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Biomedical subjects

J Bridges

Publications and source records attributed to J Bridges.

At least 19 recordsLinked to original sources
PubMed2001

Ethical relationships in paediatric emergency medicine: moving beyond the dyad.

Most areas of health-services research concentrate on a dyadic relationship between doctor and patient. In paediatric emergency medicine it may be necessary to focus on a more complicated relationship because the parents of the child play an important role in the delivery of medical services. This paper discusses the ethical principles in paediatric emergency medicine from the perspective of five disciplines: health economics, paediatrics, medical ethics, law and mental health. The general consensus is that the traditional dyadic model is inadequate and that a more complicated relationship is needed for the paediatric emergency setting, such as triadic, multiple-dyadic or polyadic. Such models allow the inclusion of the parents and possibly other family members, medical providers and community members. If the paediatric setting is considered in such a framework, it may be possible to deliver a more socially beneficial medical service.

Adolescent↗
PubMed2000

Extinct (129)I in halite from a primitive meteorite: evidence for evaporite formation in the early solar system

Halite crystals from the Zag H3-6 chondrite contain essentially pure (monoisotopic) xenon-129 ((129)Xe) produced in the early history of the solar system by the decay of short-lived iodine-129 ((129)I) (half-life = 15.7 million years). Correlated release of (129)Xe and (128)Xe, produced artificially from (127)I by neutron irradiation, corresponds to an initial ((129)I/(127)I) ratio of (1.35 +/- 0.05) x 10(-4), close to the most primitive early solar system value. If the (129)Xe was produced by in situ decay, then the halite formed from an aqueous fluid within 2 million years of the oldest known solar system minerals.

Journal Article↗
PubMed2000

Designing a nationally acceptable system of hospital peer grouping.

Little has been published on the design, use and evaluation of peer groupings of hospitals. This article explores the issue in the context of public hospitals in New South Wales. The process, established over the last two years by New South Wales Health, aims to meet six principles of peer grouping. Through a six-step procedure, the methodology focuses on the classification of hospitals by role, size and measure of acuity. Further research is needed to compare benchmarking across States and to identify which of the methodologies should be adopted nationally.

Hospitals, Public↗
PubMed2000

A health visitor for older people in an accident and emergency department.

Published studies indicate that older people have special needs on discharge from accident and emergency (A&E) departments that are not always fully met. The literature reflects that although a significant proportion of older people have a decrease in functional independence and an increased need for services following discharge from A&E, social and functional assessment by A&E staff can be inadequate, as can the arrangement of follow-up community services. As part of a wider study into the organization of care for older people in A&E, a health visitor for older people was funded to work part-time in the A&E department of a large NHS Trust. The health visitor identified potential clients through reviewing the A&E documentation of patients aged 75 years or over discharged directly from A&E. Telephone calls or home visits were used to follow up those individuals deemed to be vulnerable by the health visitor. Interventions included health education, referral to other agencies and patient or family counselling. None of the clients followed up by the health visitor (n = 212) had been referred by A&E to a specialist in gerontology, which suggests that these clients would otherwise not have received the potential benefit of specialist intervention. The pilot study described here highlights a number of practical issues in relation to the health visitor post for older people in A&E, including the importance of dedicated office space and access to a telephone. Data collected during the study, plus the positive evaluation of the role by a small group of A&E staff confirm the claims made in other studies (e.g. Runciman et al, 1996) that health visitors for older people may be of value in meeting the post-discharge needs of these people.

Accidental Falls↗
PubMed1999

Hospital discharge. Smooth passage.

The introduction of care co-ordinators into a medical directorate two years ago has reduced bed blocking and cut length of stay from 8.5 to 5.9 days. All those appointed were already working in the hospital. There have been some tensions over boundaries with nursing and social work.

Case Management↗
PubMed1995

Experimental point spread function of fm pulse imaging scheme.

In this paper, we have examined the possibility of incorporating pulse compression techniques into a conventional medical B-scan imaging scheme. Linear frequency modulation fm, one form of pulse coding among many others, has been used in this study. With this approach, one can overcome current peak intensity limitations. A theoretical framework that includes medium propagation effects, transducer bandwidth and diffraction effects is presented, which could be used to examine the system point spread function under this imaging scheme. A prototype experimental set-up and signal processing are described and used for simple imaging tasks in attenuating and nonattenuating media. Analysis of the experimental point spread functions shows that resolution similar to conventional short pulse imaging can be achieved. However, the existence of large range side lobe levels usually associated with pulse compression processing can degrade contrast resolution in medical ultrasound. We have considered various different factors that can affect the range side lobe levels and examined their effect either experimentally or through simulations. The technique has the potential for improving signal-to-noise ratio (SNR), maximum penetration depth and resolution without exceeding peak intensity limitations. Some possible applications are discussed that merit further evaluation. Our work demonstrates the feasibility of this technique and presents a theoretical framework that can be used in future studies aimed at evaluating image quality, system performance, and possible artifacts under such an imaging scheme.

Computer Simulation↗
PubMed1994

Interleukin-1 receptor antagonist treatment reduces pulmonary hypertension generated in rats by monocrotaline.

Chronic pulmonary hypertension is associated with significant vascular remodeling. We demonstrated recently in the monocrotaline (MCT) and chronic hypoxia rat models of pulmonary hypertension that treatment with platelet-activating factor (PAF) antagonists inhibited the development of chronic pulmonary hypertension. PAF and other lipid mediators interact with interleukin-1. We postulated that chronic treatment with a recombinant human interleukin-1 receptor antagonist (IL-1ra) would inhibit development of chronic pulmonary hypertension in animal models. Rats were either injected with (60 mg/kg) MCT or exposed to a stimulated high altitude of 16,000 feet; half of the animals were treated with twice-daily injections (2 mg/kg) of IL-1ra. At 3 wk after MCT injection or 3 wk of hypoxic exposure, pulmonary artery pressure and right heart ventricle weight/(left ventricle and septum weight), RV/(LV + S), were measured. IL-1ra treatment reduced pulmonary hypertension and right heart hypertrophy in the MCT model, but not in the chronic hypoxia model. Measurement of lung homogenate IL-1 alpha by radioimmunoassay showed elevated levels in the MCT-treated rats throughout the 3-wk observation period. IL-1ra treatment reduced the levels of IL-1 alpha in lung tissue in most of the MCT-treated rats. MCT treatment was also associated with an increase in lung mRNA for IL-1 alpha, IL-1 beta, and IL-1ra. Immunohistology, using an antibody against rat IL-1 alpha, revealed staining of alveolar structures and of vascular and bronchial smooth muscle. In situ hybridization using a human IL-1 alpha cDNA probe demonstrated increased expression of the IL-1 alpha gene in the lung cells after endotoxin or MCT treatment. Northern blot analysis demonstrated low-level expression of IL-1 alpha mRNA in extracts of normal rat lung and increased expression after endotoxin or MCT treatment. We conclude that chronic treatment with human IL-1ra inhibited the development of pulmonary hypertension in the inflammatory (MCT) model, but not in the chronically hypoxic rats. This result indicates that IL-1 participates in the pathogenesis of some forms of pulmonary hypertension.

Animals↗
PubMed1993

Prevalence screening for ovarian cancer in postmenopausal women by CA 125 measurement and ultrasonography.

OBJECTIVE: To assess the performance of the sequential combination of serum CA 125 measurement and ultrasonography in screening for ovarian cancer. DESIGN: The serum CA 125 concentration of each subject was determined and those with a concentration > or = 30 U/ml were recalled for abdominal ultrasonography. If ultrasonography gave abnormal results surgical investigation was arranged. Volunteers were followed up by annual postal questionnaire. SETTING: General practice, occupational health departments, ovarian cancer screening clinic. SUBJECTS: 22,000 women volunteers who were postmenopausal and aged over 45 years. MAIN OUTCOME MEASURES: Apparent sensitivity, specificity, positive predictive value, years of cancer detected. RESULTS: 41 women had a positive screening result and were investigated surgically. 11 had ovarian cancer (true positive result) and 30 had other disorders or no abnormality (false positive result). Of the 21,959 volunteers with a negative screening result, eight subsequently presented clinically with ovarian cancer (false negative result) and 21,951 had not developed ovarian cancer during follow up (apparent true negative result). The screening protocol achieved a specificity of 99.9%, a positive predictive value of 26.8%, and an apparent sensitivity of 78.6% and 57.9% at one year and two year follow up respectively. The estimated number of years of cancer detected by the prevalence screen was 1.4 years. CONCLUSIONS: This screening protocol is highly specific for ovarian cancer and can detect a substantial proportion of cases at a preclinical stage. Further investigation is required to determine the effect of the screening protocol on the ratio of early to late stage disease detected and on mortality from ovarian cancer.

Aged↗
PubMed1991

Defective Candida opsonin and procidin function in patients with recurrent pyogenic infection: a common immunodeficiency.

Polymorphonuclear cell function tests were performed in 340 patients with recurrent unexplained infections. Serum-dependent defects in phagocytosis and intracellular killing of Candida albicans (Candida opsonin and procidin defects) were specifically associated with susceptibility to recurrent pyogenic infections, Candida opsonin defects occurring in 12.7% and Candida procidin defects in 20.8% of patients compared with 3.7% of healthy controls. Saccharomyces cerevisiae opsonin deficiencies were also found frequently in patients with recurrent infections, being present in 18.2% compared with 7.4% controls, although not specifically in those with pyogenic infection.

Adolescent↗
PubMed1988

Multimodal approach to screening for ovarian cancer.

1010 postmenopausal women were recruited for an ovarian cancer screening programme incorporating serum CA-125 measurement and vaginal examination as initial tests and real-time ultrasonography as a secondary procedure in selected cases. The normal range for serum CA-125 in postmenopausal women was established. The specificity for ovarian cancer of serum CA-125 measurement and vaginal examination were 97.0% and 97.3%, respectively. The combinations of serum CA-125 measurement with ultrasound and vaginal examination with ultrasound achieved specificities of 99.8% and 99.0%, respectively. 100% specificity was achieved by serum CA-125 measurement with vaginal examination and by the combination of all three tests. The findings indicate that no individual screening test has acceptable specificity for ovarian cancer in postmenopausal women. However, the combination of CA-125 measurement with ultrasound did achieve acceptable specificity and offers the most hope of a specific and sensitive method for early detection.

Aged↗
PubMed1987

Para-aortic lymphadenectomy.

Para-aortic lymphadenectomy is a procedure that has an undoubted place within the management spectrum of gynaecological malignancies. It should be performed in selected cases by trained gynaecological oncologists who are versed in the technique and in the management of potential complications. The removal and histological examination of nodal tissue remains the most accurate method of assessing the precise extent of disease spread. Its main value, therefore, is as part of a surgical staging procedure, which provides reliable survival information. However, it is still questionable whether treatment planning based on this knowledge, including modification of adjuvant therapy, results in improved survival figures. Until more data are available to clarify the degree of patient benefit, para-aortic lymphadenectomy is a technique that is more suitably practised in investigative oncological centres rather than on a widespread clinical basis.

Aorta, Abdominal↗
PubMed1986

The effects of sorbitol on the gastrointestinal microflora in rats.

The influence of dietary sorbitol on the quantity and quality of faecal microflora was studied in Wistar albino rats. The animals were gradually adapted to 20% dietary sorbitol or sucrose and faecal samples were analyzed for the numbers of major bacteria. No major changes in the numbers of total aerobic or anaerobic bacteria, aerobic streptococci and yeasts were observed after sorbitol feeding but sucrose appeared to decrease the total aerobes and anaerobes in the faeces. However, sorbitol feeding caused a clear shift in the rat faecal microbial population from gram-negative to gram-positive bacteria. All animals were capable of adapting to 20% dietary sorbitol or sucrose and withstood sorbitol treatment without problems.

Animals↗
PubMed1985

Gut microflora interactions with xylitol in the mouse, rat and man.

The influence of dietary xylitol on the quantity and quality of faecal microflora was studied in Wistar albino rats, CD-1 mice and healthy human volunteers. In animals, the effects of xylitol adaptation and of 4-wk xylitol feeding were examined. No major changes in the numbers of total aerobic or anaerobic bacteria, aerobic streptococci, anaerobic streptococci or yeasts were observed, although there was evidence of a dose-dependent decrease in the numbers of aerobic streptococci in the faeces. However, xylitol feeding caused a clear shift in the rodent faecal microbial population from Gram-negative to Gram-positive bacteria. In human volunteers a similar shift was observed even after a single 30-g oral dose of xylitol. All animals were capable of adapting to 20% dietary xylitol and an accompanying enhancement of the ability of caecal and faecal flora to utilize xylitol was observed.

Adult↗