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Biomedical subjects

A Reed

Publications and source records attributed to A Reed.

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

Valsartan and hydrochlorothiazide in patients with essential hypertension. A multiple dose, double-blind, placebo controlled trial comparing combination therapy with monotherapy.

OBJECTIVE: This study compares the antihypertensive efficacy and tolerability of valsartan, a novel angiotensin II antagonist, given with hydrochlorothiazide (HCTZ) vs placebo or vs valsartan or HCTZ alone. DESIGN: 871 adult out-patients with essential hypertension participated in this double-blind study. Patients were randomised in equal number to receive either combination therapy of valsartan (80 mg or 160 mg) and HCTZ (12.5 mg or 25 mg), or valsartan (80 mg or 160 mg) or HCTZ (12.5 mg or 25 mg) alone, or placebo. Patients were treated once daily for 8 weeks and assessed at 2, 4 and 8 weeks after randomisation. MAIN OUTCOME MEASURES: The primary efficacy variable was change from baseline in mean sitting diastolic blood pressure (MSDBP) at end-point. The secondary variable was change in mean sitting systolic blood pressure (MSSBP) from baseline to end-point. RESULTS: All active treatments produced a statistically significant difference in MSDBP (P < 0.001) from baseline to end-point compared with placebo. Similar results were obtained for MSSBP. All combination regimens produced a statistically significantly greater reduction in MSDPB and MSSBP than the corresponding monotherapies. Dizziness and headache were the most common treatment-related adverse experiences reported. Hypokalaemia, associated with the use of thiazide diuretics, was more commonly reported in the higher dose HCTZ 25 mg groups. CONCLUSIONS: Valsartan 80 mg and 160 mg act additively with HCTZ 12.5 mg or 25 mg to lower MSDBP and MSSBP in patients with essential hypertension. The addition of HCTZ to valsartan 80 mg or 160 mg was well tolerated.

Adult↗
PubMed1998

Manufacturing a human drama from a psychiatric crisis: crisis intervention, family therapy and the work of R. D. Scott.

There has been a recent resurgence of interest in crisis intervention within psychiatry. The idea of crisis services is not, of course, a new thing, and there is a great deal to be learnt from returning to the innovative writings of those practitioners who developed similar services in the 1960s and 1970s. This article discusses the work of the psychiatrist and family therapist R. D. Scott, who developed a 24-hour family-orientated crisis intervention service in London during this era. Although under-utilized, the writings of Scott and his colleagues in this area continue to be of crucial relevance to mental health nurses and other psychiatric professionals.

Attitude to Health↗
PubMed1998

Evaluation of technician supervised treadmill exercise testing in a cardiac chest pain clinic.

OBJECTIVE: To determine the efficacy and safety of trained cardiac technicians independently performing treadmill exercise stress tests as part of the assessment of patients with suspected angina pectoris. DESIGN: Retrospective comparison of 250 exercise tests performed by cardiac technicians and 225 tests performed by experienced cardiology clinical assistants (general practitioners who perform regular NHS cardiology duties), and consultant cardiologists over the same time period. SETTING: Regional cardiac centre with a dedicated cardiac chest pain clinic. PATIENTS: All patients were referred by their general practitioners with a history of recent onset of chest pain, which was suspected to be angina pectoris. OUTCOME MEASURES: Peak workload achieved, symptoms, indications for termination, complications. RESULTS: The diagnostic yield of technician supervised tests (percentage positive or negative) was similar to that of medically supervised tests (76% v 69%, NS). The average peak workload achieved by patients was less by 1.2 mets (p < 0.005). This was probably due to more tests being terminated earlier due to chest pain and ST segment depression in the technician group compared with doctors (10% and 16% v 5% and 11% respectively, p = 0.06 and 0.07). One patient in the technician supervised group developed a supraventricular tachycardia during the recovery phase of the exercise test. CONCLUSIONS: Technician supervised stress testing is associated with a high diagnostic rate and low complication rate in patients with suspected ischaemic heart disease. Its efficacy is comparable to tests supervised by experienced doctors and its use should be encouraged.

Aged↗
PubMed1998

Pseudologia fantastica, factitious disorder and impostership: a deception syndrome.

Pseudologia fantastica and impostership are not currently included in diagnostic systems, although there is an overlap between these two syndromes and factitious disorder. A case which illustrates the overlap is described, and the diagnostic dilemma is discussed. A term 'deception syndrome' is proposed for those individuals who pathologically deceive for internal (i.e. psychological) as opposed to external reasons such as financial gain.

Adult↗
PubMed1997

Significance of preformed anti-donor antibodies in liver transplantation.

The significance of a positive cross-match in liver transplantation remains controversial, as documented by a number of recent conflicting reports. In this study, we evaluated 195 consecutive orthotopic liver transplant recipients in whom the cross-match was either negative or positive for T or B cells. Special emphasis was placed on the outcome of patients with high levels of preformed IgG antibodies directed against donor T cells. IgG anti-donor antibodies were confirmed by flow cytometry in all cases. Of 10 patients with strong T-cell antibodies, there was one early death due to nonimmunological causes. Transplantation was successful in 9/10 patients followed for 3 months to 3 years. Graft survival, incidence of acute rejection, and number of liver biopsies in patients with a positive cross-match (strong T, weak T, or B cell) were not significantly different from those of patients with a negative cross-match. In the strong T cell antibody group, one patient had early graft dysfunction, with extensive hepatic necrosis and histological signs of antibody-induced damage. Two other patients also showed some evidence of possible antibody-mediated events, such as neutrophil infiltration and hepatocyte swelling. These lesions were reversible, and the patients had uneventful recoveries. Thus, in our experience, preformed antibodies did not preclude good graft survival.

Adolescent↗
PubMed1997

Hand, space and attentional asymmetries in goal-directed manual aiming.

Two experiments were conducted to explore the interaction of the two cerebral hemispheres in motor control, by examining hand, space and attentional asymmetries in goal-directed aiming. In Experiment 1, right-handed subjects moved to targets more quickly with their right hand than their left hand. In addition, each hand was faster when moving in its own hemispace. Although in a control condition, movements were initiated more quickly with the left hand, visual distractors disrupted left hand performance more than right hand performance. For contralateral aiming, ipsilateral distractors caused the greatest interference. In Experiment 2, when targets and distractors were all presented at the midline, a right hand advantage was found for movement time along with a left hand advantage for reaction time, independent of target and distractor location. Our findings are discussed in terms of a right hemisphere role in movement preparation and the allocation of attention in space, and greater left hemisphere involvement in movement execution.

Adolescent↗
PubMed1997

The arterioportal fistula syndrome: clinicopathologic features, diagnosis, and therapy.

BACKGROUND & AIMS: Arterioportal fistulas (APFs) are rare vascular disorders of the mesenteric circulation. The aim of this study was to determine the etiology, anatomical location, and main symptom at presentation of APFs, and analyze the various modes of treatment. METHODS: The etiology, clinical presentation, radiographs, and treatment of 12 patients with APFs are reported in detail, and another 76 cases published since 1980 are reviewed. RESULTS: APFs result from trauma (n = 25, 28%), iatrogenic procedures (n = 14, 16%), congenital vascular malformations (n = 13, 15%), tumor (n = 13, 15%), aneurysm (n = 12, 14%), and other causes (n = 11, 12%). The origin of APFs is the hepatic artery in the majority of patients (n = 56, 65%). The main symptoms at presentation are lower or upper gastrointestinal bleeding (n = 29, 33%), ascites (n = 23, 26%), heart failure (n = 4.5%), or diarrhea (n = 4.5%). Radiological intervention provides definitive treatment in 42% (n = 33) of patients, whereas the remainder are treated by surgery alone (n = 27, 31%) or a combination of radiological intervention and surgery (n = 8, 9%). CONCLUSIONS: APFs result in a protean syndrome variously combining portal hypertension and other hemodynamic imbalances (heart failure, intestinal ischemia). Single or multiple interventional radiological procedures using arterial and/or venous approaches allow definitive treatment of most APFs. With increasing technological advances, it is anticipated that surgery will only be indicated in rare instances after failure of radiological intervention(s).

Adolescent↗
PubMed1997

Impact of chromosome 14q loss on survival in primary head and neck squamous cell carcinoma.

We screened 73 primary head and neck squamous cell carcinoma (HNSCC) specimens for loss of heterozygosity (LOH) on chromosome 14q. Analysis of 20 polymorphic microsatellite markers identified 29 (40%) HNSCCs exhibiting LOH of 14q in at least one locus. Six tumors had probable monosomy of 14q, displaying allelic loss for all informative markers tested, and 23 demonstrated partial losses on 14q. Fine mapping with 1-10 additional markers revealed two poorly defined regions of loss (4-7 cM) at 14q13-21 and 14q31-32.1 in seven tumors. In 53 patients with previously untreated tumors treated with curative intent, LOH of 14q in these tumors correlated with poor survival. Compared to patients with tumors that retain heterozygosity of 14q, those with 14q LOH had a 3-fold increased risk of death in multivariate analysis (hazards ratio, 3.2; 95% confidence interval = 1.2-8.4). These data have confirmed a high frequency of chromosome 14q loss in HNSCC and suggest that LOH of any region on chromosome 14q is an indicator of poor outcome.

Adult↗
PubMed1996

Patrons of the sex industry: perceptions of risk.

This paper reports on an in-depth study of how men who buy sex construe risk in relation to their sexual activities. Twenty men were contacted in a massage parlour, four more through sex workers or newspaper advertisements. In-depth, face-to-face interviews were recorded. Two main discourses were articulated by the men to "manage' risk. Parlour clients articulated a discourse of the "cordon sanitaire' which they defined in various way to encompass elements of both commercial and non-commercial sex. Most felt while they operated within this they ran only those risks inevitable in life. Outside the cordon were dangerous venues, especially the streets. A few felt either fatalistic or invulnerable about possibilities of risk even within this "cordon sanitaire'. Street clients articulated a different discourse about risk, based on a strategy of discrimination between women.

Adult↗
PubMed1996

Postmodernism.

Explore the source record for details and available documents.

Humans↗
PubMed1996

Economies with 'the truth': professionals' narratives about lying and deception in mental health practice.

In psychiatric and psychotherapeutic literature, the idea of clients lying is not one that is commonly voiced, and many therapeutic positions seem to discourage discussion of the issue. In practice, however, professionals do meet with people who they feel are not being 'truthful', and this study sought to examine the narratives that a group of colleagues provided about the resulting conflicts and dilemmas. Through the use of unstructured interviews, I invited mental health practitioners to discuss their experiences of situations where they felt clients were lying to them. From an analysis of these research conversations I propose that, in a psychiatric context, lying and secrecy often occur as response to an experience of powerlessness by service-users. I also suggest that the issue of clients lying requires more open discussion amongst practitioners, in order to explore differences in power and perspective between professionals and clients.

Attitude of Health Personnel↗
PubMed1995

The effects of augmented information on motor learning: a multidimensional assessment.

Subjects performed trials of a two-hand coordination task involving the manipulation of a small, steel ball through a maze. During the acquisition phase, control subjects received no augmented information while subjects in two experimental groups were provided with visual aids or a cognitive strategy. One day later, subjects performed under control conditions on familiar (relearning phase) and unfamiliar (transfer phase) sections of the maze. A 3 x 3 (Group x Phase) repeated measures multivariate analysis of variance revealed significant phase differences for all dependent measures but no significant group effects. Chi-square analysis of ratings of cue usage as well as postexperimental interviews suggested, however, that practice conditions differentially influenced the search strategies of subjects. Implications of the findings for contemporary theories of motor learning are discussed.

Adolescent↗
PubMed1993

Further characterization of Pasteurella haemolytica-like bacteria isolated from swine enteritis.

DNA-DNA hybridization studies were conducted on six Pasteurella haemolytica-like (PHL) organisms recovered from cases of swine enteritis. Chromosomal-enriched fractions of PHL organisms served as the source of DNA for Southern blots or as whole-chromosomal DNA probes. Under stringent hybridization conditions, chromosomal DNA probes of a prototype PHL (strain 6213A) organism distinguished other PHL organisms from Pasteurella haemolytica types A1 and T3, Pasteurella multiocida types A:1 and A:3, Escherichia coli, Pseudomonas aeruginosa, Actinobacillus pleuropneumoniae type 1, and Salmonella cholerasuis. The guanine-cytosine content of the DNA of three PHL strains was 41.2 to 42.8 mol % as calculated from the thermal denaturation midpoint temperatures. The PHL strains are Gram-negative, nonmotile, beta-hemolytic, pleomorphic, oxidase-positive, urease- and indole-negative, fermentative rods with the key characteristics of the species Pasteurella haemolytica. None of the PHL strains reacted with the type-specific antisera of P. haemolytica types 1 through 12 as tested by an agglutination procedure. These swine strains differed in their biochemical differentiation from P. haemolytica types A1 and T3 in that all produced acid from M-inositol and failed to grow on MacConkey agar. Acid production from trehalose and L-arabinose was variable with PHL strains. Leukotoxicity of PHL strains was evaluated by a colorimetric micro-titration assay. Sterile culture supernatants of three of five PHL strains were toxic to bovine neutrophils. Results of these studies suggest that the PHL organisms may belong to a new group of organisms under the genus Pasteurella.

Animals↗