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Biomedical subjects

B Rhodes

Publications and source records attributed to B Rhodes.

At least 19 recordsLinked to original sources
PubMed2001

Changing patterns of sedation use for routine out-patient diagnostic gastroscopy between 1989 and 1998.

BACKGROUND: Knowledge of sedation trends for upper gastrointestinal endoscopy is important for health service planning, particularly in view of rapidly increasing demands on endoscopy services. However, no data are available on sedation trends in Britain over the past 10 years. AIM: To determine sedation use for routine gastroscopy in a single endoscopy unit between 1989 and 1998. METHODS: This was a retrospective study of 9795 consecutive adults (mean age 56 years, range 18-100 years; 4512 females) who had undergone a gastroscopy between 1989 and 1998. Clinical, pharmacological and endoscopic data were retrieved from a computerized database. RESULTS: Over the 10-year study period, the sedation rate remained constant for patients undergoing therapeutic endoscopy (P=0.99) and those undergoing in-patient diagnostic examinations (P=0.63). In contrast, the sedation rate for out-patient diagnostic endoscopy decreased by 54%, from a high of 70% in 1990 to 32% in 1998 (P < 0.0001). Logistic regression analysis showed that the decline in sedation use was greater in females (P < 0.0001) than males and in procedures performed by non-consultant compared to consultant staff (P=0.01). CONCLUSIONS: If our results form part of a national trend, they will have important implications for cardiopulmonary monitoring strategies, recovery room practices and for complication rates due to the use of sedation for upper gastrointestinal endoscopy.

Adolescent↗
PubMed2000

Neutrophil-specific 99mTc-labeled anti-CD15 monoclonal antibody imaging for diagnosis of equivocal appendicitis.

UNLABELLED: We evaluated 99mTc-labeled anti-CD15 immunoglobulin M monoclonal antibody (LeuTech) for diagnosing acute appendicitis in patients with an equivocal clinical presentation. LeuTech avidly binds to circulating and sequestered human polymorphonuclear neutrophils in vivo, eliminating in vitro cell labeling and blood handling. METHODS: We studied 49 patients to evaluate the safety and efficacy of LeuTech imaging. 99mTc-labeled LeuTech was prepared on site using a lyophilized kit, 99mTc-labeled pertechnetate, and 2 different incubation techniques, 1 at room temperature and the other at 37 degrees C. The abdomen was serially imaged for up to 3 h after the intravenous administration of 370-740 MBq 99mTc-labeled LeuTech. Scans were read as positive or negative for acute appendicitis or other intraabdominal infection. The institutional diagnosis was established by surgery, other diagnostic studies, or 1-mo clinical follow-up. RESULTS: Scans were positive for appendicitis in all 26 patients with appendicitis, for a sensitivity of 100%, and negative for appendicitis in 19 of 23 patients without appendicitis, for a specificity of 83%. Accuracy, positive predictive value, and negative predictive value were 92%, 87%, and 100%, respectively. Results were not different between the LeuTech preparations. The rate of laparotomies with negative findings in patients who underwent surgery was 10%. The average time from injection to LeuTech visualization in the appendix for cases positive for appendicitis was 9 min. No serious adverse reactions occurred. CONCLUSION: LeuTech imaging is safe, rapid, and sensitive for diagnosis of appendicitis in equivocal cases. The potential advantages of LeuTech over currently available radiopharmaceuticals for infection imaging are ease of preparation, absence of blood handling, excellent image quality, no requirement for SPECT, and rapid diagnostic uptake.

Acute Disease↗
PubMed2000

Microleakage and retention of bonded amalgam restorations.

PURPOSE: To compare the microleakage and bond strength exhibited by two light-cured, filled dentin bonding agents, a resin cement, and cavity varnish. MATERIALS AND METHODS: The four test groups of lining agents for amalgam restorations included (LF) Light-cured, Filled resin (Clearfil Liner Bond 2); (LCF) light- and chemical-cured, Filled resin (Clearfil Liner Bond + Protect Liner); (RC) Resin Cement (Panavia 21); and (V) Varnish (Copalite). For each group, 20 Class V cavity preparations were cut in human extracted molars. Tytin amalgam was condensed into the preparation. After storage for at least 24 hrs in distilled water at 37 degrees C, all restorations were subjected to 2500 thermal cycles (8 degrees C to 48 degrees C). After 1 wk, specimens were tested. For the leakage tests, teeth were immersed in 45Ca, sectioned, and radiographs of sections were evaluated and then evaluated by Ridit analysis. Retention samples were tested to failure in tension using an Instron machine and peak load (kg) was recorded. RESULTS: Compared to varnish, the two dentin bonding agents (LF and LCF) significantly decreased microleakage at the cementum margin but not at the enamel margin. The two dentin bonding agents also exhibited significantly greater retentive strength than either the resin cement or the varnish.

Calcium Radioisotopes↗
PubMed2000

Investigation of an adhesive system used with direct and indirect applications.

A laboratory investigation was performed that examined the adhesive properties of a new adhesive system. Contrasts were made with other commercially established systems, and indirect and direct bonding procedures were investigated. For the indirect evaluation, simulated restorations were bonded with an experimental resin cement. Sealing was assessed through microleakage analysis. Adhesive strength value was measured by shear bond strength methods. Further, the marginal quality of the restorations was assessed using scanning electron microscopy. Finally, the adhesive shear bond strengths were established using direct bonding.

Adhesiveness↗
PubMed1998

Intraindividual comparison of 99mTc-labelled anti-SSEA-1 antigranulocyte antibody and 99mTc-HMPAO labelled white blood cells for the imaging of infection.

Technetium-99m labelled antigranulocyte antibodies are ready to use and are sensitive and specific in the diagnosis of infectious diseases. 99mTc-SSEA antigranulocyte antibodies have a very high affinity constant (Kd 10(-12) M) for human neutrophils (PMNs), and excellent imaging qualities with high target/background ratios. The aim of this study was to compare the diagnostic accuracy of the 99mTc-anti-SSEA-1 monoclonal antibody (Mab) with that of 99mTc-hexamethylpropylene amine oxime (HMPAO)-labelled white blood cells (WBCs). To this end, 17 patients with 23 proven infectious foci were examined with 555 MBq 99mTc-anti-SSEA-1 MAb and with 370 MBq 99mTc-HMPAO labelled autologous leucocytes within a period of 7 days. All the infections were confirmed by culture, biopsy, surgery and follow-up. Whole-body images and planar spot views with the antibody were performed at 1-h, 4-h and 24-h post injection; the biodistribution of the antibody was quantified, absorbed radiation doses were calculated and the diagnostic results were compared with the 99mTc-HMPAO WBC images. Human anti-mouse antibody (HAMA) evaluation was performed in all patients before and 3 months after antibody injection. Blood was drawn at different times after 99mTc-anti-SSEA-1 MAb injection to determine the amount of granulocyte-associated radioactivity and to calculate recovery. 99mTc-anti-SSEA-1 MAb scintigraphy detected all 23 lesions, while 21 were detected with 99mTc-HMPAO WBC scan. In this small group of patients, the sensitivity and specificity of 99mTc-anti-SSEA-1 MAb scintigraphy were 95% and 96% respectively, as compared with 91% and 82% respectively for 99mTc-HMPAO WBC scan. An increasing uptake of the injected activity in the lesion at different time points was indicative of high affinity and of specific PMN binding. There was no HAMA formation. In four of five patients investigated, a transient mild leukopenia was found at 15 min p.i.. There was increased uptake of the antibody in liver and spleen and normal uptake in kidneys and bone marrow. The estimated radiation doses for the whole body and the red bone marrow were 1.1x10(-2) cGy/37 MBq and 5.3x10(-2) cGy/37 MBq, respectively. The activity associated to the PMNs in vivo was 33.5%, 30.6%, 21.3% and 9% at 5, 15, 30 and 45 min. post-injection, respectively. It is councluded that use of 99mTc-anti-SSEA-1 antigranulocyte antibodies demonstrates promising results comparable to those obtained with 99mTc-labelled autologous WBCs. The 99mTc-labelled MAb is ready to use, has excellent image qualities and a high target/background ratio.

Adult↗
PubMed1996

Imaging inflammatory diseases with neutrophil-specific technetium-99m-labeled monoclonal antibody anti-SSEA-1.

UNLABELLED: Imaging inflammatory diseases with a 99mTc-labeled neutrophil-specific agent that can be injected directly intravenously continues to be a challenge. METHODS: The antibody, anti-SSEA-1, chosen from studies of 10 neutrophil-specific MAbs, recognizes CD-15 antigens (5.1 x 10(5)/human PMN) with a high association constant (kd = 10(-11) M). One hundred micrograms of MAb labeled with 10-20 mCi 99mTc either by a direct or DTPA conjugation method were injected intravenously into 12 patients (9 men, 3 women, aged 19-48 yr) with clinical evidence of ongoing inflammatory processes. Vital signs of all patients were recorded before and up to 3 hr following administration of the MAb. HAMA was determined in two patients. Anterior and posterior spot views and whole-body images were obtained. All patients except one underwent biopsy, US or CT examinations and/or surgical procedures. Blood samples collected from five patients were analyzed. In nine patients, quantitative organ distribution was determined and radiation dosimetry was calculated. RESULTS: Labeling yields were 94.8% +/- 1.4% and 95.8% +/- 3.5%, respectively. All patients had unequivocally positive images within 3 hr of the MAb injection. Eleven of these were confirmed by other modalities. One patient recovered on antibiotics and was sent home without surgery or other procedures. The lack of radioactivity in the thyroid or gastrointestinal tract indicated that the in vivo stability of the agent was excellent. At 3 hr postinjection, bladder activity in six patients was 1.3% +/- 0.4% of the administered dose. At this time, splenic uptake (7.7% +/- 1.0% ad. dose) and red marrow uptake (14 +/- 1.8%) were lower than those of 111In-WBC. At 49.0% +/- 3.2% administrated dose, liver uptake was at the upper limit with 111In-WBC uptake. Renal uptake was only 2.4% +/- 0.03% administered dose. At 2 hr postinjection, 14% to 51% of the radioactivity was associated with PMN. Radioactivity with lymphocytes was 0.7% to 10.9%, 1.2% to 4.3% with platelets and 1.1% to 2.4% with RBC. No HAMA were detectable in either patient, and no adverse reaction was detectable in any patient. CONCLUSION: Results are highly encouaging and have prompted us to prepare a kit for instant preparation and to initiate clinical trials.

Abscess↗
PubMed1992

Parental bonding and separation-individuation difficulties among late adolescent eating disordered women.

This study is an exploration of both interpersonal and intrapsychic factors associated with eating disorders in late adolescent women. It examines perceived parental bonding characteristics and resolution of the second separation-individuation process for both eating and non-eating disordered subjects. Subjects were 20 late adolescent eating disordered women and 20 symptom-free late adolescent female university students. All subjects received the Eating Disorder Inventory, the Parental Bonding Inventory, and the Separation-Individuation Test of Adolescence. Late adolescent eating disordered women reported significantly higher levels of maternal overprotectiveness during childhood and had significantly higher levels of separation anxiety and lower healthy separation scores than non-eating disordered students.

Adult↗
PubMed1989

Shared governance at Saint Joseph's Hospital of Atlanta: a mature professional practice model.

Quality in work comes from people who care about what they do, are consistent, and have a desire to make a difference. This is not something that can be taught, but it can be nurtured. Patient care is the perfect place to start. Nurses participating in a shared practice situation can extend their working system to others. The rewards of quality care are felt by the patient, by the staff, and ultimately by the hospital. The desire to make a difference grows as more people become involved in a system. Developing systems that are positive, goal oriented, and rewarding is the first step toward shared practice. Shared governance then becomes a natural progression in determining the framework in which a nurse functions.

Constitution and Bylaws↗
PubMed1985

Occupational ideology and clinical decision-making in British nursing.

As the first phase of a study to assess the usefulness of the nursing process model of nursing practice, a survey was carried out in one health district to ascertain the predominant occupational ideology of clinical nurses, their perception of decision-making about individual patient care in everyday work, and their view of whether they ought to exercise a decision-making role with respect to 23 aspects of patient care. Two hundred ideology scale questionnaires were processed, together with perceived and normative decisions inventories. Subjects were representative of six nursing fields, i.e. general nursing, geriatric nursing, psychiatric nursing, mental handicap nursing, health visiting and district nursing. The main findings were that nurses predominantly espouse a professional ideology, they perceive decision-making to be part of their everyday work and contend that they ought to be able to make decisions in 22 out of the 23 areas of patient care included in the inventories. Differences in ideology between the groups and between men and women are identified and discussed, and some areas of role conflict highlighted. The professional ideology was found to correlate significantly with decision-making and a significant correlation was established between paramedicine and bureaucracy.

Community Health Nursing↗
PubMed1981

Investigation into the microbial flora of healing and non-healing decubitus ulcers.

Seventy-four pressure lesions in fifty-three geriatric patients were observed at weekly intervals to determine the bacterial flora and the healing index of each lesion, expressed as initial area of lesion (cm2) - final area of lesion (cm2) divided by time in days. The micro-organisms which caused infection included Staphylococcus aureus, Proteus mirabilis, Pseudomonas aeruginosa, Bacteroides fragilis and Bacteroides asaccharolyticus. Many lesions contained a mixed flora. P mirabilis and Ps aeruginosa were associated with necrotic (p less than 0.005) and enlarging (p less than 5 x 10(-7)) lesions. Bacteroides spp were associated with necrotic lesions (p less than 0.05). The presence of S aureus in a lesion was not associated with any particular trend in healing index. The implications of the microbiological findings are discussed.

Aged↗