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Biomedical subjects

E Buxton

Publications and source records attributed to E Buxton.

7 recordsLinked to original sources
PubMed1998

Wound tensile strength and contraction rate are not affected by laparotomy or pneumoperitoneum.

BACKGROUND: Many cellular elements responsible for wound healing are affected by laparotomy. The aim of this study was to evaluate the effects of laparotomy and CO2 pneumoperitoneum on wound healing. METHODS: Male Sprague Dawley rats were randomly assigned to one of three experimental groups. Anesthesia control rats underwent no procedure. Pneumoperitoneum group rats were insufflated with CO2 gas. Laparotomy group rats underwent a 7-cm midline laparotomy incision. The interventions were 30 min long. For the incisional study (n = 30), a 4-cm dorsal full-thickness skin incision was made on each rat and then closed with staples. On postoperative days 7 and 14, an equal number of rats were sacrificed from each group, and wound tensile strength measurements were performed. For the excisional study (n = 45), each group of 15 rats underwent a 2-cm diameter circular dorsal full-thickness skin excision. Blinded measurements of wound area were performed every other day until wounds closed. RESULTS: Wound tensile strength values were not significantly different among experimental groups at either time point. The study had a power of 80% to find a 30% difference at POD 7 and a power of 80% to find a 23% difference at POD 14 to a confidence level of p < 0.05. Wound contraction data from the excisional model were analyzed with the Generalized Estimation Equations statistical approach. When we modeled the treatment group as a covariate, no statistical difference was found between groups, demonstrating equal slopes across time. CONCLUSIONS: From the results of these studies, we conclude that wound healing in this model is not significantly diminished following laparotomy or peritoneal insufflation, as compared to anesthesia control.

Animals↗
PubMed1997

Development of a sedation scoring protocol.

The creation of a research and development post within the Intensive Therapy Unit (ITU) environment at St Helier has provided the opportunity to review all aspects of practice to ensure that the care delivered is evidence-based and not merely rooted in routines and rituals. The first aspect of care to be examined was our sedation practice. It was felt that sedation procedures varied at times and that a research-based protocol was necessary to ensure that patients receive optimal levels of sedation consistently. A 'sedation scoring group' was set up in order to achieve this. Questionnaires were sent to all members of staff and the resulting data used to formulate a sedation scoring system and algorithm as well as a protocol which included information on sedative drugs and the effects of over- and under-sedating patients.

Algorithms↗
PubMed1996

The effects of patient volume and level of care at the hospital of birth on neonatal mortality.

OBJECTIVE: To examine the effects of neonatal intensive care unit (NICU) patient volume and the level of NICU care available at the hospital of birth on neonatal mortality. DESIGN: Birth certificate data linked to infant death certificates and to infant discharge abstracts were used in a logistic regression model to control for differences in each patient's clinical and demographic risks. Hospitals were classified by the level of NICU care available (no NICU: level I; intermediate NICU: level II; expanded intermediate NICU: level II+: tertiary NICU: level III) and by the average patient census in the NICU. SETTING: All nonfederal hospitals in California with maternity services. PATIENTS: All births in nonfederal hospitals in California in 1990 (N=594104), 473209 (singletons only) of which were successfully linked with discharge abstracts. Of these infants, 53229 were classified as likely NICU admissions. MAIN OUTCOME MEASURES: Death within the first 28 days of life, or within the first year of life, if continuously hospitalized. RESULTS: Patient volume and level of NICU care at the hospital of birth both had significant effects on mortality. Compared with hospitals without an NICU, infants born in a hospital with a level III NICU with an average NICU census of at least 15 patients per day had significantly lower risk-adjusted neonatal mortality (odds ratio, 0.62; 95% confidence interval, 0.47-0.82; P=.002). Risk-adjusted neonatal mortality for infants born in smaller level III NICUs, and in level II+ and level II NICUs, regardless of size, was not significantly different from hospitals without an NICU, and was significantly higher than hospitals with large level III NICUS. CONCLUSIONS: Risk-adjusted neonatal mortality was significantly lower for births that occurred in hospitals with large (average census, >15 patients per day) level III NICUs. Despite the differences in outcomes, costs for the birth of infants born at hospitals with large level III NICUs were not more than those for infants born at other hospitals with NICUs. Concentration of high-risk deliveries in urban areas in a smaller number of hospitals that could provide level III NICU care has the potential to decrease neonatal mortality without increasing costs.

California↗
PubMed1996

Trends in pharmacotherapy of Schizoaffective and bipolar affective disorders: a 5-year naturalistic study.

OBJECTIVE: The authors' goal was to determine if the actual treatment of schizoaffective and bipolar affective disorders had changed in light of recent clinical drug trials that have suggested that valproate and carbamazepine may be equivalent in efficacy to lithium. METHOD: Medication utilization rates for each 6-month period from July 1, 1989, to June 30, 1994, were compiled from the clinical database of the Palo Alto Veterans Affairs Medical Center. RESULTS: The use of valproate and valproate plus lithium was negligible in 1989. by 1994, these medication regimens accounted for 25% of the standard antimanic treatments used for bipolar affective disorder and 38% of the treatments used for schizoaffective disorder. Regimens of carbamazepine and carbamazepine plus lithium dropped from 24% of antimanic treatments in 1989 to 18% in 1994. From 1989 to 1994, there was a decline in the rate of lithium monotherapy for treatment of bipolar affective disorder (from 84% to 43%) and schizoaffective disorder (from 100% to 53%). CONCLUSIONS: In the past 5 years, valproate monotherapy has increased as a percentage of total antimanic pharmacotherapies, while lithium monotherapy has declined.

Bipolar Disorder↗
PubMed1977

Variation in the appearance of giant condyloma in an Ungandan series of cases of carcinoma of the penis.

Whole mount sections were made from all amputation specimen of patients treated for carcinoma of the penis in Mulago Hospital, Kampala, Uganda, during a 21-month period in 1968-1970. Among a total of 55 cases four tumors were found which were large, but histologically showed low invasiveness suggestive of absence of metastatic spread. There were two giant condylomas, and two giant condylomas showing possible microinvasion. Two further cases showed a small squamous cell carcinoma together with a giant condyloma in the remainder of tumor. The most chracteristic feature was an orderly, well-circumscribed, expansive downgrowth, leaving little stroma to be seen between the epithelial masses to tumor. Within these limits, however, the spectrum of growth pattern, differentiation, and malignant change was very wide and much more varied than in tumors recorded form Western countries. This should be remembered when a presumptive diagnosis of the condition is to be made on small routine biopsies. Additional changes showing marked similarities to condylomata acuminata were often seen in superficial portions of tumor. This transition in histological picture within one tumor favors the view that giant condyloma is an intermediate lesion in the development of cancer in condylomata acuminata.

Adult↗