PubMed Health⌕ Search

Biomedical subjects

H Carter

Publications and source records attributed to H Carter.

At least 19 recordsLinked to original sources
PubMed1995

Neutrophil activation in paediatric extracorporeal circuits: effect of circulation and temperature variation.

OBJECTIVE: Upregulation of neutrophil adhesion molecules (CD11b and L-selectin) and release of a modulating cytokine (IL8) have been reported in vivo and in vitro in adult cardiopulmonary bypass. The aim of this study was to determine whether paediatric bypass preparations have similar influences and whether neutrophil-endothelium interactions are required for IL8 release. METHODS: In vitro paediatric cardiopulmonary bypass circuits (n = 15) were constructed (identical to those used clinically), as well as static loops (n = 15) using donor blood. The effects of circulation and temperature (17 degrees C, 25 degrees C, 37 degrees C) on the initiation of acute inflammation were examined. Cellular expressions of neutrophil adhesion molecules CD11b and L-selectin were assayed by immunofluorescence technique, and serum IL8, IL6, TNF-alpha, leucocyte elastase, and terminal complement complex were measured by ELISA. RESULTS: In all experiments, an immediate increase in CD11b expression occurred [median values, in relative fluorescence units: 64.9 (range 45.3-212.9) at rest; 365.2 (205-835.4) at 10 min; P < 0.001], along with a decrease in L-selectin expression [153.5 (115.5-220.7) at rest; 42 (12-134) at 10 min; P < 0.01]. Serum concentrations of the following increased gradually and were higher in circulation than in static loops: IL8 [1500 (500-2500) pg.ml-1 in circuit v 600 (180-1500) pg.ml-1 in loop, P < 0.001]; TNF-alpha P < 0.05]; and terminal complement complex [25.9 (6.8-120) v 4.7 (0-21.6) AU.ml-1, P < 0.01]. Cooling decreased and rewarming increased upregulation of CD11b and downregulation of L-selectin and release of IL8. IL6 was undetectable. CONCLUSIONS: In the absence of endothelium, in vitro paediatric cardiopulmonary bypass causes profound acute inflammatory changes in donor blood with release of IL8. These changes were greater than in adult cardiopulmonary bypass. Temperature variation and circulation modulate the responses.

Adult↗
PubMed1994

Confronting patriarchal attitudes in the fight for professional recognition.

Contemporary nursing practice and education belong to a dynamic process which is likely to change the structure of nursing, as well as the relationships that have been established with other professions. This paper is concerned with the professionalization of nursing and examines how nurses and doctors maintain, or challenge, patriarchal relationships in a clinical context. It also examines the wider social climate which upholds the subordination of women in the caring environment. The implementation of alternative therapies, emphasis on patient education, rehabilitation and individualized care all contribute to a climate in which nurses are able to develop an area that can be deemed as their own. Furthermore, the achievement of research-based practice, and the implementation of primary nursing in many areas, indicate a collective approach to patient care. By linking these developments with a feminist discourse nurses are able to challenge their position within the sexual division of labour and highlight the ambiguous position they occupy.

Attitude of Health Personnel↗
PubMed1993

Measles outbreak in Fife: which MMR policy?

The introduction of measles, mumps and rubella vaccine (MMR) into the United Kingdom childhood immunisation schedule has resulted in a substantial reduction in the incidence of all three diseases. None the less, there have recently been outbreaks of measles in parts of the country which have a record of high MMR uptake among young children. In these outbreaks it is mainly older children who have been affected. This report documents such an outbreak in Fife, an area with a very high MMR uptake among two-year-old children (96%). The current policy of giving MMR vaccine only once to children at 15 months of age may not be sufficient to enable the United Kingdom to achieve the WHO target of measles elimination by the year 2000. Other possible strategies to achieve this objective are discussed.

Adolescent↗
PubMed1993

Car occupant restraint use in Fife: an observational study.

Today road traffic accidents pose a major public health problem with a significant number of deaths and injuries among drivers and passengers of all ages. As part of road safety strategy in Fife the Health Board and Regional Council have carried out an observational study of 7,885 occupants in 4,292 cars to determine the extent of appropriate restraint use in the region. Overall restraint use for urban and non-urban sites was found to be 80%. In car drivers restraint use was 94%. Passengers in all rear seat positions were observed to have a significantly lower level of restraint use, 33% overall compared with 92% overall in the front (chi 2 2,827.9, P << 0.001), with usage of restraint declining with increasing age. Particular problems noted were: the much lower use of restraint among children travelling to and from school, the use of restraint inappropriate to children's age, and the significantly lower level of restraint among taxi drivers and their passengers compared with other cars (chi 2 114.9, P << 0.001). These findings have implications for the promotion of restraint use for all car occupants.

Accidents, Traffic↗
PubMed1993

Automated percutaneous lumbar discectomy versus chemonucleolysis in the treatment of sciatica. A randomized multicenter trial.

A randomized clinical trial was conducted to compare the results of automated percutaneous discectomy with those of chemonucleolysis in 141 patients with sciatica caused by a disk herniation; 69 underwent automated percutaneous discectomy and 72 were subjected to chemonucleolysis. The principle outcome was the overall assessment of the patient 6 months after treatment. Treatment was considered to be successful by 61% of the patients in the chemonucleolysis group compared with 44% in the automated percutaneous discectomy group. At 1-year follow-up, overall success rates were 66% in the chemonucleolysis group and 37% in the automated percutaneous group. Within 6 months of treatment, 7% of the patients in the chemonucleolysis group and 33% in the discectomy group underwent subsequent open surgery. The complication rates of both treatment groups were low, with the exception of a high rate of low-back pain in the chemonucleolysis group (42%). The results of this trial confirm previous controlled studies on chemonucleolysis and suggest that controlled studies should be carried out before automated percutaneous discectomy can be considered a useful intervention.

Adult↗
PubMed1993

Rational use of measles, mumps and rubella (MMR) vaccine.

Measles, mumps, rubella (MMR) vaccine is a live vaccine preparation containing attenuated strains of all 3 viruses. MMR vaccine is widely used throughout the world, with the US having the widest experience with the vaccine. In countries where the vaccine has been introduced successfully, significant reductions in all 3 diseases for which it is protective have occurred. The vaccine has been shown to be highly immunogenic, with seroconversion rates of 95 to 100% being achieved for each of the 3 component vaccines. This immunity appears to be long-lasting and may even be lifelong. Minor adverse effects may occur approximately 1 week after immunisation. Rarely, mumps vaccine-induced meningitis (milder than that associated with wild mumps virus) may occur, its frequency varying with the strain of attenuated mumps virus contained in any particular vaccine. Clinically, the vaccine is indicated for infants aged between 12 and 15 months, and should be administered by intramuscular or deep subcutaneous injection. A few specific contraindications exist, including a genuine hypersensitivity to eggs, and to the aminoglycoside antibiotics kanamycin and neomycin. An increasing number of countries are now adopting a 2-stage MMR policy in an attempt to prevent epidemics among those who remain unprotected, and to move towards eventual disease eradication.

Drug Combinations↗
PubMed1992

The dependent elderly: a comparative survey of institutional care in Fife.

Dependency levels were assessed in 441 elderly people in long term geriatric hospital care, 488 living in private nursing homes and 637 in the local authority residential homes in Fife. Results indicated that the most dependent were in hospital care, the most able in residential homes with private nursing homes accommodating elderly people with intermediate dependency levels. While each care setting cares for severely dependent elderly people, up to 29% of those in residential homes, 24% of those in nursing homes and 6% of hospital residents were considered by care staff to be fully independent. The implications of this in relation to the future provision and pattern of long term care for the frail elderly in Fife are considerable.

Activities of Daily Living↗
PubMed1992

Urinary incontinence: a survey of knowledge, working practice and training needs of nursing staff in Fife.

Urinary incontinence results in substantial morbidity within society and presents a serious public health problem. Improvements in the well being of incontinence sufferers can be achieved by appropriately trained nursing staff. As part of the development of a strategy to tackle the problem of incontinence in Fife, a survey of nursing staff working in the Board's three health care units was carried out. Response rates between 64% and 100% were achieved among the different units. The results of the survey have revealed a number of deficiencies in current nursing practice, with a substantial proportion of nursing staff indicating a desire for more training in aspects of the management of incontinence. Health visitors in particular reported a significant lack of training in the area of childhood enuresis.

Education, Nursing↗
PubMed1992

Survey of the implementation of workplace alcohol and smoking policies among employers in Fife.

A survey of major employers in Fife shows that at present 33% of respondents have implemented written alcohol policies, while 40% have implemented written smoking policies. A total of 19% have both alcohol and smoking policies in place. The initiative for policy development appears to have arisen mainly from management, but trade unions and management have co-operated well during policy formulation. The majority of policies have been implemented for more than three years. A small number of companies in Fife appear to be interested in the development and implementation of written alcohol and smoking policies in the workplace.

Alcohol Drinking↗