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Biomedical subjects

W J Gillespie

Publications and source records attributed to W J Gillespie.

At least 37 records · Page 2Linked to original sources
PubMed1998

A preliminary exploration of the interactional skills of trainee surgeons.

BACKGROUND: The interactional skills of 21 surgical trainees were studied in the areas of breaking bad news to patients and preparing patients for potentially threatening medical procedures. When compared to the established guidelines for dealing with these issues, the trainees performed poorly. METHODS: Trainees were videotaped using clinical histories delivered by simulated patients in simulated consulting rooms. All videos were scored on standard rating scales where the criteria for rating the specific interactional skills were adopted from existing guidelines. RESULTS: The proportion of trainees who could meet the guidelines when breaking bad news was low. The proportion of trainees who met the guidelines were: closing the the consultation (0%), provided patient information about prognosis (43%) and treatment (38%) and when they gave support (10%). There were also low numbers of trainees who could meet the guidelines when they prepared patients for potentially threatening procedures. Ten per cent of trainees followed the guidelines when providing information, 25% could establish treatment goals, 35% could give a prognosis and 0% could deal appropriately with psychosocial issues or close the consultation appropriately. CONCLUSIONS: It is concluded that there is a need for further formal training in interactional skills as part of surgical training.

Clinical Competence↗
PubMed1998

Morbidity surveillance in the British Army--the first 12 months.

This paper describes the data obtained during the first 12 months of the morbidity surveillance system used, world-wide, by the British Army in operational and non-operational settings and the economic impact of such morbidity in terms of estimated working days lost. Analysis is provided on primary health care and dental morbidity, the surveillance of patients undergoing physiotherapy and those Service personnel cared for by the NHS. The surveillance of the latter population shows a high burden of morbidity which, previously, has never been quantified. The most frequent cause of attendance within primary health care is injuries (all causes) with an annual total of 77,254--a rate per 1,000 personnel per month of 51.92. This leads to an annual loss of manpower, in terms of estimated working days lost of 127,839--a rate per 1,000 personnel per month of 85.91. Army Training Regiments (ATRs-5 sites), Infantry Training Centres (ITCs-2 sites) and the Royal Military Academy Sandhurst (RMAS) are grouped together as Selected Training Establishments (STEs) and show attendance rates higher than the mean for all causes. Summary results of Cochrane systematic reviews presenting up-to-date concise information on experimental evidence as to which preventive interventions should be used to diminish the notable impact of injuries on Army personnel are also given.

Absenteeism↗
PubMed1998

Sensory nerves in the interface membrane of aseptic loose hip prostheses.

We studied the presence of sensory nerves by immunohistochemistry in the interface membranes of hip prostheses after aseptic loosening. Substance P (SP), neurokinin A (NKA) and calcitonin gene-related peptide (CGRP) were analysed as was protein gene product (PGP) 9.5, a general marker for nerve fibres. We identified nerve fibres in all samples but differences in their density were found. SP- and NKA-positive fibres were predominantly non-vascular, forming varicose nerve terminals. CGRP-immunoreactive nerve fibres with varicose terminals were seen mostly close to blood vessels, but also as free nerve endings. Sensory neuropeptides participate not only in nociception but also stimulate immune cells to release cytokines. The presence of sensory nerves in the interface membrane may reflect a pathophysiological response contributing to the aseptic loosening of hip prostheses.

Aged↗
PubMed1997

Prevention and management of infection after total joint replacement.

Prophylactic antimicrobial regimens providing adequate drug levels in tissue during surgery and for periods of 24 hours to 14 days are of proven effectiveness in reducing infection rates after joint arthroplasty. Although most surgeons employ short regimens of < 24 hours' duration, their efficacy has not been clearly established for joint replacement in placebo-controlled trials. Careful preparation of the patient before surgery and attention to operating room asepsis are also important. In early postoperative infections, surgical debridement and antibiotic treatment may allow conservation of the prosthetic components. In established infection in which the components have become loose, radical surgical debridement must include removal of all prosthetic material as well as involved bone and soft tissue; reconstruction by exchange arthroplasty has an acceptable success rate. For infections caused by organisms of low virulence, exchange arthroplasty has been successful as a one-stage procedure, but no comparative trial with two-stage exchange has yet been reported.

Antibiotic Prophylaxis↗
PubMed1997

Environmental hazards in the homes of older people.

OBJECTIVES: To investigate (i) the prevalence of environmental safety hazards in the homes of people aged 70 years and over, (ii) their knowledge of causes of injuries to older people and the safety measures they can implement to prevent such injuries and (iii) the relationship between socio-demographic characteristics of this population group and levels of home environmental hazards. METHOD: A cross-sectional survey of 425 people aged 70 years and older living in a defined geographical area of Australia. Participants were recruited through their general practitioners. A structured interview completed with each participant included questions on demographics and home safety issues. A home safety inspection was also undertaken using a predetermined rating format. RESULTS: 80% (n = 342) of homes inspected had at least one hazard and 39% (n = 164) had > 5 hazards. The bathroom was identified as the most hazardous room, with 66% (n = 279) of bathrooms having at least one hazard. Hazards relating to floor surfaces (62% of homes had one 'flooring' hazard) and absence of appropriate grab or handrails (60% of homes had one or more hazards relating to this) were prevalent. Eighty-eight percent (n = 374) of older people were able to identify falls as the most common cause of injury and 87% (n = 368) were able to accurately name at least one safety measure. Although a significant association was found between the older people's self-assessment of their home's safety and the presence of more than 5 hazards, 30% of those rating their homes as very safe (n = 289) had more than 5 hazards. Logistic regression analysis identified one variable--contact with healthcare service providers--as predictive of the hazard level in older people's homes. Older people who were never visited by service providers were twice as likely to have more than 5 hazards as those who were visited weekly or more often (OR 2.12, 95% CI 1.104, 4.088). CONCLUSION: Many older people are living in potentially hazardous environments. As yet, a causal link between the presence of environmental hazards and falls in older people has not been established. More definitive work in this area needs to be carried out.

Aged↗
PubMed1997

Osteoporosis clinical trials endpoints: candidate variables and clinimetric properties.

We reviewed evidence on endpoints used in osteoporosis clinical trials to assist in the development of a set of endpoints to be included in all trials. A MEDLINE search was conducted using the Cochrane Collaboration strategy for each endpoint. Additional published literature was obtained from content experts. A proposed list of endpoints was developed after consultation with experts in the field. Each endpoint was evaluated with respect to validity, reproducibility, redundancy, and feasibility. We classified the endpoints into 2 major categories: clinical health status outcomes and intermediate endpoints, and for each endpoint we present current evidence from the literature as pertains to defined methodologic criteria. Multiple endpoints have been used in osteoporosis clinical trials, and an agreement on a core set of measures needs to be evidence based with an emphasis on validity, reproducibility, and feasibility and to satisfy clinical credibility.

Biomarkers↗
PubMed1996

Development of hematopoietic cancers after implantation of total joint replacement.

The evidence from the 4 epidemiologic studies published before mid 1995, which have investigated the incidence of cancers in patients who have undergone joint implants, is conflicting. The results of the 2 earlier studies suggested a sustained increase in the risk of lymphoma and leukemia after total hip arthroplasty. The results of the 2 more recent studies have not confirmed this, although in 1 study an increased risk was observed in the first year after implantation. The heterogeneity may be statistical in origin, but could also have a biologic explanation in the greater proportion of metal on metal prostheses used before 1973. All 4 studies used national data as the comparison. Here, are presented the results of 2 matched cohort studies and a case control study set in North America and Scotland, and an overview of the 4 previous studies. Neither the results of the matched studies of patients operated on after 1973 nor the results of the latter 2 published studies suggest an increased risk of lymphoma or leukemia. If metal on metal articulations are reintroduced, careful surveillance is essential.

Adult↗
PubMed1996

Metal on metal total hip replacement workshop consensus document.

The objective of this workshop was to provide a forum to discuss the reintroduction of metal on metal bearings for clinical use in total hip arthroplasty. Approximately 100 researchers clinicians, and industry representatives presented the state of the art interpretation of the metal on metal total hip replacement's past performance, and the clinical, tribologic, and biologic considerations of all metal bearings. Based on the scientific presentations at the symposium, the extant literature, the clinical experience of the panelists, and the current regulatory, legal, and economic environment, consensus statements were developed.

Alloys↗
PubMed1996

Polymorphonuclear leukocyte-mediated bone degradation and influence of blood mononuclear cells on the mouse calvarial model.

OBJECTIVE: To investigate the relationships between degradation of bone and activated blood polymorphonuclear leukocytes (PMNL) and mononuclear leukocytes (ML) as well as their soluble products in vitro. MATERIALS AND METHODS: A neonatal mouse calvarial bone model was used to assess the activity of degradation (by measuring the amount of 45Ca release) by normal human blood leukocytes, separated PMNL and ML following 24-hour incubation. The effects of conditioned culture medium obtained from Staphylococcus aureus-stimulated ML on PMNL-mediated calvarial bone loss were also studied. RESULTS: It was demonstrated that isolated human PMNL rapidly degraded bone in a dose and time dependent manner. The PMNL-mediated bone degradation was enhanced by conditioned medium obtained from Staphylococcus aureus-stimulated ML. CONCLUSION: These findings implicate PMNL as major contributors to early bone loss in infectious diseases such as acute haematogenous osteomyelitis.

Animals↗
PubMed1995

Evaluation of new technologies for total hip replacement. Economic modelling and clinical trials.

Cost is a factor in the choice of prosthetic components in joint replacement. For a given performance, the least expensive components are the most cost-effective. When evaluating a new prosthesis with an unknown outcome, the use of an economic model allows estimation of potential cost-effectiveness. We used published data for the survival of cemented total hip replacements from Sweden, and cost and demographic information from New South Wales, Australia, in such a model. In young active total hip recipients a new prosthetic design which offered a 90% improvement in survivorship over 15 years and a 15% reduction in the cost of revision surgery, could be sold at a price of 2 to 2.5 times that of conventional cemented components such as the Charnley Low Friction Arthroplasty and still be cost-effective. Using more likely estimates of the improved performance of new technology, however, the upper limit of cost-effectiveness is an increase of 1.5 to 1. Only a very small increase in the cost of a prosthesis could ever be justified for older patients of either sex. Most of the potential benefits of a better level of survivorship appear towards the end of the 15-year period. The results of modelling may be incorporated in clinical trial design. Given the known performance of some well-established and relatively inexpensive designs of prostheses, very large randomised studies would be required to prove an improvement in performance.

Aged↗
PubMed1994

Does the amount of endurance exercise in combination with weight training and a very-low-energy diet affect resting metabolic rate and body composition?

Effects of large (LA; 400 min/wk) and moderate (MA; 200 min/wk) amounts of endurance exercise in combination with weight training (3 d/wk) were compared with the effects of no exercise (C) in 23 obese females after a 12-wk, 3360-kJ/d very-low-energy diet (VLED). The LA group lost 6.5 kg more weight, mainly as fat (6.4 kg), than the C group (P < 0.05). No measurable differences were found among groups for decreases in resting metabolic rate (-729 to -1233 kJ/d; NS) or fat-free mass (-2.9 to -3.9 kg; NS). No improvements in aerobic capacity were achieved with the addition of exercise to a VLED (-0.079 to -0.037 L/min; NS). Strength indexes were improved (+16 to +5 kg; P < 0.05) or maintained with exercise (-3 kg; NS) whereas a loss (-9.3 kg; P < 0.05) or maintenance (+4.5 kg; NS) was found for VLED alone. Large amounts of endurance exercise in combination with weight training added to a VLED appear to improve weight and fat loss compared with a VLED alone.

Adipose Tissue↗
PubMed1992

A comparison of elderly patients with proximal femoral fractures and a normal elderly population: a case control study.

AIM: To assess the importance of bone density and other risk factors in elderly subjects with hip fractures. METHOD: Thirty-six subjects with femoral neck fracture were compared with 72 community controls in this case control study. Variables compared included: history of falls, previous fracture, body mass index, hand grip strength, blood pressure, medication use, cigarette smoking, alcohol intake, visual acuity, age at menopause, mental status quotient, mobility index and mid thigh circumference. Bone mineral density was measured at the hip (DPA absorptiometer) in the 36 subjects with hip fracture and 36 community controls. RESULTS: Fracture patients had significantly (p < 0.01) reduced bone mineral density at femoral neck (0.64 vs 0.74 g/cm2) and trochanteric regions (0.55 vs 0.66 g/cm2). They also had significantly (p < 0.05) lower body mass index, weaker hand grip strength, smaller mid thigh circumference, reduced mobility and more previous fractures. After controlling for age and sex stepwise logistic regression identified handgrip strength, mobility status and falls in that ranking as risk factors for fracture. Bone mineral density was correlated with mobility status and grip strength. CONCLUSION: Patients with hip fracture have lower bone mineral density than controls. Mobility, grip strength and muscle bulk appear to be important in fracture aetiology and could operate either through bone density or risk of falling.

Accidental Falls↗
PubMed1992

Estimation of peak oxygen consumption from a sub-maximal half mile walk in obese females.

This study compared peak oxygen consumption estimated from a half mile sub-maximal walk test with oxygen consumption determined from a maximal treadmill test with 96 obese females. A half mile walk was completed as quickly as possible without running. Retests on 71 subjects were completed to determine the reliability of the half mile walk. Hearts rates were obtained for 15 s immediately upon completion of the walks. Stepwise regression to estimate peak VO2 was used with the following variables: walk time (TM), body weight, height, BMI, age, and heart rate (HR). The best equation was peak VO2 (ml/kg/min) = 53.23 - (1.98 x TM) - (0.32 x BMI) - (0.08 x age), r = 0.76, s.e.e. = 2.89 ml/kg/min. The mean difference between determined and estimated peak VO2 in a cross-validation group of subjects who were not included in the validation group was 0.15 ml/kg/min (n.s.), r = 0.77, s.e.e. = 3.01 ml/kg/min, E = 3.09. Reliability for time to complete the half mile walk was r = 0.87 with 0.1 min difference (n.s.). This study indicated the half mile walk to provide an accurate, reliable estimate of peak VO2 which should be useful in the clinical setting.

Adult↗
PubMed1990

Effects of age and sex on bone density at the hip and spine in a normal Caucasian New Zealand population.

We have studied a normal adult caucasian population (462 females, 264 males age range 20-84) using dual photon absorptiometry to establish patterns of bone reduction at the spine and hip. Subjects were either randomly selected from the electoral roll or volunteers. Bone mineral density reduction at the lumbar spine in females appeared to increase at 40 years and was sustained until 60 years. In males bone mineral density at the spine was preserved. The density at the hip in females decreased throughout adult life beginning before the menopause. In males bone density was preserved at the femoral neck and trochanteric region but not at Wards triangle where reduction occurred throughout life. When compared with other normal populations there was higher bone mineral density at the spine in postmenopausal New Zealand females but no significant difference at the hip.

Absorptiometry, Photon↗