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Biomedical subjects

A Lawrence

Publications and source records attributed to A Lawrence.

At least 19 recordsLinked to original sources
PubMed1999

An audit of deaths occurring in hospital after discharge from the intensive care unit.

The aim of the study was to conduct an audit of patients who died in the ward after discharge from the intensive care unit (ICU). Clinical records of those who died in the ward following discharge between 1991 and 1997 were reviewed. Patients were retrospectively grouped according to whether death was expected, unexpected or likely to die within one year. The causes of death, times in ICU and hospital, demographics, and APACHE II scores were compared. Ninety-nine patients were studied, of whom 60 were triaged to the ward expected to die at the time of ICU discharge. Five of the patients were classified as not expected to die. Of the remaining 34 patients, 65% were debilitated with more than one organ disease and 62% eventually had some treatment withdrawn on the ward. After discharge from ICU, no obvious ward treatment deficiencies were found to contribute to death. However, of those who were admitted to the ICU from the ward and who later died when back in the ward, there seemed to be avoidable events pre-ICU admission in eight (36%) patients, some of which may have contributed to the later death of the patient.

APACHE↗
PubMed1998

Ovarian dermoid cyst leakage--a cautionary tale.

This case illustrates that when a dermoid cyst is punctured, an immediate operative laparoscopy or laparotomy should be performed, along with lavage, to avoid the problems associated with dermoid cyst contents spillage.

Adult↗
PubMed1998

The opioid receptor antagonist nalmefene reduces responding maintained by ethanol presentation: preclinical studies in ethanol-preferring and outbred Wistar rats.

Nalmefene, the 6-methylene derivative of naltrexone, was examined after subcutaneous (s.c.) (0.0001 to 8.0 mg/kg) and oral (10 to 80.0 mg/kg) administration in ethanol (EtOH)-preferring rats whose responding (i.e., lever pressing) was maintained by the presentation of EtOH. Naltrexone (0.01 to 40 mg/kg) was used as a reference opioid antagonist. EtOH (10% v/v) and saccharin (0.025 to 0.1% w/v) solutions were concurrently available for 1 hr each day under a two-lever, fixed-ratio schedule in which four responses on one lever produced the EtOH solution and four responses on the other lever produced the saccharin solution. When basal response rates for saccharin were 10% that of EtOH, all routes of nalmefene administration reduced control levels of responding maintained by EtOH by 38 to 84%. When basal response rates for saccharin-maintained responding were 60% or 82% that of EtOH, only lower s.c. naltrexone (e.g., 0.01 to 0.025 mg/kg) and nalmefene (e.g., 0.01 to 0.10 mg/kg) doses produced a selective dose-dependent suppression of EtOH-maintained responding. Higher nalmefene (0.25 to 8.0 mg/kg) and naltrexone (1.0 to 20.0 mg/kg) doses failed to produce a dose-dependent suppression on EtOH or saccharin maintained responding. Both antagonists suppressed responding maintained by EtOH primarily during the initial 10-min period, with little additional suppression occurring across the remainder of the 60-min period. Subcutaneous nalmefene was 3200- to 6400-fold more potent than oral nalmefene, suggesting bioavailability was optimized using the s.c. route. Nalmefene (0.5 mg/kg, s.c.) treatment for 10 consecutive days produced mild tolerance development, whose effects dissipated by day 8. Naltrexone (10 to 40 mg/kg) and nalmefene (1.5 to 3.0 mg/kg), given 8 to 24 hr before the test session, reduced control levels of responding maintained by EtOH by 82%. Thus, immediate opioid receptor occupancy was not required to observe antagonism. These data demonstrate that, under a variety of experimental conditions, nalmefene is an effective antagonist of responding maintained by EtOH and lend support to clinical reports that nalmefene may function as an alternative pharmacotherapy to naltrexone to reduce EtOH-motivated behavior and prevent relapse.

Alcohol Drinking↗
PubMed1997

Symptomatic and asymptomatic left-ventricular systolic dysfunction in an urban population.

BACKGROUND: In most previous epidemiological studies on the prevalence of chronic heart failure (CHF) the disorder has been defined on clinical criteria. In a cross-sectional survey of 2000 men and women aged 25-74, randomly sampled from one geographical area, we assessed left-ventricular systolic function by echocardiography. METHODS: 1640 (83%) of those invited took part. They completed a questionnaire on current medication, history, and symptoms of breathlessness. Blood pressure was measured and electrocardiography (ECG) and echocardiography were done. Left-ventricular ejection fraction was measurable in 1467 (89.5%) participants by the biplane Simpson's rate method. FINDINGS: The mean left-ventricular ejection fraction was 47.3%. The prevalence of definite left-ventricular systolic dysfunction (defined as a left-ventricular ejection fraction < or = 30%) was 2.9% overall (43 participants); it increased with age and was higher in men than in women (4.0 vs 2.0%). The left-ventricular systolic dysfunction was symptomatic in 1.5% of participants and asymptomatic in 1.4%, 83% of participants with left-ventricular systolic dysfunction had evidence of ischaemic heart disease (IHD) from history or ECG criteria compared with 21% of those without this abnormality (p < 0.001). Hypertension was also more common in those with left-ventricular systolic dysfunction (72 vs 38%, p < 0.001), but there was no difference between those with and without left-ventricular systolic dysfunction in the rate of hypertension without IHD. INTERPRETATION: Left-ventricular systolic dysfunction was at least twice as common as symptomatic heart failure defined by clinical criteria. The main risk factors are IHD and hypertension in the presence of IHD; screening of such high-risk groups for left-ventricular systolic dysfunction should be considered.

Adult↗
PubMed1997

Sensitization to dust mites as a dominant risk factor for asthma among adolescents living in central Virginia. Multiple regression analysis of a population-based study.

Factors influencing asthma were investigated in a population of school children in central Virginia. A survey of 1,054 children in two middle schools (one urban and one suburban) identified 135 students with symptoms suggestive of asthma. Eighty-eight symptomatic children and 123 control subjects were randomly selected for further evaluation by skin testing using common indoor and outdoor allergens; serum assays for total IgE and specific IgE; dust samples assayed for mite (Der p 1 Der f 1), cat (Fel d 1), and cockroach (Bla g 2) allergens; and provocation with histamine to test for bronchial hyperreactivity. Forty-eight of the children with symptoms responded to < or = 3.9 mumol of histamine and were considered to have asthma. Marginal analysis identified elevated total IgE and dust mite, cat, and cockroach sensitization as significant risk factors for asthma. Using multiple regression, only dust mite sensitization was independently associated with asthma (odds ratio = 6.6; p < 0.0001). Dust from 81% of the houses contained high levels of mite allergen (> 2 micrograms/g), while approximately 40% of the children were exposed to cat and 17% were exposed to cockroach allergen. In this population, there was no significant association between asthma and race, socioeconomic status, home smoking, sensitization to outdoor allergens, or allergen concentration in the child's home. In an area where there is a high prevalence of asthma and most houses contain high concentrations of dust mite allergen, sensitization to this allergen is the dominant risk factor for asthma defined as symptomatic bronchial hyperreactivity

Adolescent↗
PubMed1997

Late adolescents' perceptions of their caregiver's feeding styles and practices and those they will use with their own children.

The purpose of this study was to examine the perceptions of late adolescents regarding their caregivers' feeding styles and practices and their perceptions of those they plan to use with their children. The 546 subjects were from a randomly selected sample of 1,000, nonparenting, 18 to 23-year old college students who responded to a questionnaire. Two distinct feeding styles emerged: adult-controlled and cooperative. The adult-controlled style reflects a perception of control which the adult decides what and how much a child will eat. The cooperative style reflects shared control where the adult decides what food will be presented and the child decides how much and whether to eat. Chi-square analysis of the relationship between subjects' perceptions of their caregivers' feeding styles and their perceptions of the styles they believe they will use with their children, resulted in a positive association. To examine perceived past and future feeding practices, a Pearson's r was computed on subscales from a factor analysis. Results indicated positive correlations between subjects' perceived past and future feeding practices. These results suggest generational transmission of feeding styles and practices. A recommendation is made for parent and nutrition educators to focus on both parenting styles and feeding practices.

Adolescent↗
PubMed1995

Evidence based dentistry.

We live in an age of information, innovation and change. Clinical decision making based on good quality evidence should lead to more effective and efficient treatments. Each practitioner has a role in assessing this information. This paper outlines this role, together with the advantages and problems of introducing an evidence based approach to dentistry.

Clinical Competence↗
PubMed1994

A dissociation in the relation between memory tasks and frontal lobe tests in the normal elderly.

In this study a group of elderly subjects were examined on three tests of frontal lobe function. Two of these tests, FAS word fluency and the Alternate Uses Test, were considered tests of spontaneous flexibility, as defined by Eslinger and Grattan [Neuropsychologia 31, 17-28, 1993]. The third, the modified Wisconsin Card Sorting Test (WCST), is considered a test of reactive flexibility. Performance on two tests of memory, release from proactive interference (PI) and a matched recall and recognition test was also measured. The elderly were shown to be impaired on all tests when compared with young controls. Analysis revealed that release from proactive interference was significantly correlated with performance on alternative uses but not WCST while the size of subjects' discrepancy between recall and recognition correlated strongly with WCST but not with Alternate Uses. In addition there was a strong correlation between the two measures of spontaneous flexibility but these measures did not correlate with WCST. Performance on the two measures of memory was also uncorrelated. The data indicate that the pattern of frontal deterioration in the elderly does not comprise a single deficit and, furthermore, that the relationship between frontal dysfunction and normal age-related memory loss is not unidimensional.

Adult↗
PubMed1994

Complications of laparoscopic hysterectomy.

Although laparoscopic hysterectomy is now being performed worldwide, few reported data are available on the associated morbidity and mortality. Between December 1990 and September 1993, 220 women underwent laparoscopic hysterectomy at the Melbourne Gynoscopy Centre. Complications occurred in 35 (15.9%). Among these were anterior abdominal wall vessel injury in 5 patients, bladder injury in 5, febrile illness in 13, secondary hemorrhage in 4, temporary ureteral obstruction in 4, and Richter hernia in 1.

Abdominal Muscles↗
PubMed1994

Diffuse brain swelling after head injury: more often malignant in adults than children?

A series of 118 patients with diffuse traumatic brain swelling was studied retrospectively in order to compare the clinical findings in children with those in adults, and to determine the occurrence of neurological deterioration and outcome. The computerized tomography (CT) picture of absent third ventricle and basal cisterns was used to identify the cases. Although this condition has been associated with children, we found the same number of children and adults (59 cases each). Secondary deterioration (decline in consciousness, the development of new focal neurological signs, or an increase in intracranial pressure) occurred in 40% of cases and was more common in adults than children. Features that were significantly associated with deterioration were the presence of prolonged coma (> 1 hour) after the injury, CT signs of diffuse axonal injury or subarachnoid hemorrhage, or a recorded episode of hypotension. A moderate or good recovery at 6 months was achieved by 70 patients (59%), but 45 patients had a poor outcome (severe disability in nine, vegetative state in three, and death in 33) and this was often a consequence of secondary deterioration. In three patients, the outcome was not known. The combination of a severe initial injury, secondary insult, and diffuse swelling is associated with a poor outlook, particularly in adults. The CT appearance of diffuse swelling may develop more readily in children because of the lack of cerebrospinal fluid available for displacement. In children, diffuse swelling may have a relatively benign course unless there is a severe primary injury or a secondary hypotensive insult.

Adolescent↗
PubMed1993

Outer-membrane protein and immunoblot analysis of Australian isolates of Haemophilus influenzae.

Strains of Haemophilus influenzae isolated from children in South Australia and the Northern Territory with systemic infections (mostly meningitis or epiglottitis) were subjected to serotyping, biotyping, outer-membrane protein (OMP) analysis and immunoblot subtyping. All 65 isolates examined were from blood or cerebrospinal fluid; 59 (91%) of the strains were identified as type b and the remainder as either type a (two strains) or non-typable (four strains). Of the 59 type b strains, 45 (76%) belonged to a single OMP subtype (equivalent to subtype 3L in the Barenkamp scheme); the remaining type b strains belonged to five other OMP subtypes. No correlation was apparent between OMP subtype and geographical region, clinical diagnosis or antimicrobial drug susceptibility pattern. Immunoblot subtyping enabled nine (18%) of 41 strains belonging to the principal OMP subtype to be distinguished from the remainder.

Australia↗