Biomedical subjects
Publications and source records attributed to J Bray.
1. There is an increasing population of older people, many of whom need health and social care. 2. It is important to obtain their viewpoints in order to provide services that meet their needs. 3. Consideration must be given to the way their views are obtained. 4. The information must be fed back to service providers.
OBJECTIVE: To evaluate the impact of oral magnesium supplementation on risk factors for end-organ disease in patients with non-insulin-dependent diabetes mellitus (NIDDM). DESIGN: A 16-week randomized, double-blind, placebo-controlled crossover trial. SETTING: Outpatient center of an academic family medicine residency program. PATIENTS: Twenty-eight patients (age range, 28 to 84 years; 57.1% black; 85.7% women) with NIDDM controlled by diet and/or an oral hypoglycemic, with a serum cholesterol levels over 5.20 mmol/L (200 mg/dL). INTERVENTION: Following a 2-week placebo run-in period, each patient was randomized to receive either sustained-release magnesium chloride (Slo-Mag), 384 mg/d, or an identical-appearing placebo for 6 weeks. After a 2-week interim washout period, each patient was then treated with the alternative regimen for an additional 6-week period. MAIN OUTCOME MEASURES: The systolic and diastolic blood pressure and levels of serum glucose, low-density and high-density lipoprotein and total cholesterol, triglycerides, and serum and total erythrocyte magnesium were measured at the beginning, midpoint, and end of each 6-week treatment phase. RESULTS: Systolic blood pressure fell an average of 7.4 mm Hg (P < .05) with treatment. There was no significant change in diastolic blood pressure or levels of serum glucose, low-density and high-density lipoprotein and total cholesterol, triglycerides, or serum and erythrocyte magnesium. CONCLUSIONS: Oral magnesium supplementation in the doses and duration studied is modestly effective in reducing systolic blood pressure in patients with NIDDM but has little impact on other important biochemical parameters related to diabetes-associated end-organ disease.
The aim of this study was to develop and evaluate an information system for monitoring impact of acute hospital care on health status of elderly patients, burden on carers, and consumer satisfaction with care. The study was undertaken on four acute care wards of an elderly care unit of a teaching hospital. We used a consensus-building process to achieve within-and-between-team convergence of policy and practice in the use of structured assessments on three wards, with parallel data collection by a research nurse on one ward. We describe the changes to our working practices, the costs of data collection, staff attitudes to the system and the assessment instruments, using 5-point Likert Scales, with additional in-depth interviews with senior staff for their attitudes to the system. We found that only nursing staff were able to change their practice. On admission, it was feasible to undertake functional assessment of activities of daily living (ADL), depression, perceived life quality and carer strain. Discharge assessment was only feasible for ADL. Other discharge assessments and follow-up assessments including consumer satisfaction interviews required audit assistant support. The total annual cost per ward was 6,225 pounds for the adopted system, or 6,455 pounds to incorporate follow-up assessments by audit assistant in a random sample of 50 patients. Staff attitudes to the system were positive, especially for use of the Relatives' Stress Scale, and for the value of follow-up interviews. We conclude that the participatory approach to the introduction of the information system produced a system which was perceived to be beneficial for patient care.(ABSTRACT TRUNCATED AT 250 WORDS)
Although important to users, practice standards rarely incorporate users' views of care provided. These views are a valuable source of information, even though there are limits to their value. To improve the standards of care in a 20 bed hospital elderly care unit caring for acute medical conditions a qualitative approach was used. Patients' and carers' perceptions of care and problems with the process of care in the unit were elicited with a specially designed semistructured interview schedule in 83 separate tape recorded interviews with a research nurse in patients' homes. In all, 50 patients and 35 carers were interviewed between 6 June 1991 and 28 May 1992. Of the 50 patients, 33 were female; seven patients were aged less than 80 years, 16, 80-85; 21, 86-90; and six over 90. A total of 16 patients lived with spouses or other carers, two with non-carers, and 32 lived alone, 18 of whom received informal care. Content analysis of the interviews disclosed patients' and carers' general satisfaction with individualised professional care and planning of follow up services on discharge but dissatisfaction in the lack of information about and involvement in treatment and care and about specific staff notes. These findings have prompted remedial changes in clinical practice in the unit; they have also formed the structure of a criterion based survey of practice. The authors conclude that the qualitative approach suited elderly users and also provided the basis for the findings to be incorporated into a continuous audit cycle through a process of feedback and standard setting.
A leading theory hypothesizes that schizophrenia arises from dysregulation of the dopamine system in certain brain regions. As this dysregulation could arise from abnormal expression of D2 dopamine receptors, the D2 receptor gene (DRD2) on chromosome 11q is a candidate locus for schizophrenia. We tested whether allelic variation at DRD2 and five surrounding loci cosegregated with schizophrenia in 112 small- to moderate-size Irish families containing two or more members affected with schizophrenia or schizoaffective disorder, defined by DSM-III-R. Evidence of linkage was assessed using varying definitions of illness and modes of transmission. Assuming genetic homogeneity, linkage between schizophrenia and large regions of 11q around DRD2 could be strongly excluded. Assuming genetic heterogeneity, variation at the DRD2 locus could be rejected as a major risk factor for schizophrenia in more than 50% of these families for all models tested and in as few as 25% of the families for certain models. The DRD2 linkage in fewer than 25% of these families could not be excluded under any of the models tested. Our results suggest that the major component of genetic susceptibility to schizophrenia is not due to allelic variation at the DRD2 locus or other genes in the surrounding chromosomal region.
A balloon-tipped catheter placed in the coronary sinus is used during cardiac surgery for retrograde cardioplegia and is secured by a purse string suture placed proximal to the atrioventricular groove in the lower right atrium. We report a complication of this procedure where a pulmonary artery catheter was sutured to the wall of the right atrium by the purse string suture in a patient scheduled for aortocoronary bypass grafting. Pulsatile resistance was noted when we attempted to withdraw the catheter indicating an attachment to the heart. The pulmonary artery catheter within the vascular space after atrial cannulation should be checked since the sheath-protected cannula will enable free mobility.
The increasing sophistication of enteral and total parenteral nutritional support techniques has resulted in improvements in the clinical practice of such support in recent years. This survey was designed to establish current clinical practice in the management of nutritionally-compromised hospital patients in 206 districts in the United Kingdom. However, despite recent developments in these techniques, the response revealed a wide variation in the practice of clinical nutritional support. The results also indicate that in each district there should be a group of people, with an interest in clinical nutrition, to monitor and advise on nutritional support. It is suggested that, a national multidisciplinary group should be formed, similar to the American and European Societies of Parenteral and Enteral Nutrition. The group would promote the appropriate use of, and research into, nutritional support specifically for the nutritionally compromised patient in the United Kingdom.
In immunologically defined National Institutes of Health miniswine, a segment of internal jugular vein was anastomosed to the carotid artery as an interposition graft. Patency of swine major histocompatibility complex matched, one haplotype mismatched, and complete mismatched veins was 9.8, 6.3, and 3.0 weeks respectively (p = 0.009). More than 90% of mismatched and 20% of matched allografts developed a positive crossmatch before occlusion (p = 0.006). The mixed lymphocyte response did not predict graft occlusion. Treatment of 10 swine with cyclosporine (10 mg/kg/day) did not significantly improve patency for one haplotype mismatched grafts. In haplotype mismatched veins, cryopreserved grafts occluded more rapidly than noncryopreserved grafts: mean 2.4 versus 6.3 weeks, respectively (p = 0.002). In all cryopreserved vein grafts, alloantibody appeared at or after graft occlusion rather than before occlusion as seen with fresh allografts (p = 0.046). The mean patency of cryopreserved versus fresh autografts was 3.3 and greater than 32 weeks, respectively (p = 0.004). In summary, these results indicate that (1) allograft patency is related to the degree of swine major histocompatibility complex match and development of cytotoxic alloantibodies; (2) moderate-dose cyclosporine does not prolong allograft patency nor suppress development of antibody; (3) cryopreservation may accelerate graft occlusion through nonimmunologic mechanisms.
PURPOSE AND PATIENTS AND METHODS: Reports of severe adverse reactions following the ingestion of single (75 mg) or double doses of the sympathomimetic drug phenylpropanolamine (PPA), with and without caffeine, prompted us to undertake a study of the effects of five drug preparations (75 mg PPA, 150 mg PPA, 75 mg PPA plus 400 mg caffeine, 400 mg caffeine, and placebo) in 16 resting, normotensive subjects. The study was of a double-blind, randomized, crossover design. Each subject consented to take the five drug preparations on different study days, which were separated by at least 48 hours. RESULTS: Compared with blood pressure (BP) values obtained after placebo ingestion, significant BP increases occurred over several hours following 150 mg PPA and after 75 mg PPA plus 400 mg caffeine. Significant BP increases after ingestion of 75 mg PPA and after 400 mg caffeine were less frequent. The mean peak BP following 150 mg PPA was 173 +/- 9/103 +/- 4 mm Hg, compared with 148 +/- 4/97 +/- 3 mm Hg after the other three active preparations; after placebo, peak BP reached 137 +/- 8/85 +/- 5 mm Hg. CONCLUSION: These results indicate that 150 mg PPA (the amount in two diet aids) substantially elevates BP. Our findings may explain some of the recent case reports of nontraumatic intracranial hemorrhage in young, healthy persons ingesting PPA at recommended or minimally greater dosages. We suggest physicians inform patients who are likely consumers of PPA (i.e., those with allergies, those with eating disorders, overweight persons, women during the postpartum period) and patients at risk for stroke (i.e., the elderly and hypertensive patients) of the risks of taking more than the recommended amounts of PPA and of combining caffeine with PPA.
Explore the source record for details and available documents.
Much is known about the essentiality of the halogens fluorine (F), chlorine (Cl), and iodine (I), but very little has been discussed with respect to bromine (Br). As a member of the halogen family its chemical properties are comparable to those of other halogens, but its presence has been masked by the presence of I and Cl in chemical analyses. By virtue of new technology and a special computerized machine called the Kevex Model 0600 Energy Dispersive X-Ray Induced X-Ray Fluorescence Spectrometer (EDXRF), we can specifically identify bromine in different compartments and verify its concentration accurately. In order to establish standard values of Br concentrations and evaluate the nature of its presence in humans, samples of serum, urine, and hair were collected from ten healthy adult males and analyzed for bromine content. Our samples had normal distributions, with serum bromine levels ranging from 3.2 to 5.6 micrograms/mL, urine levels between 0.3 to 7.0 micrograms/mL, and hair levels determined from 1.1 to 49.0 micrograms/mL. These levels, especially those of serum bromine, have been encountered by other examiners whose samples also had normal distributions. These findings suggest to us that bromine may well be an essential trace element, as are its other halogen family members.
Explore the source record for details and available documents.
Intracellular phospholipases (A2 and C types) can hydrolyse bilayer-forming phospholipids much more rapidly when diacylglycerol is added. Unsaturated long-chain diacylglycerols are much more effective than short-chain saturated diacylglycerols or 1-oleoyl,2-acetylglycerol. Diacylglycerol does not change the electrokinetic properties of the phospholipid water interface, nor does it enhance enzymic digestion of monolayers. 31P-NMR of phosphatidylcholine indicates that diacylglycerol causes an isotropic component to develop in the spectrum of the bilayers which correlates approximately with the enhancement of phospholipase A2 attack. Addition of further diacylglycerol converts this transitional stage of unknown structural origin to the hexagonal II phase with a total loss of enzyme activity.
The filtration of differently charged species of myoglobin and dextran across films of isolated basement membrane in vitro showed that the filtration behavior of both polymers was influenced by charge. Rejection increased with increasing negative charge. Titration of the isolated basement membrane revealed an isoionic point of pH 5.5 and an isoelectric point of pH 5.7. The net negative charge at pH 7.4 was 0.15 mEq/g protein; this charge was attributed to carboxylate anion. Glycosaminoglycan sulphate did not contribute significantly to the net charge. Filtration of narrow range dextran fractions across films of basement membrane at the isoelectric point markedly reduced differences in filtration due to charge confirming that the differences in behavior found at pH 7.4 were due to charge interactions between the solutes and the membranes. Physical characterization of the charged and uncharged dextran fractions revealed no substantial differences in size or shape for the differently charged species.
The Thomsen-Friedenreich (T) antigen, beta-D-Gal-(1 leads to 3)-alpha-D-GalNAc, is exposed in reactive form on many human adenocarcinomata, but not on corresponding benign tissues. Peanut lectin (PNA) has a strong binding affinity for the T antigen and reportedly binds preferentially to certain malignant tissues. We investigated the potential of radiolabelled PNA as a tumour localising agent in an animal model system using a mouse lymphoma (RI) shown to bind fluorescein-labelled PNA in vitro. The radioiodinated lectin showed good tumour localization and rapid blood clearance. Clear images of tumours were obtained, in serial scintigraphic imaging, by 24 and 48 h. No blood background subtraction was necessary. Biodistribution studies revealed tumour to blood ratios in mice were 6:1 (at 24 h) and 17:1 (at 48 h), and tumour to muscle ratios were 34:1 (at 24 h) and 40:1 (at 48 h). Rapid in vivo breakdown of 125I-PNA led to some localization of free iodide in the kidneys, stomach, thyroid and salivary glands.
An in vitro assay for assessing degradative action of neutrophils on basement membrane has been developed. Basement membrane adhering to the base of microtitre wells can be reacted with neutrophils allowing monitoring of the release of cell components or of isotope from labelled membranes. Using either sheep or rat renal membranes labelled with [3H]propionate it was shown that either rabbit anti-sheep basement membrane antibody or rabbit anti-rat nephrotoxic serum promoted degradation of the membranes by neutrophils from rabbits. Studies with proteinase inhibitors showed that the degradation was a result of proteolytic action. Comparisons of the effects of serum or plasma with the effects of heat-inactivated serum or plasma showed that complement did not increase degradative activity but did increase the exocytosis of lysozyme by the cells. Hydroxyl radical was the principal oxygen-derived metabolite produced by the cells but free radical scavengers had no effect on the extent of degradation effected by the cells.
Using a cytotoxicity assay, we have shown that all of 40 normal human sera tested contained antibodies cytotoxic for neuraminidase-treated red blood cells in the presence of complement. The antibodies were shown to be specific for the T disaccharide by studies using a synthetic T antigen (formula: see text). Certain patients with metastatic gastrointestinal cancer were found to have depressed serum levels of anti-T when compared to normal controls. There was a correlation between depression of circulating anti-T and disease burden in that 83% of patients with extensive disease had lower than normal levels of cytotoxic anti-T as compared to 45% of patients with moderate disease and none with minimal disease. There was no correlation between the concentration of cytotoxic anti-T and the age of the patients, time since surgery or the type of therapy the patient was receiving. Patients with low levels of cytotoxic anti-T had normal levels of cytotoxic anti-sheep red blood cell antibody. Measurement of circulating anti-T in the serum of certain cancer patients may prove valuable in the monitoring of disease progression.
The use of a utilization system in a nuclear radiology department has resulted in productivity improvement and cost reductions.