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Biomedical subjects

A Edwards

Publications and source records attributed to A Edwards.

At least 163 records · Page 9Linked to original sources
PubMed1997

Communication about risk--dilemmas for general practitioners. The Department of General Practice Working Group, University of Wales College of Medicine.

Measures of risk frequently contribute to our understanding, prevention, or treatment of disease, but it is important that general practitioners (GPs) explain clinical risks effectively to patients to ensure they are not misunderstood, as risk information can assist in decision-making processes and encourage behavioural change. However, the interpretation of risks by patients and doctors varies. It is argued that problems arise because communication about risk is usually framed in terms of the language of chance or probability. In this paper, we describe how probability theory developed, and suggest that attempts to communicate empirical risk processes in probabilistic language are bound to produce dilemmas. We explore how the theory relates to clinical practice and identify key issues that doctors must address in discussing risk with individual patients.

Communication↗
PubMed1996

Novel, cross-restricted, conserved, and immunodominant cytotoxic T lymphocyte epitopes in slow progressors in HIV type 1 infection.

HIV-specific cytotoxic T lymphocytes (CTLs) play an important role in the immune response to HIV infection. Long-term nonprogressors (LTNPs) or slow progressors (SPs) in HIV infection may make qualitatively different CTL responses compared to those generated by seropositive individuals who progress to disease at a faster rate. The class I molecule HLA-B*57 has been identified as one restriction element overrepresented in SP groups studied, and, together with the closely related molecule HLA-B*58, occurs commonly in ethnic groups where HIV is most prevalent. In this study, we have identified five new HLA-B*57-restricted CTL epitopes recognized by SP donors, one of which is also HLA-B*5801 restricted. These HLA-B*57-restricted responses represent the dominant HIV-specific CTL response in each of the SP donors tested. These and other such epitopes may be an important component in future vaccine design.

Amino Acid Sequence↗
PubMed1996

In vitro biosynthesis of androgens in the Australian lungfish, Neoceratodus forsteri.

The serum concentration of testosterone was estimated from a population of wild lungfish over 6-7 years of sampling. Male lungfish were found to have high circulating levels of testosterone (approximately 50 ng/ml) which varied seasonally and could be correlated with spermatogenesis as judged by testis histology. Incubation of testis tissue slices with [3H]progesterone, [3H]17-hydroxyprogesterone, or [3H]testosterone confirmed that testosterone is the major androgen in Neoceratodus. Not even trace amounts of 11-keto- or 11 beta-hydroxytestosterone or 5 alpha-dihydrotestosterone could be identified by TLC separations. There was little or no conjugation of steroids by the testes, except during the spawning season, when glucuronides of androstenedione and testosterone were produced.

Androgens↗
PubMed1996

Pain management knowledge, attitudes and clinical practice: the impact of nurses' characteristics and education.

This study examined the knowledge, attitudes, and clinical practice of registered nurses (N = 120) regarding pain management. Data were collected from nine varied clinical units in a large, university-affiliated, teaching hospital in an urban area of the Northeast. Demographic information was also collected to explore the relationship between nurses' characteristics, including previous pain education, clinical experience, area of clinical practice, and other variables, and knowledge, attitudes, and clinical practice. Three instruments were used in the study: (a) the Pain Management: Nurses' Knowledge and Attitude Survey; (b) a 12-item demographic questionnaire; and (c) a Pain Audit Tool (PAT) to gather data regarding pain assessment, documentation, and treatment practices from charts. Mean scores from the nursing knowledge and attitudes survey on pain revealed knowledge deficits and inconsistent responses in many areas related to pain management (mean, 62%; range, 41%-90%). The top two nurse-ranked barriers to pain management were related to patient reluctance to report pain and to take opioids for pain relief. Demographic data revealed that education about pain was most inadequate in the following areas: nonpharmacological interventions to relieve pain, the difference between acute and chronic pain, and the anatomy and physiology of pain. Chart audits with the Pain Audit Tool revealed that 76% of the charts (N = 82) lacked documentation of the use of a patient self-rating tool by nurses to assess pain, despite a high reported use (76%) of such a self-rating tool. Adjunct medications were ordered with some consistency, but appeared to be underutilized. This was especially true of nonsteroidal anti-inflammatory agents (mean use, 1%). Ninety percent of the charts had no documentation of the use of nonpharmacological interventions to relieve pain. Although this clinical setting has policies and resources in place regarding the management of pain, it would appear that they are not optimal. Practical recommendations are presented for increasing nurses' knowledge about pain management; improving the quality and the consistency of the assessment, documentation and treatment of pain; and disseminating pain management information.

Attitude of Health Personnel↗
PubMed1996

A prospective audit of wound infection rates after caesarean section in five West Yorkshire hospitals.

A three month prospective audit of wound infection following emergency and elective caesarean section was carried out in five West Yorkshire hospitals. Among 4076 women undergoing delivery in the five obstetric departments, the caesarean rate was 15.4%. The overall infection rate was 45/628 (7.2%) with a range of 2.5-17.2% between the five centres. The infection rate was 14/226 (6.2%) when antibiotics were used compared with 31/402 (7.7%) without antibiotics. The use of prophylactic antibiotics made no significant difference to the infection rate, which did not correlate with duration of labour or of ruptured membranes. The number of vaginal examinations correlated with the infection rate. In conclusion, the caesarean section rate observed was higher than that estimated for the UK as a whole, but was distorted by one centre with a high rate. For the other four hospitals the caesarean rate was unexceptional. The ratio of emergency to elective operations was comparable with recently reported values in the UK and the wound infection rate was within the widely varying limits found in previous studies. In view of the relatively low infection rate recorded without antibiotics, in the interests of cost effectiveness, prophylaxis may be limited in future to selected women at high risk. Because this was an audit rather than a randomized study we cannot exclude that this is already happening on an empirical basis.

Antibiotic Prophylaxis↗
PubMed1996

Patterns of help-seeking behaviour for toddlers from two contrasting socio-economic groups: new evidence on a neglected topic.

OBJECTIVE: This descriptive study aimed to assess patterns in help-seeking behaviour for common childhood symptoms. METHOD: Clinic attenders aged 9-18 months of two child health clinics on Tyneside, UK, one with substantial economic deprivation, were studied. Outcome measures were parental reporting of common symptoms, utilization of professional advice and general practitioner records of consultations. RESULTS: Children in the affluent area had had fewer general practitioner consultations (mean 7.3) than those in the poorer area (mean 15.1; 95% CI for difference 4.3-11.4). They were less likely to present with an episode of diarrhoea or cold but were as likely as the poorer group to present with fever. Behaviour problems were reported less frequently (23% versus 47%), but if present, this was far more likely to result in help seeking than in the poorer group (86% versus 33%; P < 0.05). CONCLUSIONS: Variations in help-seeking behaviour between two economically contrasting groups were identified; this has implications for clinical understanding and service provision in primary care.

Chi-Square Distribution↗
PubMed1996

Fifteen years of a videotape review program for internal medicine and medicine-pediatrics residents.

The medical interview remains the most valuable component in patient evaluation. In addition to its diagnostic usefulness, it is the foundation upon which the doctor-patient relationship is built. It is essential, therefore, that health care providers be well trained in interviewing. Evidence suggests that having residents conduct videotaped interviews with patients and review the videotapes with faculty is an excellent way to teach interviewing skills. Videotape review has been part of the residency programs in primary care internal medicine and medicine-pediatrics at Wayne State University School of Medicine for 15 years. Throughout the history of the videotape program, the authors have endeavored to make the review process less stressful for residents by ensuring that the reviews are nonthreatening, nonjudgmental, and learner-centered. In this paper, the authors discuss (1) the structure and process of the videotape review program; (2) recurrent themes of the review sessions; (3) residents' perspectives on the process; and (4) potential barriers to a successful videotape review program and suggestions for how to avoid or overcome them.

Communication↗
PubMed1996

Frequency of photographically apparent optic disc and parapapillary nerve fiber layer drusen in Usher syndrome.

PURPOSE AND DESIGN: Using a retrospective case series, the authors determine the frequency and clinical features of optic disc and parapapillary nerve fiber layer drusen in type I and type II Usher syndrome (congenital deafness and retinitis pigmentosa). METHODS: Color fundus photographs available on 43 patients with type I and 108 patients with type II Usher syndrome were analyzed for the presence of optic disc or parapapillary nerve fiber layer drusen. RESULTS: Optic disc and/or parapapillary nerve fiber layer drusen were observed in 15 (35%) of 43 patients with type I Usher syndrome and 9 (8%) of 108 patients with type II Usher syndrome for whom color photographs were available. Bilateral drusen were observed in 11 patients (73%) with type I and 3 patients (33%) with type II Usher syndrome. In 3 (20%) of the 15 patients with type I and in 5 (56%) of the 9 patients with type II, only an isolated druse was seen. Six of the 15 patients with type I Usher syndrome showed parapapillary nerve fiber layer drusen, whereas the drusen were within the optic disc in all 9 patients with type II. CONCLUSIONS: Drusen of the optic disc and parapapillary nerve fiber layer tended to occur more frequently in type I than type II Usher patients and also were more often bilateral and multiple, with a tendency to occur in the parapapillary region and within the optic disc.

Adolescent↗
PubMed1996

Evidence that a 77-kilodalton protein from the starch of pea embryos is an isoform of starch synthase that is both soluble and granule bound.

In this paper we provide further evidence about the nature of a 77-kD starch synthase (SSII) that is both soluble and bound to the starch granules in developing pea (Pisum sativum L.) embryos. Mature SSII gives rise to starch synthase activity when expressed in a strain of Escherichia coli lacking glycogen synthase. In transgenic potatoes (Solanum tuberosum L.) expressing SSII, the protein is both soluble and bound to the starch granules. These results confirm that SSII is a starch synthase and indicate that partitioning between the soluble and granule-bound fraction of storage organs is an intrinsic property of the protein. A 60-kD isoform of starch synthase found both in the soluble and granule-bound fraction of the pea embryos is probably derived by the processing of SSII and is a different gene product from GBSSI, the exclusively granule-bound 59-kD isoform of starch synthase that is similar to starch synthases encoded by the waxy genes of cereals and the amf gene of potatoes. Consistent with this, expression in E. coli of an N-terminally truncated version of SSII gives rise to starch synthase activity.

Amino Acid Sequence↗
PubMed1996

Identification of the major starch synthase in the soluble fraction of potato tubers.

The major isoform of starch synthase from the soluble fraction of developing potato tubers has been purified and used to prepare an antibody and isolate a cDNA. The protein is 140 kD, and it is distinctly different in predicted primary amino acid sequence from other isoforms of the enzyme thus far described. Immunoinhibition and immunoblotting experiments and analysis of tubers in which activity of the isoform was reduced through expression of antisense mRNA revealed that the isoform accounts for approximately 80% of the activity in the soluble fraction of the tuber and that it is also bound to starch granules. Severe reductions in activity had no discernible effect on starch content or amylose-to-amylopectin ratio of starch in tubers. However, they caused a profound change in the morphology of starch granules, indicative of important underlying changes in the structure of starch polymers within the granule.

Amino Acid Sequence↗
PubMed1996

Molecular scanning of candidate mitochondrial tRNA genes in type 2 (non-insulin dependent) diabetes mellitus.

Mitochondrial DNA (mtDNA) gene defects may play a role in the development of non-insulin dependent diabetes mellitus (NIDDM). In order to search for potentially diabetogenic mtDNA defects we have applied the technique of single stranded conformational polymorphism (SSCP) analysis to 124 patients with a history of NIDDM and 40 non-diabetic controls. No new heteroplasmic mutations were detected. However, a variety of homoplasmic variants were found in patients with NIDDM; some of these merit further investigation.

Base Sequence↗
PubMed1996

Resistance to biodegradative stress cracking in microporous vascular access grafts.

Degradative cracking, more commonly known as "environmental stress cracking" (ESC) has been observed in many implanted polyetherurethane elastomers. This phenomenon has been attributed to biochemical and cellular interactions at the surface of the implanted material causing polymer chain cleavage. This may result in surface fissuring followed by the deep cracking associated with considerable biodegradation of the polymer, resulting in loss of mechanical strength and the formation of aneurysms in an in vivo situation. These cracking effects are believed to be due to mechanical stress combined with the oxidising actions of macrophages and giant cells, as surface cracking has been observed to occur directly under adherent macrophages on a polyetherurethane implant. These cells form part of the body's immune response which uses enzymes and reactive oxygen species (O2, O2-, and HO. and H2O2) to degrade foreign material. We describe a modification of an in vitro test method developed by Zaho et al. [1] using glass wool and a Hydrogen Peroxide/Cobalt (II) Chloride (H2O2/CoCl2) mixture to replicate the oxidising effects of macrophages in vivo. The modifications were made to establish a routine testing system for resistance to biodegradation which could be used to screen a range of polymers designed for use in microporous vascular grafts. The grafts are pre-stressed by a method devised by Stokes et al. [2] where each graft is stretched to a predetermined elongation over a mandrel and the strain is fixed by tying PTFE tape around each end of the mandrel.

Biocompatible Materials↗