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Biomedical subjects

C Taylor

Publications and source records attributed to C Taylor.

At least 37 records · Page 2Linked to original sources
PubMed2005

A review on pelvic inflammatory disease.

Pelvic inflammatory disease (PID) remains a significant cause of morbidity worldwide, with the potential to result in serious reproductive complications. Much of the definitive work regarding PID was completed in the 1960s and 1970s. More recently, however, there have been a range of studies published that have contributed to our understanding of PID. Aetiologically, the main pathogens are chlamydia and gonorrhoea, but may include Mycoplasma genitalium and anaerobic Gram-negative rods. Risk factors associated with the development of PID include inconsistent barrier contraception, possibly vaginal douching, and the oral contraceptive pill likely masking the clinical severity of the disease. The small risk associated with the intrauterine device is limited to the first few weeks after insertion. New diagnostic techniques being evaluated include Doppler ultrasound and magnetic resonance imaging. Management must be prompt to prevent complications, and there are no apparent differences in clinical outcomes, whether treated as an inpatient or outpatient. Effective disease prevention includes widespread chlamydia screening and improving education.

Female↗
PubMed2004

Cervical HPV infection and neoplasia in a large population-based prospective study: the Manchester cohort.

Cytology and histology records and cervical samples for HPV assay were obtained from a prospective cohort of 49 655 women attending clinics for routine cervical cytology in or near Manchester between 1988 and 1993. The women were followed up for cytological abnormality and neoplasia through the cytology laboratory's records. HPV at entry was assayed in an age- and period-stratified random sample of 7278 women and in prevalent and incident CIN3 cases. The prevalence of newly diagnosed CIN3 increased with time since last normal smear, indicating that most cases persist for several years. CIN3 prevalence did not increase further for screening intervals exceeding 5 years, however, suggesting that CIN3 eventually regresses cytologically. CIN2 prevalence increased less steeply with screening interval, while the prevalence of lesser abnormality was almost independent of screening interval. The prevalence of oncogenic HPV at entry declined from 19% among women aged under 25 to less than 3% at age 40 or above. Oncogenic HPV infection was strongly predictive of subsequent CIN3 (OR 17.2, 95% CI 10.4-28.4), but only weakly related to CIN2 (OR 2.3, 95% CI 0.5-10.7) and lesser abnormality (OR 1.4, 95% CI 0.8-2.5). At current incidence rates, the lifetime risk of developing CIN3 will be 9% in this population. The cumulative risk of CIN3 diagnosis among cytologically normal women with oncogenic HPV detected at entry was 28% (CI 18-43%) after 14 years. Persistence of oncogenic HPV may be more sensitive and specific than cytology for early detection of CIN3 and invasive cancer.

Adolescent↗
PubMed2004

Hypoxia inhibits human bladder smooth muscle cell proliferation: a potential mechanism of bladder dysfunction.

AIMS: Recent animal studies have suggested that bladder outflow obstruction causes bladder wall hypoxia during both the filling and the voiding phases of the micturition cycle. We have previously demonstrated that mechanical deformation of human detrusor leads to smooth muscle (SM) cell hypertrophy and hyperplasia, which may then contribute to hypoxia in the dysfunctional bladder. We hypothesise that the detrusor's response to a hypoxic environment contributes to bladder dysfunction. The aim of this study was to evaluate the effect of hypoxia on detrusor cell survival and growth. METHODS: Normal human detrusor muscle was obtained at radical cystectomy and primary cultures were established. Cells were then cultured in the presence of 1% oxygen in a hypoxic chamber for different times. Apoptosis was assessed by propidium iodide DNA staining and flow cytometry. Proliferation was assessed by radiolabelled thymidine incorporation. Cell supernatants were retained for growth factor estimation by enzyme linked immuno-sorbent assay (ELISA), and total cell and nuclear extracts were isolated for Western blotting. RESULTS: SM cells responded to the presence of hypoxia through significant upregulation of survival factors hypoxia inducible factor (HIF 1alpha) and vascular endothelial growth factor (VEGF) in a time-dependent manner. Hypoxia did not induce cell death, but significantly reduced the rate of proliferation over time, associated with an increase in the cell cycle inhibitor p27kip1. CONCLUSIONS: In an in vitro human detrusor cell culture model, cells demonstrate a resistance to hypoxia-induced apoptosis but proliferation is inhibited. We suggest that the anti-proliferative effects of hypoxia may limit the ability of detrusor cells to respond to, and compensate for, alterations in their environment contributing to bladder dysfunction.

Apoptosis↗
PubMed2004

Maximising household waste recycling at civic amenity sites in Lancashire, England.

In the UK, all local authorities have been set statutory performance standards for the recycling and composting of household waste. As part of their strategy for achieving these standards, Lancashire County Council (LCC) has made a number of alterations to the layout and facilities available at civic amenity sites (renamed Household Waste Recycling Centres (HWRCs)) in the county and tried to create a more positive image of the sites for members of the public. This study consisted of two surveys carried out in order to establish how to maximise household waste recycling at the 26 HWRCs in Lancashire. A telephone survey was carried out amongst all Lancashire's HWRC attendants in order to establish the effects of recent site improvements and to provide an indication of overall customer satisfaction. An on-site questionnaire survey was conducted amongst HWRC customers on five selected sites, over three separate seasons, incorporating comparative weekend and weekday surveys at each site. This survey investigated public opinion of HWRCs in Lancashire, as well as exploring effective methods that would assist customers in maximising the amount of recycling at HWRCs. The attendants' survey revealed that site attendants were actively encouraging customers to segregate waste more efficiently at the HWRCs, and that a recycling-related bonus scheme had provided an incentive towards this effort. Site attendants have a key role in educating the public about waste segregation and the effective use of HWRCs. Lancashire HWRC users were mostly male, used private cars to transport waste and showed high levels of customer satisfaction. Practical changes to encourage more recycling at HWRCs were clearly identified in the customers' survey; these include longer opening hours and the provision of boxes to enable pre-separation of waste. The study has clearly shown how the results of user surveys can provide practical assistance in the development of improved sustainable waste management strategies.

Community Participation↗
PubMed2004

Patient satisfaction in emergency medicine.

A systematic review was undertaken to identify published evidence relating to patient satisfaction in emergency medicine. Reviewed papers were divided into those that identified the factors influencing overall satisfaction in emergency department patients, and those in which a specific intervention was evaluated. Patient age and race influenced satisfaction in some, but not all, studies. Triage category was strongly correlated with satisfaction, but this also relates to waiting time. The three most frequently identified service factors were: interpersonal skills/staff attitudes; provision of information/explanation; perceived waiting times. Seven controlled intervention studies were found. These suggested that increased information on ED arrival, and training courses designed to improve staff attitudes and communication, are capable of improving patient satisfaction. None of the intervention studies looked specifically at the effect of reducing the perceived waiting time. Key interventions to improve patient satisfaction will be those that develop the interpersonal and attitudinal skills of staff, increase the information provided, and reduce the perceived waiting time. Future research should use a mixture of quantitative and qualitative methods to evaluate specific interventions.

Attitude of Health Personnel↗
PubMed2004

Clinical presentation of acute chest syndrome in sickle cell disease.

In this study the records of 45 patients with sickle cell disease involved in 63 presentations of acute chest syndrome at the Princess Margaret Hospital in Nassau, the Bahamas, between 1997 and 2001 were examined. Patients were divided into three groups on the basis of age (<13 years, 13-18 years, >/=19 years) with a view to assessing clinical presentation. The incidence of symptoms, physical signs, and laboratory findings were enumerated and significant differences between age groups determined. The data were analysed using analysis of variance, t test, and chi(2) test and compared with existing knowledge on the subject. This study proposed to evaluate the clinical presentation of acute chest syndrome with emphasis on historical and physical findings, and to encourage the physician to maintain a high index of suspicion for the condition in susceptible patients. It was found that presentation varied significantly with age groups, children presenting most classically with fever and cough and adults, with chest pain. The 13-18 age group emerged as the group which presented most frequently with the typical symptoms of chest infection, thus potentially making diagnosis easier. Of note, the most frequent finding was a normal examination, while the second commonest physical finding was crepitations on auscultation of the chest.

Acute Disease↗
PubMed2003

Characterization of a North American orf virus isolated from a goat with persistent, proliferative dermatitis.

The characterization of an orf virus (OV) isolated from skin lesions of a goat kid with severe, persistent, proliferative dermatitis, and designated orf virus-San Angelo 2000 (OV-SA00) strain, is described. The identity of OV-SA00 was confirmed by a combination of methods, including electron microscopy, amplification of specific fragments of viral DNA by polymerase chain reaction, restriction enzyme analysis of viral DNA and gene sequencing. Restriction endonuclease analyses of viral DNA and the protein profile studied by Western blot revealed differences between OV-SA00 strain and the profiles of other OV strains that have been published. The restriction enzyme profile of OV-SA00 was also different from the orf virus vaccine (OV-V) strain used to vaccinate this kid. Comparison of the nucleotide and deduced amino acid sequences indicated that OV-SA00 is closely related to OV-V strain, the Scottish OV strains orf11 and MRI Scab, and the human OV-CE/Shoe strain and more distant to bovine papular stomatitis virus (BPSV) reference strain and the pseudocowpox virus (PCPV)-MNV/Till strain. These results indicate that OV-SA00 is a strain of OV rather than a different parapoxvirus. Further studies are necessary to determine if the severity of orf-induced lesions in this goat kid was the result of individual host susceptibility factors.

Amino Acid Sequence↗
PubMed2003

Sharps injury reduction using Sharpsmart--a reusable sharps management system.

Sharps containers are associated with 11-13% of total sharps injuries (SI) yet have received little attention as a means of SI reduction. A newly developed reusable sharps containment system (Sharpsmart) was trialed in eight hospitals in three countries. The system was associated with an 86.8% reduction of container-related SI (CRSI) (P=0.012), a 25.7% reduction in non-CRSI (P=0.003), and a 32.6% reduction in total SI (P=0.002) compared with historical data. The study concludes that the Sharpsmart system is an effective engineered control in reducing SI.

Accidents, Occupational↗
PubMed2003

Intravenous busulfan for allogeneic hematopoietic stem cell transplantation in infants: clinical and pharmacokinetic results.

SUMMARY: High-dose busulfan is an important component of myeloablative regimens. Variable drug exposure may occur following oral administration. Therefore, the use of intravenous busulfan has been advocated. Previous work has suggested a cumulative dosage of 16 mg/kg for haematopoietic transplantation in children less than 3 years of age, but only limited data are available in infants. Pharmacokinetics of intravenous busulfan administered at the suggested dosage were studied in 14 infants (median age 4.7 months). Busulfan plasma concentrations were measured by either GC-MS or HPLC-UV. In seven patients, the dose was decreased to target an area- under- the- curve of 600-1300 micromol min. The median total dose given was 13.8 mg/kg. All patients engrafted. Severe veno-occlusive disease occurred in one patient. Our study demonstrates that a cumulative dosage of 16 mg/kg is associated with higher exposure than expected in infants. We suggest an initial dose of 0.8 mg/kg followed by pharmacokinetically guided dose adjustment.

Area Under Curve↗
PubMed2003

Epidemiological risk factors for hypersensitivity reactions to abacavir.

We investigated risk factors for hypersensitivity reactions (HSR) to abacavir in a case-control study. In a multivariate analysis, white race [odds ratio (OR), 5.16; 95% confidence interval (CI), 1.16-22.97] and a higher CD8 cell count at initiation of abacavir (>850 vs. < or =850 cells: OR, 3.74; 95% CI, 1.19-11.77) were found to be significantly associated with the development of HSR. Age, gender, stage of disease, prior antiretroviral exposure and type of concurrent antiretroviral therapy were not associated with HSR. Differences in predisposition to HSR according to ethnicity and baseline CD8 cell count may be explained by the reported MHC genetic associations with HSR.

Adult↗
PubMed2003

Introduction, audit and review of guidelines for delegated authorization of nuclear medicine investigations in compliance with the Ionising Radiation (Medical Exposure) Regulations 2000.

The introduction of the Ionising Radiation (Medical Exposure) Regulations 2000 in Great Britain required every nuclear medicine investigation to be justified by a practitioner holding an appropriate Administration of Radioactive Substances Committee (ARSAC) certificate. The task of authorizing the radiation exposure may be performed by the practitioner (direct authorization) or delegated to an appropriately trained operator working to written guidelines approved by the practitioner (delegated authorization). In this study, we look at the process of implementation, audit and review of a set of Delegated Authorization Guidelines (DAG). The process of drafting the DAG is outlined. Following the introduction of the DAG, an audit of nuclear medicine referrals was performed at two sites for a period of 3 months. Each referral was compared with the DAG to determine whether it matched the criteria set out. If it did not match, it was further categorized as being due to: (1) insufficient referral information; or (2) clinical indication not included in the DAG. All non-matching requests were reviewed by the practitioner. Four hundred and thirty-seven of 632 (69%) referrals fitted the DAG, 12% (n=75) required clarification from the referrer before fitting with the criteria and 19% (n=120) were directly authorized by the practitioner. From those referrals that were directly authorized, some additional indications were identified and the DAG were subsequently revised. In conclusion, a delegated authorization procedure for nuclear medicine investigations can be implemented successfully. Regular audit is essential. This study identified the need to improve the format of the request card and to obtain additional referral information from the referrer.

Certification↗
PubMed2003

Impact of human immunodeficiency virus (HIV) infection on the progression of liver fibrosis in hepatitis C virus infected patients.

OBJECTIVES: To compare the rate of hepatic fibrosis progression in hepatitis C virus (HCV) infected and human immunodeficiency virus (HIV)-HCV coinfected patients, and to identify factors that may influence fibrosis progression. PATIENTS AND METHODS: A total of 153 HCV infected and 55 HCV-HIV coinfected patients were identified from two London hospitals. Eligible patients had known dates of HCV acquisition, were HCV-RNA positive, and had undergone a liver biopsy, which was graded using the Ishak score. Univariate and multivariate logistic regression analyses were used to identify factors associated with fibrosis progression rate and the development of advanced fibrosis (stages 3 and 4). RESULTS: The estimated median fibrosis progression rate was 0.17 units/year (interquartile range (IQR) 0.10-0.25) in HIV-HCV coinfected and 0.13 (IQR 0.07-0.17) in HCV monoinfected patients (p=0.01), equating to an estimated time from HCV infection to cirrhosis of 23 and 32 years, respectively. Older age at infection (p<0.001), HIV positivity (p=0.019), higher alanine aminotransferase (ALT) level (p=0.039), and higher inflammatory activity (p<0.001) on first biopsy were all independently associated with more rapid fibrosis progression. ALT was correlated with histological index (r=0.35, p<0.001). A CD4 cell count < or =250 x 10(6)/l was independently associated with advanced liver fibrosis (odds ratio 5.36 (95% confidence interval 1.26-22.79)) and was also correlated with a higher histological index (r=-0.42, p=0.002). CONCLUSION: HIV infection modifies the natural history of HCV by accelerating the rate of fibrosis progression by 1.4 fold, and the development of advanced fibrosis threefold. A low CD4 cell count was independently associated with advanced disease and correlated with higher histological index, which suggests that early antiretroviral therapy may be of benefit in slowing HCV progression in coinfected patients.

Adult↗
PubMed2003

A qualitative study of the psychosocial implications of lipodystrophy syndrome on HIV positive individuals.

OBJECTIVES: To investigate the psychosocial impact of lipodystrophy on the lifestyles of HIV positive patients on highly active antiretroviral therapy (HAART). METHODS: In-depth interviews were conducted with 14 HIV positive patients on HAART at an outpatient sexually transmitted infections (STI) and HIV clinic in central London. Qualitative data from interview transcripts were analysed using grounded theory to elicit key categories and subcategories. RESULTS: Three main themes relating to lipodystrophy emerged: effect on the individual; impact on the social world of the individual; responses of the individual. Lipodystrophy had physical and psychological effects, ranging from bodily discomfort to low self esteem and depression. Owing to its physical manifestations it was viewed as a visible marker of HIV disease. At the level of social functioning, lipodystrophy led to problems with personal and family relationships, although having a partner was protective. Individuals reported narrowing their social world, in some cases to degrees of social isolation. Individual responses included changes in diet, increased exercise regimes, steroid use and plastic surgery (mainly collagen injections to the face). For those who had experienced serious illness related to HIV, there was a more sanguine acceptance of lipodystrophy as an unfortunate consequence of longevity and drug therapy CONCLUSIONS: Health professionals need to address the psychosocial implications of lipodystrophy, including the ways in which it may affect different groups and their adherence to therapy. Formative evaluations are needed to assess the potential for targeted interventions.

Adult↗
PubMed2003

Psychiatric morbidity and substance use in young people aged 13-15 years: results from the Child and Adolescent Survey of Mental Health.

BACKGROUND: Psychoactive substance use is strongly associated with psychiatric morbidity in both adults and adolescents. AIMS: To determine which of alcohol, nicotine and cannabisis mostclosely linked to psychiatric disorders in early adolescence. METHOD: Data from 2624 adolescents aged 13-15 years were drawn from a national mental health survey of children. The relationship between psychiatric morbidity and smoking, drinking and cannabis use was examined by logistic regression analyses. RESULTS: Having a psychiatric disorder was associated with an increased risk of substance use. Greater involvement with any one substance increased the risk of other substance use. Analyses of the interactions between smoking, drinking and cannabis use indicated that the relationship between substance use and psychiatric morbidity was primarily explained by regular smoking and (to a lesser extent) regular cannabis use. CONCLUSIONS: In this sample, links between substance use and psychiatric disorders were primarily accounted for by smoking. The strong relationship is likely to be due to a combination of underlying individual constitutional factors and drug-specific effects resulting from consumption over the period of adolescent development and growth.

Adolescent↗