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Biomedical subjects

J M Lowe

Publications and source records attributed to J M Lowe.

At least 19 recordsLinked to original sources
PubMed2005

An evaluation of the Cobra Perilaryngeal Airway: study halted after two cases of pulmonary aspiration.

The Cobra Perilaryngeal Airway (Engineered Medical Systems, Indianapolis, IN) is a new supraglottic airway designed for spontaneous and controlled ventilation. It is not yet commercially available in the UK. Our aim was to evaluate the performance of the Cobra Perilaryngeal Airway in a cohort study and in a randomised, controlled, crossover comparison study with the Classic Laryngeal Mask Airway. After studying 29 patients, both studies were suspended and later stopped after two cases of significant pulmonary aspiration had occurred in patients whilst using the Cobra Perilaryngeal Airway. These cases raised concern about both the design and the safety of the Cobra Perilaryngeal Airway, particularly during controlled ventilation. We suggest that the Cobra Perilaryngeal Airway should not be marketed for controlled ventilation until more safety data are available.

Adult↗
PubMed2005

Trends in health service use for women in Australia with diabetes.

OBJECTIVE: To describe the health, health service use and use of recommended guidelines for care for women in Australia with diabetes. METHODS: Analysis of survey data 1996-99 from the Australian Longitudinal Study on Women's Health, linked with Medicare data for 1997-2001. Participants were 12,338 mid-age women aged 45-50 years in 1996 (1.9% with diabetes) and 10,421 older women aged 70-75 years at Survey 1 in 1996 (8.1% with diabetes). The outcome measures were number of general practice and specialist visits and use of glycosylated haemoglobin (HbAlc), lipids and microalbuminuria tests. RESULTS: Women with diabetes at Survey 1, and those diagnosed by Survey 2, were more likely to have hypertension, heart disease and eyesight problems, have high rates of polypharmacy (four or more medications: mid age 32%, older 64%) and more consultations with general practitioners and specialists than women without diabetes. During 1997-2001, there was a trend for a greater percentage of women with diabetes to have an HbA1c test at least annually (mid age 44%-52%, older age 46%-58%). Rates of testing microalbuminuria and lipids also increased but were far from conforming to guidelines. Having more frequent consultations with a general practitioner was significantly associated with having all three recommended tests. CONCLUSIONS: There is an increasing use of services by women with diabetes, in part due to an increase in compliance with guidelines for the management of diabetes. IMPLICATIONS: Linked health and administrative data provide a means to monitor health service utilisation, adherence to principles for best practice care and issues of equity in care.

Adolescent↗
PubMed2001

Community-based health improvement: lessons from the Learning for Action Institute, Simmons College.

The Learning for Action Institute at the Graduate School for Health Studies, Simmons College, uses continuous quality improvement concepts and methods to help community-based groups to make positive change. Eight core concepts are the basis for creating sustainable improvements, developing new models for community capacity, and building and disseminating knowledge of what has been learned. These concepts are: clarify the aim, form the right team, target improvement efforts, use data, listen to the customer, use tools and methods, conduct improvement and learning cycles, and make improvements. Two community-based projects are used to illustrate the concepts.

Academies and Institutes↗
PubMed2001

School-based health centers as a locus for community health improvement.

School-based health centers are critical resources for providing and coordinating health and medical services for children and adolescents. As such, they are an increasingly important component in a strategy to meet the comprehensive health, social, and educational needs of students and families. We show how educators and health professionals, using the language, methods and principles of continuous improvement, can collaborate effectively in addressing the specific concerns of school attendance and teen smoking.

Adolescent↗
PubMed2000

Needle diameter in outpatient myelography: rates of adverse effects and current practice trends.

Telephone calls were made to 1251 consecutive patients one day following outpatient myelography. Data were available on 518 patients punctured with 22-gauge (g) (large-diameter) and 465 with 25-g (small-diameter) spinal needles. We surveyed 48 academic and private practice groups regarding needle diameter use in myelography; data were obtained from 34 private practice and 14 academic radiology departments. Patients reported adverse effects including mild and severe headache, back pain and nausea. The percentage of total adverse effects was significantly greater in the 22-g than in the 25-g needle group. The percentage of patients with headache was higher in the 22-g than in the 25-g group, but this difference was not statistically significant. Only 19% of private practice groups and 17% of academic centers use 25-g needles; the remainder use 20-g or 22-g needles.

Adult↗
PubMed1998

Management and outcomes of congestive heart failure: a prospective study of hospitalised patients.

OBJECTIVES: To characterise the morbidity, mortality and patterns of care for patients hospitalised with congestive heart failure (CHF). DESIGN: Prospective cohort study with one-year follow-up. PATIENTS: 409 patients aged 60 years and over admitted to hospital with congestive heart failure between 1 May and 30 November 1993. SETTING: John Hunter Hospital (tertiary referral for cardiology) and Mater Hospital (non-tertiary referral for cardiology), Newcastle, New South Wales. OUTCOME MEASURES: Length of hospital stay (LOS); unplanned readmissions; mortality at 28 days and one year; and relationship between outcomes and patient and disease characteristics determined by multivariate analysis. RESULTS: Annual hospitalisation rate for CHF in the 60 years and over age group was 783/100,000, with CHF accounting for 10.9% of patients in this age group. Median LOS was eight days, and varied significantly between hospitals. ACE inhibitors were being taken by 66% of subjects at discharge. Rate of unplanned readmissions within 28 days was 20%. Mortality was 12.5% at 28 days and 33% at one year. For a first admission for CHF, 28-day mortality was lower than for readmissions (odds ratio, 0.25; 95% confidence interval, 0.1-0.62), and average LOS was 17% lower. Increasing age and renal impairment were significantly associated with higher one-year mortality. Greater comorbidity was associated significantly with longer LOS and non-significantly with higher 28-day and one-year mortality. CONCLUSIONS: CHF is a common reason for admission, often results in unplanned readmissions, and has a high mortality. Undertreatment with ACE inhibitors continues. The importance of avoiding recurrent admissions was clear. A program of intensive case management may reduce the burden attributable to CHF.

Aged↗
PubMed1997

Evaluation of a diabetes education program in Newcastle, NSW.

OBJECTIVE: To assess the level of coverage and effectiveness of diabetes education provided by the Newcastle Diabetes Education and Stabilisation Centre (DESC) to people taking insulin. RESEARCH DESIGN AND METHODS: A community based survey of people presenting a prescription for insulin to retail pharmacies in the Hunter Region. The study characterised participants and non-participants in the DESC program by social and demographic factors and assessed the knowledge, blood glucose control and symptoms of diabetic complications they reported. The study also assessed their attitude towards diabetes and diabetic self-care and their feelings towards and use of clinical services. RESULTS: There were 229 respondents, 75% had attended the DESC course, however single males living in rural areas were significantly less likely to attend. Course attenders were more likely to do blood tests and visit an ophthalmologist and podiatrist than non-attenders, but were not more knowledgable about diabetes or reported fewer complications. Despite high levels of use of health care services including eye care, by people with diabetes, and an overall positive attitude to diabetes management, the study revealed a widespread ignorance of the serious consequences of diabetes. CONCLUSIONS: People with diabetes taking insulin in the Hunter Region have an overall positive attitude to diabetes and a high level of participation in a formal diabetes education program. Attendance was associated with increased use of eye care and foot care services, despite little demonstrable effect on knowledge or self-reported diabetes control.

Adult↗
PubMed1996

Modulation by glucose of insulin secretion and glucose phosphorylating activity in cultured pancreatic islets from obese (fa/fa) Zucker rats.

OBJECTIVE: In normal B-cells, glucokinase activity is regulated by glucose. We hypothesized that chronic exposure to low or high glucose levels would regulate glucokinase function and insulin secretion differently in islets of fa/fa compared with lean rats. SUBJECTS, DESIGN, and MEASUREMENTS: Islets isolated from lean and fa/fa rats (8-12 wk old) were cultured for 1-7 days in low (3.3 mM), moderate (12.5 mM) or supraphysiological (25.0 mM) glucose-supplemented medium. Sensitivity to glucose of hexokinase, glucokinase (by enzyme assay and kinetic analysis), and the insulin response (by radioimmunoassay) were assessed in each group of islets. RESULTS: Islets of fa/fa rats cultured in 12.5 mM glucose for 1-7 days demonstrated a left-shift in both the EC50 of the insulin response and the Km of glucokinase to glucose. The glucokinase Vmax of fa/fa rat islets was lower under all conditions tested, thereby limiting the potential increase in insulin secretion. When cultured in 3.3 mM glucose for 1-7 days, fa/fa rat islets retained responsiveness to glucose longer and the estimated EC50 for glucose actually declined. However, the glucokinase Km for glucose increased three-fold in both phenotypes cultured in low glucose. Lean and fa/fa rat islets cultured in 25.0 mM glucose demonstrated a paradoxical hypersecretion of insulin to basal glucose concentrations and desensitization to stimulation by high concentrations of glucose. Islets from fa/fa rats were more easily desensitized, with significant effects in 25.0 mM glucose by 3 days compared with 7 days for the lean rat islets. Culture in high glucose erased the phenotype differences in glucokinase Km that were observed in 12.5 mM glucose cultured islets. CONCLUSIONS: Differences in fa/fa rat islet glucokinase were observed only at moderate, near physiological glucose conditions. Glucokinase activity was similarly affected by low or high glucose in the two phenotypes, although differences in insulin secretion pattern were still detected, leading to the conclusion that factors other than glucokinase contribute to altered insulin secretion in the fa/fa rat. Further study of the glucose desensitization phenomenon in fa/fa rat islets might help unravel the factors that increase susceptibility to development of diabetes mellitus in some phenotypes.

Animals↗
PubMed1984

Seven years experience of home management in pregnancy in women with insulin-dependent diabetes.

Fifty-eight of a consecutive series of 75 pregnancies in women with insulin-dependent diabetes went into the third trimester. Diabetes was managed by home blood glucose monitoring and women were not routinely admitted at any stage before delivery. The mean number of in-patient days before delivery was 15 for the whole series but has been reduced to 9 during the past four years. Each woman performed an average of 171 blood glucose measurements during her pregnancy. Mean blood glucose (including post-prandial levels) fell significantly from 7.9 mmol/l in the first trimester to 7.3 in the second and 6.4 in the third. Mean percentage of haemoglobin A1 was within the normal range in the second and third trimesters. The cesarean section rate was high at 66% but there were no perinatal deaths. Three infants had congenital abnormalities. We conclude that home blood glucose monitoring is a safe and effective way of managing pregnant diabetic women as out-patients. The cost of meters and sticks is repaid many times over in the saving of hospital costs. In addition, home blood glucose monitoring is popular with the patients and many choose to continue it after delivery.

Blood Glucose↗
PubMed1981

The changing pattern of toxicity of digoxin.

Toxicity to digoxin was monitored in 437 consecutive recipients in a comprehensive drug surveillance programme, Adverse reactions developed in 19.5% and, in contrast to previous reports, were generally of a relatively benign nature. There were no drug-related deaths, but patients with adverse reactions spent longer in hospital. Low body weight, impaired renal function, old age and concurrent use of diuretics individually did not increase the risk of toxicity. This was attributed to improvements in the prescribing of digoxin. There was a highly significant excess of gastrointestinal reactions in women, which tended to occur early in the course of therapy. This susceptibility is not widely recognized. The use of loading doses may have caused many early reactions and it is suggested that this practice cold be abandoned in all but the most urgent cases.

Age Factors↗
PubMed1981

Contract management of health care facilities: structural models.

Increasing numbers of hospitals and other health care facilities are evaluating various forms of contract management. Three models of health care facility contract management are the operating division, the wholly owned subsidiary and the shared or joint management models.

Contract Services↗
PubMed1980

Blood viscosity in young male diabetics with and without retinopathy.

Blood viscosity (shear rates 100s-1 and 0.94s-1) and several of its major determinants (haematocrit, plasma fibrinogen and plasma viscosity) have been measured in 38 male insulin-treated diabetics, aged 18-50 years, and in 38 non-diabetic control subjects matched for age and smoking habit. Diabetics without fundoscopic retinopathy (n=20) had higher mean blood viscosity than controls at the high shear rate (7.07 cP vs 6.75 cP, p < 0.05) and the low shear rate (21.2 cP vs 18.7 cP, p < 0.025). These differences persisted after correction of blood viscosity to a standard haematocrit, and were associated with increased plasma viscosity (1.41 cP vs 1.34 cP, p < 0.025) and plasma fibrinogen (2.9 g/L vs. 2.5 g/L, p < 0.025). Diabetics with retinopathy (n = 18) had higher mean blood viscosity than diabetics without retinopathy at the high shear rate (7.53 cP vs 7.07 cP, p < 0.05) and the low shear rate (24.3 cP vs. 21.2 cP, p < 0.05), associated with a higher haematocrit (p < 0.05). Blood viscosity and haematocrit correlated with the duration of diabetes (r > 0.32, p < 0.05).

Adolescent↗
PubMed1979

Fellowships offer expanded views of the health care world.

The authors briefly describe three fellowships that are currently available to health administration graduates. They also make some important observations about the usefulness of such fellowships and offer suggestions regarding fellowships in various key areas of the field of health care administration.

Education, Graduate↗