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Biomedical subjects

C McDermott

Publications and source records attributed to C McDermott.

At least 19 recordsLinked to original sources
PubMed2006

A placebo-controlled, double-blind, randomized controlled trial of a natural killer cell stimulant (BioBran MGN-3) in chronic fatigue syndrome.

BACKGROUND: Previous research has suggested that natural killer (NK) cell activity may be reduced in patients with chronic fatigue syndrome (CFS). AIM: To evaluate the effectiveness of a putative NK cell stimulant, BioBran MGN-3, in reducing fatigue in CFS patients. DESIGN: Randomized, double-blind, placebo-controlled trial. METHODS: We recruited 71 patients with CFS (according to the Centers for Disease Control 1994 criteria) attending an out-patient specialist CFS service. Participants were given oral BioBran MGN-3 for 8 weeks (2 g three times per day) or placebo equivalent. The primary outcome measure was the Chalder physical fatigue score. Self-reported fatigue measures, self-assessment of improvement, change in key symptoms, quality of life, anxiety and depression measures were also included. RESULTS: Data were complete in 64/71 patients. Both groups showed marked improvement over the study duration, but without significant differences. Mean improvement in the Chalder fatigue score (physical scale) was 0.3 (95%CI -2.6 to 3.2) lower in the BioBran group. DISCUSSION: The findings do not support a specific therapeutic effect for BioBran in CFS. The improvement showed by both groups over time highlights the importance of placebo controls when evaluating interventions in CFS.

Adult↗
PubMed2006

Trampoline injuries in children.

We reviewed the records of children referred to our hospital between April and September 2005 who had been injured whilst trampolining. Of 88 such children there were 33 boys and 55 girls with a mean age of 8 years 6 months (2 years 4 months to 15 years 9 months). Most of the injuries (53; 60%) occurred when bouncing and 34 (39%) were secondary to falls from the trampoline. The cause of injury was unknown in one child. The injured child was supervised in only 35 cases (40%). In 31 (35%) cases, the injury was related to the presence of others on the trampoline. A total of 36 (40%) children required surgery. Fractures of the upper limbs occurred in 62 cases (70%). Injuries related to the recreational use of trampolines are a significant cause of childhood injury. Our results suggest strongly that there is a need for clear guidelines on safe and responsible use of domestic trampolines.

Adolescent↗
PubMed2001

Social isolation predicts re-hospitalization in a group of older American veterans enrolled in the UPBEAT Program. Unified Psychogeriatric Biopsychosocial Evaluation and Treatment.

OBJECTIVES: Does social isolation predict re-hospitalization in a group of older men enrolled in Unified Psychogeriatric Biopsychosocial Evaluation and Treatment (UPBEAT), a mental health care-coordination project at nine Veterans Affairs Healthcare Centers nationwide? METHODS: The current study examined 123 UPBEAT patients located at West Los Angeles, whose ratings were available on the Lubben Social Network Scale (LSNS), the SF-36 scale, the Cumulative Illness Rating Scale (CIRS) and the Mental Health Index (MHI-38) Depression and Anxiety subscales. Within one year of enrollment, 55% of patients were re-hospitalized. Odds of re-hospitalization were calculated using two logistic regression models. Social isolation risk (LSNS) and demographic covariates were included. In addition, Model 1 contained depression and anxiety measures (MHI-38) and physician-rated medical burden (CIRS), while in Model 2, patient-perceived physical (PCS) and mental health (MCS) subscales from the SF-36 were included. RESULTS: The group of patients who were socially isolated or at high or moderate risk for isolation, were 4-5 times more likely to be re-hospitalized within the year, than low isolation risk patients. In both Models 1 (chi-square = 19.86; p = 0.031) and 2 (chi-square = 26.42; p = 0.002) demographic characteristics were not significant predictors of re-hospitalization, but social isolation risk was a significant predictor (Model 1: odds ratio (OR) = 5.31; 95% confidence intervals (CI) = 1.81-15.53; and Model 2: OR = 3.86; 95% CI = 1.39-10.73). In addition, MHI-Anxiety was a significant predictor (OR = 1.22; 95% CI = 1.05-1.43) in Model 1 and in Model 2, patient-perceived physical health significantly predicted re-hospitalization (OR = 0.91; 95% CI = 0.86-0.96). CONCLUSION: When controlling for other covariates, social isolation, physical health and mental health were significant risk factors for re-hospitalization. These findings underline the importance of assessing and addressing lack of social support, along with other factors, in the health care of older male veterans.

Aged↗
PubMed1996

Costs and cost effectiveness of cardiovascular screening and intervention: the British family heart study.

OBJECTIVE: To measure costs and cost effectiveness of the British family heart study cardiovascular screening and intervention programme. DESIGN: Cost effectiveness analysis of randomised controlled trial. Clinical and resource use data taken from trial and unit cost data from external estimates. SETTING: 13 general practices across Britain. SUBJECTS: 4185 men aged 40-59 and their 2827 partners. INTERVENTION: Nurse led programme using a family centered approach, with follow up according to degree of risk. MAIN OUTCOME MEASURES: Cost of the programme it self; overall short term cost to NHS; cost per 1% reduction in coronary risk at one year. RESULTS: Estimated cost of putting the programme into practice for one year was 63 pounds per person (95% confidence interval 60 pounds to 65 pounds). The overall short term cost to the health service was 77 pounds per man (29 pounds to 124 pounds) but only 13 pounds per woman (-48 pounds to 74 pounds), owing to differences in utilisation of other health service resources. The cost per 1% reduction in risk was 5.08 pounds per man (5.92 pounds including broader health service costs) and 5.78 pounds per woman (1.28 pounds taking into account wider health service savings). CONCLUSIONS: The direct cost of the programme to a four partner practice of 7500 patients would be approximately 58,000 pounds. Annually, 8300 pounds would currently be paid to a practice of this size working to the maximum target on the health promotion bands, plus any additional reimbursement of practice staff salaries for which the practice qualified. The broader short term costs to the NHS may augment these costs for men but offset them considerably for women.

Adult↗
PubMed1996

What can be concluded from the Oxcheck and British family heart studies: commentary on cost effectiveness analyses.

OBJECTIVES: To provide a commentary on the economic evaluations of the Oxcheck and British family heart studies: direct comparison of their relative effectiveness and cost effectiveness; comparisons with other interventions; and consideration of problems encountered. DESIGN: Modelling from cost and effectiveness data to estimate of cost per life year gained. SUBJECTS: Middle aged men and women. INTERVENTIONS: Screening for cardiovascular risk factors followed by appropriate lifestyle advice and drug intervention in general practice, and other primary coronary risk management strategies. MAIN OUTCOME MEASURES: Life years gained; cost per life year gained. RESULTS: Depending on the assumed duration of risk reduction, the programme cost per discounted life year gained ranged from 34,800 pounds for a 1 year duration to 1500 pounds for 20 years for the British family heart study and from 29,300 pounds to 900 pounds for Oxcheck. These figures exclude broader net clinical and cost effects and longer term clinical and cost effects other than coronary mortality. CONCLUSIONS: Despite differences in underlying methods, the estimates in the two economic analyses of the studies can be directly compared. Neither study was large enough to provide precise estimates of the overall net cost. Modelling to cost per life year gained provides more readily interpretable measures. These estimates emphasise the importance of the relatively weak evidence on duration effect. Only if the effect lasts at least five years is the Oxcheck programme likely to be cost effective. The effect must last for about 10 years to justify the extra cost associated with the British family heart study.

Adult↗
PubMed1992

Neutrophil activation associated with increased neutrophil acyloxyacyl hydrolase activity during inflammation in cattle.

Acyloxyacyl hydrolase (AOAH) is a lysosomal enzyme found in neutrophils and macrophages that acts to partially deacylate the lipid-A component of the endotoxin of gram-negative bacteria rendering it less toxic, yet maintaining much of its immunostimulatory potential. We have found that the activity of neutrophil AOAH per cell increased during localized inflammation. The purpose of this study was to determine the mechanism(s) responsible for these increases in neutrophil AOAH activity. Because changes in neutrophil maturity commonly are associated with inflammation, intravascular infusion of purified gram-negative bacterial lipopolysaccharide and SC injection of bovine recombinant granulocyte colony-stimulating factor was used to induce large numbers of circulating immature neutrophils. Immature neutrophils were found to have AOAH activity equal to that of mature cells; however, when neutrophils were stimulated in vitro with known activators, AOAH activity of activated cells was more than that of unstimulated cells. The increase in AOAH activity was inversely related to prestimulation activity. Increases in AOAH activity after neutrophil activation were not a result of de novo synthesis of the enzyme, because cycloheximide did not prevent activation-induced increases in activity.

Animals↗
PubMed1991

The Minnesota Child Development Inventory: validity and reliability for assessing development in infancy.

The concurrent validity and reliability of the Minnesota Child Development Inventory (MCDI) was assessed by comparing the MCDI general development index score, and each of the seven subscale scores, with the mental and psychomotor age equivalents achieved on the Bayley Scales of Infant Development. In addition, the co-positivity, co-negativity, positive and negative predictive values of the MCDI in identifying infants with a mental development index (MDI), or psychomotor development index (PDI) of greater than 2 SD below the mean were assessed. Subjects were 101 infants (8 to 19 months old) who were seen at a neonatal developmental follow-up clinic after discharge from the neonatal intensive care unit. Correlations were obtained for the entire sample as well as for the two chronological age groups (i.e., 8 to 10 months and 17 to 19 months) within the sample. A strong correlation between the MCDI scales and the Bayley Mental and Psychomotor Scales was documented for the entire population as well as for the individual age groups. The overall validity of the MCDI in identifying infants with a MDI or PDI of greater than 2 SD below the mean was limited due to relatively poor co-positivity and positive predictive value. Although the MCDI may yield consistent information about the development of an infant's skills, this research suggests the MCDI has limited capacity to discern infants having delayed development.

Aptitude↗
PubMed1989

Nosocomial bloodstream infection at a veterans hospital; 1979 to 1987.

Studies of nosocomial bloodstream infection (NBI) have come primarily from university, municipal or community hospitals with little specific information from veterans hospitals. The objective of this study was to define trends in NBI at a tertiary care veterans hospital. Patients with NBI were identified by retrospective review of microbiology records and of infection control surveillance records from 1979 to 1987 at the Buffalo Veterans Administration Medical Center (VAMC). Between 1979 and 1985 there was no significant upward or downward trend. Beginning in early 1986 a significant increase in NBI was noted. This increase was because of changes in incidence of gram-positive NBI (primarily Staphylococcus aureus [corrected] and enterococcus) while there was no change in incidence of gram-negative NBI. The most common source of NBI were similar to previous studies and included urinary tract infection, pneumonia, surgical wound infections and intravenous catheter related infections. The frequency of various organisms causing NBI was likewise similar to other studies except for pneumonia in which Streptococcus pneumoniae most commonly was isolated. The yearly incidence of gentamicin resistance among gram-negative NBI isolates demonstrated no significant trend. In conclusion, there was a significant increase in incidence of NBI at the Buffalo VAMC between 1979 and 1987 that occurred primarily in the last two years studied. The importance of gram-positive organisms as a cause of NBI at the Buffalo VAMC has been clearly documented as a recent phenomenon.

Catheters, Indwelling↗
PubMed1988

Recurrent gram-negative bacteremia.

PURPOSE: Recurrent gram-negative bacteremia is defined as two or more episodes of bacteremia occurring in the same patient with an infection-free interval between each episode. Our purpose was to identify patients with recurrent gram-negative bacteremia in order to define possible risk factors for its recurrence. PATIENTS AND METHODS: During a recently completed prospective study of all episodes of gram-negative bacteremia at the Buffalo Veterans Administration Center between April 1, 1984, and May 31, 1987, 35 patients with 74 episodes of gram-negative bacteremia were identified. The following information was obtained from all 35 patients: age, service, date of hospital admission, date of the bacteremia, underlying diseases, initial antimicrobial therapy, focus of infection, the presence or absence of shock, antimicrobial susceptibility of the blood isolate, and outcome. RESULTS: All 35 patients were men, had a mean age of 69 years, and all had one or more underlying diseases; 45 percent had a malignancy. The duration of time between a pair of episodes was four weeks or more for 74 percent of 38 pairs of episodes. In 25 of 38 (66 percent) pairs of episodes, the focus of infection was the same; in 80 percent of these 25 pairs, the urinary tract was the focus. Overall, the urinary tract was the focus of gram-negative bacteremia in almost 50 percent. Escherichia coli was the single most common organism isolated (28 percent of all episodes), followed by Proteus mirabilis (17.5 percent) and Pseudomonas aeruginosa (17.5 percent). Six of 35 (17 percent) patients died due to gram-negative bacteremia; five of these six had a respiratory tract focus of infection. CONCLUSIONS: In a population of veterans, recurrent gram-negative bacteremia was identified in almost 10 percent of all patients with gram-negative bacteremia during a 37-month study period. Recurrent gram-negative bacteremia most frequently occurred in the setting of underlying malignancy with the urinary tract as a common focus of infection. The mortality rate of 17 percent was similar to that of all patients with gram-negative bacteremia reported in previous studies.

Aged↗
PubMed1987

Staphylococcus aureus bacteremia caused by infected intravenous catheters.

A prospective study of all cases of Staphylococcus aureus bacteremia (SAB) has been ongoing at our institution since April 1983. Data collected as of December 1984 reveal that of 79 episodes of SAB identified, 28 (35%) were caused by infected intravenous catheters; 14 of these were peripheral catheters and 14 were subclavian catheters. Endocarditis or metastatic infection was not recognized; two patients, one with a prosthetic heart valve and the other with recurrent SAB, did not meet the criteria for these complications but the clinical circumstances were strongly suggestive. Six of the 28 patients (21%) died of their infection, and local complications (inflammation or purulent drainage at the insertion site) were common. Only four of 22 patients who recovered were administered antibiotics for greater than 14 days. We conclude that patients with SAB caused by an infected intravenous catheter have a low risk of endocarditis or metastatic infection when the infected catheter is promptly removed and no risk factors (valvular heart disease or a prosthetic valve) are present that favor development of endocarditis. The duration of antimicrobial therapy need not exceed 2 weeks in this situation. The mortality related to SAB, however, was high and emphasizes the need to develop methods to prevent this infection.

Aged↗
PubMed1987

Routine culturing for Legionella in the hospital environment may be a good idea: a three-hospital prospective study.

The source for nosocomial Legionnaires' disease is the water distribution system. However, the implications for legionella contamination in a hospital without known Legionnaires' disease is unclear. Therefore, culturing for Legionella pneumophila in the environment has not been routinely recommended. The authors conducted a prospective pneumonia study in three hospitals, none of which was known to have a major problem with endemic legionellosis. The water system of Hospital 1 was colonized with L. pneumophila, serogroup 1; Hospital 2 was colonized by L. pneumophila, serogroup 5 (which is rarely associated with disease); Hospital 3 was essentially free of L. pneumophila. Sputum culture on selective legionella media, direct fluorescent antibody testing, and serology were performed for all nosocomial pneumonias regardless of clinical impression. At the end of the study the incidence of nosocomial legionnaires' disease was found to be 9%, 0%, and 0% in Hospitals 1, 2, and found to be 9%, 0%, and 0% in Hospitals 1, 2, and 3, respectively. In Hospital 1, monoclonal antibody subtyping confirmed that the patient isolates were identical to the environmental isolates. The authors conclude that environmental culturing, despite the absence of known Legionnaires' disease, is useful. Positive cultures from the hospital water supply would mandate the introduction of legionella testing into the laboratory and stimulate physicians to consider Legionnaires' disease when encountering nosocomial pneumonias.

Cross Infection↗
PubMed1984

Morganella morganii: epidemiology of bacteremic disease.

A retrospective review of microbiology records revealed 19 documented episodes of M. morganii bacteremia in 18 patients at a Veterans Administration hospital during a 5.5 year period. Thirteen of 19 bacteremias were related to nosocomial infections; 11 of the 13 nosocomial bacteremias occurred in surgical patients. Nine of the 13 patients with nosocomial bacteremia had received recent therapy with a beta-lactam antibiotic. The most common source of bacteremia was a postoperative wound infection (seven episodes). Only one episode was related to a urinary tract infection. Retrospective analysis showed that clusters of cases of M. morganii bacteremia had occurred almost yearly. This finding prompted a six-month period of prospective monitoring of all cultures for M. morganii to identify human reservoirs in our institution. Sixty percent of all cultures growing M. morganii came from urine cultures, 18% came from wound cultures, and the remaining 22% came from a variety of body fluids or tube drainage. Thirty-one percent of patients harboring M. morganii were on the Surgical Service. M. morganii bacteremia most commonly occurs in postoperative patients who receive beta-lactam antibiotics. From the data in this study, M. morganii is an infrequent cause of bacteremia, and its presence in blood cultures may be an indicator of an environment conducive for an outbreak of nosocomial infection.

Adult↗
PubMed1979

Avian antigen-binding cells. II. Enrichment of antigen-binding B and T cells.

Antigen-binding B and T cells from chicken spleens were selected on plates of antigen-derived gelatin. Hapten-specific B cells from DNP-immune normal chicken spleens were selected on DNP-gelatin. As much as 165-fold functional enrichment of precursors of anti-DNP antibody-producing cells, as measured in an adoptive transfer system, was achieved. However, the enrichment of DNP-binding cells assessed by rosette formation and autoradiography was no more than 25-fold. HGG-specific T cells from bursectomized agammaglobulinemic chickens immunized with deaggregated HGG were selected on HGG-gelatin. In the fraction adherent to HGG-gelatin, at least a 20-fold enrichment of suppressors of the antibody response to TNP-HGG, as measured by adoptive transfer, was accomplished. In contrast, no more than 6-fold enrichment of HGG-binding cells was detected by autoradiography. Antigen-specific depletion and enrichment of suppressor T cells and of HGG-binding cells occurred in parallel, suggesting that suppressor cells can bind soluble antigen and can be isolated on antigen coupled to a solid support.

Animals↗
PubMedDate not supplied

Maternal worry about neonatal hearing screening.

OBJECTIVE: To identify and compare the prevalence and degree of maternal worry about neonatal hearing screening at the time of an initial neonatal hearing screen and rescreen in 1997 and 1999. STUDY DESIGN: We report on a prospective cross-sectional investigation of maternal worry about newborn hearing screening. Demographic data, maternal knowledge of hearing screening, and degree of maternal worry were collected on 307 mothers at the time of the neonatal screen and 40 mothers at the time of the rescreen. RESULTS: Degree of maternal worry was significantly greater at the rescreen compared to the screen. Mothers who reported greater worry at the time of the screen were more likely to be socioeconomically disadvantaged. Although maternal knowledge about hearing screening increased between the two time periods, degree of worry remained unchanged. CONCLUSION: Efforts to minimize the neonatal false-positive hearing screen rates and to educate mothers about hearing screening are indicated to minimize unnecessary worry.

Anxiety↗
PubMedDate not supplied

Prospective study of 114 consecutive episodes of Staphylococcus aureus bacteremia.

From 1 April 1983 to 31 October 1985, 114 episodes of Staphylococcus aureus bacteremia (SAB) were identified in 111 patients at the Buffalo Veterans Administration Medical Center. Only 14% of the episodes were community-acquired, and 29% were due to methicillin-resistant strains. The commonest foci of SAB were intravascular catheters (33%), postoperative wounds (11%), skin infections (7%), and pulmonary infections (7%). Complications were infrequent, with endocarditis in two patients and metastatic infection in one. Mortality due to SAB was 32%, with no difference in mortality between community-acquired and hospital-acquired SAB. Although not statistically significant, there was a trend of higher mortality for methicillin-resistant SAB (42%) than for methicillin-sensitive SAB (28%) and for patients with no focus of SAB (43%) than for those with a defined primary focus (28%). A review of studies of SAB published since 1940 revealed several trends. SAB is now predominately a nosocomial infection; intravascular-catheter infection has become the commonest cause of SAB; with several exceptions, the risk of endocarditis in patients with SAB is low (5%-20%); mortality due to SAB has decreased over the past 40 years but not over the past 10 years.

Endocarditis, Bacterial↗