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Biomedical subjects

J Dick

Publications and source records attributed to J Dick.

At least 37 records · Page 2Linked to original sources
PubMed1999

An outbreak of vancomycin-dependent Enterococcus faecium in a bone marrow transplant unit.

Outbreaks of vancomycin-resistant enterococci (VRE) are well described. The presence of mutants of VRE, such as vancomycin-dependent enterococci (VDE), in individual patients has been documented, but their potential to spread nosocomially has not been known. We present the first cluster of patients who acquired VDE nosocomially. Five bone marrow transplantation patients were infected or colonized by a genotypically indistinguishable multiantibiotic-resistant strain of Enterococcus faecium. Vancomycin dependence in 3 of the 5 isolates was demonstrated. All cluster patients had received protracted prophylactic treatment with vancomycin (mean, 22.6 days), and specimens from >/=2 body sites were repeatedly culture-positive for the outbreak strain. The outbreak was controlled with aggressive infection control strategies, and prophylactic antibiotic policies were revised. Awareness of the potential for nosocomial spread of multiantibiotic-resistant VDE is vital for the care of immunocompromised patients, especially those receiving prophylactic antibiotics.

Adult↗
PubMed1999

Prolonged contraction-relaxation cycle of fast-twitch muscles in parvalbumin knockout mice.

The calcium-binding protein parvalbumin (PV) occurs at high concentrations in fast-contracting vertebrate muscle fibers. Its putative role in facilitating the rapid relaxation of mammalian fast-twitch muscle fibers by acting as a temporary buffer for Ca2+ is still controversial. We generated knockout mice for PV (PV -/-) and compared the Ca2+ transients and the dynamics of contraction of their muscles with those from heterozygous (PV +/-) and wild-type (WT) mice. In the muscles of PV-deficient mice, the decay of intracellular Ca2+ concentration ([Ca2+]i) after 20-ms stimulation was slower compared with WT mice and led to a prolongation of the time required to attain peak twitch tension and to an extension of the half-relaxation time. The integral [Ca2+]i in muscle fibers of PV -/- mice was higher and consequently the force generated during a single twitch was approximately 40% greater than in PV +/- and WT animals. Acceleration of the contraction-relaxation cycle of fast-twitch muscle fibers by PV may confer an advantage in the performance of rapid, phasic movements.

Animals↗
PubMed1999

Perceptions of overweight African women about acceptable body size of women and children.

PURPOSE: Malnutrition, presenting as obesity in women and under-nutrition in children, is a prevalent problem in the squatter communities of Cape Town. Food habits are determined by a complex matrix of economic, social and cultural factors which need to be understood by health professionals prior to the implementation of strategies to improve the nutritional status of this community. This qualitative study is designed to explore the perceptions of overweight black women in Cape Town, with underweight infants, about the culturally acceptable body size for women and children. METHOD: Qualitative in-depth interviews were conducted with 10 overweight black women who were resident in the metropolitan area of Khayelitsha in Cape Town. A snowballing technique was utilised to select the key informants, all of whom were mothers of underweight infants. The interviews were conducted in Xhosa and recorded, with the permission of participants, onto tape. They were then transcribed and translated into English. The transcripts were coded and analysed by two researchers who worked independently to ensure content validity. RESULTS: The informants came from disadvantaged communities in which food was highly valued as a result of the fact that food security was not assured. The concept of an individual voluntarily regulating the intake of nutrients when food did become available, appeared unacceptable to the informants. It was not clear from the interviews how the participants perceived their normal or "desired" body weight. Increased body mass was regarded as a token of well-being in that marital harmony was perceived to be reflected in increased body weight. Overweight children were regarded as reflecting health as it was associated with sufficient food supply and intake. CONCLUSIONS: Although women expressed the desire to loose some excess weight for practical reasons, there was no negative social pressure to motivate this. The attitudes recorded from this qualitative research project suggest cultural perceptions of excess body weight that will complicate the design of effective health promotion strategies to normalise and maintain ideal body weight in this group of African women.

Adolescent↗
PubMed1998

Risk factors and clinical impact of central line infections in the surgical intensive care unit.

OBJECTIVE: To determine the risk factors and clinical impact of central line infections in critically ill surgical patients. DESIGN: Retrospective study. SETTING: The surgical intensive care unit of a large tertiary care university hospital. PATIENTS: A total of 232 consecutive central line catheters sent for culture from patients in a surgical intensive care unit during 1996 and 1997. Catheters were sent for microbiologic analysis when the patient was clinically infected and the central line was a possible source. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Risk factors associated and clinical impact of a positive catheter culture. RESULTS: Of 232 consecutive catheters from 93 patients sent for microbiologic analysis, 114 catheters (49%) had no growth, 40 (17%) were colonized (<15 colonies), and 78 (34%) were considered infected (> or =15 colonies). Univariate analysis showed that site (internal jugular vs subclavian, P<.001), catheter use (monitoring > dialysis > fluid > nutrition, P=.006), placement in the operating room vs the intensive care unit (P=.02), and placement of a new catheter (> guide wire, > new site, P=.003) were all significant factors. Surprisingly, neither the number of lunmens nor the duration of the catheter in situ were predictors when a catheter was suspected and not proved infected compared with a suspected and proved catheter infection. In the multiple regression model, the placement of the catheter in the internal jugular position was the single most important predictor of a catheter infection (P<.001; odds ratio, 1.83; 95% confidence interval [CI], 1.41-2.37). The presence or absence of a specific clinical sign of infection was not predictive of a proved catheter infection. Eighty-six percent of patients had gram-positive bacteria identified on the culture, while the remaining patients had gram-negative bacteria or Candida identified. Of the catheter infections, 68% were monomicrobial, whereas 32% were polymicrobial. Of the catheters sent for microbiologic analysis, 209 (90%) had concurrent peripheral blood cultures for analysis. Nineteen (32%) with no growth from the catheter, and 14 (23%) of colonized catheters had concurrent bacteremia; all had another identifiable cause of infection. Twenty-seven (45%) of infected catheters had a concurrent bacteremia, and 9 of 27 had a second site positive for the same organism. Death related to the infection occurred in 15 patients, 2 in the first 72 hours and 13 in the following 14 days. CONCLUSIONS: Central line infections remain an important cause of morbidity and mortality. Comprehensive review of hospital practices may show a directed focus for performance improvement practices. At our institution, internal jugular catheters have the highest rate of infection. This may suggest breaks in technique during catheter insertion or during catheter maintenance and care.

Analysis of Variance↗
PubMed1998

CREB-2, a cellular CRE-dependent transcription repressor, functions in association with Tax as an activator of the human T-cell leukemia virus type 1 promoter.

The Tax protein of the human T-cell leukemia virus type 1 (HTLV-1) has been implicated in human T-cell immortalization. The primary function of Tax is to transcriptionally activate the HTLV-1 promoter, but Tax is also known to stimulate expression of cellular genes. It has been reported to associate with several transcription factors, as well as proteins not involved in transcription. To better characterize potential cellular targets of Tax present in infected cells, a Saccharomyces cerevisiae two-hybrid screening was performed with a cDNA library constructed from the HTLV-1-infected MT2 cell line. From this study, we found 158 positive clones representing seven different cDNAs. We focused our attention on the cDNA encoding the transcription factor CREB-2. CREB-2 is an unconventional member of the ATF/CREB family in that it lacks a protein kinase A (PKA) phosphorylation site and has been reported to negatively regulate transcription from the cyclic AMP response element of the human enkephalin promoter. In this study, we demonstrate that CREB-2 cooperates with Tax to enhance viral transcription and that its basic-leucine zipper C-terminal domain is required for both in vitro and in vivo interactions with Tax. Our results confirm that the activation of the HTLV-1 promoter through Tax and factors of the ATF/CREB family is PKA independent.

Amino Acid Sequence↗
PubMed1998

'Dysphagia Severity Score' system: clinical outcomes in paediatric dysphagia.

Clinical evaluation and analysis of therapeutic intervention, by means of a user-friendly outcome measure system, is essential in the management of a paediatric dysphagia caseload. The objective of this study was to design a Dysphagia Severity Score (DSS) system and to evaluate its usefulness in profiling dysphagia outcomes. Clinical outcome data, based on ten clinical parameters describing dysphagic status pre- and post-intervention, were collated for 23 concurrent cases and recorded on a data base. Results indicate that all subjects scored an improvement in DSS percentage post-intervention, with an average improvement of 21%. Dysphagia Severity Score profiles are presented for two patients and the limitations and applications are discussed.

Acute Disease↗
PubMed1998

A cost analysis of the tuberculosis control programme in Elsies River, Cape Town

SETTING: Four primary health care clinics located in the suburb of Elsies River in the metropolitan area of Cape Town. AIM: To measure the cost of the Tuberculosis Control Programme to the health service in Elsies River and determine the costs associated with each of the clinic, community and self-supervised methods of treatment of pulmonary tuberculosis patients. DESIGN: A cost analysis designed to assess the resource input requirements of the three alternative programmes of implementing the supervision of antituberculosis therapy. The main outcome measurement was the estimated cost per patient treated for the health services by three different supervision methods (clinic, self and community-based). RESULTS: The estimated cost per patient for a 6-month period in each of the supervision groups (clinic, self and community) was R3 600, R1 080 and R720 respectively. CONCLUSION: Directly observed therapy, short-course (DOTS), has been adopted as the recommended policy for managing tuberculosis in South Africa. The costs incurred by the variety of supervision options evaluated in this study indicate that community-based directly observed therapy by a volunteer lay health worker may be less costly to the health services than either clinic or self supervision.

Journal Article↗
PubMed1998

A graphical tool for ad hoc query generation.

Medical data are characterized by complex taxonomies and evolving terminology. Questions that clinicians, medical administrators, and researchers may wish to answer using medical databases are not easily formulated as SQL queries. In this paper we describe a graphical tool that facilitates formulation of ad hoc questions as SQL queries. This tool manages multiple attribute hierarchies and creates SQL query strings by navigating through the hierarchies. This interactive tool has been optimized using indexing to improve the overall speed of the query building and the data retrieval process. Indexed queries performed 5 to 100 times faster than query strings. However, query string generation time depends on the size of the taxonomies describing the hierarchies, while the index generation time depends on the size of the data warehouse.

Abstracting and Indexing↗
PubMed1997

Use of 2% propofol to produce diurnal sedation in critically ill patients.

OBJECTIVE: The assessment of propofol to produce diurnal sedation in critically ill patients. DESIGN: Prospective clinical study. SETTING: Intensive Care Unit, University Hospital. PATIENTS AND PARTICIPANTS: Thirty consecutive patients admitted to the Intensive Care Unit older than 18 years who were expected to be sedated for more than 50 h. INTERVENTIONS: The patients were randomised into two groups. All received sedation with a constant background infusion of morphine and a variable infusion rate of propofol, which was altered hourly to maintain the intended sedation score. The first group received constant light sedation (CLS) over 50 h aiming for a Ramsay score of 2-3. The second group received CLS between 0600 h and 2200 h and additional night sedation (ANS) with propofol between 2200 h and 0600 h, aiming for a sedation score of 4-5. MEASUREMENTS AND RESULTS: Patients were studied for 50 h from 1800 h on the first day of admission. Recordings of heart rate, blood pressure, sedation scores and propofol and morphine infusion rates were made hourly. An APACHE II score was recorded for each patient. Sedation scores were analysed by blind visual assessment and cosinor analysis, which is used in chronobiology to examine the correlation of data with a cosine curve. Patients in the ANS group had significantly better rhythmicity of sedation levels using cosinor analysis (r = 26% v 8%) p < 0.01. There was no difference between the CLS and ANS groups with respect to age, sex or APACHE II scores. Nine out of 15 patients in the ANS group achieved diurnal sedation. Three patients in the CLS group showed diurnal rhythmicity of sedation, which can be attributed to natural sleep, and had a median APACHE II score of 12. Five patients in the CLS group and three in the ANS group showed a deep constant sedation pattern. They had high APACHE II scores (median 21.5) and an obtunded conscious level on admission due to severe sepsis. CONCLUSION: Propofol can safely provide diurnal sedation in the critically ill when titrated against the Ramsay score. Sedation levels cannot be manipulated in some severely ill patients.

APACHE↗
PubMed1997

Propofol 2% in critically ill patients: effect on lipids.

OBJECTIVE: To investigate the concentrations of triglyceride, cholesterol, and high-density lipoprotein during a 50-hr infusion of 2% propofol, starting within 24 hrs of admission to the intensive care unit (ICU). DESIGN: Prospective, clinical study. SETTING: ICU, university hospital. PATIENTS: Thirty adult patients, who were ventilated and expected to be sedated for >2 days, were studied for 50 hrs, beginning at 1800 hrs on the first day of ICU admission. MEASUREMENTS AND MAIN RESULTS: Triglyceride, cholesterol, and high-density lipoprotein were measured at 2000, 0400, and 0800 hrs. Tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, and C-reactive protein were measured at 2000 hrs. Median cholesterol and high-density lipoprotein concentrations were at the low end of the normal range. In seven patients, peak triglyceride concentrations were >3 mmol/L up to a maximum of 4.83 mmol/L. Although there was no statistical difference in lipid concentrations between days 1 and 2, there was an apparent pattern of increasing triglyceride concentrations. There was a correlation between peak triglyceride concentration and total propofol consumption, but there was no correlation between lipids and age, gender, or Acute Physiology and Chronic Health Evaluation II scores. There was a direct correlation between triglyceride and C-reactive protein concentrations, and an inverse correlation between cholesterol and C-reactive protein. Twenty-two patients had evidence of TNF and 11 patients had an IL-6 of >1000 pg/mL, but there was no relationship between concentrations of cytokines and triglycerides in plasma. CONCLUSIONS: Infusion of 2% propofol to critically ill patients over a 50-hr period does not result in a significant increase in triglyceride concentrations. Mean cholesterol and high-density lipoprotein concentrations were low throughout the study period. There was a significant direct correlation between triglyceride and C-reactive protein and an inverse correlation between cholesterol and C-reactive protein, suggesting that the changes in lipids in critically ill patients may be partly attributable to the acute-phase response.

APACHE↗
PubMed1997

Communication with TB patients; a neglected dimension of effective treatment?

Previous research has shown that patients who are satisfied with their interactions with a health provider tend to adhere to treatment. This study sets out to investigate the quality of the communication in the interactions between clinic nurses at a Western Cape clinic and newly notified tuberculosis patients. Routine interviews between clinic nurses and tuberculosis patients were video-recorded, transcribed and analysed, using a qualitative instrument devised by the researchers. The interactions were evaluated as being essentially nurse-centred; there was an unequal distribution of control, poor receptivity to the patient and little confirmation of the patient. The nursing staff received a period of training in communication skills. After this training their interviews with patients revealed a significant shift towards a more patient-centred approach, resulting in mutual satisfaction of nurse and patient. Training in communication skills should be introduced at TB clinics, in order to improve patients' adherence to therapy.

Analysis of Variance↗
PubMed1997

Combating tuberculosis--lessons learnt from a rural community project in the Klein Drakenstein area of the Western Cape.

OBJECTIVE: To describe and evaluate a lay worker project designed to enhance the effective control of tuberculosis in a rural/farm setting. DESIGN: A descriptive cohort study using both qualitative and quantitative research methodology. SETTING AND PARTICIPANTS: Farming community in the Klein Drakenstein area of Paarl, Western Cape, with health services provided by the Cape Metropolitan Council. The adherence of patients receiving tuberculosis treatment from 1 January 1993 to 31 December 1995 was analysed. The acceptability of the project was assessed using indepth interviews with key stakeholders. RESULTS: A cohort of 402 tuberculosis patients was included in the study. This cohort was divided into the patients from farms that had participated in the project (intervention group) and those that had not (non-intervention group). The adherence data for children and adults were analysed separately. The adherence rates for children in both groups were the same (RR = 1.00, 95% Cl 0.88-1.14), whereas the adherence rate for the adult intervention group was significantly better than that of the non-intervention group (RR = 1.19, 95% Cl 1.08-1.31). The qualitative component of the investigation indicated a high level of commitment to the intervention from the members of the implementation team, the farm health workers and their employers. The farm health workers described how their role had assisted their communities and had improved their own perceptions of self-efficacy. The close bond that they had developed with the formal health sector had improved the access of the labourers on the farm to primary health care. Although the project had commenced as a tuberculosis initiative, the farm health workers were dealing with a variety of health issues. Their ongoing training was designed to facilitate this development. The formal health sector found their activities facilitated by the easy access that they had with a representative from each farm. The employers were satisfied that the project had increased the cost-effectiveness of their economic endeavours. CONCLUSION: This farm worker project appears to be a model of a well-designed and expertly managed community-based project for tuberculosis control in rural/farm areas.

Adolescent↗
PubMed1997

Shared vision--a health education project designed to enhance adherence to anti-tuberculosis treatment.

SETTING: Two adjacent Cape Town Local Authority health clinics in Cape Town, South Africa, were selected. Clinic A was designated the 'intervention clinic' and Clinic B the 'control clinic.' OBJECTIVE: To assess whether the combined strategy of a patient-centred interview plus the issuing of a patient education booklet would have the effect of increasing the adherence of notified pulmonary tuberculosis (TB) patients to prescribed treatment. DESIGN: A controlled intervention study was implemented using a cohort of the first 60 consecutive patients notified with pulmonary TB at both Clinic A and Clinic B; the patient cohort thus consisted of 120 patients. RESULTS: The risk of patient non-adherence to anti-tuberculosis treatment was significantly reduced at the intervention clinic compared to the control clinic. CONCLUSION: The results of this study indicate the need for further operational research to assist health providers in developing standardised protocols of health education to enhance adherence to treatment in patients who require protracted treatment regimens.

Attitude to Health↗
PubMed1996

Induction of transmitter release at the neuromuscular junction prevents motoneuron death after axotomy in neonatal rats.

Motoneurons to rat hindleg muscles die after neonatal nerve injury. Here we show that increasing transmitter release of motor nerve terminals by treatment with 4-aminopyridine, prior to nerve injury at three days, reduces the extent of motoneuron death. Retrograde labelling of soleus motoneurons was carried out in 10-week-old animals that had their sciatic nerve crushed on one side when they were three days old. Only 20% (+/- 4.2 S.E.M.) of the motoneurons survived the nerve injury. A group of animals similarly injured at three days had their calf muscles treated with 4-aminopyridine at birth, prior to nerve injury. In these animals a significantly higher percentage (51 +/- 6.6% S.E.M.) of soleus motoneurons survived. In order to assess the proportion of surviving alpha-motoneurons only, the number of motor units in both the soleus and extensor digitorum longus muscles was established by following the stepwise increments of twitch tension in response to increasing intensity of stimulation of the respective motor nerve. After nerve injury at three days only 18% (+/- 4.1% S.E.M.) of motor units to soleus and 28.5% (+/- 4.9% S.E.M.) to extensor digitorum longus survived and were able to reinnervate their respective muscles. If the nerve injury was preceded by local application of 4-aminopyridine, then the number of motor units present in the reinnervated muscles was significantly greater, so that in soleus 52.7% (+/- 5.4% S.E.M.) and in extensor digitorum longus 52.1% (+/- 2.4% S.E.M.) of motor units were present. This increase of motoneuron survival was reflected in a smaller weight loss and in a better restoration of force production by the pretreated as compared to untreated muscles on reinnervation after nerve injury. It is suggested that enhancing transmitter release from nerve endings in neonatal animals induces the motoneuron to become more resistant to nerve injury.

4-Aminopyridine↗