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Biomedical subjects

H Bateman

Publications and source records attributed to H Bateman.

15 recordsLinked to original sources
PubMed2003

Equid herpesvirus (EHV-1) live vaccine strain C147: efficacy against respiratory diseases following EHV types 1 and 4 challenges.

The temperature sensitive and host range mutant clone 147 of equine herpesvirus 1 (EHV-1) was assessed for its ability to protect conventional, susceptible adult horses against respiratory infection by EHV-1 and equine herpesvirus 4 (EHV-4). Intranasal (IN) vaccination with 5.2 log(10) TCID(50) did not cause adverse clinical reactions although a limited virus shedding and viraemia (leukocytes) was observed in 11 of 15 and 10 of 15 vaccinated horses respectively. All 15 vaccinated horses showed a significant seroresponse to both EHV-1 and EHV-4 for virus neutralising (VN) antibody. None of 14 control horses shed virus or became viraemic or seroconverted prior to challenge. EHV-1 challenge (dose 6.0 log(10)) 6 weeks after vaccination resulted in pyrexia in all eight control horses while eight vaccinated horses remained unaffected. Six control horses developed nasal discharge, five of which were mucopurulent nasal discharge (mean duration 3.2 days) which also occurred in four vaccinated horses for 1 day. All eight control horses shed challenge EHV-1 at a significantly higher level (group mean titre 2.6+/-0.4 log(10) TCID(50) per sample) and for much longer (mean duration 4.8+/-1.5 days) than that (group mean titre 1.4+/-0.8 log(10) TCID(50) per sample and mean duration 1.5+/-0.5 days) in six vaccinated horses. Furthermore, all eight control horses became viraemic (mean duration 2.9 days) but viraemia did not occur in eight vaccinated horses. Following EHV-1 challenge, all eight control horses showed a significant VN antibody rise to both EHV-1 and EHV-4 but this occurred in only one vaccinated horse and to EHV-4 only. In EHV-4 challenge (dose of 4.2 log(10) TCID(50)) of a separate pair of seven vaccinated and six control horses, 6 weeks after EHV-1 vaccination resulted in pyrexia (mean duration 2.3 days) and nasal discharge (mean duration 1.8 days) in three and five control horses respectively but the only reaction observed in the vaccinated group was nasal discharge for 1 day in one animal. All six control animals shed virus (mean titre 2.5+/-0.6 log(10) TCID(50) per sample and mean duration 2+/-0.6 days) compared to one vaccinated animal. Although EHV-4 viraemia is rare, 3 of 6 control horses became viraemic after EHV-4 challenge but this was not observed in vaccinated horses. After EHV-4 challenge 3 and 5 of 6 control horses seroconverted for VN antibody to EHV-1 and EHV-4 respectively; a non-responsive control horse had high level of pre-existing VN antibody to EHV-4. However, only 1 of 7 vaccinated horses showed a significant antibody rise and only to EHV-4.

Administration, Intranasal↗
PubMed2003

Derivation and characterisation of a live equid herpes virus-1 (EHV-1) vaccine to protect against abortion and respiratory disease due to EHV-1.

A German abortion isolate of EHV-1 (strain M8) was grown in equine dermal (ED) cells at a low multiplicity of infection in presence of 5-bromo-2-deoxy uridine. The resulting stock was dialysed, titrated and cloned by terminal dilution in ED cells grown in 96-well microtitration plates. Of 192 clones each originating from a single focus, clone 147 (C147) was found to be restricted for growth at and above temperatures of 38.5 degrees C. It was also restricted for growth at 37 degrees C in rabbit kidney (RK-13) cells which are widely used for the isolation and titration of EHV-1; hence clone 147 was EHV-4-like. Clone 147 showed a remarkable efficacy as a vaccine in protecting conventional pregnant Welsh Mountain pony mares against abortions due to EHV-1. A single intranasal (IN) vaccination protected five out of six (83.3%), and four out of five (80%) of mares upon challenge 4 and 5-6 months, respectively, after the immunisation, whereas all six unvaccinated mares aborted between 9 and 19 days after IN EHV-1 challenge. With the exception of the day 9 abortion, foetuses of the remaining five mares were EHV-1 infected. Placenta from the early aborting mare was, however, EHV-1 positive. Both groups of vaccinated mares were also significantly protected against clinical reaction (notably pyrexia), nasal shedding and viraemia following challenge infection.

Abortion, Veterinary↗
PubMed2002

Doctors telling stories: the place of anecdote in GP registrar training.

Observational studies within a hospital setting confirm the widespread use of anecdotes in hospital-based medical education and hypothesize a number of reasons for this. Whilst anecdotes may be used effectively in teaching there can be dangers in their inappropriate use. There is no information on the level and nature of the use of anecdotes within medical education in the community. The authors undertook a questionnaire study that asked GP trainers about how they used anecdote in their GP registrar teaching. The results suggested that GP trainers use anecdotes frequently in their registrar teaching, recognize the use of anecdotes described in the literature and have little concern that anecdotes might mislead. The authors discuss how anecdotes may be used to help build registrars' illness scripts, and to develop ways of thinking and working congruent with the existing professional community.

Anecdotes as Topic↗
PubMed2002

Ethical considerations for services offering one-to-one guidance for primary care practitioners interested in research.

Initiatives which offer support to primary care practitioners interested in research have become widespread in the UK. There has been little debate, however, about the ethical issues involved in such interactions with practitioners. Established codes of practice and analyses of the institutional and strategic contexts have been used to inform this discussion. The paper concludes with a recommendation that more explicit quasi-contractual relationships should be negotiated between those offering and those seeking help.

Biomedical Research↗
PubMed2001

Journeys and pathways: exploring the role of professional development advice and educational guidance for practitioners expressing interest in research.

BACKGROUND: Recent policy reports highlight the need to increase the number of primary care practitioners with academic experience, research skills and higher level qualifications. Various courses, training schemes and awards are available but it is not clear what advice and support might best assist practitioners to access and successfully pursue such opportunities. AIM: To understand and document the professional development support needs of primary care practitioners who wish to develop their own paths forward in research. METHOD: A research adviser based in the Unit of General Practice, University of Cambridge invited enquiries on any aspect of research activity from practitioners. Summaries of contacts, enquiries and other relevant issues were prepared on a monthly basis. Through the process of offering help and through reflexive engagement with the summaries we sought to understand and document practitioner support needs. FINDINGS: Many enquiries from practitioners concerned professional development. Practitioners requested help before embarking on a new course of action and during the course of their progress along a chosen track. The advice required went beyond the provision of information about the opportunities which existed and often evolved into a mentoring relationship. The impact of the advice offered can be viewed in terms of contribution to the journey of the individual practitioner and contribution to nationally recognized strategic aims. CONCLUSION: The need for professional development advice and educational guidance for those interested in research may be more widespread than appreciated. If this need is to be successfully addressed we should consider the skills and expertise required of advisers and the specific outcomes to be anticipated from their roles.

Education, Medical, Continuing↗
PubMed2000

Update on Lyme Carditis.

Lyme carditis is an uncommon manifestation of infection with Borrelia bugdorferi. It is easily treated with standard antibiotic regimens and prognosis is excellent, especially if treatment is prompt. For symptomatic or higher degrees of block, patients may require hospitalization for monitoring and occasionally temporary external pacing. Intravenous antibiotics are warranted for such patients. For less severe conduction disturbances, oral therapy suffices.

Journal Article↗
PubMed2000

Treating individuals according to evidence: why do primary care practitioners do what they do?

Research evidence does not necessarily translate into changed management for individual patients, but that may not mean that the evidence has been ignored. Drawing on accounts from general practitioners, we use a study of non-rheumatic atrial fibrillation (NRAF) to illuminate the processes by which practitioners became aware of and assimilated research evidence. We follow that with an account of how the evidence was incorporated into practice protocols for anticoagulation and then applied to a review of individual patients' records. Practitioners used a range of sources of evidence. They reported difficulties arising from their own skills and circumstances and from the perceived quality of the evidence. Creating a protocol involved overcoming problems of scheduling, resources and managing judgements about the value of the review process. In applying the protocol practitioners drew on their knowledge of the patients' preferences, circumstances and previous specialist consultations. As a result, practitioners made judgements that evidence, combined with prior experience, did not support the initiation of anticoagulation in 52% of an unselected primary care population with NRAF. Our findings have implications for evidence-based practice and for practitioner education.

Anticoagulants↗
PubMed2000

Grounding policy development within an educational setting: an exploration.

OBJECTIVE: To explore an approach for informing the development of regional policy by eliciting the considered views of GP participants at an educational event. In particular we discuss the reaction of GP participants to this approach. (In this instance our GP participants were trainers and the evolving policy under discussion was that of 'clinical governance'.) METHOD: An educational event was planned to facilitate discussion and the recording of the considered views of GP trainer participants. The acceptability of this approach to the participants was evaluated via observation and through feedback forms. RESULTS: While observation suggested that the participants were involved in many lively and constructive discussions, the feedback generated showed that many participants felt uncomfortable about the use of an educational event to inform development. DISCUSSION: We recognize the need to inform and facilitate change through the involvement of those who will be participants in the change process. The rapid timescales imposed by change and the 'burden' of additional research involvement on practitioners are issues. Approaches based on action research and participatory research principles may have potential and can throw light on the difficulties we experienced. CONCLUSION: We need to identify approaches which will allow us to ground development within the views of those to be affected by change. Our own attempt demonstrated difficulties. We would welcome further debate over methods and approaches applicable in this border territory between research, development and education.

Clinical Competence↗
PubMed2000

Increased cervical dysplasia in intravenous cyclophosphamide-treated patients with SLE: a preliminary study.

To determine if intravenous cyclophosphamide (IV-C) causes an excess of cervical dysplasia and/or cancer in systemic lupus erythematosus (SLE) patients, a retrospective review was conducted. Patients with SLE who received IV-C between 1988-98 (study group) were compared with a group of SLE patients who had not received IV-C (control group). Of the 79 IV-C-treated SLE patients identified, we excluded 18 because of absence of pertinent data. We found 10 cases of cervical dysplasia in the remaining 61 patients, compared to 2 in 49 non-exposed patients (P<0.04). Comparison of the two groups revealed no difference in: mean years of disease duration, months of follow-up and age. The non-exposed patients were more likely to be on estrogen and hydroxychloroquine but less often on steroids and azathioprine. The study group with and without dysplasia were assessed; we found no difference in the mean, or total IV-C dose, smoking and estrogen use. There was a significant decrease in time to dysplasia in those, given IV-C, with previous dysplasia compared to those without. These preliminary data suggests that IV-C causes an increased number of abnormal Papanicolaou (Pap) smears in SLE patients, particularly those with previous dysplasia.

Adult↗
PubMed1999

It takes two to fight: a test of relational factors and a method for assessing aggressive dyads.

Observations of aggressive interactions in boys' laboratory play groups were used to evaluate the relative importance of relational and individual factors in accounting for aggressive acts. A classroom peer-rating method for identifying mutually aggressive dyads was validated in 11 5-session play groups, composed of 2 mutually aggressive boys and 4 randomly selected male classmates from 11 predominately African American 3rd-grade classrooms. When the social relations model was used, relationship effects accounted for equally as much of the variance in total aggression and proactive aggression as either actor or target effects. Mutually aggressive dyads displayed twice as much total aggression as randomly selected dyads. Members of mutually aggressive dyads attributed greater hostile intentions toward each other than did randomly selected dyads, which may serve to explain their greater aggression toward each other. The importance of studying relational factors, including social histories and social-cognitive processes, is discussed.

Aggression↗
PubMed1999

Applying research evidence to individuals in primary care: a study using non-rheumatic atrial fibrillation.

BACKGROUND: There is strong research evidence that anticoagulation of patients with nonrheumatic atrial fibrillation reduces the morbidity and mortality of stroke. This evidence is incompletely applied. OBJECTIVES: We aimed to report consequences associated with the intention to apply evidence about anticoagulation for non-rheumatic atrial fibrillation (NRAF) to individuals in general medical practice. METHODS: The study involved prospective structured reporting of the processes of applying evidence about NRAF to individual patients in six general practices in Cambridge. The subjects were patients identified to have NRAF in these practices. The intervention consisted of a practice-based review of evidence and the construction of a practice-owned protocol. This was followed by a review of individual patients' records according to protocol criteria. The main outcomes were indentification of the characteristics of the patients, quantitation of GPs' intention to change treatment, explicit reporting of the reasons for not anticoagulating individuals and time to achieve the practice protocol. RESULTS: The data collected confirmed that patients excluded from the authoritative randomized controlled trials predominate among patients cared for in general medical practice. Practitioners overestimated the prevalence of NRAF in their patients and underestimated the extent to which their current practice offered intervention. Practitioners initially overestimated the amount of change required in patient management. In reviewing their patients' records with the intention of following evidence-based practice, practitioners explicitly described and regarded as appropriate their reasons for not prescribing anticoagulation to certain individuals. The review process was time-consuming and will need to be repeated as further evidence emerges.

Aged↗
PubMed1999

Lupus anticoagulant-hypoprothrombinemia syndrome associated with systemic lupus erythematosus: report of 2 cases and review of literature.

We describe two patients whose initial presentation of systemic lupus erythematosus (SLE) was accompanied by haemorrhagic episodes and significant coagulopathy. Further investigation demonstrated positive lupus anticoagulant and decreased Factor II (prothrombin) activity. Both patients were diagnosed with lupus anticoagulant-hypoprothrombinemia syndrome (LAC-HPS) as a result of non-neutralizing antibodies directed against Factor II. LAC-HPS is a rare clinical entity that can occur in association with SLE, transient viral infections, drug reactions or even in healthy individuals. Mixing studies, which can be affected by other coagulation factor inhibitors, play an important role in the diagnosis of LAC-HPS. Factor VII level was decreased in the second patient, a finding that has not previously been reported in association with SLE. In both patients, bleeding stopped promptly and coagulation studies improved significantly with high dose corticosteroids. We discuss the pathogenesis, diagnosis and management of LAC-HPS in patients with SLE.

Adult↗
PubMed1998

Social-cognitive and behavioral correlates of aggression and victimization in boys' play groups.

A contrived play group procedure was utilized to examine the behavioral and social-cognitive correlates of reactive aggression, proactive aggression, and victimization via peers. Eleven play groups, each of which consisted of six familiar African-American 8-year-old boys, met for 45-min sessions on five consecutive days. Social-cognitive interviews were conducted following the second and fourth sessions. Play group interactions were videotaped and examined by trained observers. High rates of proactive aggression were associated with positive outcome expectancies for aggression/assertion, frequent displays of assertive social behavior, and low rates of submissive behavior. Reactive aggression was associated with hostile attributional tendencies and frequent victimization by peers. Victimization was associated with submissive behavior, hostile attributional bias, reactive aggression, and negative outcome expectations for aggression/assertion. These results demonstrate that there is a theoretically coherent and empirically distinct set of correlates associated with each of the examined aggression subtypes, and with victimization by peers.

Black or African American↗