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Biomedical subjects

C Dempsey

Publications and source records attributed to C Dempsey.

13 recordsLinked to original sources
PubMed2006

Helicobacter pylori: prevalence of antimicrobial resistance in clinical isolates.

This study aims to determine the in vitro susceptibility of Helicobacter pylori to clarithromycin, metronidazole, amoxycillin and tetracycline, the four antibiotics commonly used in eradication therapies. These data are used to evaluate the efficacy of current empiric treatment of H. pylori infection in the Southern Region of Ireland. Culture is performed on gastric biopsy samples obtained from 147 consecutive patients undergoing gastroscopy for investigation of dyspepsia. Susceptibility testing to metronidazole, clarithromycin, amoxycillin and tetracycline is performed on the isolates by Etest. Isolates demonstrating clarithromycin resistance are subjected to polymerase chain reaction (PCR) amplification and nucleotide sequence analysis to identify the presence of point mutations in the peptidyltransferase region of the 23S rRNA gene previously associated with resistance to clarithromycin. Prevalence of H. pylori in the population studied was 31% (45 isolates). Antimicrobial resistance to metronidazole and clarithromycin was detected in nine (20%) and four (8.9%) of the isolates, respectively. A single isolate demonstrated co-resistance to metronidazole and clarithromycin (2.2%). No resistance was detected to either amoxycillin or tetracycline. The low level of resistance demonstrated among this group of isolates indicates that the empiric treatment currently in place in the Southern Region of Ireland is likely to be successful.

Amoxicillin↗
PubMed2001

Delivery of pediatric after-hours care by call centers: a multicenter study of parental perceptions and compliance.

BACKGROUND: Despite the rapid growth of centralized call centers to provide after-hours triage to patients of multiple providers, little is known about the perceptions of parents regarding this type of care and their compliance with triage disposition recommendations. DESIGN/METHODS: From August through September 1999, randomized samples of after-hours calls were selected each day from computerized records at 4 pediatric call centers at 1) Children's Hospital, Denver, Colorado; 2) Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; 3) Rainbow Babies and Children's Hospital, Cleveland, Ohio; and 4) All Children's Hospital, St Petersburg, Florida. All participating call centers use the same triage software. Calls were randomly selected to yield at least 250 callers with nonurgent dispositions and 100 with urgent dispositions from each site. Telephone surveys to callers were conducted by an external survey unit 3 to 7 days after the call to the call center. RESULTS: Surveys were completed for 70.5% of those sampled (N = 1561). Parents indicated they were very satisfied or satisfied with aspects of care received from 92.6% (waiting time) to 99.4% (nurse courteousness) of the time. Satisfaction did not differ by site or by recommended disposition of the index call. Most parents (65.2%) reported no preference about speaking with a physician or nonphysician for after-hours care, whereas 27.7% preferred to speak with a physician. Usually speaking with a physician during office hours (odds ratio [OR]: 1.48), feeling it was important that provider knows child's medical history (OR: 3.47), and respondent having an educational level of college graduate or higher (OR: 1.30) were significant predictors of preferring to speak with a physician. Of the 37.0% (N = 723) of parents who reported any change in their relationship with their primary provider as a result of the after-hours call center, 95.7% (N = 691) assessed the change to be positive. Reported compliance with the call center disposition recommendation was 83.3% for urgent referral, 41.0% for next day, 4.5% for visit at a later time, and 78.2% for home care. The major reason given by parents for noncompliance was reporting that they heard a different disposition (76.9% for urgent to 100% for visit at a later time). CONCLUSIONS: Parental satisfaction with pediatric call centers was uniformly high in 4 different geographic locations, and almost all parents who reported any effect on their relationship with their primary provider assessed it as positive. Compliance with recommendations for urgent evaluation or home care was relatively high but for intermediary dispositions was low. In most cases in which noncompliance occurred, parents reported hearing a different disposition. Additional study is needed to clarify whether noncompliance, especially in cases in which an urgent recommendations was made, is attributable to poor nurse communication of the recommended disposition, parental misinterpretation, or parental difference of opinion.

Community Health Services↗
PubMed2000

Appropriateness of urgent referrals by nurses at a hospital-based pediatric call center.

OBJECTIVES: To evaluate (1) the appropriateness of the after-hours referral (AHR), (2) clinical characteristics of urgently referred patients, and (3) parental compliance with disposition recommendations by the After-Hours Call Center of the Children's Hospital, Denver, Colo. SUBJECTS: Patients of Denver, Colo, pediatricians who called after office hours were triaged by nurses using a computerized triage system, and were referred for after-hours evaluation to 1 of 5 urgent care sites (N = 409). DESIGN: Data were collected at each site for 2-week periods every 3 months, from October 1996 to October 1997 (total study period, 10 weeks). Appropriateness of AHRs (diagnoses, clinical interventions, and final dispositions) were determined by a questionnaire that was completed by the evaluating physician. Parental compliance with the AHR was assessed by review of the after-hours site patient database and by telephone survey. RESULTS: Of the referred patients, 339 (82.9%) complied with the recommendation for AHR and, of these, physician questionnaires were completed for 332 (97.9%). The mean percentage of evaluated patients judged appropriate was 90.7% and did not differ statistically by site or by physician training. A history indicating a potentially serious condition was the most common reason for judging a referral appropriate (80.1%), followed by patient discomfort (53.3%), findings from a physical examination (42.5%), parental anxiety (41.5%), and an urgent need for diagnostic test or therapy (34.7%). Of evaluated patients, 37.0% had a diagnostic test, and in 43.5% of cases, the evaluating physician thought a therapeutic intervention was necessary that night. Of the total sample, 93.4% were discharged and 6.6% were admitted to the hospital. The major reasons given by families for noncompliance were lack of understanding of the disposition recommendation and disagreement with the need for urgent referral. CONCLUSIONS: Approximately 90% of patients who complied with a referral for urgent evaluation by the After-Hours Call Center were judged by the evaluating physician to have been appropriately referred. The appropriateness rate for all referrals may be lower if there is significant self-selection in those families who do not comply.

Algorithms↗
PubMed2000

Reducing after-hours referrals by an after-hours call center with second-level physician triage.

OBJECTIVES: One-third of practices signing-out to The Children's Hospital Call Center in Denver, Colorado, choose to do second-level physician (SLP) triage for calls judged by the Center to require after-hours referral (AHR). We examined: 1) the effect of SLP triage on the rate of AHRs and 2) reasons for physicians' decisions. DESIGN: From January 1998 to August 1998 all calls from patients using a 5-member suburban pediatric practice judged by the Call Center to require AHR were referred to the practice's on-call physician who did SLP triage and completed a questionnaire. RESULTS: There were 955 eligible calls, 22% (N = 216) of which were initially given an urgent disposition by Call Center nurses. Physician questionnaires were completed for 97% (N = 209). Of patients initially triaged for AHR, 49% (N = 103) were subsequently given an AHR, 17% (N = 35) a next day office referral, and 34% (N = 71) home care and advice. Reasons for not urgently referring included the following: 1) medical problem didn't require urgent evaluation (95%, N = 99); 2) change in the patient's condition; (40% N = 43); 3) prior knowledge of family's ability to evaluate and care for the patient (40%, N = 43); and 4) knowledge of the patient's medical history (18%, N = 19). After SLP triage the overall urgent referral rate was 11%. CONCLUSIONS: Signing out to a Call Center decreased physicians' after-hours calls by 77% and SLP triage halved the number of urgent after-hours referrals.

Emergencies↗
PubMed1999

Introduction of a recorded health information line into a pediatric practice.

OBJECTIVE: To examine the utilization, satisfaction, and parental health-seeking behavior associated with the introduction of the Parent Advice Line (PAL), a collection of 278 recorded health-related messages accessible by telephone, into a private practice. DESIGN: Booklets listing PAL topics were mailed to eligible families, and utilization data were collected for all incoming PAL calls from June to August 1996. Satisfaction and effect on health-seeking behavior were assessed using a recorded questionnaire appended to each call (n = 561) and a randomized telephone questionnaire (n = 821). SETTING: A suburban, 7-pediatrician practice in Colorado. PATIENTS: Families with children younger than 12 years seen in the practice within 2 years (N = 8365). RESULTS: Of families who reported receiving the mailed PAL booklet, 32% used PAL. Sixty percent of PAL calls were placed during office hours, 21% from 5 PM to 9 PM, and 8% after midnight; call volume was higher on weekdays than on weekend days (25 calls per day vs 10 calls per day, respectively; P<.05 by chi2 test). The 5 most commonly requested topic categories were toilet training, sexual development, discipline problems, sleep problems, and teenage behavior. Preventive care topics predominated in infants, behavioral topics in preschool children, and acute illness topics in school-aged children. Of users, 88% were satisfied or very satisfied and 98% said that they would use PAL again. Respondents to the 2 questionnaires reported that use of PAL made a call or visit to their child's physician unnecessary 58% to 69% and 61% to 70% of the time, respectively. CONCLUSIONS: The PAL was used primarily to access information about behavioral and developmental issues during office hours. Its use was associated with high rates of satisfaction and, by parental report, decreased calls or visits to a physician.

Adult↗
PubMed1994

The tyrosine-containing internalization motif in the cytoplasmic domain of TGN38/41 lies within a nascent helix.

TGN38 and TGN41 are isoforms of an integral membrane protein (TGN38/41) which is predominantly located in the trans-Golgi network of mammalian cells, but which constitutively recycles between the TGN and the plasma membrane. The cytoplasmic domain tetrapeptide sequence "YQRL" is responsible for the internalization of TGN38/41 from the plasma membrane. This sequence conforms to the tyrosine containing internalization motif ("YXXhydro," where X is any amino acid and hydro is any large bulky hydrophobic amino acid) found in other integral membrane proteins which are internalized from the plasma membrane via clathrin-coated vesicles. Structural predictions have suggested that the YXXhydro motif might adopt a tight turn structure in solution, a prediction supported previously by nuclear magnetic resonance (NMR) studies on short synthetic peptides corresponding to variants of the generic YXXhydro motif. We have synthesized a 21-amino acid peptide which encompasses the TGN38/41 internalization motif and used it as template for two-dimensional NMR analysis. The data from these experiments demonstrate that the internalization motif in the cytoplasmic domain of TGN38/41 lies within a nascent helix, not a tight turn. This is the first study to show that tyrosine containing internalization motifs do not necessarily adopt a beta-turn conformation.

Amino Acid Sequence↗
PubMed1992

Characteristics of bacteriuria in a homogeneous maternity hospital population.

Bacteriuria and urinary tract infection are a common cause of morbidity in pregnancy. Recent evidence has, however, questioned the magnitude of this risk and the effectiveness of therapy in reducing it. To clarify matters, a prospective study on 3123 ante-natal women was carried out. Screening for bacteriuria was carried out by culturing a mid-stream specimen of urine. Treatment was given to all patients with a positive culture and was based on antibiotic sensitivity testing. Repeat culture was performed 1 week after completion of therapy. The prevalence of bacteriuria in our population was 4.74%. Over half of these patients were asymptomatic. 67% of those with bacteriuria at screening were symptomatic or had a past history of urinary tract infection. Escherichia coli was the predominant organism cultured. The most effective antibiotic was Nitrofurantoin, which was sensitive in over 90% of isolates. Late urinary tract infection occurred in 3.52% of patients. There was no increase in maternal or foetal complications amongst those with bacteriuria. We concluded that it might be more cost-effective to confine screening to those patients who are symptomatic or have a past history of urinary tract infection.

Adult↗
PubMed1989

Weak interaction of spectrin with phosphatidylcholine-phosphatidylserine multilayers: a 2H and 31P NMR study.

Spectrin from human erythrocytes binds to bilayer dispersions of both DMPC and DMPS:DMPC (1:1, w/w). However, no effect of bound spectrin on the conformation of the lipid head groups, as measured from the deuterium quadrupolar splittings of DMPC or DMPS specifically deuterated in the polar head groups, was detected in 1:1 mixtures of the two lipids containing either deuterated DMPC or DMPS. Neither the phase transition of the DMPS:DMPC mixtures, nor the spin-lattice relaxation time (T1) of the deuterated DMPS head group, was affected by spectrin. These results argue against any strong interaction of spectrin with phosphatidylserine and rule out the possibility that spectrin is responsible for the maintenance of PS in the inner monolayer of the erythrocyte membrane during the whole life-span of this cell.

Deuterium↗
PubMed1988

Hydrogen exchange from the transbilayer hydrophobic peptide of glycophorin reconstituted in lipid bilayers.

The hydrophobic transbilayer peptide of erythrocyte glycophorin has been purified following exchange of tritium into the backbone amides, and reconstituted in egg phosphatidylcholine micelles. Analysis of tritium exchange from the backbone amides of the membrane-reconstituted peptide shows that about two of the amides are virtually non-exchangeable, about 10 are slowed by factors of 10(7) relative to free amides in unstructured water soluble peptides and the remainder of the amides (about 20) have slowing factors of less than 1000. These classes of amides are proposed to reflect the stability of the peptide with respect to hydrogen bond breaking fluctuations and the accessibility of the amides to exchange catalysts in different regions of the bilayer.

Amides↗
PubMed1979

An evaluation of the A4 folder system in general practice.

All 63 general practices known to have introduced the A4 folder system were asked to complete questionnaires comparing A4 records with the traditional medical records envelope system. Of the 77 per cent who replied, an overwhelming majority favoured the A4 system and felt that it helped them to obtain higher standards of care for patients.

Family Practice↗