PubMed Health⌕ Search

Biomedical subjects

D B Freedman

Publications and source records attributed to D B Freedman.

14 recordsLinked to original sources
PubMed1996

Evidence based practice: clinicians' use and attitudes to near patient testing in hospitals.

AIM: To survey the use made of laboratory services for urgent tests and clinicians' attitudes to near patient testing. METHODS: A questionnaire was sent to clinicians working in acute hospitals within Trent and North West Thames Regions. RESULTS: 197 replies were received. Most demand came from intensive care units. Overall, clinicians requested a median of six urgent tests a day. Blood glucose and dip stick urine testing were the most commonly performed bedside tests, but 41% of clinicians did not use ward testing. The most frequently cited indication for bedside testing was the need for speed. 85% of clinicians trusted results obtained in their central hospital laboratory, but there was an almost equal division between those who did (34%) and those who did not (38%) trust the results from near patient testing. A slightly larger proportion indicated they would accept responsibility (44%) for results obtained on the ward than would not (35%). Most staff indicated that better transport to the laboratory would remove the need for near patient testing. CONCLUSIONS: Clinicians have demonstrated an apparent need for rapid response testing but there is a strong preference for rapid transport systems and central laboratory analysis rather than bedside testing as a solution to this problem. There is a need to investigate the clinical and cost-effectiveness of near patient testing as a solution to rapid response testing.

Attitude of Health Personnel↗
PubMed1989

Low-normal concentrations of free thyroxin in serum in late pregnancy: physiological fact, not technical artefact.

Free thyroxin (FT4) concentrations, total thyroxin/thyroxin-binding globulin (T4/TBG) ratios, and thyrotropin (TSH) and albumin concentrations were measured in serum in a longitudinal study in each of the three trimesters of 25 normal pregnancies. In late pregnancy, FT4 estimates by assays reputedly either affected or unaffected by albumin were in the lower half of the reference range for nonpregnant subjects. T4/TBG ratios and albumin concentrations were similarly lower. FT4 overall was significantly (P less than 0.001) correlated with these latter two values. Serum TSH concentrations increased as FT4 declined in late pregnancy. Nonesterified fatty acid (NEFA) concentrations were too low to displace T4 from its binding proteins and were not correlated with other measurements. Within any one of the trimesters, FT4 and T4/TBG were independent of variations in TBG or albumin concentrations. This implies that lower FT4 concentrations in late pregnancy are real, merely coinciding with parallel decreases in albumin. They are not artefacts of albumin-affected assays.

Adult↗
PubMed1984

Exocrine pancreatic function in diabetes mellitus.

An investigation of serum immunoreactive trypsin concentration and pancreatic isoamylase activity in patients with diabetes mellitus has shown that exocrine pancreatic deficit is maximal in insulin dependent diabetics, intermediate in those controlled with sulphonylureas, and absent in patients controlled with biguanides or diet or both. A significant correlation between the serum concentrations of both these pancreatic enzymes and C peptide was found. Serum pancreatic enzyme concentrations were not related to glycosylated haemoglobin concentrations, the dosage of insulin, or the age of onset of diabetes. The concentration of immunoreactive trypsin was found to be low in most of the insulin dependent diabetics in whom this enzyme was measured at the time of the clinical onset of diabetes. Thus exocrine pancreatic deficit in diabetes closely parallels the endocrine beta cell deficit and occurs concurrently with, or antedates, the clinical presentation of type I diabetes. It is therefore possible that in type I diabetes similar mechanisms are entailed in the pathogenesis of impaired endocrine and exocrine pancreatic function.

Biguanides↗
PubMed1984

Persistence of parathyroid hypersecretion after vitamin D treatment in Asian vegetarians.

An investigation into plasma calcium concentrations and the biochemical factors which regulate it in vegetarian Asian subjects without clinical or radiological features of osteomalacia revealed the presence of low serum 25-hydroxyvitamin D concentrations and elevated PTH concentrations, even in the presence of calcium levels in the normal range (up to 2.35 mmol/liter). These elevated PTH concentrations, though not as high as those in osteomalacic patients with hypocalcemia, often persisted despite treatment with vitamin D, normalization of 25-hydroxyvitamin D, and an increase in calcium concentrations. In one patient the PTH concentration remained high even when the plasma calcium concentration became supranormal. Therefore, secondary hyperparathyroidism is commonly associated with vegetarianism, and may play an important role in maintaining calcium concentrations within the normal range. Persistent elevation of PTH despite normalization of 25-hydroxyvitamin D also points to autonomous PTH hypersecretion, which may result in osteolysis in the long term, and raises the question of the need for vitamin D supplementation in vegetarians with low dietary intake of vitamin D.

25-Hydroxyvitamin D 2↗
PubMed1984

Contrast-medium-induced acute renal failure and Tamm-Horsfall proteinuria.

An acute obstructive nephropathy due to precipitation of urinary glycoprotein-contrast complexes in the renal tubules has been postulated to explain the episodes of renal failure occasionally seen following intravascular contrast medium administration. In an in vitro study we were unable to produce any precipitation of contrast-glycoprotein complexes over a wide range of concentrations, temperatures and pH values in urine with any urographic contrast agent, conventional or new. Meglumine ioglycamide (Biligram: Schering) alone, the strongly protein-binding agent, exhibited the phenomenon, and only in high concentration. It is concluded that such a mechanism is unlikely to play a role in contrast medium nephrotoxicity, which therefore remains unexplained.

Acute Kidney Injury↗
PubMed1983

Low pancreatic lipase in insulin-dependent diabetics.

Serum samples obtained from 20 insulin-dependent diabetics (IDD), 23 non-insulin-dependent diabetics (NIDD) and 30 controls were assayed for their pancreatic lipase activity, immunoreactive trypsin concentration and glycosylated haemoglobin (HbA1) respectively. The distribution of serum pancreatic lipase activity in normal subjects and diabetics was nonparametric. The median serum lipase activity in IDDs (86 U/l) was significantly lower that that in controls (131 U/l, p less than 0.002) and NIDDs (126 U/l, p less than 0.001). There was a significant correlation between serum pancreatic lipase activity and serum IRT concentration (r = 0.65, p less than 0.001). Neither pancreatic lipase activity nor IRT was related to HbA1 concentrations. These data show for the first time that serum pancreatic lipase activity is diminished in IDDs.

Diabetes Mellitus↗
PubMed1982

Hypoparathyroidism and hypocalcaemia during treatment for acute leukaemia.

Nine patients with acute leukaemia developed a complex syndrome of hypocalcaemia and hypomagnesaemia during treatment. These metabolic abnormalities developed rapidly in some patients and gave rise to acute symptoms. Immunoreactive parathormone concentrations in these patients were found to be either absolutely or inappropriately low. Hypomagnesaemia and the action of chemotherapeutic agents, especially adriamycin or cytarabine, or both may have contributed to the pathogenesis of this syndrome.

Adolescent↗
PubMed1982

Glycosylated haemoglobin in rheumatoid arthritis.

Shortened red cell survival has a role in the anaemia of rheumatoid arthritis (RA), but direct measurement of it is difficult. Glycosylated haemoglobin (HbA1) provides an index of red cell life span in normoglycaemic patients, because glycosylation depends on both the concentration of blood glucose and the duration of erythrocyte survival. HbA1 was significantly lower in 30 patients with RA (5.6 +/- 0.7%, mean +/- SD) than in 15 healthy controls (7.3 +/- 0.7%) and 14 patients with osteoarthritis (7.4 +/- 0.7%, p less than 0.001). HbA1 was depressed less in active RA than during remission, which is consistent with diminished red cell production in active RA. These data on HbA1 confirm that shortened red cell survival is common in RA, and point to diminished red cell production in active disease. Determination of HbA1 should prove to be of clinical value in the assessment of normoglycaemic patients with RA but is an inadequate index of glucose homoeostasis in diabetics with RA.

Adolescent↗