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Biomedical subjects

G Phillips

Publications and source records attributed to G Phillips.

At least 37 records · Page 2Linked to original sources
PubMed2000

Not so simple cystitis: how should prescribers be supported to make informed decisions about the increasing prevalence of infections caused by drug-resistant bacteria?

Trimethoprim is a safe, effective, and inexpensive treatment for cystitis. However, at least 25% of bacteria isolated from urine samples in general practice are now resistant to trimethoprim in the laboratory. The relationship between laboratory resistance and clinical outcome is complex. Cephalexin appears to be more active than trimethoprim in the laboratory but has been consistently less effective in clinical trials. There is little point in collecting data about the prevalence of drug resistance in urinary bacteria unless it is linked to evidence about the impact of resistance on clinical outcomes. Pragmatic clinical trials are required to provide practices with clear thresholds for managing their antibiotic policies; for example, 'Change from trimethoprim to drug X when the probability of trimethoprim resistance reaches Y%.' Prescribers should be aware that trimethoprim resistance is most likely to occur in patients who have been exposed to trimethoprim or other antibiotics in the previous six months, and that the risk increases with age. This information could be used to stratify women according to risk of infection by trimethoprim-resistant bacteria. Health education leaflets are an effective method for reducing the frequency of recurrent cystitis. Symptomatic treatment can control symptoms and allow time for microbiological investigation. Both of these strategies may help to reduce unnecessary prescribing of antibiotics in general and quinolones in particular.

Adult↗
PubMed2000

The Breast Health Center at Women & Infants Hospital: origin, philosophy, and features.

The Breast Health Center, a component of the program in Women's Oncology at Women & Infants Hospital, is a multidisciplinary center devoted to the treatment and study of benign and malignant breast diseases. The philosophy, structure, and function of The Breast Health Center are described along with its specific components. The Breast Health Center's three fundamental missions of patient care, education, and research are discussed.

Biopsy↗
PubMed1999

Design, synthesis, and activity of 2,6-diphenoxypyridine-derived factor Xa inhibitors.

A novel series of 2,6-diphenoxypyridines has been designed to inhibit factor Xa, a serine protease strategically located in the coagulation cascade. The evolution from the photochemically unstable bisamidine (Z,Z)-BABCH to potent bisamidine compounds with a pyridine heterocycle as the core scaffold has been achieved. The most potent compound in the series, 6h, has a Ki for human factor Xa of 12 nM. The selectivity of 6h against bovine trypsin and human thrombin was greater than 90- and 1000-fold, respectively. Two proposed modes of binding of 6h to factor Xa are made based on the crystal structures of 6h by itself and of 6h bound to bovine trypsin.

Amidines↗
PubMed1999

Microbiological aspects of clinical waste.

It is a requirement that hospitals and other areas that generate clinical waste must comply with good practice and legislation regarding its disposal. To meet the stringent European emission standards enforced in October 1995, there is a need to find an alternative to local incineration for dealing with clinical waste. The options included technologies such as gasification, steam sterilization or heat disinfection which can be used to process certain categories of clinical waste prior to landfill--all have advantages and disadvantages. Segregation of clinical and domestic wastes in healthcare settings is important to avoid accidents and litigation and to contain costs. Evidence that most clinical waste (other than perhaps waste from patients with certain infections and sharps) is a significant hazard to the public is lacking. More still needs to be done in the area of clinical waste management to assess the real risks and hazards of this waste.

Humans↗
PubMed1999

Patients' psychosocial concerns following stem cell transplantation.

Information regarding the nature, frequency, correlates and temporal trajectory of concerns of stem cell transplantation (SCT) recipients is critical to the development of interventions to enhance quality of life (QOL) in these individuals. This study examined psychosocial concerns in 110 SCT (87% autologous) recipients drawn from two SCT centers. Participants were a mean of 46 years of age and 17 months post-SCT (range 3-62 months). Information regarding current and past SCT-related concerns, performance status, and demographic characteristics was collected by telephone interview or questionnaire. Recipients reported a wide variety of psychosocial concerns following SCT. Recipients who were younger, female and evidenced a poorer performance status reported a larger number of post-SCT concerns. Examination of the temporal trajectory of concerns suggests that some concerns are salient throughout the course of post-SCT recovery (eg disease recurrence, energy level, 'returning to normal'), some are salient early in the course of recovery (eg quality of medical care, overprotectiveness by others), and others emerge later in the course of recovery (eg feeling tense or anxious, sexual life, sleep, relationship with spouse/partner, ability to be affectionate). Implications for the development of interventions to enhance post-SCT QOL are identified.

Adult↗
PubMed1999

Factors associated with trimethoprim-resistant bacteria isolated from urine samples.

Urine samples with trimethoprim-resistant or trimethoprim-sensitive Gram-negative bacteria and samples with no bacterial growth (NG) were identified. Age-sex matched community controls were generated with each trimethoprim-resistant case. These four groups were evaluated for exposure. Prior trimethoprim use was significantly more common in the trimethoprim-resistant group when compared with the trimethoprim-sensitive or the NG group. Prior hospitalization was significantly less common in the trimethoprim-resistant than the trimethoprim-sensitive group, but not with the NG group. Prior oestrogen exposure was associated with trimethoprim resistance. There were no associations found for diabetes or prior corticosteroid exposure. Community controls were found to be inappropriate controls for the study of trimethoprim-resistant bacteria in urine samples.

Anti-Bacterial Agents↗
PubMed1999

Laparoscopic-assisted Doderlein hysterectomy: retrospective analysis of 300 consecutive cases.

OBJECTIVE: To assess the clinical outcomes of the Doderlein laparoscopic-assisted hysterectomy. DESIGN: A retrospective study. SETTING: Women's Endoscopic Laser Foundation at South Cleveland Hospital, Middlesbrough and St James's University Hospital, Leeds. POPULATION: Three hundred consecutive women who had a laparoscopic-assisted Doderlein hysterectomy. METHODS: Patients were identified from the laparoscopic hysterectomy theatre log at both sites. Case notes were requested and examined. MAIN OUTCOME MEASURES: Operative time, uterine weight, associated pelvic pathology, blood loss, hospital stay, intra-operative and post-operative complications. RESULTS: The operations were performed by eight different surgeons, seven of whom were laparoscopic trainees. The mean operating time was 102 minutes (SD 30). Additional surgery including unilateral or bilateral salpingo-oophorectomy, was carried out in 247 patients (82%). The mean uterine weight was 140 g (SD 74). One hundred and thirty-two women (44%) had a normal pelvis at hysterectomy. The mean drop in haemoglobin and haematocrit was 1.46 g (SD 0.95) and 4.4% (SD 2.8), respectively. The overall complication rate was 18%, of which 6.2% were classed as major. The major complications included four cystotomies, five unscheduled laparotomies, seven post-operative blood transfusions, one pulmonary embolus and two re-operations (within six weeks). The mean hospital stay was three days. CONCLUSIONS: Laparoscopic-assisted Doderlein hysterectomy is an alternative to standard laparoscopic hysterectomy techniques. It has the advantage of being easy to learn and is associated with low complication rates, compared with other laparoscopic and traditional techniques for hysterectomy.

Blood Loss, Surgical↗
PubMed1999

Radical surgery for endometriosis.

Infiltrative endometriosis is an uncommon condition that may involve all pelvic organs and is associated with considerable morbidity. A small percentage of patients will have disease that is unresponsive to hormonal therapy and is unsuitable for conservative surgery. Presented is a review of 5 case reports of patients who required radical surgery for control of symptoms caused by endometriosis. Radical surgery was associated with minimal morbidity and a high rate of resolution of symptoms. Radical surgery should be considered as part of the treatment strategy particularly when there is evidence of endometriosis invading into the adjacent gastrointestinal tract or urinary tract.

Adult↗
PubMed1999

The acute-phase protein response to human immunodeficiency virus infection in human subjects.

Although several studies have shown that asymptomatic human immunodeficiency virus infection elicits an increase in whole body protein turnover, it is not known whether this increased protein turnover includes changes in the kinetics of acute-phase proteins (APPs). To answer this question, we measured 1) the plasma concentrations of four positive (C-reactive protein, alpha1-antitrypsin, haptoglobin, and fibrinogen) and four negative APPs [albumin, high-density lipoprotein (HDL)-apolipoprotein (apo) A1, transthyretin, and retinol-binding protein] and 2) the fractional (FSR) and absolute (ASRs) synthesis rates of three positive and three negative APPs using a constant intravenous infusion of [2H5]phenylalanine in five subjects with symptom-free acquired immunodeficiency syndrome (AIDS) and five noninfected control subjects. Compared with the values of the controls, the plasma concentrations, FSRs, and ASRs of most positive APPs were higher in the AIDS group. The negative APPs had faster FSRs in the AIDS group, there was no difference between the ASRs of the two groups, and only HDL-apoA1 had a lower plasma concentration. These results suggest that symptom-free AIDS elicits an APP response that is different from bacterial infections, as the higher concentrations and faster rates of synthesis of the positive APPs are not accompanied by lower concentrations and slower rates of synthesis of most of the negative APPs.

Acute-Phase Proteins↗
PubMed1999

Intravascular sonography in the assessment of traumatic injury of the thoracic aorta.

OBJECTIVE: The objective of this study is to describe the use of intravascular sonography in the evaluation of suspected injury of the thoracic aorta as an adjunctive tool to digital subtraction arteriography (DSA). SUBJECTS AND METHODS: Images of the thoracic aorta were obtained using DSA and intravascular sonography in 20 consecutive patients who underwent arteriography after chest trauma. A 6-French, 12.5-MHz sonography catheter was used for the intravascular sonography study. Diagnoses based on the review of both studies were compared. RESULTS: Five of 20 patients had aortic or great vessel injuries confirmed by surgery. Intravascular sonographic findings were positive (one false-positive) in seven patients, whereas DSA findings were positive in six patients (one false-positive and one false-negative). Surgery showed the lesion that was false-positive using both techniques to be a ductus diverticulum. Intravascular sonographic findings included intimal flaps, intramural lesions (hematomas), pseudoaneurysms, and perivascular hematomas. CONCLUSION: In our initial limited experience, intravascular sonography of the thoracic aorta and great vessels effectively identified traumatic injuries. Intramural injury without pseudoaneurysm formation or obvious intraluminal flap was visualized by intravascular sonography in one patient but was not detected by DSA. On the other hand, a ductus diverticulum was erroneously interpreted as trauma using both techniques. Intravascular sonography is a relatively new procedure with an obvious learning curve in the interpretation of the findings. An atypical ductus diverticulum may still be mistakenly interpreted as a sign of traumatic injury of the aorta. Familiarity with intravascular sonography in the setting of aortic trauma is necessary for correct interpretation of the images. The sonographic findings offer views of the aorta that are complementary to those of aortography.

Adult↗
PubMed1999

The silent voice of reason.

In the arena of environmental health science, we need more data, and we must better interpret the information we have already. Perhaps our greatest deficit, however, lies in the need to communicate more effectively with the public on matters of environmental health science. At the heart of better environmental health, we believe, is a critical need for scientists to become more active in communicating environmental risks.

Communication↗
PubMed1999

Clinical record keeping in patients receiving antibiotics in hospital.

BACKGROUND: Antibiotic prescribing is associated with the growth of antibiotic resistance in micro-organisms. Prescribing therefore needs to be restricted by well-designed antibiotic protocols. Audit of such protocols is only possible if clinical information about infection is properly recorded. OBJECTIVE: To assess the quality of clinical data recording in case notes of patients receiving antibiotics in hospital and to assess the effect of feedback of this information on clinical practice. DESIGN: Four point prevalence surveys. SETTING: Directorate of General Medicine, Dundee Teaching Hospitals NHS Trust. SUBJECTS: Inpatients receiving antibiotics. INTERVENTION: Feedback of results from the first two surveys to clinicians. MAIN OUTCOME MEASURES: Proportion of patients in the Medical Directorate with the recording of an antibiotic indication and the temperature in the case notes before, immediately after, and three months after, feedback of survey results. RESULTS: In each survey one third of patients were receiving antibiotics. The antibiotic indication was recorded in 64% of patients prior to feedback and in 86.5% after feedback (p = 0.004). Three months later this had fallen to 74%. Temperature recording improved between 2nd and 3rd surveys (57% to 86.1%, p < 0.001) and declined to 61% in the 4th survey (p < 0.001). Respiratory infection was the commonest recorded indication for an antibiotic; recording of this indication improved between the 2nd and 3rd surveys but declined by the 4th survey. CONCLUSIONS: Audit and feedback of information about clinical record keeping improves standards but improvements are not sustained. Clinical record keeping must be improved so compliance with antibiotic protocols can be properly audited. An "antibiotic sticker" in addition to immediate concurrent feedback may improve such deficiencies.

Anti-Bacterial Agents↗
PubMed1998

Risk of hysterectomy after 1000 consecutive endometrial laser ablations.

OBJECTIVES: To determine the hysterectomy rate after endometrial laser ablation, allowing for variable follow up times, and to evaluate the factors that might predict outcome. DESIGN: Observational cohort study. SETTING: Specialist minimal access gynaecology unit in a district general hospital. METHODS: Data were obtained from case notes, theatre records, and follow up postal questionnaires. The risk of hysterectomy following endometrial laser ablation was assessed using survival curve estimates. Proportional hazards regression analysis was used to identify the predictor(s) of this outcome. RESULTS: A single endometrial laser ablation was carried out on 746 patients (85.4%); 124 patients (14.2%) underwent one repeat procedure and three (0.4%) underwent two repeat ablative procedures. The cumulative rate of return of the postal questionnaires was 87.3% (762/873 patients). Survival curve analysis showed that the overall hysterectomy rate projected over a follow up period of 6.5 years was 21% (95% CI 16%-27%). The age of the patient at endometrial ablation, uterine cavity length, operative time, volume of fluid absorbed, the presence or absence of dysmenorrhoea, premenstrual syndrome and the method of endometrial preparation prior to surgery did not contribute significantly to the regression model. Having a repeat endometrial ablation procedure increased the risk of having a subsequent hysterectomy (RR = 2.93; 95% CI 1.59-5.40; P = 0.0015), whereas the presence of intrauterine pathology (eg, polyps, fibroids and uterine shape abnormalities) decreased the risk of this outcome (RR = 0.26; 95% CI 0.08-0.86; P = 0.0082) after adjustment for confounding due to patient's age and dysmenorrhoea prior to surgery. CONCLUSIONS: Endometrial laser ablation is a safe and effective treatment for menstrual dysfunction. Repeat ablative procedures significantly increased, and the presence of intrauterine pathology decreased, the risk of subsequent hysterectomy.

Adult↗
PubMed1998

Primary ciliary dyskinesia: diagnosis and standards of care.

Primary ciliary dyskinesia (PCD) is characterized by disease of the upper and lower respiratory tract, in association with visceral mirror image arrangement in 50% of cases, due to abnormal structure and/or function of cilia. The purpose of this paper is to review the clinical features, diagnosis and management of PCD. Presentations include neonatal respiratory distress, recurrent lower respiratory tract infection, chronic rhinosinusitis and male infertility. PCD enters the differential diagnosis of bronchiectasis, atypical asthma, and unusually severe upper airway disease. Diagnosis is by a cascade of investigations, starting with the saccharin test in patients older than 10 yrs; ciliary beat frequency and pattern on light microscopy; and electron microscopy to assess ciliary morphology and orientation. It is important not to confuse primary and secondary ciliary abnormalities. Nasal nitric oxide is low in PCD, and this measurement shows promise as a screening test for PCD. Diagnosis is important, in order to prevent the development of bronchiectasis and to avoid any unnecessary otorhinolaryngological procedures. Regular follow-up is essential, and management should be multidisciplinary, with input from centres with a special interest in PCD, having access to paediatric and adult chest physicians, otolaryngologists and audiological physicians, physiotherapists, counselling services and fertility clinics. The prognosis is good, but morbidity can be considerable if PCD is incorrectly managed.

Adult↗
PubMed1998

The use of spectrophotometry to estimate melanin density in Caucasians.

The density of cutaneous melanin may be the property of the skin that protects it from damage by solar radiation, but there is not an accepted, noninvasive method of measuring it. To determine whether the density of cutaneous melanin can be estimated from reflectance of visible light by the skin, reflectance of 15-nm wavebands of light by the skin of the inner upper arm of each of 82 volunteers was measured at 20-nm intervals with a Minolta 508 spectrophotometer. A 3-mm skin biopsy was then taken from the same site, and four nonserial sections of it were stained with Masson Fontana for melanin. The melanin content of the basal area was calculated using the NIH Image analysis system. We show that cutaneous melanin in Caucasians can be estimated by the difference between two measurements of reflectance of visible light by the skin: those at wavelengths 400 and 420 nm. This new spectrophotometric measurement was more highly correlated (r = 0.68) with the histological measurements of cutaneous melanin than was skin reflectance of light of wavelength 680 nm (r = 0.33). Reflectances in the range of 650-700 nm have been used previously in skin cancer research. This relatively accurate measurement of melanin is quick and noninvasive and can be readily used in the field. It should provide improved discrimination of individual susceptibility to epidermal tumors in Caucasians and information about melanin's biological role in the causation of skin cancer.

Adult↗