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Biomedical subjects

C Starkey

Publications and source records attributed to C Starkey.

17 recordsLinked to original sources
PubMed2005

Reproducibility of exhaled breath condensate pH in chronic obstructive pulmonary disease.

Increasingly, exhaled breath condensate (EBC) is being used to sample airway fluid from the lower respiratory tract. EBC pH may be a biomarker of airway inflammation in chronic obstructive pulmonary disease (COPD). In this study, the reproducibility of EBC pH in COPD was investigated. A total of 36 COPD patients and 12 healthy nonsmoking subjects participated in several investigations: duration of argon deaeration, within-sample variability, effect of freezing, leaving samples at room temperature, nose-peg use, within- (WD) and between-day (BD) variability. Analysis of repeated measurements was performed using the Bland-Altman method with limits of agreement (LOA; mean difference+/-2 SD). Wider LOA indicate greater variability. EBC pH became significantly higher with argon deaeration for < or =5 min. Variability during sample analysis was minimal; LOA of within-sample variability, freezing for 3 months and leaving at room temperature for 3 h were -0.29-0.45, -0.37-0.42 and -0.13-0.09, respectively. In contrast, variability due to nose-peg use (LOA -1.46-1.99), WD (LOA -1.50-2.48) and BD variability (LOA -2.52-3.02) were higher in COPD. In healthy nonsmoking subjects, nose-peg use (LOA -0.27-0.23), WD (LOA -0.33-0.40) and BD variability (LOA -0.46-0.44) were more reproducible. In conclusion, the variability of exhaled breath condensate pH in chronic obstructive pulmonary disease patients is mainly due to changes in airway pH over time, which are not seen in healthy nonsmoking subjects. Reasons for these fluctuations in exhaled breath condensate pH are unclear and require further investigation.

Adult↗
PubMed2001

Hepatitis C virus RNA assays: a comparison of SuperQuant and Monitor.

Hepatitis C RNA testing has been used extensively to assess the efficacy of antiviral therapy and has increasingly become an integral part of clinical management of patients with chronic hepatitis C. A variety of commercially available hepatitis C virus (HCV) RNA tests are used to detect HCV RNA qualitatively or quantitatively. These commercial tests have fundamental differences that are reflected on the values they generate. We compared two widely used assays, HCV SuperQuant (SQ) and Amplicor HCV Monitor (M1 and M2), in sera of patients with chronic hepatitis C. A total of 506 sera from 79 patients were tested with both assays. The data were logarithmically transformed and analyzed by linear regression and measurement of agreement. Two hundred thirty-eight sera had HCV RNA values within the dynamic range of both assays. The correlation between the assays was fair, with a correlation coefficient (r) of 0.699. Overall, SQ generated higher values than M1 with a mean difference of 0.558 log (SD = 0.624). One hundred ninety-four (38%) and 121 (24%) of the sera were below the dynamic range of M1 and SQ, respectively. Seventy-three sera, undetectable by M1, were positive by SQ. The Amplicor HCV Monitor 2.0 (M2) was performed in 66 sera. All were positive by SQ and M2, but only 38 were within the dynamic range of M1. The correlations between these tests were good (r = 0.68-0.78), but the agreement was rather poor. In conclusion, this study confirms that both SQ and M2 are more sensitive than M1. Additionally, our results show rather poor agreements between these assays. The recent attempts in standardizing the reporting of these assays should make their results more easily interchangeable.

Adult↗
PubMed2000

Computerised systematic secondary prevention in ischaemic heart disease: a study in one practice.

BACKGROUND: One of the most effective interventions that the primary health care team can make is that of secondary prevention in ischaemic heart disease (IHD). There is still a need to improve the uptake of effective interventions such as aspirin and statins in these patients. General Practice in the UK is 95% computerised, but many functions are under-utilised. In the majority of cases primary care clinicians use the keyboard rather than mouse for data entry. Methods of data entry using the keyboard or CHUI (Character User Interface) can be cumbersome and time consuming. This can limit data collection and its assimilation for patient care. The object of this study was to assess the feasibility and effectiveness of a new software programme, which provides computerised support to primary care staff in their preventive care of IHD patients. AIM: To demonstrate that a systematic computer facilitated secondary prevention programme for IHD was effective, feasible, and acceptable to patients and improved patient care. METHOD: Evidence-based guidelines and intervention levels for secondary prevention of IHD were agreed at practice level and embedded in the software. Patients aged 80 and under were identified by the use of Read codes and repeat prescribing. The nurse-run programme consisted of a detailed review of electronic and written records and then the clinical review of 141 patients. At follow-up patients were issued with a questionnaire to assess their satisfaction with the process. RESULTS: From a general practice computer search for ischaemic heart disease Read Code (G3) and/or nitrate prescription an initial cohort of 242 patients was established. 90 were excluded on clinical grounds (not IHD, deceased, over-riding other clinical problems), and eleven patients could not be recruited (eight declined and three had moved away). The final cohort consisted of 141 patients, of whom 101 patients suffered angina, 67 had a previous history of myocardial infarction, and 28 had had coronary artery bypass grafting. Hypertension had been diagnosed in 80 and hyperlipidaemia in 43. As a result of the study new diagnoses included: hyperlipidaemia where statins were indicated (38), congestive cardiac failure requiring treatment with ACE (Angiotensin Converting Enzyme) inhibitors (2) and carotid bruits requiring referral (4). In addition diabetes was diagnosed in three patients. The programme proved acceptable to patients, doctors and practice staff; follow-up continues. CONCLUSION: The use of this methodology, in a single practice, has improved the care of patients well beyond that achieved with established template-based secondary prevention programmes. The outcome has been measured in terms of increased diagnosis and active management of hyperlipidaemia and other risk factors.

Aged↗
PubMed2000

The pond is wider than you think! Problems encountered when searching family practice literature.

OBJECTIVE: To explain differences in the results of literature searches in British general practice and North American family practice or family medicine. DESIGN: Comparative literature search. SETTING: The Department of Family and Community Medicine at the University of Toronto in Ontario. METHOD: Literature searches on MEDLINE demonstrated that certain search strategies ignored certain key words, depending on the search engine and the search terms chosen. Literature searches using the key words "general practice," "family practice," and "family medicine" combined with the topics "depression" and then "otitis media" were conducted in MEDLINE using four different Web-based search engines: Ovid, HealthGate, PubMed, and Internet Grateful Med. MAIN OUTCOME MEASURES: The number of MEDLINE references retrieved for both topics when searched with each of the three key words, "general practice," "family practice," and "family medicine" using each of the four search engines. RESULTS: For each topic, each search yielded very different articles. Some search engines did a better job of matching the term "general practice" to the terms "family medicine" and "family practice," and thus improved retrieval. The problem of language use extends to the variable use of terminology and differences in spelling between British and American English. CONCLUSION: We need to heighten awareness of literature search problems and the potential for duplication of research effort when some of the literature is ignored, and to suggest ways to overcome the deficiencies of the various search engines.

Depression↗
PubMed2000

Injuries and illnesses in the national basketball association: a 10-year perspective.

OBJECTIVE: To present an overview of the medical conditions experienced by athletes competing in the National Basketball Association (NBA) from the 1988-1989 through the 1997-1998 seasons. DESIGN AND SETTING: Athletic trainers completed profiles that provided demographic information for each player. Injury reports indicated when and where the injury occurred, pathology, onset, activity, and the mechanism of injury. The amount of time lost, injured list status, hospitalization, and surgery were also reported. Reportable injuries were those that resulted in (1) physician referral, (2) a practice or game being missed, or (3) emergency care being rendered. SUBJECTS: A total of 1094 players appeared in the database 3843 times (mean, 3.3 +/- 2.6 seasons). Mean player demographics were age 26.7 (+/- 3.7) years, NBA playing experience 4.1 (+/- 3.7) years, height 200.8 (+/- 9.9) cm, and weight 100.2 (+/- 13.5) kg. Players averaged 52 (+/- 34.7) games and 1263.1 (+/- 1073.8) minutes played. MEASUREMENTS: The frequency of injury, time lost, and game exposures were tabulated, and game-related injury rates were then calculated. RESULTS: Ankle sprains were the most frequently occurring orthopaedic injury (942, 9.4%), followed by patellofemoral inflammation (803, 8.1%), lumbar strains (491, 5.0%), and knee sprains (258, 2.3%). The greatest number of days missed were related to patellofemoral inflammation (7569, 11.5%), knee sprains (5712, 8.6%), ankle sprains (5122, 7.7%), and lumbar strains (3365, 5.1%). CONCLUSIONS: Professional athletes in the NBA experience a rate of game-related injuries that is twice as high as their collegiate counterparts. Patellofemoral inflammation is a significant problem among NBA players.

Journal Article↗
PubMed1999

Amplicor enterovirus polymerase chain reaction in patients with aseptic meningitis: a sensitive test limited by amplification inhibitors.

OBJECTIVE: To evaluate the sensitivity and specificity of reverse-transcription polymerase chain reaction (RT-PCR) and routine cell culture for the detection of enterovirus in cerebrospinal fluid. METHODS: Thirty-eight cerebrospinal fluid specimens were included. Cell culture was inoculated immediately and incubated for 14 days. An aliquot was kept frozen for Amplicor RT-PCR. Chart review was performed to determine the validity of the results. RESULTS: Nine of 38 specimens were positive for enterovirus by culture, and 14 were positive by RT-PCR. There were 7 discrepancies between the 2 methods. Six specimens were positive by RT-PCR and negative by the culture method. The 1 culture-positive but RT-PCR--negative specimen was determined to contain PCR inhibitors. All discrepant results were confirmed as true positives by chart review. Patients whose cerebrospinal fluid was negative by both methods had a final diagnosis other than enterovirus infection. CONCLUSION: Amplicor PCR is more sensitive than cell culture (93.3% vs. 60%) and is very specific. With the incorporation of appropriate controls for the detection of amplification inhibitors, RT-PCR could be a valuable tool in the diagnosis of enteroviral meningitis.

Cell Culture Techniques↗
PubMed1995

The National Basketball Association eye injury study.

OBJECTIVE: To investigate the epidemiology of eye injuries sustained by professional basketball players in the National Basketball Association (NBA). METHODS: A prospective study involving all NBA athletes who sustained eye injuries between February 1, 1992, and June 20, 1993, was conducted. Twenty-seven NBA team athletic trainers, physicians, and ophthalmologists were provided data forms to complete for any player examined for an eye injury. Practice and game exposures during the preseason, regular season, playoffs, and championships were included. RESULTS: Of the 1092 injuries sustained by NBA players during the 17-month period, 59 (5.4%) involved the eye and adnexa. Eighteen (30.5%) of the injuries occurred while the player was in the act of rebounding, and 16 (27.1%) while the player was on offense. The most common diagnoses included 30 abrasions or lacerations to the eyelid (50.9%), 17 contusions (edema and/or ecchymosis) to the eyelid or periorbital region (28.8%), and seven corneal abrasions (11.9%). There were three orbital fractures (5.1%). Most injuries were caused by fingers (35.6%) or elbows (28.8%). Nine players (15.3%) missed subsequent games because of their injury. Fifty-seven players (96.6%) were not wearing protective eyewear at the time of injury. CONCLUSIONS: The incidence of eye injuries in NBA players during the 17-month period was 1.44 per 1000 game exposures. Frequent physical contact in professional basketball players leaves them at great risk for sustaining eye injuries. To prevent these injuries, protective eyewear is recommended.

Anterior Eye Segment↗
PubMed1995

Comparative stabilities of quantitative human immunodeficiency virus RNA in plasma from samples collected in VACUTAINER CPT, VACUTAINER PPT, and standard VACUTAINER tubes.

This study compared the levels of human immunodeficiency virus (HIV) virion RNA in plasma from whole blood collected in VACUTAINER CPT (cell preparation tube), VACUTAINER PPT (plasma preparation tube), VACUTAINER SST (serum separation tube), and standard VACUTAINER tubes with sodium heparin, acid citrate dextrose, sodium citrate, and potassium EDTA used as anticoagulants. Quantitative plasma HIV RNA levels were measured by branched-DNA signal amplification. Blood from all tubes was either processed within 1 to 3 h after collection or stored at room temperature or at 4 degrees C for analysis at 6 to 8 and 30 h postdraw. Immediately separated plasma from sodium citrate CPT tubes held at 4 degrees C maintained better stability of HIV RNA equivalents than whole blood held at room temperature or 4 degrees C. The highest number of HIV RNA equivalents was seen with EDTA VACUTAINER tubes. HIV RNA equivalents in all types of plasma were significantly higher than in SST tubes. Although a decline in HIV RNA equivalents was seen in all collection devices after 30 h, a significantly greater decline in plasma HIV RNA equivalents occurred in acid citrate dextrose VACUTAINER tubes than in citrate CPT, PPT, and standard EDTA VACUTAINER tubes. In order to minimize the variability of quantitative HIV RNA test results, our data suggest that samples collected for a particular assay should be processed at the same time postdraw using a particular tube type throughout a given study.

Anticoagulants↗
PubMed1995

Performance on the athletic training certification examination based on candidates' routes to eligibility.

The National Athletic Trainers' Association Board of Certification initiated a task force whose purpose is to evaluate the criteria that determine eligibility for the athletic training certification examination. Candidates may qualify to take the examination through one of two routes: an academic-based curriculum program or the practical education, work-experience-based internship route. The certification examination is comprised of three sections: a written examination, a written simulation, and a practical examination. We retrospectively examined certification examination scores during a 2-year period to determine whether a significant difference existed between the two groups of candidates. Test results for first-time candidates sitting for one of the nine examinations administered during 1992 and 1993 were extracted from the data base maintained by Columbia Assessment Services, Inc (Raleigh, NC) and grouped according to the candidates' route to eligibility. Curriculum candidates had significantly greater scores than did internship candidates on each of the three parts of the examination. Although the test analysis yields strong statistical power in interpreting these results, examination outcomes may also be influenced by the structure and content of the academic program followed, the quality of the clinical experience, the heterogeneity of each of the routes, and the psychosocial rigors of the examination process.

Journal Article↗
PubMed1994

Athletic trainers' attitudes toward drug screening of intercollegiate athletes.

Since the inception of NCAA-mandated drug screening in 1986, college athletic trainers have found themselves involved at various levels in institutional drug-screening programs. Several legal, moral, and ethical questions have been raised regarding the drug screening of college athletes, and studies have been conducted to rate athletes' attitudes toward this practice. We examined the responses of certified athletic trainers employed in college settings to ascertain their attitudes toward the drug screening of athletes in general, and, specifically, how they view their role in this process. Surveys were distributed to 500 college athletic trainers randomly selected from the membership database maintained by the National Athletic Trainers' Association, Inc (Dallas, TX). The results of this survey indicate that the majority of athletic trainers feel that their association with the drug-screening process places them in the dual role of police and counselor, but that this relationship does not negatively affect their rapport with their athletes. Opinions regarding the drug-screening process and the importance of education in deterring drug use are somewhat dependent upon the athletic trainer's involvement in the drug-screening process. Athletic trainers possess a stronger desire to serve as resource persons who organize substance abuse education programs rather than serving as administrators of the sampling process.

Journal Article↗
PubMed1987

Acute infection with the human immunodeficiency virus (HIV) associated with acute brachial neuritis and exanthematous rash.

Clinical descriptions of acute or primary infection with the human immunodeficiency virus (HIV) are rare. Among cases previously reported, most describe an acute illness resembling infectious mononucleosis. We describe the case of a 32-year-old homosexual man with an acute illness associated with strong serologic evidence of a primary infection with HIV. This case illustrates two new clinical features: an acute, bilateral brachial neuritis, and a vesicular, pustular exanthematous and enanthematous rash. Studies of HIV-related serologic results show differential sensitivities for enzyme-linked immunosorbent assay, Western blot, immunofluorescence, and viral antigen techniques in the acute phase of HIV infection. There appears to be significant clinical heterogeneity of the acute phase of HIV infection.

Acute Disease↗
PubMed1981

Stereoselective effects of opiate agonists and antagonists on ingestive behavior in rats.

In male Sprague Dawley rats, the (-)-isomer of the opiate antagonist GPA 1843 (beta-9-methyl-5-phenyl-2-allyl-2'-hydroxy-6, 7-benzomorphan) produced dose-related decreases in nocturnal feeding and of hyperphagias induced by 2-deoxy-D-glucose (2-DG; 400 mg/kg) and 24 hr food deprivation (FD). The hyperphagia induced by insulin (10 U/kg) was not significantly decreased by GPA 1843. In contrast, comparable doses of the (+)-stereoisomer, GPA 1847, had no effect on nocturnal, 2-DG or FD hyperphagia. In addition, hyperphagia and hyperdipsia were observed following administration of the opiate agonist levorphanol, but not its stereoisomer, dextrorphan. Thus, the effects of these agents on consummatory behavior are mediated by a stereospecific interaction with opiate receptors, which further indicates that endogenous opiate peptides are involved in the expression of these opiate-related hyperphagias.

Animals↗
PubMedDate not supplied

Incidence of lateral meniscus injury in professional basketball players.

We reviewed National Basketball Trainers Association data over a 6-year period to determine the incidence of lateral meniscus injury among professional basketball players. Our results indicated that 58% of all injuries involved the lateral meniscus, while 42% involved the medial meniscus. This differs from what other authors have reported for basketball players. The lateral meniscus may be vulnerable to chronic injury and subject to microtrauma from repetitive submaximal stresses associated with cutting or changing direction while running, or from pivoting. A professional player is at more risk of injury during a game than practice, and thus is exposed to injury more than a collegian because the professional season has three to four times as many games. Also, magnetic resonance imaging may aid the physician in accurately diagnosing some tears that would otherwise have gone undetected or required arthroscopy for diagnosis. In addition, injury to the lateral meniscus could produce secondary symptoms such as instability or patellofemoral pain to structures other than the lateral meniscus.

Adult↗
PubMedDate not supplied

Antibodies to the human T lymphocytotropic type I in systemic lupus erythematosus.

We tested sera from 94 patients with systemic lupus erythematosus (SLE) by Western immunoblot. Using the criteria established by the Public Health Service Working Group, 11 (12%) sera were reactive, 29 (31%) indeterminate and 54 (57%) unreactive. When the reactive sera were immunoblotted against an extract from an uninfected control lymphoblastoid cell line, identical bands were obtained. HTLVI antigenemia could not be detected in any of the reactive sera. This suggests that previously described "antibodies to HTLVI" in SLE represent artifactual reaction with cellular components in the antigenic extract.

Blotting, Western↗