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Biomedical subjects

I Jacobs

Publications and source records attributed to I Jacobs.

At least 19 recordsLinked to original sources
PubMed2005

International Resuscitation Network Registry: design, rationale and preliminary results.

There is a lack of high-quality information about the effectiveness of resuscitation interventions and international differences in structure, process and outcome after out-of-hospital cardiac arrest and cardiopulmonary resuscitation because data are not collected uniformly. An internet-based international registry could make such evaluations possible, and enable the conduct of large randomized controlled trials of resuscitation therapies. A prospective international cohort study was performed that included 571 infants, children and adults (a) who experienced cardiac arrest requiring chest compressions or external defibrillation, (b) outside the hospital in the study communities and (c) upon whom resuscitation was attempted by EMS personnel. Cardiac arrest was defined as lack of responsiveness, breathing or movement in individuals for whom the EMS system is activated for whom an arrest record is completed. All data were collated via a secure and confidential web-based method by using automated forms processing software with appropriate variable range checks, logic checks and skip rules. Median number of missing responses for each variable was 0 (interquartile range 0, 0). Twenty-seven percent of the patients had a first recorded rhythm of ventricular fibrillation or ventricular tachycardia, 60% had a witnessed arrest, and 34% received bystander CPR. Mean time from call to arrival on scene was 7.1+/-5.1 min. Six percent of the patients survived to hospital discharge. The resuscitation process was highly variable across centers, and survival and neurological outcome were also significantly and independently different across centers. This study shows that it is possible to collect data prospectively describing the structure, process and outcome associated with cardiac arrest in multiple international sites via the internet. Therefore, it is feasible to conduct adequately powered randomized trials of resuscitation therapies in international settings.

Adolescent↗
PubMed2005

Age related trends in the incidence of endometrial cancer in South East England 1962-1997.

Important population demographic changes have occurred over the last 50 years in the UK. Birth rates have fallen, obesity rates have increased and there has been an increase in the use of reproductive hormones, factors which may influence the epidemiology of endometrial cancer. We analysed the age-related trends in the incidence of endometrial cancer in South East England between 1962 and 1997 to determine if there was a correlation with the population demographic changes over this time period. We undertook a retrospective review of systematically collected data, looking specifically at the change in overall incidence of endometrial cancer and the age-related incidence for each five year group from 25 to 85 + years. The overall incidence of endometrial cancer remained unchanged over the 35-year study period. In women aged 35-54 years there was a decrease in incidence of endometrial cancer and this was significant in the 40-45 year age group. The study also revealed a statistically significant increase in incidence of endometrial cancer in women aged over 65 years with a greater rate of increase in older women, particularly those aged over 85. Thus, there is evidence from this study of significant changes in the age-related incidence of endometrial cancer in the 35-year study period that may be explained by alterations in life style and behaviour. The increased incidence in women aged 85 and over have potential implications for the planning and provision of cancer services in the future.

Adult↗
PubMed2003

Management of women who test positive for high-risk types of human papillomavirus: the HART study.

BACKGROUND: Certain types of human papillomavirus (HPV) are the primary cause of almost all cervical cancers. HPV testing of cervical smears is more sensitive but less specific than cytology for detecting high-grade cervical intraepithelial neoplasia (CIN2+). HPV testing as a primary screening approach requires efficient management of HPV-positive women with negative or borderline cytology. We aimed to compare the detection rate and positive predictive values of HPV assay with cytology and to determine the best management strategy for HPV-positive women. METHODS: We did a multicentre screening study of 11085 women aged 30-60 years. Women with borderline cytology and women positive for high-risk HPV with negative cytology were randomised to immediate colposcopy or to surveillance by repeat HPV testing, cytology, and colposcopy at 12 months. FINDINGS: HPV testing was more sensitive than borderline or worse cytology (97.1% vs 76.6%, p=0.002) but less specific (93.3% vs 95.8%, p<0.0001) for detecting CIN2+. Of 825 randomised women, surveillance at 12 months was as effective as immediate colposcopy. In women positive for HPV at baseline, who had surveillance, 73 (45%) of 164 women with negative cytology and eight (35%) of 23 women with borderline cytology were HPV negative at 6-12 months. No CIN2+ was found in these women, nor in women with an initial negative HPV test with borderline (n=211) or mild (32) cytology. INTERPRETATION: HPV testing could be used for primary screening in women older than 30 years, with cytology used to triage HPV-positive women. HPV-positive women with normal or borderline cytology (about 6% of screened women) could be managed by repeat testing after 12 months. This approach could potentially improve detection rates of CIN2+ without increasing the colposcopy referral rate.

Adult↗
PubMed2003

Current research and treatment for epithelial ovarian cancer. A Position Paper from the Helene Harris Memorial Trust.

In March 2003, an international mulltidisciplinary group of scientists and clinicians with a specific interest in ovarian cancer met for 4 days to discuss research into and treatment of this challenging disease. Under the headings of molecular genetics, molecular biology, the biology of ovarian cancer, old therapies, new targets and the early detection of the disease, this Position Paper summarises the presentations and discussion from the 9th Biennial Helene Harris Memorial Trust Forum on Ovarian Cancer. In particular, we highlight the potential of international collaborations in translating laboratory science into useful clinical interventions.

Antineoplastic Agents↗
PubMed2003

Efficacy of cardiopulmonary resuscitation performed in a dental chair.

BACKGROUND: Within the dental setting, historically there has been some concern as to whether cardiopulmonary resuscitation (CPR) can be performed effectively in the dental chair. This study tested the hypothesis that there is no difference in the efficacy of CPR performed in the dental chair or on the floor. METHODS: Four cycles of two-person CPR were performed by three health professionals on a manikin positioned alternately on the floor and in a dental chair. Ventilation was performed using a Laerdal pocket mask, without oxygen supplementation. Compression and ventilation performance was recorded using a computerized manikin skill meter. RESULTS: Each of the participants was able to achieve a mean cardiac compression depth of between 41 and 50cm, irrespective of the CPR surface. The only statistically significant difference found in expired air resuscitation (EAR) and external cardiac compression performance was that 37 per cent of ventilations performed on the floor were deemed to be too shallow, compared to only 15 per cent in the dental chair (p=0.001). CONCLUSIONS: It is possible for those trained in basic life support to perform CPR effectively in the dental chair. Each of the participants agreed that CPR, in particular EAR, was easier to perform when the manikin was in the dental chair compared with the floor. Dentists are encourage to regularly update their CPR knowledge and skills, including the practice of CPR in the dental chair.

Cardiopulmonary Resuscitation↗
PubMed2003

Radioimmunoscintigraphy with Tc-99m-labelled SM3 in differentiating malignant from benign adnexal masses.

OBJECTIVE: Ultrasound scanning, serum CA125 and menopausal status have previously been combined in a risk of malignancy index for the differential diagnosis of adnexal masses. Although this approach has greater accuracy than either individual tests or clinical assessment, it has a significant false positive and false negative rate. Efforts have been directed at refining differential diagnosis and this study assessed the role of radioimmunoscintigraphy using the stripped mucin 3 (SM3) antibody that has a 17-fold greater uptake in malignant than benign ovarian tumours in vitro. DESIGN: Prospective study of patients with a pelvic mass using radioimmunoscintigraphy. SETTING: Department of Nuclear Medicine of St Bartholomew's Hospital in collaboration with Cancer Network. POPULATION: A total of 93 patients with pelvic masses were recruited for this study of which 32 had ovarian cancer and 61 had benign lesions. METHODS: Radioimmunoscintigraphy was performed with Tc-99m-labelled SM3 (600 MBq), anterior and posterior pelvis imaged at 10 minutes and at 4 and 24 hours and evaluated with change detection analysis and probability mapping. MAIN OUTCOME MEASURES: Sensitivity and specificity of radioimmunoscintigraphy for ovarian cancer. RESULTS: Radioimmunoscintigraphy had a sensitivity for ovarian cancer of 84% (27 true positive and 5 false negatives) and a specificity of 87% (53 true negatives and 8 false positives) giving a negative predictive value of 91%. CONCLUSION: These results suggest that radioimmunoscintigraphy could be used to reduce the number of false positive findings in a strategy to refine differential diagnosis of the pelvic mass.

Adnexa Uteri↗
PubMed2001

Community attitudes towards performing cardiopulmonary resuscitation in Western Australia.

OBJECTIVE: to determine the attitudes of the Western Australian community towards performing cardiopulmonary resuscitation, and the factors affecting these attitudes. METHODS: telephone survey of a randomly selected sample of people from suburban Perth and rural Western Australia; practical assessment of a sub-sample of volunteers from those surveyed, to correlate survey answers with practical skills. RESULTS: of 803 people surveyed, the majority (90.7%) definitely would give mouth-to-mouth ventilation to a friend or relative, but less than half (47.2%) would to a stranger. The reluctance was mostly (56%) because of health and safety concerns, particularly related to HIV infection. Higher percentages of people would definitely provide cardiac massage for a friend or relative (91.4%) or stranger (78.1%). People were more likely to give mouth-to-mouth and cardiac massage if they had been trained in cardiopulmonary resuscitation (CPR), trained several times, trained recently, and used their CPR skills in real life. There were no significant differences between city and country people in whether they would provide CPR, but older people were less willing to provide mouth-to-mouth or cardiac massage. On practical assessment of 100 volunteers, there were significant errors and omissions in airway assessment, mouth-to-mouth resuscitation and cardiac massage. Volunteers with better practical scores were more prepared to provide CPR. DISCUSSION: our results indicate a significant reluctance of the Western Australia public to perform mouth-to-mouth, except to a friend or relative. Earlier CPR training, practice and use seemed to diminish this reluctance. Practical CPR skills were not well executed. Those with better skills were less reluctant to use them. We recommend increasing CPR training in the community, greater frequency of refresher courses and public education on the risks of CPR to improve rates of bystander CPR.

Attitude to Health↗
PubMed2001

Randomized controlled trial of midazolam premedication to reduce the subjective adverse effects of adenosine.

OBJECTIVE: To determine the safety and efficacy of midazolam premedication to minimize the subjective adverse effects of adenosine. METHODS: Double-blind prospective randomized controlled trial of patients presenting to an urban emergency department. Included were a convenience sample of patients who would have received adenosine by the existing department protocol. Exclusion criteria were pregnancy, benzodiazepine allergy, regular benzodiazepine medication, alcoholism, altered mental state (precluding informed consent), and age less than 18 or greater than 65 years. Subjects received either 1.5 mg of intravenous midazolam or normal saline placebo 5 min prior to the administration of adenosine. Side-effect recall was judged by a questionnaire at 1 h and 24 h postadenosine administration. RESULTS: A total of 34 patients were recruited into the trial, 16 in the placebo group and 18 in the midazolam group. The groups were well matched for demographics, treatment and outcome. There was a significant reduction in the midazolam group for complaint scores of palpitations (P = 0.04) and chest pain (P = 0.02) and a trend to reduction in complaint scores for most other parameters. There were no adverse outcomes in any of the patients studied. CONCLUSIONS: Co-administration of midazolam can safely reduce the recall of the unpleasant adverse effects of adenosine. Its use may be most appropriate in patients who are particularly anxious or have had previous adverse experiences with adenosine.

Adenosine↗
PubMed2001

Implementation and evaluation of an undergraduate emergency medicine curriculum.

OBJECTIVE: To describe the implementation and evaluation of an undergraduate course in the first Australian academic emergency medicine unit. METHODS: A descriptive study of a course involving fifth year medical students at the University of Western Australia was undertaken. Teaching included self-directed case problem solving, small group tutorials, practical-skills teaching, clinical attachments and information handouts. Evaluation involved questionnaire scores and written feedback regarding life-support skills, tutorial teaching, course materials, clinical attachments and the course in general. Some groups of students underwent pre-course and post-course examinations. RESULTS: Subjective and objective testing showed that student knowledge significantly improved. Feedback was especially positive toward clinical attachments in emergency departments, practical skills tutorials and the case-based learning method. Students requested longer attachments to emergency departments, and more practical, case-based, interactive and bedside teaching. Problems encountered included inadequate time for teaching, vagueness about student roles and objectives, and dealing with death for the first time without adequate preparation. CONCLUSION: Undergraduate emergency medicine education should become an essential part of Australian and international undergraduate medical education. Emergency medicine is enjoyable and eminently suitable for problem-based, interactive and integrated teaching and improves confidence, clinical experience in emergencies, practical skills and teamwork. Improvements include more problem-based teaching, more practical skills sessions and better definition of student roles. These are general principles that can be applied to other undergraduate courses and to designers of other emergency medicine courses, both undergraduate and postgraduate.

Analysis of Variance↗
PubMed2001

Action sequence for layperson cardiopulmonary resuscitation.

Although some minor modifications were forged, the general consensus was to maintain most of the current guidelines for phone first/phone fast, no-assisted-ventilation CPR, the A-B-C (vs C-A-B) sequence of CPR, and the recovery position. The decisions to leave these guidelines as they are were based on a lack of evidence to justify the proposed changes, coupled with a reluctance to make revisions that would require major changes in worldwide educational practices without such evidence.Nonetheless, some major changes were made. The time-honored procedure ol pulse check by lay rescuers was eliminated altogether and replaced with an assessment for other signs of circulation. Likewise, it was recommended that even the professional rescuer now check for these other signs of circulation. Although professional rescuers may simultaneously check for a pulse, they should do so only for a short period of time (within 10 seconds). There was also enthusiasm for deleting the ventilation aspect of EMS dispatcher-assisted CPR instructions that are provided to rescuers at the scene who are inexperienced in CPR. lt was made clear, though, that the data are applicable only to adult patients who are receiving CPR and that the data are appropriate most for EMS systems with rapid response times.

Adult↗
PubMed2001

The chain of survival.

Explore the source record for details and available documents.

Advanced Cardiac Life Support↗
PubMed2001

Effect of caffeine and ephedrine ingestion on anaerobic exercise performance.

PURPOSE: Ingestion of a combination of caffeine (C) and ephedrine (E) prolongs time to exhaustion during high-intensity aerobic exercise. CNS stimulation by C and E was proposed as part of the mechanism for the improvement. It was thought that this arousal might also be of benefit during anaerobic exercise. The purpose of this study was to investigate the effect of C, E, and C+E ingestion on performance of anaerobic exercise. METHODS: Two groups were used to evaluate the effect of C and E on anaerobic performance. Group 1 (WIN) consisted of 16 healthy untrained male subjects who performed a 30-s Wingate test. Group 2 (MAOD) consisted of 8 healthy untrained male subjects who performed a supramaximal (125%VO(2peak)) cycle exercise trial to exhaustion to determine maximum accumulated oxygen deficit. The trials commenced 1.5 h after ingesting either C (5 mg x kg(-1)), E (1 mg x kg(-1)), a combination of C+E, or a placebo (P). All trials were randomized and double blind. Blood samples were assayed for lactate and glucose post drug ingestion just before exercise, and again 3, 5, and 10 min post exercise. Catecholamines were measured in the preexercise and 10-min postexercise blood samples. RESULTS: Ephedrine increased power output during the early phase of the Wingate test, whereas C increased time to exhaustion and O(2) deficit during the MAOD test. C, E, and C+E increased blood lactate, glucose, and catecholamine levels. CONCLUSION: The improvement in anaerobic exercise performance is likely a result of both stimulation of the CNS by E and skeletal muscle by C.

Adult↗
PubMed2001

Changes in respiratory function during a wilderness multisport endurance competition.

OBJECTIVE: To document the changes in respiratory function seen in competitors during a typical wilderness multisport endurance event. METHODS: A prospective observational cohort study measuring forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) at baseline, midrace, and end of race in competitors in a 105-km ski/run/cycle/paddle race held midwinter in the mountains of Victoria, Australia. RESULTS: Twenty-five adult subjects (22 men) between 20 and 42 years of age were studied. The mean decline in FEV1 was 15.1% (95% CI 10.3-19.8) and for FVC was 13.0% (95% CI 8.1-17.9). Fourteen (56%) of the 25 subjects had a >10% decline in FEV1 and FVC, and 7 (28%) of the 25 subjects had a >20% decline. In 9 control subjects, aged between 21 and 55 years, there was no significant change in FEV1 or FVC from prerace to end of race. CONCLUSIONS: Significant declines in FEV1 and FVC are common during wilderness multisport endurance events. The focus of future research should be the etiology, which as yet remains speculative.

Adult↗
PubMed2001

MR imaging of uterine sarcomas.

OBJECTIVE: The MR imaging appearances of uterine sarcomas are not well described in the literature. We describe the MR imaging features of uterine sarcomas. MATERIALS AND METHODS: MR images from all patients with histologically proven uterine sarcomas scanned between 1993 and 2000 were reviewed. Tumor size, its relationship to the uterus, signal characteristics, and enhancement pattern after IV injection of gadolinium were noted. RESULTS: Twenty-five scans from 22 patients were reviewed. Findings from the scans included 11 leiomyosarcomas, five mixed müllerian tumors, two rhabdosarcomas, and four endometrial stromal sarcomas. Two patterns of disease were observed, including a characteristic large heterogenous pelvic mass (n = 17) and an endometrial mass indistinguishable from endometrial carcinoma (n = 8). On T2-weighted images, the large masses were characteristically of low or intermediate background signal intensity with pockets of very high T2 signal. The areas of high T2 signal corresponded to cystic necrosis in the tumor. Pockets of high T1-weighted signal corresponded to hemorrhage. Gadolinium enhancement was present in the solid components of all tumors. This pattern was observed in all recurrent sarcomas. Some correlation was shown between the histologic subtypes and the MR imaging appearances. CONCLUSION: Uterine sarcomas show two patterns on MR imaging. The most common presentation is a large heterogenous mass. However, sarcomas can mimic endometrial carcinoma.

Adult↗
PubMed2000

Characterization of nicotinic acetylcholine receptor-mediated [(3)H]-dopamine release from rat cortex and striatum.

The objective of this study was to use a new high throughput method to compare nicotinic acetylcholine receptor (nAChR)-mediated [(3)H]-dopamine (DA) release from slices of rat striatum and cortex. (-)Nicotine, (-)-cytisine, 1,1-dimethyl-4-phenyl-piperazinium (DMPP), and (+/-)-epibatidine evoked release of striatal [(3)H]-DA with pEC(50) values of 6.7, 8.25, 5.11, and 9.08, respectively. The same agonists evoked release of cortical [(3)H]-DA with pEC(50) values of 6.98, 8.06, 5.58, and 9.59. Relative to (-)-nicotine, (-)-cytisine was a partial agonist in both tissues. In contrast, the maximal response evoked by DMPP differed between the two tissues. The rank order of potency for antagonists to block DA release was the same (mecamylamine (Mec)>dihydro-beta-erythroidine (DHbetaE)>hexamethonium (Hex)>D-tubocurarine (D-TC)); however, the pIC(50) values varied between the two regions. Whereas Mec potently antagonized (-)-nicotine-evoked DA release similarly from striatum and cortex, with pIC(50) values of 6.07 and 6.53 respectively, the values obtained for DHbetaE, D-TC and Hex differed. Additionally, the present study was able to distinguish exocytotic vesicular-mediated from transporter-mediated DA release, by altering temperature of the incubation and exclusion of calcium. Assays carried out under these conditions indicate that approximately 60% of nicotine-evoked cortical DA release was likely mediated through the DA transporter. In contrast, under the same conditions only 15%-20% of striatal release appeared to be transporter-mediated. We conclude that the relative contributions of the mechanisms by which (-)-nicotine evokes DA release differ between striatum and cortex. In addition, the data suggest that the subtypes of nAChRs involved in regulating [(3)H]-DA release may be somewhat different in the two tissues.

Alkaloids↗