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Biomedical subjects

A Metcalfe

Publications and source records attributed to A Metcalfe.

16 recordsLinked to original sources
PubMed2002

[Factors associated with hospital mortality in patients admitted to the intensive care unit in Colombia].

OBJECTIVES: To describe the demographic features, reasons for hospital admission and factors associated with hospital mortality in patients admitted to intensive care in Colombia. METHOD: A cohort study of patients admitted to intensive care units (ICUs). Of 89 ICUs identified in Colombia, 20 in ten cities were invited to gather information on 200 consecutive patients admitted to each ICU. RESULTS: Three thousand sixty-six patient cases were available for analysis. The mean age was 53 years and 43% were women (men vs. women, p < 0.001). The most frequent cause of admission was medical (63.9%), acute myocardial infarction patients (7.1%) comprising the largest group. Severity of disease measured as APACHE II and III was a mean 14.0 (SD 6.9) and 48.3 (SD 23.5), respectively. Multivariate analysis, independent of adjustment for severity (APACHE II or III), showed that the factors associated with hospital death were the need for mechanical ventilation, pupillary response, transfer from a medical ward, and management by the ICU team prior to admission (p < 0.01). CONCLUSION: The most common reason for admission to an ICU in Colombia was myocardial infarction. Besides severity of disease, other variables related to medical care in Colombia are associated with hospital mortality, such as invasive ventilation. Although these variables may be artifacts related to disease severity, they are more likely to be related to quality of care.

APACHE↗
PubMed2001

Nurse consultants. Room at the top.

The role of nurse consultant needs to be embedded in trust culture if it is to achieve its potential. The process of defining key competencies can enhance the organisation's ownership. The post needs to be evaluated at local level.

Consultants↗
PubMed2000

Bed numbers. Inadmissible evidence.

Little research has been done on the number of intensive care beds the UK needs, and provision varies widely across the country. There is no indication of systematic under-provision of intensive care unit beds in the UK. There is confusion about appropriate referrals and admissions. Research suggests that with the current number of beds there are 2,100-2,500 avoidable deaths a year. But it is unclear how many of these would be avoided by providing extra beds.

Health Care Surveys↗
PubMed1997

Epithelial apoptosis.

Apoptosis is an essential part of the normal cellular phenotype repertoire. In the absence of appropriate survival factors, apoptosis is activated through specific signalling cassettes. Epithelia form distinctive three-dimensional cohesive structures that depend on adhesive interactions in order for these tissues to carry out their specialised roles, such as secretion and reproduction. The cellular programme that triggers apoptosis in epithelial cells has not yet been shown to differ form that in other cell types, yet the unique characteristics of epithelia endow them with specific determinants for survival. In particular, cell-matrix and cell-cell interactions are required to prevent entry of epithelial cells into apoptosis, and soluble factors that have profound effects on epithelia, such as steroid hormones or hepatocyte growth factor, also influence their survival. The regenerative capacity of certain epithelia is controlled by intrinsic expression of survival genes within stem cell populations, and may regulate the susceptibility of different epithelial tissues to undergo carcinogenesis.

Animals↗
PubMed1996

Requirement of basement membrane for the suppression of programmed cell death in mammary epithelium.

Apoptosis is an active mechanism of cell death required for normal tissue homeostasis. Cells require survival signals to avoid the engagement of apoptosis. In the mammary gland, secretory epithelial cells are removed by apoptosis during involution. This cell loss coincides with matrix metalloproteinase activation and basement membrane degradation. In this paper we describe studies that confer a new role for basement membrane in the regulation of cell phenotype. We demonstrate that the first passage epithelial cells isolated from pregnant mouse mammary gland die by apoptosis in culture, but that cell death is suppressed by basement membrane. The correct type of extracellular matrix was required, since only a basement membrane, not plastic or a collagen I matrix, lowered the rate of apoptosis. Attachment to a matrix per se was not sufficient for survival, since apoptotic cells were observed when still attached to a collagen I substratum. Experiments with individually isolated cells confirmed the requirement of basement membrane for survival, and demonstrated that survival is enhanced by cell-cell contact. A function-blocking anti-beta1 integrin antibody doubled the rate of apoptosis in single cells cultured with basement membrane, indicating that integrin-mediated signals contributed to survival. We examined the cell death-associated genes bcl-2 and bax in mammary epithelia, and found that although the expression of Bcl-2 did not correlate with cell survival, increased levels of Bax were associated with apoptosis. We propose that basement membrane provides a survival stimulus for epithelial cells in vivo, and that loss of interaction with this type of matrix acts as a control point for cell deletions that occur at specific times during development, such as in mammary gland involution.

Animals↗
PubMed1994

Development and evaluation of an information system for quality assurance.

The aim of this study was to develop and evaluate an information system for monitoring impact of acute hospital care on health status of elderly patients, burden on carers, and consumer satisfaction with care. The study was undertaken on four acute care wards of an elderly care unit of a teaching hospital. We used a consensus-building process to achieve within-and-between-team convergence of policy and practice in the use of structured assessments on three wards, with parallel data collection by a research nurse on one ward. We describe the changes to our working practices, the costs of data collection, staff attitudes to the system and the assessment instruments, using 5-point Likert Scales, with additional in-depth interviews with senior staff for their attitudes to the system. We found that only nursing staff were able to change their practice. On admission, it was feasible to undertake functional assessment of activities of daily living (ADL), depression, perceived life quality and carer strain. Discharge assessment was only feasible for ADL. Other discharge assessments and follow-up assessments including consumer satisfaction interviews required audit assistant support. The total annual cost per ward was 6,225 pounds for the adopted system, or 6,455 pounds to incorporate follow-up assessments by audit assistant in a random sample of 50 patients. Staff attitudes to the system were positive, especially for use of the Relatives' Stress Scale, and for the value of follow-up interviews. We conclude that the participatory approach to the introduction of the information system produced a system which was perceived to be beneficial for patient care.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1994

Presence of nonfunctional thyrotropin receptor variant transcripts in retroocular and other tissues.

The TSH receptor (TSHR) has been proposed as an antigenic link between the thyroid and the orbit; TSHR transcripts have been demonstrated by other groups, one in orbital tissue and the other in orbital and dermal fibroblasts. In a previous study we were unable to demonstrate transcripts for the complete TSHR in retroocular muscle containing also fibroblasts. We now confirm this finding. A 1.3-kilobase variant of the TSHR messenger ribonucleic acid (mRNA) has been described in normal and Graves' thyroids; it contains exons 1-8 of the major mRNA species and a unique 3'-sequence predicted to encode further amino acids and a polyadenylated tail. Lacking the membrane-spanning region, the corresponding variant protein, if expressed, is not expected to couple to G-proteins. Using primers specific for this variant in reverse polymerase chain reaction experiments, Southern blotting and frequencies, we demonstrate the presence of this transcript in normal and Graves' thyroid, extraocular muscle, peripheral blood mononuclear cells, and, to a lesser extent, in fat and fibroblasts. TSH-mediated protein synthesis, cAMP, and glycosaminoglycan production have been measured in cultured fibroblasts. At 5 mU/mL, bovine TSH stimulated glycosaminoglycan production, but recombinant TSH did not, even at higher concentrations, suggesting that contaminating factors are responsible. Together the data do not support the presence of a functional complete TSHR in orbital tissue. However, they are compatible with a role for the extracellular portion of the receptor as a nonfunctional autoantigen and provide some explanation for the conflicting results with regard to the relevance of the TSHR in the pathophysiology of thyroid-associated ophthalmopathy.

Actins↗
PubMed1993

Community worry about heart disease: a needs survey in the Coalfields and Newcastle areas of the Hunter region.

A needs survey was administered by mail in the Coalfields area of the Hunter region (a lower socioeconomic area around Cessnock) and in a higher socioeconomic area of Newcastle. The purpose was to assist planning for Coalfields Healthy Heartbeat--a community-action heart disease prevention program. Response rates from random samples of residents were 435/897 (49 per cent) for the Coalfields and 565/875 (65 per cent) for Newcastle. In both study areas heart attack was ranked eleventh from a list of 17 potential community worries, well below drugs, crime, road safety, the environment, cancer and 'loss of health'. Coalfields respondents were more worried about all issues on the list than were the residents in Newcastle and were less likely to have heard about recent health promotion campaigns. Coalfields respondents felt that heart disease prevention was the responsibility of the individual, the family, and the medical profession, in that order, and much less the responsibility of local community groups. Results suggest that health promotion strategies incorporating values, language and symbols that are meaningful to distinct subgroups may be more successful than disease-specific programs aimed at the general population.

Adult↗
PubMed1987

Ovarian neoplasms, functional ovarian cysts, and oral contraceptives.

The incidence of ovarian neoplasms and functional ovarian cysts diagnosed at laparotomy or laparoscopy among the 17,000 women taking part in the Oxford Family Planning Association contraceptive study was investigated. Epithelial cancer of the ovary was only 25% as common among those who had ever taken oral contraceptives as those who had never done so (95% confidence interval 8% to 67%). There was little evidence of any important association between use of oral contraceptives and benign teratoma or cystadenoma. Functional cysts of the ovary occurred much less commonly in women who had recently (in the six months preceding diagnosis) taken combined oral contraceptives (but not in those who had taken progestogen only oral contraceptives) than in those who had never taken oral contraceptives or had taken them in the past. This protective effect was more pronounced for corpus luteum cysts (78% reduction; 95% confidence interval 47% to 93%) than for follicular cysts (49% reduction; 95% confidence interval 20% to 70%). It is estimated that about 28 (95% confidence interval 16 to 35) operations for functional ovarian cysts are avoided among every 100,000 women who take oral contraceptives each year.

Adult↗
PubMed1986

Mortality and facial dyskinesia.

In 1965 a psychiatric in-patient population was surveyed for the prevalence of facial dyskinesia. The present investigation reports on their survival time. Among male and female patients with functional disorders (mostly schizophrenia) there was a strong association between moderate or severe facial dyskinesia and shortened survival, but no clinical factors were found to explain this. Mild facial dyskinesia in functional disorders was not associated with reduced life expectancy and may be attributable to the general effects of ageing rather than to a specific pathological process. Among patients with primary organic brain syndromes, dyskinesia was not associated with reduced life expectancy.

Aged↗
PubMed1983

Structural homology in the amino-terminal domains of two aminoacyl-tRNA synthetases.

The three-dimensional structures of two animoacyl-tRNA synthetases, the methionyl-tRNA synthetase from Escherichia coli (MetRS) and the tyrosyl-tRNA synthetase from Bacillus stearothermophilus (TyrRS), show a remarkable similarity over a span of about 140 amino acids. The region of homologous folding corresponds to a five-stranded parallel beta-sheet, including a mononucleotide-binding fold. One cysteine and two histidine residues that were found to be invariant in the amino acid sequences occupy similar places in the nucleotide-binding fold. In TyrRS, these residues are close to the adenylate binding site, and in MetRS to the Mg2+-ATP binding site.

Amino Acid Sequence↗
PubMed1982

Role of antibody in the protection of mice from arthritis induced by Mycoplasma pulmonis.

C3H and C57Bl10 mice exhibit a differential susceptibility to arthritis induced by Mycoplasma pulmonis. Resistant C57Bl10 mice consistently demonstrated higher complement-fixing antibody titres than susceptible C3H mice throughout the development of the acute arthritis. A strong correlation was demonstrated between the levels of anti-mycoplasma antibody and resistance to acute arthritis in six strains of mice. To test the hypothesis that the difference of arthritis resistance of C3H and C57Bl10 mice was caused by a different susceptibility of their lymphocytes to mitogenic stimulation by M. pulmonis, we investigated the generation of non-specific immunoglobulin in vivo and in vitro. M. pulmonis acted as a polyclonal mitogen, but stimulated approximately equal responses in lymphocytes of both strains.

Animals↗
PubMed1981

Role of viable mycoplasmas in the pathogenesis of arthritis induced by M. pulmonis.

The role of viable M. pulmonis organism in the pathogenesis of both the acute and chronic phases of M. pulmonis-induced arthritis was examined. In the acute phase of the arthritis most clinically involved joints contained organisms and the degree of clinical arthritis in a given joint correlated with the number of organisms isolated. The more severe the acute arthritis, the more frequently the M. pulmonis organism was isolated from the joints during the chronic phase. In the chronic phase, arthritis defined histologically correlated with the presence of M. pulmonis organisms within a given joint. No correlation was observed between clinical arthritis during the chronic phase and histopathology or the presence of M. pulmonis organisms within the joint. In chronically infected mice, M. pulmonis was isolated from the joints only but not from the blood, liver, spleen, lung or kidney of any mouse examined. The results support the concept that viable organisms play an essential role in the pathogenesis of the acute and chronic phases of M. pulmonis-induced arthritis in mice.

Animals↗
PubMed1981

Enhanced resistance of mice to Mycoplasma pulmonis-induced arthritis by administration of killed Corynebacterium parvum.

Inoculation of mice with Corynebacterium parvum 14 days before intraperitoneal inoculation of Mycoplasma pulmonis resulted in arthritis of significantly lesser magnitude than in control mice as measured both clinically and histologically. Mycoplasmas were isolated from the joints of mice inoculated with C. parvum less frequently than from control mice when the arthritis was maximal. Mycoplasmas were also isolated in smaller numbers from the blood and joints of mice pretreated with C. parvum within 2 hr after M. pulmonis inoculation. Complement-fixing antibody to M. pulmonis did not account for the differences observed. C. parvum given during an established mycoplasmal infection, although capable of enhancing elimination of M. pulmonis from the joints of infected mice, had no effect upon the arthritis as measured clinically or histologically. The results provide evidence that immunomodulators such as C. parvum are capable of enhancing elimination of mycoplasmas from the joints of infected mice prior to or after the induction of arthritis.

Animals↗