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Biomedical subjects

A Wilson

Publications and source records attributed to A Wilson.

At least 19 recordsLinked to original sources
PubMed2006

A multi-centre prospective case-control study of campylobacter infection in persons aged 5 years and older in Australia.

There are an estimated 277,000 cases of campylobacteriosis in Australia each year, most of which are thought to be sporadically acquired. To explore causes for these infections, we conducted a multi-centre case-control study of patients and community controls across five Australian States during 2001-2002. A total of 881 campylobacter cases and 833 controls aged 5 years were recruited into the study. Crude logistic analyses were conducted within various food and non-food exposure groups. A final most parsimonious multivariable logistic regression model was developed and adjusted odds ratios (aOR), 95% confidence intervals (95% CI) were derived together with adjusted population attributable risks (PAR). Consumption of undercooked chicken (aOR 4.7, 95% CI 2.6-8.4) and offal (aOR 2.0, 95% CI 1.0-4.0), ownership of domestic chickens aged<6 months (aOR 12.4, 95% CI 2.6-59.3) and domestic dogs aged<6 months (aOR 2.1, 95% CI 1.1-4.2) were found to be independent risk factors for illness in the final model. The PAR proportions indicate that eating chicken meat, either cooked or undercooked may account for approximately 30% of campylobacter cases that occur each year in Australia. These results justify the continued need for education of consumers and foodhandlers about the risks associated with the handling of raw chicken and the potential for cross-contamination.

Adolescent↗
PubMed2006

An unusual cause of locking.

This case report describes the discovery of a plastic foreign body in a patient's knee joint 21 years from the initial injury. The patient was thoroughly investigated radiologically with plain X-rays both immediately after the initial injury and years later in orthopaedic outpatients. He also subsequently received an MRI. All these were reported as normal. The patient's symptoms persisted and an arthroscopy was performed. At this procedure the presence of the foreign body was confirmed and the offending plastic was safely removed. The patient's symptoms of intermittent locking resolved. This experience stresses this importance of clinical suspicion despite apparently normal radiology.

Adult↗
PubMed2006

Development and testing of a questionnaire to measure patient satisfaction with intermediate care.

BACKGROUND: Individual trials have suggested high levels of general patient satisfaction with intermediate care, but this topic has not been examined in detail. AIMS: To identify the key elements of patient satisfaction with intermediate care, and to see whether these can be validly measured using a questionnaire. METHOD: A questionnaire was developed on the basis of a literature review and piloting with patients and staff on participating schemes (phase I). In phase II, the questionnaire was tested for validity and reliability in a group of patients recently discharged from two "hospital-at-home" intermediate-care schemes. In phase III, a shortened version of the questionnaire was psychometrically tested in five sites taking part in a national evaluation of intermediate care. RESULTS: 96 patients with an average age of 76.5 years took part in phase II. Test-retest reliability was evaluated by repeating the questionnaire 2 weeks later in a subsample of 42 patients. This was "moderate" (kappa 0.4-0.6) for 12 questions, "fair" (kappa 0.2-0.4) for 6 questions and "poor" (kappa 0.1-0.2) for 5 questions. Scores correlated well with the Client Satisfaction Questionnaire (Spearman's r = 0.75, p<0.001). 843 patients (57% of those eligible) from five intermediate-care schemes took part in phase III. Principal components analysis suggested six factors or subscales: general satisfaction, affective response, cognitive response, timing of discharge, coordination after discharge, and access to pain relief, although the last three factors comprised only one question each. The intraclass correlation coefficients in the first three subscales varied from 0.82 to 0.89. Scores for all subscales differed by scheme, suggesting construct validity. Only one question (on general satisfaction) was found to be redundant. CONCLUSION: The questionnaire, with some minor amendments to improve performance, could be used as a validated tool for audit and research in intermediate care. An amended version and scoring programme is available from us on request.

Aged↗
PubMed2006

Drugs to support smoking cessation in UK general practice: are evidence based guidelines being followed?

BACKGROUND: Prescribing drugs to support smoking cessation is one of the most cost effective interventions in primary care, but there is evidence they are underused. Little is known about how far guidelines have been adopted. AIMS: To examine the context in which nicotine replacement therapy (NRT) and bupropion are prescribed in UK general practice and whether guidelines are being followed. DESIGN: Patient questionnaire survey. SETTING: Twenty five general practices from the Trent Focus Collaborative Research Network in South Yorkshire and East Midlands, UK. METHODS: Participating practices posted a questionnaire to up to 40 patients prescribed NRT and bupropion respectively in the previous 3-9 months. RESULTS: The response rate for people prescribed NRT was 44.7% (323/723) and for bupropion 42.5% (77/181). Patients reported initiating the prescription request in 258 cases (65%), whereas GPs were reported as suggesting it in 49 (12%), smoking cessation services (SCS) in 38 (10%), and practice nurses in 36 (9%). Of those who could recall the content of the consultation in which NRT or bupropion was prescribed, 191 (79%) reported receiving advice on treatment use and 209 (68%) were encouraged to set a quit date. Follow up by SCS was recommended to 186 (64%) and practice follow up was offered to 212 (63%), but 41 (15%) reported no offer of follow up support. CONCLUSIONS: The majority of patients reported receiving advice and follow up in line with guidelines. However, relatively few prescriptions were suggested by GPs or practice nurses and, in a significant minority of cases, neither follow up by the practice nor additional support from SCS was recommended. More active implementation of guidelines could increase the impact of general practice on the prevalence of smoking.

Adult↗
PubMed2006

The anatomy of category-specific object naming in neurodegenerative diseases.

Neuropsychological studies suggest that knowledge about living and nonliving objects is processed in separate brain regions. However, lesion and functional neuroimaging studies have implicated different areas. To address this issue, we used voxel-based morphometry to correlate accuracy in naming line drawings of living and nonliving objects with gray matter volumes in 152 patients with various neurodegenerative diseases. The results showed a significant positive correlation between gray matter volumes in bilateral temporal cortices and total naming accuracy regardless of category. Naming scores for living stimuli correlated with gray matter volume in the medial portion of the right anterior temporal pole, whereas naming accuracy for familiarity-matched nonliving items correlated with the volume of the left posterior middle temporal gyrus. A previous behavioral study showed that the living stimuli used here also had in common the characteristic that they were defined by shared sensory semantic features, whereas items in the nonliving group were defined by their action-related semantic features. We propose that the anatomical segregation of living and nonliving categories is the result of their defining semantic features and the distinct neural subsystems used to process them.

Adult↗
PubMed2005

Angiogenesis is confined to the transient period of VEGF expression that follows adenoviral gene delivery to ischemic muscle.

Therapeutic angiogenesis involves the introduction of exogenous growth factor proteins and genes into ischemic tissues to augment endogenous factors and promote new vessel growth. Positive results from studies in animal models of peripheral arterial disease (PAD) and coronary artery disease over the past decade have supported the implementation of clinical trials testing vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF) proteins and genes. Although several clinical trials reported positive results, others have been disappointing and results of a recent Phase II trial of VEGF delivered by adenovirus (the RAVE trial) were negative. It has been suggested that the duration of gene expression following delivery by adenovirus may be insufficient to produce stable vessels. Here we present direct evidence in support of this using the rabbit ischemic hindlimb model injected with adenovirus encoding VEGF165. Immunohistology indicated an activation of endothelial cell cycling and proliferation 2-3 days after VEGF delivery that coincided closely with transient VEGF expression. Ki-67-positive endothelial nuclei were evident at high levels in capillaries and large vessels in muscles from treated animals. Angiography indicated increased density of both large and small vessels in Ad-VEGF-treated muscle at 1 week, but no significant differences thereafter. The early burst of endothelial proliferation was accompanied by increased nuclear fragmentation and condensation in VEGF-treated muscles, suggesting coincident apoptosis. No further endothelial cell proliferation took place after 1 week although there was still evidence of apoptosis. The results suggest that angiogenesis is confined to the short period of VEGF expression produced by adenovirus and early gains in collateralization rapidly regress to control levels when VEGF production ceases.

Adenoviridae↗
PubMed2005

A case of familial third ventricular colloid cyst.

Colloid cyst of the third ventricle is a rare benign intracranial lesion, and familial cases are rarer still. They may be asymptomatic or present with symptoms of raised intracranial pressure, including sudden death. Surgical excision is curative. We report a 24 year old pregnant woman with familial colloid cyst, who presented with headaches and suffered a cardiorespiratory arrest. Early computed tomography scan of the brain is advised in patients with a family history of third ventricular colloid cyst presenting to the accident and emergency department with headache.

Adult↗
PubMed2005

Smoking cessation treatment in primary care: prospective cohort study.

OBJECTIVE: To compare the characteristics of smokers who do and do not receive smoking cessation treatment in primary care. DESIGN: Prospective cohort study using practices registered with the pilot QRESEARCH database. SETTING: 156,550 patients aged 18 years and over from 39 general practices located within four strategic health authorities, representing the former Trent Region, UK. SUBJECTS: Patients registered with practices between 1 April 2001 and 31 March 2003 aged 18 years and over who were identified as smokers before the two year study period. OUTCOME: Prescription for smoking cessation treatment (nicotine replacement therapy (NRT) or bupropion) in the two year study period. VARIABLES: Age, sex, deprivation score, co-morbidity. RESULTS: Of the 29,492 patients recorded as current smokers at the start of the study period 1892 (6.4%) were given prescriptions for smoking cessation treatment during the subsequent two years. Of these, 1378 (72.8%) were given NRT alone, 406 (21.5%) bupropion alone, and 108 (5.7%) both treatments. Smokers were more likely to receive smoking cessation treatment if they lived in the most deprived areas (odds ratio (OR) for the most relative to the least deprived fifth, adjusted for sex, age, and co-morbidity, 1.50, 95% confidence interval (CI) 1.26 to 1.78), and if they were aged 25-74 years compared to 18-24 years or 75 and over. Smokers with co-morbidity were also more likely to receive smoking cessation treatment. Smokers were less likely to receive smoking cessation treatment if they were male (adjusted OR 0.68, 95% CI 0.62 to 0.75). CONCLUSION: The low proportion of smokers being prescribed these products strongly suggests that a major public health opportunity to prevent smoking related illness is being missed.

Adolescent↗
PubMed2004

The effectiveness of a modified version of the Wilkinson questionnaire in screening for TIA and minor stroke in the United Kingdom.

BACKGROUND: Transient ischaemic attacks (TIAs) and minor strokes are important to diagnose as there are effective secondary preventive interventions. Significant under-reporting by patients occurs, but general practitioners tend to over-diagnose the condition, contributing in part to long clinic waiting lists. An accurate screening test could address both these problems. METHODS: A modified version of a questionnaire designed to detect TIA was tested against the gold standard of specialist diagnosis in two vascular outpatient clinics in Leicester, UK. RESULTS: The questionnaire was sent by post with the clinic appointment and completed by 136 participants. In 99 cases the same questionnaire was administered by a clinic nurse. Overall levels of agreement (kappa, 95% CI) with specialist diagnosis of TIA, stroke or neither were 0.32 (0.15, 0.48) and 0.31 (0.12, 0.50) for postal and administered questionnaires, respectively. When the diagnoses of TIA and stroke were combined, agreement rose to 0.38 (0.23, 0.53) for postal and 0.38 (0.20, 0.57) for administered versions. For this outcome, the postal version had a sensitivity of 0.56 (0.43, 0.68) and specificity of 0.81 (0.71, 0.90). Equivalent figures for administered questionnaires were 0.61 (0.46, 0.76) and 0.76 (0.63, 0.87). CONCLUSION: The questionnaire has potential in prioritising outpatient referrals but is not sufficiently specific to be used for research or population screening.

Aged↗
PubMed2004

Modulation of the mouse testis transcriptome during postnatal development and in selected models of male infertility.

The aim of this study is to develop an overview of genetic events during spermatogenesis using a novel, specifically targeted gonadal gene set. Two subtracted cDNA libraries enriched for testis specific and germ cell specific genes were constructed, characterized and sequenced. The combined libraries contain >1905 different genes, the vast majority previously uncharacterized in testis. cDNA microarray analysis of the first wave of murine spermatogenesis and of selected germ cell-deficient models was used to correlate the expression of groups of genes with the appearance of defined germ cell types, suggesting their cellular expression patterns within the testis. Real-time RT-PCR and comparison to previously known expression patterns confirmed the array-derived transcription profiles of 65 different genes, thus establishing high confidence in the profiles of the uncharacterized genes investigated in this study. A total of 1748 out of 1905 genes showed significant change during the first spermatogenic wave, demonstrating the successful targeting of the libraries to this process. These findings highlight unknown genes likely to be important in germ cell production, and demonstrate the utility of these libraries in further studies. Transcriptional analysis of well-characterized mouse models of infertility will allow us to address the causes and progression of the pathology in related human infertility phenotypes.

Animals↗
PubMed2004

Performance feedback of hand hygiene, using alcohol gel as the skin decontaminant, reduces the number of inpatients newly affected by MRSA and antibiotic costs.

In March 2000 the Plastic Surgery Unit of our 600-bedded district general hospital agreed to be the pilot ward for the introduction of a new standard of hand hygiene, emphasizing the use of alcohol gel on socially clean hands between clinical contact with patients. Hand hygiene practice of healthcare workers (HCWs) was observed using Formic forms. The data from completed forms were scanned into an Excel database, and results fed back to HCWs in graphical form. The case notes of patients newly affected by methicillin-resistant Staphylococcus aureus (MRSA), likely to have been acquired as inpatients, were reviewed for one year before and after this performance feedback of hand hygiene. The cost of teicoplanin use (for MRSA infections) was also determined for the two periods. There was a significant reduction in the number of patients newly affected by MRSA (P<0.05), and in the use of teicoplanin, suggesting that performance feedback of hand hygiene reduces nosocomial MRSA infection rates and antibiotic use.

Alcohols↗
PubMed2004

Coverage in screening for diabetic retinopathy according to screening provision: results from a national survey in England and Wales.

AIM: To assess the proportion of people with diabetes screened for retinopathy according to provision of screening services. METHODS: Twenty-five health authorities in England and Wales were sampled after stratification by type of screening provision for diabetic retinopathy. Nine did not have a population-based screening scheme, six had an optometry scheme, six had a camera scheme and four had schemes with more than one method of screening ('mixed schemes'). Within each authority general practices were randomly sampled, 129 in total, and in each the records of a sample of diabetic patients examined. RESULTS: Of the 9200 records examined, 5812 (63.2%) had a record of one or more retinal examinations from any source in the year before the survey. This proportion did not differ significantly according to type of screening provision. The proportion of people with one or more retinal examinations by an 'expert' (defined as ophthalmologist, diabetologist, optometrist or screening scheme) in the last year was 44.7% where there was no screening scheme and 62.2%, 59.4%, and 61.6%, respectively, where optometry, camera and mixed schemes were present. Adjusted relative odds (95% confidence interval) for a retinal examination from any source in the last year compared with areas with no screening schemes were 1.19 (0.73, 1.93), 1.26 (0.80, 1.98), and 1.19 (0.77, 1.84) for camera, optometry and mixed schemes, respectively. Equivalent figures for an expert retinal examination were 2.30 (1.51, 3.49), 1.86 (1.25, 2.78) and 2.13 (1.32, 3.45). Coverage by schemes themselves did not differ according to type of scheme. Highest coverage rates, including examinations by screening schemes, were achieved in those treated with insulin, and the lowest rates found in those treated with diet alone. CONCLUSIONS: Screening schemes have had a small impact on overall retinal examinations, but a higher impact on the coverage of examinations performed by experts.

Adult↗
PubMed2004

Comparison of human immunodeficiency virus (HIV)-specific T-cell responses in HIV-1- and HIV-2-infected individuals in Senegal.

Human immunodeficiency virus type 2 (HIV-2) infection is typically less virulent than HIV-1 infection, which may permit the host to mount more effective, sustained T-cell immunity. We investigated antiviral gamma interferon-secreting T-cell responses by an ex vivo Elispot assay in 68 HIV-1- and 55 HIV-2-infected Senegalese patients to determine if differences relate to more efficient HIV-2 control. Homologous HIV-specific T cells were detected in similar frequencies (79% versus 76%, P = 0.7) and magnitude (3.12 versus 3.08 log(10) spot-forming cells/10(6) peripheral blood mononuclear cells) in HIV-1 and HIV-2 infection, respectively. Gag-specific responses predominated in both groups (>/=64%), and significantly higher Nef-specific responses occurred in HIV-1-infected (54%) than HIV-2-infected patients (22%) (P < 0.001). Heterologous responses were more frequent in HIV-1 than in HIV-2 infection (46% versus 27%, P = 0.04), but the mean magnitude was similar. Total frequencies of HIV-specific responses in both groups did not correlate with plasma viral load and CD4(+) T-cell count in multivariate regression analyses. However, the magnitude of HIV-2 Gag-specific responses was significantly associated with lower plasma viremia in HIV-1-infected patients (P = 0.04). CD4(+) T-helper responses, primarily recognizing HIV-2 Gag, were detected in 48% of HIV-2-infected compared to only 8% of HIV-1-infected patients. These findings indicate that improved control of HIV-2 infection may relate to the contribution of T-helper cell responses. By contrast, the superior control of HIV-1 replication associated with HIV-2 Gag responses suggests that these may represent cross-reactive, higher-avidity T cells targeting epitopes within Gag regions of functional importance in HIV replication.

Adolescent↗
PubMed2004

Traumatic tear of tibialis anterior during a Gaelic football game: a case report.

Reports of traumatic injury to the anterior lower leg muscles are scarce, with only a handful of reports of traumatic injury to the tibialis anterior. A database search of Medline, Cinhal, and Sports Discus only revealed three such cases, and they did not result from a direct sporting injury. This report documents the case of a traumatic rupture of tibialis anterior muscle in a young female Gaelic football player. It details the surgical repair and management of tibialis anterior muscle and the physiotherapy rehabilitation to full function.

Adult↗
PubMed2003

Jumpers and fallers: a comparison of the distribution of skeletal injury.

AIM: The aim of this study was to compare the distribution of injuries between patients who have fallen and those who have jumped from a height, and to relate the mechanism of injury to the fractures sustained. MATERIALS AND METHODS: Three hundred and ninety-nine patients, admitted via Helicopter Emergency Medical Service (HEMS), classified as either having fallen or jumped from a height were included in the study. The radiographs from the primary survey, together with radiographs of specific injury sites were analysed. The distribution of injury was compared in the two groups. RESULTS: Of the 399 patients, 342 were fallers and 57 were jumpers. Jumpers had a higher Injury Severity Score (ISS), death rate and number of fractures per person. Jumpers sustained more rib fractures (particularly on the right), pelvic and lower limb fractures but fewer skull fractures. CONCLUSION: Jumpers tend to sustain different injuries to fallers. It is proposed that jumpers have a tendency to land feet-first and then try to break their falls on their dominant side, sustaining more right-sided rib fractures in the process. The patterns of injury that have emerged from this study have important implications for evaluating skeletal injuries in those who jump or fall from a height.

Accidental Falls↗
PubMed2003

Prolonged gene expression in mouse lung endothelial cells following transfection with Epstein-Barr virus-based episomal plasmid.

The development of a strategy to deliver a gene to pulmonary endothelium will be useful for gene function study and for pulmonary gene therapy. Cationic lipidic vectors are efficient in gene transfer to pulmonary endothelium via the vascular route; however, gene expression is transient and lasts for only a few days. In this study, we show that pulmonary gene transfer via cationic lipidic vectors can be significantly improved using an Epstein-Barr virus (EBV)-based expression plasmid. Systemic administration of cationic liposomes followed by the EBV-based plasmid led to gene expression in the lung that lasted for more than 3 weeks. Prolonged and high levels of gene expression can also be obtained in primary mouse lung endothelial cells (MLEC) following lipofection with an EBV-based plasmid. These results suggest the utility of this gene transfer protocol in studying the expression of cloned genes in lung endothelial cells and in pulmonary gene therapy.

Animals↗