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Biomedical subjects

J House

Publications and source records attributed to J House.

At least 19 recordsLinked to original sources
PubMed2002

Rural residents' utilisation of health and visiting specialist health services.

INTRODUCTION AND OBJECTIVES: The purpose of the study was to identify the demographic and health service characteristics impacting on rural residents' utilisation of health and visiting specialist services in Western Australia. METHOD: Focus group discussions were held with an age-stratified, randomly selected group of forty-eight residents in four rural Western Australian towns between May and June 2000. RESULTS: Discussions revealed a preference to use local health services for basic care and to travel for the treatment of major or severe illnesses. The focus group participants supported visiting specialist services, indicating a willingness to use them for consultations, diagnostic and minor procedures. Utilisation of visiting services was conditional on the provision of information on specialist reputation, service outcomes, integration of the service into local facilities, and recommendation by the local general practitioner. CONCLUSION: Numerous factors influence the service-seeking behaviour of rural patients. These factors need to be recognised and considered in the design and promotion of resident and visiting specialist services if the migration for health care is to be rationalised.

Journal Article↗
PubMed2001

Costs of accessing surgical specialists by rural and remote residents.

INTRODUCTION: Access to surgical specialist services by rural and remote residents in Australia is limited. Little information is available on the cost to rural residents of accessing specialist treatment. The aim of the present study was to define the personal costs incurred by country patients in Western Australia when accessing specialist surgical services in a rural or metropolitan setting. METHODS: A random sample of 50 patients who attended a visiting rural surgical service between December 1998 and February 1999 inclusive was recruited. In a structured telephone interview patients were asked 40 non-clinical questions relating to their recent specialist consultation. The cost of accessing these services was determined from time lost from work, distance and travel expenses. The same formula was then applied to estimate the cost of attending a base metropolitan hospital. The need for an accompanying person was determined from a subset of 16 patients who had transferred to metropolitan specialist consultation in the previous 12 months. Average waiting list times for consultations and common surgical procedures for the visiting service were compared with those for a metropolitan-based service. RESULTS: An estimated saving of AU$1,077 was made per specialist consultation when accessing a local rather than a metropolitan service. Savings were observed in travel time, distance travelled, lost income, provision of an escort and waiting time. CONCLUSION: The present study shows that the personal costs and difficulties incurred by rural and remote residents when accessing specialist treatment can be reduced if a visiting specialist service is available.

Adult↗
PubMed2000

Improving basic surgical skills for final year medical students: the value of a rural weekend.

BACKGROUND: Hospitals employing medical graduates often express concern at the inexperience of new interns in basic surgical skills. In self assessment questionnaires, our senior medical students reported little clinical procedural experience. A practical skills workshop was staged in order to set learning goals for the final study year. This gave the students an opportunity to learn, revise and practice basic surgical techniques. METHOD: The Bruce Rock rural community sponsored a surgical camp at the beginning of the academic year. Ninety-five (80%) of the class registered at the workshop, which rotated them through teaching modules, with private study opportunities and the capacity to cater for varied skill levels. Eight teaching stations with multiple access points were provided, and ten mock trauma scenarios were staged to augment the learning process. RESULTS: The teaching weekend was rated by students on an evaluative entrance and exit questionnaire. Sixty-five (73%) students returned questionnaires. They recorded significant improvement (P < 0.05) in their ability to handle the teaching stations. All students had inserted intravenous lines in practice prior to the camp, so the rating change in intravenous line insertion ability was not statistically significant. CONCLUSIONS: The weekend retreat offers students a chance to focus on surgical skills, free from the pressures of a clinical setting or the classroom. The emphasis was on the value of practice and primary skills learning. Students endorsed the camp as relevant, practical and an enjoyable learning experience for basic surgical skills.

Cardiopulmonary Resuscitation↗
PubMed1999

Differentiation of convalescent animals from those vaccinated against foot-and-mouth disease by a peptide ELISA.

We have identified continuous antigenic determinants within the amino acid sequences of the conserved nonstructural region containing proteins 2C and 3ABC of foot-and-mouth disease virus which can distinguish between the sera from vaccinated and infected animals. An ELISA based on a 3B peptide gave a positive reaction with sera from cattle, pigs, sheep and guinea pigs infected with all seven serotypes of the virus, but not with sera from vaccinated animals. In experiments with cattle and pigs to determine the duration of the antibody response, positive reactions were obtained as late as one year after infection. The advantages of using peptides from the nonstructural viral proteins instead of recombinant proteins for differentiating vaccinees from infected animals include their exquisite specificity, nonreactivity with antibodies against host cell-derived proteins (e.g. E. coli and insect cell proteins), and their ease of preparation.

Animals↗
PubMed1999

Asymptomatic carotid artery stenosis associated with peripheral vascular disease: a prospective study.

This study aimed to determine the prevalence of symptomless internal carotid artery stenosis in consecutive patients presenting with peripheral vascular disease. Duplex ultrasound screening of the carotid arteries was used to determine the degree of stenosis. Co-morbidities were recorded together with age, sex and tobacco use. Internal carotid artery stenosis of > 50% was found in 35% of patients. Among these there was > or = 70% stenosis in 18% of patients and of this group 5% had an occluded carotid vessel at first presentation. Males presented with peripheral vascular disease and associated carotid stenoses at a younger age than females. Male smokers had a higher prevalence of stenosis (P = 0.036) but all smokers had developed stenoses 3-5 years before non-smokers. Females with abdominal aortic aneurysms had a greater prevalence of carotid stenosis (P = 0.037), and male aneurysmal disease diminished stenosis prevalence (P = 0.023). Men with an elevated serum creatinine were more likely to have a stenosis (P = 0.019), but not women. The other co-morbidities were not specifically associated with carotid artery stenosis.

Adult↗
PubMed1999

Split flexor pollicus longus tendon transfer for stabilization of the thumb interphalangeal joint: a cadaveric and clinical study.

The split flexor pollicus longus (FPL) tendon transfer is a surgical technique using the radial half of the FPL tendon rerouted dorsally and inserted into the extensor pollicis longus tendon for correction of Froment's sign. A cadaveric model was designed to investigate the effects of the split FPL tendon transfer on pinch strength. Pinch strength was compared for extrinsic thumb flexion (1) without the split FPL and (2) with the split FPL, tensioned at 3 different positions (0 degrees flexion, 30 degrees flexion, and 60 degrees flexion). We report the clinical results of key pinch strength using split FPL tendon transfer as part of thumb reconstruction for 12 thumbs in 10 patients at an average follow-up time of 2 years. The cadaveric study showed no significant difference in pinch force between specimens with or without split FPL transfer or when comparing tensioning at 0 degrees versus 30 degrees versus 60 degrees. Froment's sign wa s reproduced in all cadavers with pinch activation without split FPL transfer and was eliminated in all specimens after the split FPL transfer. In the clinical portion of this study 12 transfers in 10 patients had an average follow-up pinch strength of 33.7 N (range, 18-80 N) and no evidence of Froment's sign. We conclude that the split FPL tendon transfer is an effective method for correction of Froment's sign due to intrinsic paralysis of the thumb.

Adult↗
PubMed1999

The relative cost of outpatient telemedicine services.

OBJECTIVE: This study compares the costs of offering outpatient care to primarily orthopedic and dermatology patients via live, interactive telemedicine to the estimated costs of direct face-to-face care for the same patients. MATERIALS AND METHODS: A simple, yet detailed methodology was used to evaluate the cost of adding telemedicine to a health care delivery system, using a "hub-and-spoke" model located in Minnesota. The costs and cost savings of telemedicine were evaluated from the perspectives of patients, providers, insurers, employers, and society as a whole. Sensitivity analysis was used to investigate the impact of various factors on the model. RESULTS: The variable cost of a telemedicine referral was $144, versus an estimated face-to-face referral cost of $183. Reductions in patient travel costs and in lost employee productivity were the principal benefits of the system. The break-even point, where total costs equal total cost savings, equalled 1,449 consultations annually. Sensitivity analyses indicated that the breakeven point varies from a low of 152 telemedicine consultations for a "best case" scenario to no possible breakeven point for a "worst case" scenario. CONCLUSIONS: At the system's current level of 300 consultations per year, the telemedicine system is estimated to add $45,000 to society's costs of providing medical care for these patients. The additional cost is primarily due to personnel expenses and an increase in the volume of specialty care. Patients see specialists more often due to improved access to care and lower transportation costs. Providers bear the cost while patients and employers enjoy substantial savings.

Ambulatory Care↗
PubMed1998

Developing visiting surgical services for rural and remote Australian communities.

The University Department of Surgery at Queen Elizabeth II Medical Centre (Perth, Western Australia) has undertaken a pilot project to provide surgical services to country communities where no such service exists. Three surgeons undertake a regular schedule of appointments, and are accompanied by final-year medical students to give them experience with common conditions rarely managed in teaching hospitals. The service is supported by a central administrative office and coordinated by a general practitioner, who negotiates with the regional healthcare providers. Patients are referred by their general practitioner, who may work with the surgeon as anaesthetist or surgical assistant.

Ambulatory Surgical Procedures↗
PubMed1998

Surgical treatment of carpal tunnel syndrome and trigger digits in children with mucopolysaccharide storage disorders.

The role of surgical intervention for carpal tunnel syndrome (CTS) and trigger digits in children with mucopolysaccharide storage disorders (MPSDs) has not been clearly defined, particularly as the treatment of the underlying disease has advanced to include bone marrow transplantation. This study reviews our experience in the treatment of CTS and trigger digits in 22 children with MPSDs who were evaluated for CTS by electromyographic (EMG)/nerve conduction velocity (NCV) testing. Seventeen children were diagnosed with CTS by EMG/NCV testing and were treated with bilateral open surgical release with or without flexor tenosynovectomy. The EMG/NCV testing revealed normal results in 5 patients who are subsequently being monitored. Forty-five digits in 8 children were diagnosed clinically with trigger digits. Nineteen digits were treated by annular pulley release alone. Twenty-six digits were treated by annular pulley release with partial flexor digitorum superficialis tendon resection. The average age at the time of hand surgery was 6.3 years, and at the time of follow-up, 9.6 years. Postoperative EMG/NCV testing in 7 children showed 1 with improvement and 6 with normalization. None of the patients undergoing carpal tunnel release went on to develop thenar atrophy or absent sensibility, as has been reported in untreated cases. Patients were evaluated for triggering digits both by preoperative tendon palpation and by intraoperative flexor tendon excursion at the time of open carpal tunnel release. All patients undergoing trigger release had improved active digital flexion seen at the final follow-up visit. Because of the very high incidence of CTS and trigger digits in this population, the authors currently recommend routine screening of EMG/NCV for all children with MPSDs. Early surgical intervention for nerve compression and stenosing flexor tenosynovitis can maximize hand function in these children.

Age Factors↗
PubMed1997

Income dynamics and adult mortality in the United States, 1972 through 1989.

OBJECTIVES: The aim of this study was to examine relationships between income and mortality, focusing on the predictive utility of single-year and multiyear measures of income, the shape of the income gradient in mortality, trends in this gradient over time, the impact of income change on mortality, and the joint effects of income and age, race, and sex on mortality risk. METHODS: Data were taken from the Panel Study of Income Dynamics for the years 1968 through 1989. Fourteen 10-year panels were constructed in which predictors were measured over the first 5 years and vital status over the subsequent 5 years. The panels were pooled and logistic regression was used in the analysis. RESULTS: Income level was a strong predictor of mortality, especially for persons under the age of 65 years. Persistent low income was particularly consequential for mortality. Income instability was also important among middle-income individuals. Single-year and multiyear income measures had comparable predictive power. All effects persisted after adjustment for education and initial health status. CONCLUSIONS: The issues of low income and income instability should be addressed in population health policy.

Black or African American↗
PubMed1996

Fulminant hepatic failure associated with oral administration of diazepam in 11 cats.

Acute fulminant hepatic necrosis was associated with repeated oral administration of diazepam (1.25 to 2 mg, PO, q 24 or 12 h), prescribed for behavioral modification or to facilitate urination. Five of 11 cats became lethargic, atactic, and anorectic within 96 hours of initial treatment. All cats became jaundiced during the first 11 days of illness. Serum biochemical analysis revealed profoundly high alanine transaminase and aspartate transaminase activities. Results of coagulation tests in 3 cats revealed marked abnormalities. Ten cats died or were euthanatized within 15 days of initial drug administration, and only 1 cat survived. Histologic evaluation of hepatic tissue specimens from each cat revealed florid centrilobular hepatic necrosis, profound biliary ductule proliferation and hyperplasia, and suppurative intraductal inflammation. Idiosyncratic hepatotoxicosis was suspected because of the rarity of this condition. Prior sensitization to diazepam was possible in only 1 cat, and consistent risk factors that could explain susceptibility to drug toxicosis were not identified. On the basis of the presumption that diazepam was hepatotoxic in these cats, an increase in serum transaminase activity within 5 days of treatment initiation indicates a need to suspend drug administration and to provide supportive care.

Animals↗
PubMed1995

African horse sickness and African carnivores.

African horse sickness (AHS) is a disease that affects equids, and is principally transmitted by Culicoides spp. that are biological vectors of AHS viruses (AHSV). The repeated spread of AHSV from sub-Saharan Africa to the Middle East, northern Africa and the Iberian peninsula indicate that a better understanding of AHS epizootiology is needed. African horse sickness has long been known to infect and cause mortality among domestic dogs that ingest virus contaminated meat, but it is uncertain what role carnivores play in transmission of the virus. We present evidence of widespread natural AHS infection among a diversity of African carnivore species. We hypothesize that such infection resulted from ingestion of meat and organs from AHS-infected prey species. The effect of AHS on the carnivores is unknown, as is their role in the maintenance cycle of the disease.

Africa↗
PubMed1993

Synthetic prostaglandin E1 misoprostol as a treatment for tinnitus.

OBJECTIVE: A pilot study to determine if the synthetic prostaglandin E1 misoprostol is effective in treating severe tinnitus, to test the hypothesis that tinnitus production is related to prostaglandin metabolism. DESIGN: Blinded, placebo controlled, hemicrossover. SETTING: House Ear Clinic, Los Angeles, Calif. PATIENTS: A volunteer and convenience sample of 24 subjects complaining of severe tinnitus was recruited from mailings, telephone calls, and the clinic population. The patients were not preselected except to be in otherwise good health. INTERVENTION: Subjects were started on a regimen of placebo or 200 micrograms/d of misoprostol. The dosage was increased every 5 days by 200 micrograms until a total of 800 micrograms/d was achieved. After 1 month of drug administration, the placebo group was crossed over to the active drug phase. MAIN OUTCOME MEASURES: Outcome was measured in terms of subjective reports of tinnitus severity, sleep patterns, and ability to concentrate. RESULTS: Eight (33%) of the 24 patients reported improvement during the active drug phase. There were no placebo responders. Responders reported improvement in tinnitus severity, sleep, and concentration. CONCLUSIONS: Findings support the contention that prostaglandins may be useful in the treatment of tinnitus. Further studies with larger samples are needed before widespread use of this intervention can be recommended.

Adult↗
PubMed1993

Sensibility deficiencies in the hands of children with spastic hemiplegia.

We evaluated 40 children with spastic hemiplegia due to cerebral palsy for sensory function and relative limb size in the affected and unaffected upper extremities. Sensory function of each limb was evaluated with respect to stereognosis (12 objects), two-point discrimination, and proprioception. Four size measurements of each limb were made: arm and forearm circumference and forearm and forearm-hand length. This study showed that 97% of the spastic limbs had a stereognosis deficit, 90% had a two-point discrimination deficit, and 46% had a proprioception deficit. Thus sensory deficits are the rule rather than the exception in children with spastic hemiplegia. Those children with severe stereognosis deficits had significantly smaller limbs in all four measurement parameters than the children with mild or moderate stereognosis deficits. In the preoperative evaluation of children with spastic hemiplegia, severe size discrepancy is a physical examination tool that can be used as a predictor of severe sensory deficits. This information is helpful for the hand surgeon in establishing realistic surgical goals.

Anthropometry↗
PubMed1993

Safety and immunogenicity of a combined hepatitis B virus-Haemophilus influenzae type B vaccine formulation in healthy adults.

We administered a combined preparation of hepatitis B virus (HBV) vaccine and Haemophilus influenzae type b (Hib) conjugate vaccine (meningococcal protein conjugate) to 20 healthy adult volunteers. Participants received two doses of vaccine one month apart, and had serum samples drawn each time they received the vaccine and 1 month after the second dose. In 18 of 19 persons who were positive for antibody to hepatitis B surface antigen (anti-HBs), these levels had a median fold increase of 23.4 (range 0.69 to 270) 1 month after the first dose of vaccine. Anti-HBs levels generally fell slightly one month after the second dose was given. All of the study participants initially had detectable levels of antibody to Hib capsular polysaccharide (anti-PRP), and 19 of the 20 exhibited a median fold increase of 11.2 (range 0.81 to 740) in anti-PRP 1 month after vaccination. Over half (65%) continued to demonstrate increased levels of anti-PRP with the second dose of vaccine. Most participants experienced some slight to moderate discomfort at the injection site. The results indicate that the combined Hib/HBV vaccine produces increased antibody levels in healthy adults who have previously been exposed to these two antigens.

Adult↗
PubMed1990

Evidence of identification of peste des petits ruminants from goats in Egypt.

Peste des petits ruminants virus was isolated from young goats in an outbreak of the disease for the first time in Egypt. Affected goats showed symptoms simulating rinderpest, disease in cattle. The mortality rate was about 30%, and morbidity reached 90%. History, clinical symptoms, postmortem lesions, and diagnosis were discussed.

Animals↗