible control of vasopressin synthesis in mammalian CNS with relatively rapid onset of behavioral effects and minimal side effects.

Animals↗
PubMed1995

Individual and team consensus ratings of child functioning.

The authors examined agreement between interdisciplinary teams of professionals in rating the functional abilities of children with disabilities. 129 children were rated on the ABILITIES index by 72 professionals working in nine developmental evaluation centers. Independent individual ratings were made first, followed by a consensus rating. Team members had a high degree of agreement on independent ratings of abilities and limitations, with nearly 90 per cent of the ratings within one point of each other. More disagreement was associated with rating areas of behavior and communication, team experience and increased severity of disability. The team's consensus ratings were more likely to defer to the ratings of the expert in particular areas. Implications for team assessment and team functioning are discussed.

Adolescent↗
PubMed1995

Lipocortin-1 distribution in bronchoalveolar lavage from healthy human lung: effect of prednisolone.

Lipocortin-1 (LC-1; annexin-1) may mediate some anti-inflammatory actions of the glucocorticoids, probably after binding to specific cell surface binding sites. We have quantified LC-1 levels in bronchoalveolar lavage (BAL) fluid and cells collected from seven healthy volunteers before and after 7 days of treatment with an oral glucocorticoid, prednisolone (30 mg/day). Extracellular BAL LC-1 was higher and cellular LC-1 was lower after prednisolone than before [extracellular: before, median 98 ng/mg albumin (range 48-350 ng/mg albumin); after, 236 ng/mg albumin (19-414 ng/mg albumin); P < 0.05. Cellular: before, 23.3 ng/10(6) cells (14.6-26.9 ng/10(6) cells); after, 18.0 ng/10(6) cells (122-268 ng/10(6) cells); P < 0.05]. The distribution of LC-1 within BAL cells ex vivo (cell surface = 25%, cytosol = 50%, membrane = 25%) was unaffected by prednisolone treatment. However, in adherent cells that had been cultured for 4 h, 70-80% of the LC-1 was on the cell surface. In summary, prednisolone appears to promote cellular release of LC-1. The difference in distribution of cellular LC-1 in BAL cells ex vivo and in vitro may reflect adherence and/or activation.

Adult↗
PubMed1995

Prevalence of low vision in elderly patients admitted to an acute geriatric unit in Liverpool: elderly people who fall are more likely to have low vision.

The prevalence of visual impairment among elderly patients admitted to hospital is unknown. This group of patients may be particularly at risk from poor vision which could jeopardise their independence. A prospective study of visual imapairment and its aetiology in acute geriatric admissions assessed after the acute illness had settled was performed. Subjects were all patients aged 65 years or over, excluding those chronically confused, admitted to the Department of Geriatric Medicine at the Royal Liverpool University Hospital with an acute medical illness. After the acute illness had settled visual impairment, as defined by the American criteria (best acuity 6/18), was assessed on the ward with a Snellen chart read at 6 m using binocular vision and current glasses. Those patients identified with impaired vision on initial screening were formally assessed in the ophthalmology department to identify the cause. 200 patients were examined. 101 patients (50.5%) had impaired vision. In these patients, correctable refractive errors were present in 40%, cataract in 37% and senile macular degeneration in 14%. Of the 101 patients with impaired vision 79% had a reversible cause. Comparing these results with a recent study in the community showed a much higher incidence for patients admitted to hospital. There was a particularly high prevalence in those elderly patients who were admitted with falls (76%, p = 0.0003). In conclusion, elderly patients, especially those presenting with falls, admitted to hospital have a high prevalence of visual impairment. Visual impairment may be compounding or causing falls.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidental Falls↗
PubMed1995

Escalated MVAC with or without recombinant human granulocyte-macrophage colony-stimulating factor for the initial treatment of advanced malignant urothelial tumors: results of a randomized trial.

PURPOSE: Hematopoietic growth factors have been shown to ameliorate the side effects of chemotherapy. Here we assess the ability of recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) to increase the dose-intensity and reduce the side effects of escalated methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) chemotherapy. PATIENTS AND METHODS: A prospective randomized trial to compare escalated MVAC versus escalated MVAC with rhGM-CSF was conducted. All patients were treated at The University of Texas M.D. Anderson Cancer Center (UTMDACC) and had a metastatic or unresectable urothelial tumor. Forty-eight patients were randomized (25 to MVAC with rhGM-CSF and 23 to escalated MVAC alone). The clinical characteristics of the study populations were similar (ie, degree of tumor dissemination and performance status). RESULTS: The dose-intensity in the two arms of the study did not differ significantly. No difference in the frequency of bacteriologically documented infections occurred between the two study arms. CONCLUSION: The use of the hematopoietic growth factor rhGM-CSF did not result in an increased dose-intensity of escalated MVAC. The inability to increase the dose-intensity of MVAC further was a result of nonhematologic side effects of the chemotherapy. Escalation of treatment delivered at its median-tolerated dose is unlikely to result in additional therapeutic benefit for patients with common solid tumors. Future development of therapy may require the development of new agents or concepts, rather than modification of existing therapies.

Adult↗
PubMed1995

Serum neuron-specific enolase in human status epilepticus.

Neuron-specific enolase (NSE) is a sensitive marker of brain injury after stroke, global ischemia, and coma. We report changes in serum NSE (s-NSE) in 19 patients who sustained status epilepticus. s-NSE peaked within 24 to 48 hours after status epilepticus. The mean peak s-NSE level for the entire group was elevated compared with the levels for normal controls (24.87 ng/ml versus 5.36 ng/ml, p = 0.0001) and for epileptic controls (24.87 ng/ml versus 4.61 ng/ml, p = 0.0001). The mean peak s-NSE level for the 11 subjects without an acute neurologic insult (15.44 ng/ml) was also significantly increased compared with levels for normal and epileptic controls. Further, s-NSE was significantly correlated with outcome and duration. We conclude that s-NSE is a promising in vivo marker of brain injury in status epilepticus and warrants further study in larger populations.

Humans↗
PubMed1995

Late progression to diabetes and evidence for chronic beta-cell autoimmunity in identical twins of patients with type I diabetes.

Previous studies suggest that after 6 years of discordance, identical twin pairs rarely become concordant for type I diabetes. With up to 39 years of follow-up from the onset of diabetes in the index twin, we determined how many discordant twins have evidence of beta-cell autoimmunity and how many develop overt diabetes. We longitudinally followed 23 pairs of identical twins (or triplets) that were selected from a total group of 30 pairs because they were discordant for type I diabetes when first ascertained. Seven developed diabetes after 3, 3, 7, 8, 9, 31 and 36 years of discordance. By survival analysis, the concordance after 10 years from the onset of diabetes in the index twin was estimated as 23% (95% confidence interval, 5-40%), increasing to 38% (95% confidence interval, 8-69%) after 31 years. Among 16 twins remaining nondiabetic at last follow-up (8-39 years of discordance), 12 were assessed with serial intravenous glucose tolerance tests and a total of 407 measurements by radioassay of antibodies against three defined autoantigens (glutamic acid decarboxylase, insulin, and the recently cloned molecule ICA512). Two-thirds (8 of 12) had evidence of beta-cell autoimmunity (persistently positive autoantibody levels) and/or first-phase insulin release less than the 1st percentile of control subjects. In summary, identical twins may develop diabetes after a prolonged period of discordance and approximately two-thirds of long-term discordant twins have evidence of persistent beta-cell autoimmunity and/or beta-cell damage. The concordance for beta-cell autoimmunity, therefore, is much higher than for overt diabetes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Alterations in nutritional status and disease activity during treatment of Crohn's disease with elemental diet.

BACKGROUND: The mechanisms by which elemental diets induce remission in patients with Crohn's disease is unknown, but it has been suggested that improvement in nutritional state may play a part. METHODS: We assessed sequential changes in disease activity (clinical and laboratory indices and faecal excretion of indium-111-labelled leucocytes) and nutritional status (anthropometry, body composition variables), hepatic secretory proteins (albumin, pre-albumin, transferrin), and trace elements (iron, magnesium, copper, zinc) during treatment of acute Crohn's disease with an elemental diet. RESULTS: Disease activity indices improved significantly by 2 weeks and were maintained at 4 weeks of treatment. There was a significant increase in pre-albumin at 4 weeks and an increase in serum iron and a decrease in serum copper during the study period. The changes occurring in the measures of nutrition did not correlate significantly with the changes in disease activity. CONCLUSION: The fact that changes in disease activity appear to precede any detectable changes in nutritional state, it suggests that the beneficial action of elemental diet in patients with active Crohn's disease is not due to an improvement in nutritional status.

Adolescent↗
PubMed1995

Is fever a good sign for clinical malaria in surveys of endemic communities?

Although fever is the characteristic sign of clinical malaria, many Plasmodium falciparum malaria cases in endemic areas do not present with measurable temperature elevations. In a field study in Tanzania, malaria morbidity was defined to be any current self- or parentally reported illness associated with malaria parasite densities higher than those in healthy individuals. Without diagnosis of individual episodes, prevalences of malaria-attributable morbidity of 9.8% in infants, 1.3% in children 1-4 years of age, and 0.6% in those 5-9 years of age were estimated. No illness was considered to be due to malaria in older individuals. In infants, 66.5% of malaria-attributable morbidity episodes corresponded to axillary temperatures < 37.5 degrees C. In older children, most of the episodes due to malaria corresponded to increased temperatures. This age dependence should be considered when designing diagnostic procedures and outcome measures for epidemiologic studies of malaria.

Adolescent↗
PubMed1995

Assessing the public health importance of Schistosoma mansoni in different endemic areas: attributable fraction estimates as an approach.

Assessment of the public health importance of schistosomiasis mansoni is hampered by the nonspecificity of many of its disease symptoms. Parasitologic, clinical, and anamnestic data from two areas in Burundi were used to obtain estimates of the attributable fractions for different disease symptoms at both the population level and within different age strata. A large proportion of individuals had symptoms commonly associated with Schistosoma mansoni infection that were not attributable to this parasite. The clinical indicator with the best test efficiency was shown to be bloody diarrhea. At the population level, 35% of bloody diarrhea cases were attributable to S. mansoni, compared with only 9% of diarrhea cases without blood. The attributable fractions were age-dependent, and in the case of diarrhea (with and without blood), children had a higher proportion of cases attributable to S. mansoni infection than adults. The association between infection and disease symptoms also increased with the intensity of infection. The prevalence of morbidity attributable to S. mansoni was similar for all symptoms, and higher in children than adults. The estimation of attributable fractions provides a simple approach to quantify S. mansoni-related morbidity, which could also be extended to both S. haematobium and S. japonicum. Attributable fraction estimates for these three schistosome species in different endemic areas would greatly aid in the assessment of the health burden of this parasite and the effectiveness of control programs.

Abdominal Pain↗
PubMed1995

Care of the elderly patient following surgery for a fracture of the proximal femur.

A short postal questionnaire was sent to all practising orthopaedic surgeons in the United Kingdom, to determine the current pattern of post-operative care for patients with a fracture of the proximal femur, and to determine the current contribution to care being undertaken by geriatricians. This paper presents the responses of 616 orthopaedic surgeons who are actively involved in the care of patients with a fracture of the proximal femur. For the patient who had been partially dependent on family and social services before injury, and thus had most to benefit from an effective rehabilitation, there was a diversity of care on offer. Sixty-three per cent of surgeons stated that this category of patient was routinely cared for on an acute orthopaedic ward; 36% regularly transferred such patients to rehabilitation units, which were geriatric units in 18% of cases, 'second line' orthopaedic beds in 9% of cases and orthogeriatric units in a further 9% of cases. Surgeons who regularly transferred patients to designated rehabilitation units were more satisfied than those whose patient care took place in the environment of the acute orthopaedic ward. Eighty per cent of surgeons were satisfied with orthogeriatric units, and 62% were satisfied with transfer of patients to units supervised by geriatricians. By contrast, only 17% of surgeons were satisfied with a system of care in which geriatricians were available for consultation by written request only. The specialties of orthopaedic surgery and geriatric medicine have a vital role to play in the post-operative care of patients, and a combined effort to address this issue should be made.

Aged↗
PubMed1995

Differences between general practices in hospital admission rates for self-inflicted injury and self-poisoning: influence of socioeconomic factors.

BACKGROUND: Self-inflicted injury and self-poisoning are major causes of hospital admission of young adults throughout the United Kingdom, while in Scotland, suicide is the leading cause of death each year in persons aged 15 to 40 years. General practitioners are in a unique position in that they may have contact with the patient before the attempted suicide and later play a supportive role along with other health service and social work professionals. AIM: This study set out to examine the differences between 72 general practices in Tayside in the hospital admission rates for self-inflicted injury/poisoning among their patients, and the extent to which these differences were related to the socioeconomic conditions prevailing in the patients' areas of residence and in the areas in which practices were located. The study also aimed to examine the agents of self-inflicted injury/poisoning most commonly used by different age groups. METHOD: Details of admissions to hospitals in Tayside for self-inflicted injury/poisoning, from 1991 to 1993 inclusive, were obtained from a national, hospital inpatient discharge summary scheme, loaded onto a microcomputer and analysed using standard commercial software. Data from the 1991 census at the postcode sector level and death registrations summaries were obtained from the office of the registrar general for Scotland. The deprivation categories used were based on 1991 census data. RESULTS: In the study period, 52% of hospital admissions for self-inflicted injury/poisoning were of patients aged 30 years or over. Overall, the number of admissions of females exceeded that of males by 26%. Annual hospital admission rates for self-inflicted injury/poisoning per 1000 registered patients averaged over the Tayside practices correlated closely with the male unemployment rate in, and deprivation category of, the postcode sector in which the practice was located. Rates ranged from an average of 1.1 admissions per 1000 registered patients per year in sectors with less than 5% male unemployment of 4.6 where male unemployment was 15% or over. Similarly, the admission rates ranged from 1.1 per 1000 registered patients per year in the most affluent sectors to 3.3 in the most deprived sectors. The proportion of older patients who used sedatives, hypnotics and tranquillizers to poison themselves was greater than that of younger patients; analgesics, such as paracetamol, were the agents most commonly used for self-poisoning by the younger age groups. CONCLUSION: The routine monitoring at national level of hospital admission rates for self-inflicted injury/poisoning, using established computerized information systems, would enable the identification of those practices that have a relatively high proportion of such admissions. This would provide a starting point for the identification of pilot sites for the development of protocols for offering multi-agency support to high-risk groups of patients.

Adolescent↗
PubMed1995

Routine omentectomy is not required in children undergoing chronic peritoneal dialysis.

A routine omentectomy is recommended in children commencing chronic peritoneal dialysis, but is not routine practice in adults. We reviewed the outcome of 66 catheters (57 straight and 9 spiral) inserted into 38 patients (median age 7.8 years, 12 patients under 2 years) over a period of 4.8 years. The aim of the study was to determine whether an omentectomy affects the incidence of catheter blockage or peritonitis. Mean catheter life was 6.8 months (range 0.2-28 months). Fifteen are still in situ, and 14 were removed electively (transplantation). Blockage occurred in 1/22 catheters inserted after an omentectomy, compared with 10/44 inserted without an omentectomy (absolute risk reduction with omentectomy = 0.18). Blockage was more frequent with spiral catheters (4/9 vs 7/57; p < 0.05). Thirty-seven catheters were associated with one or more episodes of peritonitis. Peritonitis was not significantly more frequent after omentectomy. We conclude that a routine omentectomy is not routinely indicated in children commencing chronic peritoneal dialysis. Eleven omentectomies are required to prevent two omental blockages (1/0.18), and secondary omentectomy after blockage is a straightforward procedure. Spiral catheters conferred no benefit in this study. Omentectomy does not influence the incidence of peritonitis.

Adolescent↗