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Biomedical subjects

D Richmond

Publications and source records attributed to D Richmond.

At least 19 recordsLinked to original sources
PubMed2004

National audit of incontinence surgery in the United Kingdom.

The aim of the study was to describe the experience, current trends and management of incontinence surgery for urodynamic stress incontinence (USI) in the United Kingdom. The study was a postal questionnaire survey that was sent to a cohort of surgeons known to be performing continence surgery. The subjects addressed included the considered role of the surgeon, the total number and type of operations performed in the last year, urodynamics and physiotherapy prior to incontinence surgery, operative complications, postoperative advice and follow-up (lengths and methods). The response rate was 54%. Large variations were found in all areas. The survey provides evidence of the number of incontinence operations performed, potentially important trends and differences in the practice and management of incontinence in the United Kingdom. This survey may be helpful in making guidelines and standards for audit at regional, local and individual levels as well as recommendations for strategies to enhance professional expertise in urogynaecology in the United Kingdom.

Consensus↗
PubMed2004

Tension-free vaginal tape (TVT) in the United Kingdom.

Four hundred and twenty-six surgeons identified as performing TVT in the United Kingdom in the year ended 1 January 2002 were sent a postal questionnaire to identify the technique employed and the complications encountered. An 81% response rate was achieved. Over 7000 TVT operations were reported. Large numbers of surgeons perform a small number of operations each year. A variety of different surgical techniques and anaesthetics are used. Bladder perforations have been reported by 44% and de novo bladder overactivity by 37% of surgeons. Tape erosion is seen in 0.33%. Twenty-eight per cent of surgeons have seen voiding abnormalities that persist for more than 6 weeks. Fifty-seven per cent of surgeons perform short-term follow-up only. The operation is performed in a variety of different ways, by surgeons with variable experience and volumes of work. The different surgical techniques have not been evaluated prospectively and complications are seen more commonly than originally reported.

Anesthesia↗
PubMed1999

Applying HEDIS clinical measures to community health centers: a feasibility study.

Since participation in managed care is critical for community health centers' (CHCs) survival, centers must demonstrate their good performance to purchasers (e.g., state Medicaid agencies) and health plans. Such measures also can contribute to quality improvement. Ideally, the effort would use measures and methods widely recognized in the managed care industry, logically the Health Plan Employer Data and Information Set (HEDIS). This article summarizes a feasibility study of applying HEDIS clinical measures to CHCs as providers. It finds that, with concerted, well-directed efforts, it will be possible to use clinical HEDIS measures in health centers.

Community Health Centers↗
PubMed1999

Protein ProQ influences osmotic activation of compatible solute transporter ProP in Escherichia coli K-12.

ProP is an osmoregulatory compatible solute transporter in Escherichia coli K-12. Mutation proQ220::Tn5 decreased the rate constant for and the extent of ProP activation by an osmotic upshift but did not alter proP transcription or the ProP protein level. Allele proQ220::Tn5 was isolated, and the proQ sequence was determined. Locus proQ is upstream from prc (tsp) at 41.2 centisomes on the genetic map. The proQ220::Tn5 and prc phenotypes were different, however. Gene proQ is predicted to encode a 232-amino-acid, basic, hydrophilic protein (molecular mass, 25,876 Da; calculated isoelectric point, 9.66; 32% D, E, R, or K; 54.5% polar amino acids). The insertion of PCR-amplified proQ into vector pBAD24 produced a plasmid containing the wild-type proQ open reading frame, the expression of which yielded a soluble protein with an apparent molecular mass of 30 kDa. Antibodies raised against the overexpressed ProQ protein detected cross-reactive material in proQ+ bacteria but not in proQ220::Tn5 bacteria. ProQ may be a structural element that influences the osmotic activation of ProP at a posttranslational level.

Amino Acid Sequence↗
PubMed1998

Effect of HIV counseling and testing on sexually transmitted diseases and condom use in an urban adolescent population.

OBJECTIVE: To determine whether human immunodeficiency virus (HIV) counseling and testing has an effect on reducing subsequent risk behaviors in those tested, to evaluate stability in condom use over time, and to determine whether self-reported frequency of condom use relates to the incidence of sexually transmitted diseases (STDs). DESIGN: Cohort study with 2-year follow-up. SETTING: An urban adolescent-medicine clinic. PARTICIPANTS: A random sample of 149 patients (118 female and 31 male adolescents) with a mean (+/- SD) age of 16.4 +/- 1.51 years were selected from a cohort of 500 patients at high risk for HIV infection. The patients had received a risk behavior questionnaire during pretest counseling for HIV testing. They were divided into 3 groups, identified by the letter F, S, or R, based on their self-report of frequency of condom use at enrollment: 24% used condoms frequently/always (F); 40%, sometimes (S); and 36%, rarely/never (R). One hundred twenty-six patients (85%) made return visits. INTERVENTION: HIV counseling and testing. MAIN OUTCOME MEASURES: Medical record documentation of STDs before and after HIV testing, and self-reported condom use frequency. RESULTS: Before HIV testing, all 3 condom use groups had a similar frequency of STD visits per month. The number of STD visits per month did not decrease significantly in the posttest period for either the total group or each of the 3 subgroups. Also, most patients (F, 67%; S, 44%; R, 53%) in each of the 3 subgroups had shifted unfavorably to rarely/never (R) condom use within the month before their follow-up visit. Only 24% (8 patients) of those in the initial frequently/always (F) group reported continued frequent condom use. CONCLUSIONS: As has been found in adult studies, single-dose interventions such as HIV counseling and testing did not seem to reduce HIV risk behaviors in our sample of high-risk adolescent patients. None of the 3 groups showed a significant decrease in STDs after HIV testing and counseling. Also, our adolescent patients reported widely varying condom use frequency over time, yet the incidence of STDs did not correlate with self-reported condom use.

AIDS Serodiagnosis↗
PubMed1997

Are adolescents accurate in self-report of frequencies of sexually transmitted diseases and pregnancies?

PURPOSE: Many surveys of adolescent behavior are dependent on self-reported data. We sought to assess the accuracy of adolescent self-report of sexually transmitted diseases (STDs) and pregnancies. METHODS: We randomly selected 149 (118 females, 31 males) adolescents to participate in this accuracy study. Follow-up questionnaires were administered to the 126 patients (99 females, 27 males) who returned after enrollment. Patients were asked about STDs and pregnancies during the follow-up period which ranged from 6 months to 1 year. All patient charts were reviewed to validate post-testing history. RESULTS: Return visits were made by 126 patients (84%). Fifty-one (40%) denied having had an STD at all during the follow-up period but were found to have had at least one STD. Another 11 (9%) admitted having had an STD but had multiple STDs in excess of what they reported. Only 46% of the patients provided accurate information on the follow-up questionnaire. Of the 99 girls who returned for follow-up, the inaccurate patients (10%) consisted of 9 who reported no visits for a pregnancy but had a pregnancy documented in their charts and 1 who underreported her number of pregnancies. Reliability analysis of the accuracy of STD and pregnancy self-report for our patients showed kappas ranging from 0.185 to 0.413 (slight and fair to moderate, respectively). Pearson correlation coefficients were 0.3107 and 0.4364 for STD and pregnancy, respectively. CONCLUSIONS: Our patients' histories of visits for STDs and pregnancies are often not substantiated by review of their medical records. The reason for the inaccuracies in self-report of sexual behaviors is unclear. Further research in this area should be done. Physicians must confirm patient history concerning sexual practices through appropriate record review and medical evaluation.

Adolescent↗
PubMed1995

Tonsillectomy and adenoidectomy in patients with Down syndrome.

Tonsillectomy and adenoidectomy in patients with Down syndrome usually relieves symptoms of upper airway obstruction due to adenotonsillar hypertrophy. A retrospective review of 16 patients with Down syndrome who underwent a tonsillectomy and adenoidectomy was conducted to define early postoperative morbidity, and to evaluate the results of the procedure. Fifteen of 16 patients had upper airway obstruction manifest by adenotonsillar hypertrophy. One had adenoid hypertrophy only. Tonsillectomy and adenoidectomy (13), adenoidectomy (1), tonsillectomy (1), and UP3/adenoidectomy (1) were performed on these patients. Four patients (25%) required observation in an intensive care setting the first night. An average hospital stay of 2.1 days was noted with a range of 0 to 7 days. Significant postoperative apnea was common, and oxygen was used in over 60% of patients. Symptoms were resolved in 69% of patients at last follow up. In conclusion, tonsillectomy and adenoidectomy can be a useful procedure for children with Down syndrome and obstructive sleep apnea, however overnight hospitalization for observation and treatment of persistent apnea is appropriate.

Adenoidectomy↗
PubMed1995

Is sexual abuse in childhood or adolescence a predisposing factor for HIV infection during adolescence?

This exploratory study was conducted to determine whether sexual abuse might be a risk factor or marker for other risk factors for Human Immunodeficiency Virus (HIV) infection. Twenty-five HIV-positive adolescents were assessed for a variety of possible risk factors for HIV infection, including prior history of sexual abuse. Fifteen (60%) had a history of sexual abuse. A history of sexual abuse may be a risk factor for HIV infection directly, or it may be associated with or predispose one to other risk factors. The latter mechanism may be related to the long-term negative outcomes of some individuals with a history of sexual abuse. These may include same-sex sexual experiences as an adolescent, re-victimization with additional episodes of abuse, multiple consensual sexual partners, and drug and/or alcohol abuse. Preventive interventions aimed at reducing the risk of HIV infection must take a history of sexual abuse into account. Patients with such a history deserve intensive psychological counseling to help prevent adverse behavioral outcomes that can result in HIV infection.

Adolescent↗
PubMed1992

How does rHuEPO effect D/P creatinine ratios?

Initially starting CAPD patients on EPO was concerning after hearing reports of hemodialysis patients stating that they "may need more dialysis". The rationale given was that with a higher hematocrit the percentage of plasma in whole blood would decrease, leading to an increase of red cell mass. This decreased plasma volume and increased viscosity would lead to a slower blood flow ultimately resulting in less efficient dialysis. Assessing CAPD patients' peritoneal efficiency was the next step. We obtained pre and post-EPO PETs and evaluated. The initial results showed that D/P creatinine ratios were dropping as our Hcts increased, and ultrafiltration results projected an improvement. What remained unanswered was what took place over extended periods of time on EPO therapy. We examined twelve patients over a period of 27 months. Each patient received 4 exchanges per day using 1500 to 2500 volume. PET tests were performed on each patient prestudy, and at months three, six, and 25-27. Initially each patient received EPO 4000 units, 3/week, SQ. EPO easily increased and maintained our patients' hematocrits within 12 weeks after starting the study. D/P creatinine ratios initially dropped but as our study continued there was a return of D/P creatinine ratios to 6% greater than baseline. One report suggests that EPO may have a direct vasoconstricting effects on blood vessels caused by the stimulation of calcium toward the cell. Vasoconstriction of the vessels would lead to a decrease in exchangeable surface area resulting in a decreased D/P creatinine ratio.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Illness, injuries, and deaths from pesticide exposures in California 1949-1988.

Data on human acute illness/injury and death associated with pesticide exposure in California for the 40-yr period, beginning with 1949, were reviewed. Even though California has better data of this type than most government jurisdictions in the world, there are some shortcomings. In the early part of this period, nonoccupational data were scant because poison information centers were just being developed. Also in the early period, many occupational exposures were not recorded in state statistics although a good system to allow for such reporting was in place. California data currently available still do not take into account (i) persons who are exposed and become ill, but do not visit a physician or call a poison center, and (ii) most occupational exposures of the self-employed, U.S. military employees, U.S. government employees, maritime workers, and interstate railroad workers. In 1987, 268,092,595 kg of pesticides were sold and estimated as used in the state. Although the amount of pesticides used annually in California is estimated to have increased 4-fold in this 40-yr period, it is believed that the actual number of pesticide-related occupational illnesses/yr increased very little. Cholinesterase inhibitors and methyl bromide were most often involved in the more serious occupational systemic poisonings throughout the time period. Well-educated and trained farmers and other pesticide handlers as well as a strict regulatory system have contributed to keeping the number and the extent of pesticide exposure in check, considering the widespread use of pesticides, some of which are quite toxic and potentially hazardous if misused. In 1987, there were 1,507 cases of occupational illness identified, with 744 of these demonstrating systemic toxic symptoms. In 1987, approximately 17,000 human pesticide exposure incidents, almost all of which were nonoccupational, were handled by poison control centers. It is estimated that about 30 to 60% developed signs or symptoms. Occupational deaths for the past 10 yr have averaged about 1/yr. Suicides by use of pesticides are estimated at 15/yr, and nonsuicides, nonoccupational deaths are estimated at 5/yr. This paper does not address chronic effects such as cancer induction, developmental effects, or reproductive effects that may be suspected as being the result of pesticide exposure. Data presented in this report may be useful in estimating the number of poisonings that may occur in other geographic settings. Numerous variables that must be considered in making such estimates are discussed.

Agricultural Workers' Diseases↗
PubMed1988

Trophoblastic differentiation in a malignant mixed mesodermal tumor of the ovary.

Trophoblastic differentiation in an extragonadal carcinoma is a rare and unusual phenomenon which has been observed in the carcinomas of stomach, bronchus, esophagus, ovary, liver, urinary bladder, endometrium, and, rarely, in the sarcomas. To our knowledge, this phenomenon has not been observed previously in a mixed mesodermal sarcoma (MMS), and the present communication is to record such a case of MMS of ovary with this phenomenon.

Aged↗
PubMed1987

Management of pregnancy in mothers with spina bifida.

Pregnancy complicated because of maternal spina bifida remains uncommon. With more aggressive surgical management in the 1960s these patients are now in adulthood and achieving pregnancies. In this series all four patients were delivered by caesarean section. As most patients have undergone extensive urological surgery great care is required at operation to avoid trauma to the urinary tract.

Adult↗
PubMed1986

Analysis of the pattern of urine loss in women with incontinence as measured by weighing perineal pads.

Three hundred and thirty-five women with urinary incontinence underwent a pad-weighing test for quantifying urine loss. Each one wore a series of pre-weighed sanitary towels for a total of 1 h. The pads were weighed again after use. The test results gave information about the severity of the incontinence which was not easy to obtain either from patient interview or from clinical examination. The type of activity was the main factor determining urine loss, although patients with detrusor instability lost more on average than the others. Voiding during the test period did not appear to influence the overall test results. Reproducibility of the test has been studied in 50 patients.

Adult↗