PubMed Health⌕ Search

Biomedical subjects

D Cochrane

Publications and source records attributed to D Cochrane.

At least 19 recordsLinked to original sources
PubMed2006

A dental workforce review for a Midlands Strategic Health Authority.

OBJECTIVE: To explore opportunities for workforce development in NHS general dental services (GDS) in Shropshire and Staffordshire. METHOD: Secondary data sources were supplemented with a primary survey of GDS practices to build up a profile of the existing GDS workforce and its current capacity. Attitudes and perceptions on current workforce issues and potential solutions were gathered using a second survey and explored further through other qualitative techniques including interviews and a focus group discussion. RESULTS: The results confirm that there is a shortage of dentists in the area, fuelled by multiple factors including the move from NHS to private work, the decision to retire early and a growing disillusionment with NHS policies and remuneration. Modelling of alternate approaches to future dental clinical needs highlighted the opportunity for meeting the consequent workforce demands through increased involvement of hygienists and therapists. CONCLUSIONS: This study has provided local evidence to inform dental service development in Shropshire and Staffordshire. It has provided a starting point for exploring new ways of working and will contribute towards a more effective implementation of new and evolving service strategies.

Attitude of Health Personnel↗
PubMed2005

Emergency department visits for concern regarding anthrax--New Jersey, 2001.

INTRODUCTION: In October of 2001, after letters processed in Trenton, New Jersey, resulted in multiple cases of anthrax, emergency departments (EDs) in New Jersey experienced an increase in visits from patients concerned about possible exposure to agents of biologic terrorism. Information about the effect of an actual biologic terrorism attack on the emergency department population might be useful in the design of biosurveillance systems, particularly with regard to their performance during the mitigation phase that occurs after an attack. In addition, such information might help identify issues that arise regarding the public health response in the ED setting. OBJECTIVES: The objectives of this report were to identify and characterize ED visits, by patients concerned with exposure to biologic terrorism agents, in selected New Jersey hospitals after the anthrax attack in fall 2001. METHODS: A retrospective cohort design was used in this study. The setting was 15 New Jersey EDs within a 55-mile radius of Trenton. Participants were consecutive patients evaluated by ED physicians for the following four periods in 2001: 1 month before September 11; 1 month after September 11; 1 month after October 11; and for the second month after October 11. Percentages of visits were calculated with a concern for exposure (CE) visits by using International Classification of Diseases, Ninth Revision (ICD-9) descriptors: Feared Complaint-No Diagnosis (ICD-9 code v65.6) and Screening for Infectious Disease (ICD-9 code v75.9) for all hospitals and for Trenton versus non-Trenton hospitals as a percentage of ED visits. Charts were reviewed by using a structured data form. RESULTS: A total of 225,403 ED visits occurred during the 4 months, of which 698 were CE visits. The percentages of CE visits for the four periods were 0.06%, 0.06%, 0.92%, and 0.10%, respectively. For the peak third period, the percentage was increased for the two Trenton hospitals, 1.81%, versus 0.82% for the 13 non-Trenton hospitals. This report is a summary of the 508 visits associated with concern for anthrax exposure during the peak third period: 47% reported exposure to powder, 13% were postal workers, 4% received chest radiographs, 65% had a nasal swab for anthrax, 13% had ED decontamination, and 32% received antibiotics. CONCLUSION: An increase in CE visits occurred during the 1-month period after October 11, 2001. During the peak month, a higher increase occurred in Trenton EDs. Considering the substantial variation in diagnostic evaluation and treatment, readily available guidelines are needed.

Anthrax↗
PubMed2000

Identification of natural ligands for SH2 domains from a phage display cDNA library.

The cytoplasmic domain of the Fc gamma receptor IIB (FcgammaRIIB) can be successfully displayed on the surface of filamentous phage, and after phosphorylation in vitro, can interact specifically with the SH2 domains of SHP-2, a cytoplasmic tyrosine phosphatase. When full-length FcgammaRIIB is expressed on phage, however, this interaction is greatly compromised, illustrating that characteristics of the full-length sequence are not well tolerated by the phage display system. Many associations in cell physiology are driven by similar interactions involving small modular binding domains or ligands, and so a fragmented cDNA library will facilitate display of such domains free of sequences which compromise their expression. A fragmented leukocyte cDNA display library of 10(8) clones was constructed. This library was phosphorylated in vitro with fyn kinase and was selected against the tandem SH2 domains of SHP-2 in the search for additional ligands. A depletion strategy to remove non-specific clones was employed, using SHP-2 Sepharose, prior to in vitro phosphorylation and selection. This permitted the emergence of clones encoding the cytoplasmic domain of PECAM-1, another natural ligand for SHP-2. The importance of dual phosphorylation of tyrosine residues at positions 663 and 686 was confirmed in competition ELISA experiments using phosphorylated phage and synthetic peptides. Thus, phage display of fragmented cDNA libraries permits the identification and characterisation of phosphorylated ligands of modular binding domains based on their functional interaction.

Amino Acid Sequence↗
PubMed2000

The initial treatment of hydrocephalus: an assessment of surgeons' preference between third ventriculostomy and shunt insertion.

Third ventriculostomy is an option for patients who have traditionally received a ventriculoperitoneal shunt. This study has been conducted to determine: 1. How common is third ventriculostomy as the initial treatment of hydrocephalus? 2. Does the frequency of third ventriculostomy vary among surgeons? 3. What factors influence surgeons' decision to choose third ventriculostomy? Surgeons completed a questionnaire addressing patient selection and technique factors. Nine case scenarios were reviewed by surgeons who were then asked to choose a ventriculoperitoneal shunt or a third ventriculostomy as the initial treatment. Forty-three responses were received. The proportion of new patients treated with third ventriculostomy varied widely (0%-100%, median 13%). This was not related to years in practice, type of training or presence of residents/fellows. Factors that increased the chance of a third ventriculostomy were triventricular hydrocephalus on CT/MR, isolated aqueduct stenosis, thin ballooned floor and tectal tumor. Factors that decreased the chance of a third ventriculostomy were dilated subarachnoid spaces, meningitis and head injury. The presence of myelomeningocele or age < 1 year were less likely to influence the choice of operation. Variation in the rate of third ventriculostomy as the first treatment for hydrocephalus is large. It is unlikely that this degree of variation can be explained by differences in patient populations. Further work to refine and disseminate the indications for third ventriculostomy is warranted.

Cerebrospinal Fluid Shunts↗
PubMed2000

Pediatric peri-insular hemispherotomy.

A number of surgical procedures are available for patients with epilepsy associated with diffuse hemispheric disorders. In this report, 16 pediatric patients had hemispherectomy: 5 underwent hemidecortication and 11 had peri-insular hemispherotomy. The clinical records were retrospectively reviewed, and the results and complications of the procedures were documented. The procedure was feasible in very young children and in the absence of ventriculomegaly.

Adolescent↗
PubMed2000

Long-term follow-up data from the Shunt Design Trial.

BACKGROUND: A previously reported multicenter randomized trial assessed whether 2 new shunt valve designs would reduce shunt failure rates compared to differential pressure valves. The study did not show a significant difference in the time to first shunt failure. Patients entered the trial between October 1, 1993, and October 31, 1995. The primary results were based on the patients' status as of October 31, 1996 (a minimum follow-up of 1 year). This report describes the late complications based on the patients' most recent follow-up. METHODS: Three hundred and forty-four hydrocephalic children at 12 North American and European centers were randomized to 1 of 3 valves: a standard differential pressure valve; a Delta valve (PS Medical-Medtronic) or a Sigma valve (NMT Cordis). Patients were followed until their first shunt failure. Shunt failure was defined as shunt surgery for obstruction, overdrainage, loculation or infection. If the shunt did not fail, follow-up was continued until August 31, 1999. RESULTS: One hundred and seventy-seven patients had shunt failure. Shunt obstruction occurred in 131, overdrainage in 13, loculated ventricles in 2 and infection in 29. The overall shunt survival was 62% at 1 year, 52% at 2 years, 46% at 3 years, 41% at 4 years. The survival curves for the 3 valves were similar to those from the original trial and did not show a survival advantage for any particular valve. CONCLUSIONS: Prolonged follow-up to date does not alter the primary conclusions of the trial: there does not appear to be one valve that is clearly the best for the initial treatment of pediatric hydrocephalus.

Adolescent↗
PubMed1999

Haemodynamic effects of rapacuronium in adults with coronary artery or valvular disease.

We have assessed the haemodynamic effects of rapacuronium (Org 9487) in adults undergoing cardiac surgery and compared these with vecuronium and placebo. We studied 56 adult patients undergoing coronary artery bypass grafting or valve replacement surgery using a fentanyl-based anaesthetic technique. A pulmonary artery flotation catheter was inserted before induction of anaesthesia. After induction, tracheal intubation and stabilization of haemodynamic measurements, subjects were allocated randomly to receive rapacuronium 1.5 mg kg-1 vecuronium 0.1 mg kg-1 or saline placebo. Haemodynamic measurements were made before drug administration and 1, 3, 5 and 10, and if possible, 15 min after administration. Rapacuronium was associated with statistically significant increases in heart rate (17%) and cardiac index (15%) and decreases in mean arterial pressure (11%) and systemic vascular resistance (18%), whereas vecuronium and placebo were associated with significant decreases in heart rate only (14-15%) (P < 0.05). No cutaneous signs of histamine release were observed. Clinically, the results were within acceptable limits. Our results suggest that administration of rapacuronium may be associated with significant changes in heart rate and arterial pressure in patients undergoing coronary artery bypass grafting.

Adult↗
PubMed1999

Covert tamponade.

Explore the source record for details and available documents.

Aortic Valve↗
PubMed1997

Effect of hyperventilation on regional cerebral blood flow in head-injured children.

OBJECTIVES: To study cerebral blood flow and cerebral oxygen consumption in severe head-injured children and also to assess the effect of hyperventilation on regional cerebral blood flow. DESIGN: Prospective cohort study. SETTING: Pediatric intensive care unit at a tertiary-level university children's hospital. PATIENTS: Twenty-three children with isolated severe brain injury, whose admission Glasgow Coma Scores were <8. INTERVENTIONS: PaCO2 was adjusted by altering minute ventilation. Cerebral metabolic measurements were made at three levels of PaCO2 (>35, 25 to 35, and <25 torr [>4.7, 3.3 to 4.7, and <3.3 kPa]) after allowing 15 mins for equilibrium. MEASUREMENTS AND MAIN RESULTS: Thirty-eight studies (each study consisting of three sets of measurements at different levels of PaCO2) were performed on 23 patients. At each level of PaCO2, the following measurements were made: xenon-enhanced computed tomography scans; cerebral blood flow; intracranial pressure; jugular venous bulb oxygen saturation; mean arterial pressure; and arterial oxygen saturation. Derived variables included: cerebral oxygen consumption; cerebral perfusion pressure; and oxygen extraction ratio. Cerebral blood flow decreased below normal after head injury (mean 49.6 +/- 14.6 mL/min/100 g). Cerebral oxygen consumption decreased out of proportion to the decrease in cerebral blood flow; cerebral oxygen consumption was only a third of the normal range (mean 1.02 +/- 0.59 mL/min/100 g). Neither cerebral blood flow nor cerebral oxygen consumption showed any relationship to time after injury, Glasgow Coma Score at the time of presentation, or intracranial pressure. The frequency of one or more regions of ischemia (defined as cerebral blood flow of <18 mL/min/100 g) was 28.9% during normocapnia. This value increased to 73.1% for PaCO2 at <25 torr. CONCLUSIONS: Severe head injury in children produced a modest decrease in cerebral blood flow but a much larger decrease in cerebral oxygen consumption. Absolute hyperemia was uncommon at any time, but measured cerebral blood flow rates were still above the metabolic requirements of most children. The clear relationship between the frequency of cerebral ischemia and hypocarbia, combined with the rarity of hyperemia, suggests that hyperventilation should be used with caution and monitored carefully in children with severe head injuries.

Adolescent↗
PubMed1996

Pneumococcal pericarditis--out of sight, out of mind?

Pneumococcal pericarditis has been an uncommon condition in recent years. This report describes the case of a 57-year-old woman with sarcoidosis who presented with cardiac tamponade due to pneumococcal pericarditis. She responded to pericardiocentesis and intravenous antibiotic therapy. At 4-month review, she remains well.

Anti-Bacterial Agents↗
PubMed1995

Model for the cost analysis of shunted hydrocephalic children.

This paper describes a model for forecasting the treatment costs for hydrocephalic patients with ventriculoperitoneal shunts. Modeling with institution-specific or reported failure rates allows the prediction of shunt failure in real and/or theoretical populations. The addition of costing factors (derived from hospitalization, operative and drug costs) to the model allows the derivation of partial or total cost estimates. The effects of varying the failure rate, infection rate, number of new patients, number of lost patients and costing factors can be simulated and measured. Basing this model on data from our institution, decreasing the rate of failure during the first year following shunt insertion or revision has the potential for greater cost savings over time than either decreasing the shunt infection rates or the duration of hospital stay. By combining shunt performance and financial data, an estimate of the cost of the treatment of a population with hydrocephalus, over time, can be derived. These data can be critical for institutional and program budgeting and serve as an estimate of the economic effects of treatment changes proposed in clinical trials.

Child↗
PubMed1994

Direct access exercise electrocardiography: a new service that improves the management of suspected ischaemic heart disease in the community.

OBJECTIVE: To assess the safety and value of an exercise electrocardiography service for the diagnosis of suspected ischaemic heart disease to which general practitioners have direct access. DESIGN: Direct access to a hospital exercise electrocardiography service was offered on a trial basis to 122 general practitioners in a defined urban area. Maximal exercise tests were performed according to the modified Bruce protocol and the results were dispatched promptly to the referring doctors who were responsible for the subsequent management of their patients. SETTING: All general practices in north and west Belfast (combined list size about 180,000) and the regional medical cardiology centre. PATIENTS: 212 request forms were received in a two year period and 192 eligible patients attended for exercise testing. All patients were suspected to have pain due to myocardial ischaemia, were aged < or = 65, and had no contraindications to exercise testing. MAIN OUTCOME MEASURES: Proportion of general practitioners who used the service. Proportion of exercise tests that were positive. Referring doctors' assessment of the service. RESULTS: 43% of general practitioners referred patients and 34 tests (18%) were positive. No complications occurred. The pretest likelihood of ischaemic heart disease, assessed by the referring doctor, was high in 48 (25%), moderate in 82 (43%), and low in 62 (32%). A high pretest likelihood of ischaemic heart disease predicted a positive test result with a sensitivity of 50% and specificity of 80%. General practitioners decided to refer 19 (10%) patients to a hospital cardiology department for further assessment, including 16 of the 34 who had a positive exercise test. In most cases the service was found to be helpful and 97% of patients would have been referred directly to a hospital cardiology clinic if it had not been available. CONCLUSIONS: Direct access exercise electrocardiography for patients with suspected ischaemic heart disease is safe, feasible, and helpful to general practitioners. This service seems to reduce the number of patients referred to cardiology outpatient clinics and to facilitate the management of these patients in the community.

Cardiology Service, Hospital↗
PubMed1992

Continuous intrathecal baclofen treatment of severe spasms in two children with spinal-cord injury.

This study reports the use of intrathecal baclofen in two ventilator-dependent children with severe spasms secondary to spinal-cord injury. Baclofen was delivered via a subcutaneously implanted, programmable pump. The children were followed for 12 and 24 months. Baclofen dramatically reduced spasms, resulting in more stable ventilation, improved ease of care, reduced distress and better integration into the community. Although effective, intrathecal baclofen represents a significant intervention; careful consideration must be given to potential complications and the need for long-term management. Full effectiveness was dependent on free CSF flow.

Adolescent↗
PubMed1991

The effects of labor and delivery on spinal cord function and ambulation in patients with meningomyelocele.

Two hundred and eight patients with meningomyeloceles were reviewed to assess the role of birth trauma in the pathogenesis of their neurological deficit. Vaginal breech-delivered patients appeared to have poorer neurological function in the newborn period. The factors responsible include: (1) a mid or upper lumbar level, that by sparing hip flexors and knee extensors, predisposes to breech presentation; (2) limb posturing due to residual neurological function and intrauterine positioning that limits the accurate neurological assessment of the newborn; (3) nervous system or soft tissue injury due to labor and delivery. Regardless of the mechanism, vaginal breech-delivered patients showed improvement in function, and eventually exhibited ambulatory function comparable to those infants born by cesarian section or vaginally after vertex presentation and labor. In our patient population, elective cesarian section did not offer a spinal cord or ambulatory advantage over vaginal delivery for those pregnancies presenting in a vertex fashion. Thus, it should be reserved for fetuses who are presenting breech or who have other obstetrical indications for operative delivery.

Birth Injuries↗
PubMed1990

How big can we grow?

Explore the source record for details and available documents.

Attitude of Health Personnel↗