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Biomedical subjects

J Read

Publications and source records attributed to J Read.

At least 55 records · Page 3Linked to original sources
PubMed1997

Integrated mental health care: practitioners' perspectives.

OBJECTIVE: Integrated mental health care (IMHC) is a community-based model that considers the patient and informal carers to be the major contributors to stable recovery from severe mental health problems. This study investigates the implementation of IMHC by 35 New Zealand practitioners 1 year after being trained in the model. It also explores their experiences and perceptions regarding the model. METHOD: Quantitative and qualitative data were gathered by combining a questionnaire survey with in-depth interviews. RESULTS: Few of the trainees had been able to implement the model as much as they would have liked. A primary barrier to implementation was created by the resource constraints that impede most innovative community care initiatives even when demonstrated to be more cost-effective than traditional hospital-based approaches. Concerns particular to IMHC included issues relating to flexibility, time-intensiveness and applicability to New Zealand. Many practitioners found some of the specific intervention strategies and the clear overall structure of the model useful. Its psychosocial emphasis had a positive impact on many practitioners' beliefs about the causes and prognosis of severe mental health problems. CONCLUSIONS: Participants offer a range of recommendations as to how IMHC might be applied and adapted. Consultation with staff, consumers, families and Maori, as well as a strengthening of the psychosocial components, are recommended.

Attitude of Health Personnel↗
PubMed1995

Mutations of the microsomal triglyceride-transfer-protein gene in abetalipoproteinemia.

Elevated plasma levels of apolipoprotein B (apoB)-containing lipoproteins constitute a major risk factor for the development of coronary heart disease. In the rare recessively inherited disorder abetalipoproteinemia (ABL) the production of apoB-containing lipoproteins is abolished, despite no abnormality of the apoB gene. In the current study we have characterized the gene encoding a microsomal triglyceride-transfer protein (MTP), localized to chromosome 4q22-24, and have identified a mutation of the MTP gene in both alleles of all individuals in a cohort of eight patients with classical ABL. Each mutant allele is predicted to encode a truncated form of MTP with a variable number of aberrant amino acids at its C-terminal end. Expression of genetically engineered forms of MTP in Cos-1 cells indicates that the C-terminal portion of MTP is necessary for triglyceride-transfer activity. Deletion of 20 amino acids from the carboxyl terminus of the 894-amino-acid protein and a missense mutation of cysteine 878 to serine both abolished activity. These results establish that defects of the MTP gene are the predominant, if not sole, cause of hereditary ABL and that an intact carboxyl terminus is necessary for activity.

Abetalipoproteinemia↗
PubMed1995

Read Codes Version 3: a user led terminology.

Version 3 of the Read Codes was designed in response to a new set of requirements generated by three new terming initiatives in the UK, the Clinical Terms Project, the Professions Allied to Medicine Terms Project and the Nursing Terms Project. The challenge was to cope with the detail required by clinical specialists for maintaining a computerised record, to capture the natural language used by clinicians in their everyday work, and to support efficient analysis across medical records required to extract information from clinicians' individual patient data. The structure of Version 3 allows a directed acyclic graph to replace the traditional hierarchy; permits multiple such graphs if necessary; introduces qualifiers, embedding these in an information model to support analysis; introduces one-to-many mapping to external classifications where this is necessary; and maintains the tradition of a dynamic terminology that stresses the inclusion of natural clinical terms.

Artificial Intelligence↗
PubMed1994

Interaction between baricity (glucose concentration) and other factors influencing intrathecal drug spread.

The effects of intrathecal injection of 0.5% bupivacaine in solutions containing various concentrations of glucose have been studied in four groups of 20 patients. When solutions containing 0.8% glucose were injected at the L3-4 interspace the median maximum extent of block was higher, and the range of blocks wider, with the 8% solutions. All patients receiving 0.8% glucose had blocks between the T5 and T10 dermatomes, confirming previous work on the benefits of this concentration of glucose. In the two other groups 0.5% bupivacaine containing 0 or 0.8% glucose was injected at the L2-3 interspace. In both groups of patients a wider range of blocks, with a median maximum extent that was higher, was produced. These results demonstrate how glucose concentration may be used to influence the spread of intrathecal solutions and how other factors can obscure the effect of glucose concentration.

Aged↗
PubMed1991

The generation of neurons and oligodendrocytes from a common precursor cell.

We have used a recombinant retrovirus carrying the lacZ gene to study the developmental potential of precursor cells from the embryonic rat cerebral cortex in dissociated cell culture. Virus was used to label a small number of cultured cells genetically so that their fate could be determined. Infected clones were detected with an anti-beta-galactosidase serum, and the labeled cells were identified using monoclonal antibodies. The results revealed that most precursor cells generated a single cell type, the majority being either neurons or oligodendrocytes. However, a proportion of the neuronal clones also included oligodendrocytes. This proportion increased until embryonic day 16 when 18% of the neuronal clones were of this type. This suggests that during neurogenesis in the cerebral cortex there exists a cell with the potential to generate these two quite different neural cell types.

Animals↗
PubMed1991

Multicenter study of superficial bladder cancer treated with intravesical bacillus Calmette-Guerin or adriamycin. Results of long-term follow-up.

We evaluated 158 cases of patients with superficial bladder cancers (Stages Ta, T1, and Tis). These cases were treated with either intravesical bacillus Calmette-Guerin (BCG) (Tice strain) or Adriamycin (ADR), in a multicenter, nonrandomized study. One hundred thirty-one of these patients were followed up; the results continue to show a higher percentage of initial complete remissions with BCG (68%) than with ADR (57%). With additional therapy, both BCG and ADR achieved complete remission in 83 percent of the patients. When 7 failures with patients taking ADR were switched to BCG and the disease cleared, the rate of complete remission for BCG rose to 85 percent. The recurrence rate per 100 patient-months was only slightly different for BCG (0.9) and ADR (0.8). The percentage of progressions continued to be higher for BCG (8%) than for ADR (5%). Cystectomies were performed in 2.5 percent of the BCG patients. Using the Cox regression model with covariates, we found drug treatment, tumor grade, and sex to be statistically significant in determining failures throughout the protocol. Although both BCG and ADR were effective over the course of the study, BCG is the drug of choice for residual tumor (Stages T1 and Tis).

Administration, Intravesical↗
PubMed1990

Multicenter study of superficial bladder cancer treated with intravesical bacillus Calmette-Guérin or adriamycin.

We evaluated 155 patients with superficial bladder cancers (Stages Ta, T1, and TIS) and treated them with either intravesical bacillus Calmette-Guérin (Tice strain) (BCG) or doxorubicin hydrochloride (Adriamycin), in a multicenter nonrandomized study. At present 140 of these patients in treatment Groups I and II are being followed up. With additional follow-up, BCG continued to produce a higher percentage of complete remissions (71%) than doxorubicin (54%). The percentage of incomplete remission with BCG (7%) was half that with doxorubicin (14%). Half of the patients whose initial therapy failed had complete remission after additional therapy. However, for patients with recurrence, additional follow-up shows a recurrence rate per 100 patient-months for BCG (1.0) only slightly lower than that for doxorubicin (1.1). The percentage of progressions continued to be higher with BCG (8.5%) than with doxorubicin (5%), but the difference between these results for the two drugs proved slightly less than we reported previously. Of the patients in this study, 2.5 percent (all treated with BCG) required cystectomy. A comparison of the results of our study with those of 13 other studies using BCG to treat bladder cancer indicates that therapy beyond an initial course of 6 weekly treatments increases the percentage of complete response. All of the studies showed that the greatest improvement in percentage of complete response occurred with the second course of treatment. The value of maintenance therapy cannot yet be determined, since few studies have used that protocol. The percentage of patients requiring cystectomy in studies with fewer than 20 treatments was 2.2 times higher than in studies with more than 20 treatments.

Administration, Intravesical↗
PubMed1989

Hydrops fetalis and premature closure of the ductus arteriosus: a review.

The purpose of this report is to describe a case of nonimmune hydrops fetalis that resulted from an unusual congenital heart defect, premature closure of the ductus arteriosus. In this fetus, the ductal closure was not associated with other heart defects such as tetralogy of Fallot or truncus arteriosus, nor was it related to maternal use of nonsteroidal antiinflammatory agents. Despite adequate digitalization of the mother, the fetus died of congestive heart failure at 29 weeks of gestation. Autopsy confirmed stricture of the ductus in association with enlargement of the foramen ovale and marked dilation of the right atrium and main pulmonary artery.

Adult↗
PubMed1988

Cotton-wool spots in acquired immunodeficiency syndrome compared with diabetes mellitus, systemic hypertension, and central retinal vein occlusion.

The cotton-wool spot is a common fundus finding in patients with many ocular and systemic diseases. We investigated the characteristics of cotton-wool spots in patients with four major diseases, ie, acquired immunodeficiency syndrome, diabetes mellitus, systemic hypertension, and central retinal vein occlusion, to see if any differences were detected in their number, size, or location. A composite of all the cotton-wool spots for each of these four categories was obtained by computed reconstruction to analyze variations in their distribution and size. The cotton-wool spots had a predilection for the temporal quadrants in the four categories and were smaller in patients with acquired immunodeficiency syndrome than the other groups. Patients with ischemic central retinal vein occlusion had more cotton-wool spots than the other groups. No other definite differences were detected. Cotton-wool spots than the other groups. No other definite differences were detected. Cotton-wool spots seem to be a common pathway following various insults to the retina, most probably of a vaso-occlusive origin.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Superficial bladder cancer treated with intravesical bacillus Calmette-Guérin or adriamycin: follow-up report.

We evaluated 139 patients with superficial bladder cancer (Stages Ta, Tl, and TIS) and treated them with either intravesical bacillus Calmette-Guérin, Tice strain (BCG), or doxorubicin hydrochloride (Adriamycin [ADR]) in a nonrandomized, multicenter study. Our follow-up study comprises 135 of these patients. Of these patients, 78 tumors were completely resected, and 61 were incompletely resected. When a proportional-hazards model (Cox) was applied, there was a statistically significant difference between the recurrence rates for the two drugs. On the basis of recurrence rates per 100 patient-months, both BCG (1.2) and ADR (0.9) worked well with completely resected tumors. However, for incomplete resections, the recurrence rate for BCG (0.9) was less than half that for ADR (1.9). The overall recurrence rates were 1.1 and 1.3 for BCG and ADR, respectively. There have been 42 failures of treatment with either BCG or ADR. We defined failure as any recurrence of tumor; progression of the cancer in stage, grade, tumor number or size; or any residual tumor after 18 treatments (14 months of therapy). As to the failures in patients whom we followed up, and whose treatment was either switched from ADR to BCG or continued on further BCG treatment, 53 per cent have achieved complete remission. Complete remission for BCG and ADR were 76 per cent and 52 per cent, respectively. Of the various factors considered in the study, only tumor grade and treatment drug were statistically significant. The cystectomy rate was 1 per cent for BCG-treated patients and 0 for ADR-treated patients.

Administration, Intravesical↗
PubMed1988

Does bacillus Calmette-Guérin immunotherapy accelerate growth and cause metastatic spread of second primary malignancy?

In our study, 29 of 150 patients with bladder cancer also had other associated primary malignancies, 10 of which were manifested after intravesical treatment with bacillus Calmette-Guérin (BCG). Second primary malignancies developed in 5 of these patients within three months of the start of BCG therapy. All 5 showed acceleration of the second primary tumor, and distant metastatic lesions developed in 4. In the other 5 patients nonbladder primary malignancies developed eight months or more after intravesical BCG therapy started, but did not show acceleration or spread. Twenty patients with other primary malignancies that had developed months to years before intravesical therapy did not show acceleration or spread of those tumors. We have seen enough cases of patients who received intravesical BCG at the time of growth and spread of second primary malignancies to warrant concern. Animal and human studies of BCG use for treatment of malignancy indicate that the temporal relationship between the starting point of tumor development and the starting point of BCG treatment is crucial in determining whether BCG will eradicate or exacerbate the tumor. We have therefore instituted a change in our treatment until the question of whether or not BCG causes the appearance and spread of these second malignancies is answered.

Administration, Intravesical↗