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Biomedical subjects

J Shaw

Publications and source records attributed to J Shaw.

At least 37 records · Page 2Linked to original sources
PubMed2003

Error reduction: academic detailing as a method to reduce incorrect prescriptions.

OBJECTIVES: Clinical decision making can be influenced by academic detailing, and it was hypothesised that this technique may be used to reduce simple errors when prescribing drugs of addiction. These prescriptions require specific details to be included, otherwise the prescription has to be returned to the prescriber and re-written, wasting the time of the dispenser and prescriber alike. METHODS: The legal requirements for the prescription of addictive drugs were used to define prescription errors. Prescription error rates at six hospitals were assessed, including a control and an intervention hospital where academic detailing was carried out. Prescription error rates were documented before and after an academic detailing visit to junior doctors, including the provision of a bookmark containing the requirements for these drugs. These errors were expressed as a percentage of the total written for a 4-week period. RESULTS: At the intervention hospital, there was a significant decrease in error rate (from 41% to 24%, P<0.0001) with an improvement in all the requirements stated on the bookmark. At this hospital, the confidence of the junior doctors on a self-rating 5-point scale in writing prescriptions for these drugs increased from a mean of 3.25 (95% CI 2.92-3.58) to 4.14 (95%CI 3.90-4.38) after the intervention (P=0.03). The baseline error rates at the other hospitals ranged from 25% to 46%, but the control hospital did not show a significant change in error rate over the same study period ( P=0.66). A post-hoc review suggested that liquid preparations were more difficult to prescribe correctly, which in part accounted for the differences in error rate between hospitals. CONCLUSIONS: Academic detailing appears to be a useful method of reducing erroneous hospital prescriptions; and, to our knowledge, this is a novel finding.

Analgesics, Opioid↗
PubMed2003

Analysis of the regional pulse wave velocity by Doppler: methodology and reproducibility.

Increased arterial stiffness is observed in a number of cases. The analysis of the regional functional arterial properties is of interest to determine the role of a given risk factor on the vascular wall and in some diseases such as atherosclerosis. We analysed the pulse wave velocity (PWV) measured by the Doppler method with 2D guidance and its reproducibility in different arterial segments in 15 men with coronary artery disease. Regional Doppler PWV was defined as the distance between the extremities of a given segment divided by the transit time calculated by Doppler. Intra- and interobserver reproducibilities of the Doppler measurements were studied in all of the subjects. The variation coefficients were low, maximum at the level of ascending aorta and minimal at the level of iliac segment. This good reproducibility was validated by the Bland-Altman method. Moreover, using this Doppler technique, we found a progressive increase in PWV from the ascending aorta to the iliac segment. These data demonstrate that noninvasive Doppler analysis is a feasible and reproducible method to determine regional PWV.

Aged↗
PubMed2003

Asthma management by New Zealand pharmacists: a pharmaceutical care demonstration project.

BACKGROUND: Pharmaceutical care services became recognized in New Zealand in the mid-1990s, albeit with limited evidence of the acceptability and effectiveness of the model. An asthma-specific pharmaceutical care service was trialled in southern New Zealand, based on a 'problem-action-outcome' method, with pharmacists adopting a patient-centred, outcome-focused approach with multidisciplinary consultation. OBJECTIVE: To report on the implementation and outcomes of a specialist asthma service offered by community pharmacists. DESIGN: Pharmacists in five pharmacies, servicing predominantly rural, established clientele, received training in the asthma service and research documentation. Ten patients per pharmacy were recruited in each year (years 1 and 2) of the study. The patients were entered into the study in cohorts of five per pharmacy twice yearly, with year 2 mirroring year 1. The phase-in design minimized the impact on the pharmacists. The patients acted as their own controls. All patients received individualized care and had approximately monthly consultations with the pharmacist, with clinical and quality of life (QoL) monitoring. RESULTS: A total of 100 patients were recruited. On average, 4.3 medication-related problems were identified per patient; two-thirds of them were compliance-related. The most common interventions were revision of patients' asthma action plans, referral and medication counselling. Clinical outcomes included reduced bronchodilator use and improved symptom control in around two-thirds of patients. Asthma-specific QoL changes were more positive and correlated well with clinical indicators. CONCLUSION: Further research is warranted to integrate this service into daily practice. Clinical outcomes were generally positive and supported by QoL indicators. Characteristics of New Zealand practice and this sample of pharmacies may limit the generalizability of these findings.

Adolescent↗
PubMed2003

Preventing Type 2 diabetes and the dysmetabolic syndrome in the real world: a realistic view.

The last two decades have seen an explosive increase in the number of people with diabetes globally. There is now an urgent need for strategies to prevent the emerging global epidemic. Several recent successful intervention studies, both lifestyle and pharmacological, targeting subjects with impaired glucose tolerance (IGT) have stimulated enthusiasm for prevention of Type 2 diabetes. Lifestyle interventions reduced the incidence of diabetes by over 50% in the Finnish Diabetes Prevention Study and the Diabetes Prevention Program. Can the findings of these two studies be applied globally? Underpinning the enthusiasm, there needs to be a realistic approach to interventions in both developed and developing nations, and in ethnic groups where a better understanding of the socio-economic, cultural and demographic issues and perceptions surrounding chronic diseases such as diabetes is required. Whether the strategies used in these two studies can be translated into a 'real world' scenario is doubtful. In practice, it is more than likely that a number of strategies will be needed to compliment the lifestyle approach. These will include pharmacological approaches with metformin, acarbose and other agents used to treat diabetes and its complications, currently under investigation. Longer-term follow-up studies will also clarify whether both lifestyle and pharmacological interventions actually prevent Type 2 diabetes, or merely delay its onset.

Diabetes Mellitus, Type 2↗
PubMed2003

In vitro maturation of oocytes from non-stimulated common wombats.

Assisted reproductive techniques, such as in vitro oocyte maturation in conjunction with in vitro fertilisation, may be used as a tool to manipulate reproduction. Using the common wombat as a model for the critically endangered northern hairy-nosed wombat, the present study examined whether oocyte maturation could be achieved under field conditions. At the time of collection, no oocytes were at the metaphase II (MII) stage (0/42). After 60 h culture using the submarine incubation system, 34% of oocytes (24/70) matured to telophase/MII, as indicated by the presence of a polar body. The proportion of oocytes that reached MII was higher for oocytes collected from follicles >2 mm in diameter compared with follicles <2 mm (40% v. 22%, respectively). The presence of cumulus cells alone did not influence the maturation potential. Oocytes without cumulus cells collected from follicles >2 mm in diameter had the highest maturation rate (58%). Maturation was not affected by the reproductive status of the common wombat or a delay of up to 5 h before oocyte collection. In conclusion, the present study demonstrated that oocytes collected from non-stimulated common wombats can mature to MII in culture.

Animals↗
PubMed2003

Fertility of mice following receipt of ovaries slow cooled in dimethyl sulphoxide or ethylene glycol is largely independent of cryopreservation equilibration time and temperature.

Cryopreservation procedures generally depend on both the cryoprotectant used and the equilibration conditions to which the material is exposed. The aim of the present study was to examine the effect of cryoprotectants (dimethyl sulphoxide (DMSO) and ethylene glycol (EG)) and equilibration conditions (0, 30 or 120 min at 0 degrees C or 120 min at room temperature) on the fertility of mice receiving cryopreserved mouse ovaries. The study compared the fertility of cryopreserved Day 14 mouse pup ovaries following grafting to adult recipient mice for 4 months. There was no effect of the cryoprotectant or equilibration condition used on the interval to the first plugging/mating or on the interval to the birth of the first litter, the size of litters, the number of litters produced or the total number of offspring produced. Despite this, when compared with control females (untreated, sham and fresh transplant) the cryopreservation and transplantation procedures delayed fertility. However, the size of litters was equivalent for all cryopreserved and control groups (P > 0.05). The results show that, for the equilibration conditions examined, DMSO and EG are equally efficient cryoprotective agents for mouse ovarian tissue.

Animals↗
PubMed2003

Effect of ovariectomy and graft position on cryopreserved common wombat (Vombatus ursinus) ovarian tissue following xenografting to nude mice.

Ovarian tissue xenografting may be applied to increase the population size of rare or endangered animals. However, optimal grafting conditions, such as graft position and recipient hormonal status, are yet to be established. The present study, using common wombat ovarian tissue, showed that development of xenografted ovarian tissue to the antral follicle stage can be achieved irrespective of graft position. However, increased graft recovery rates and follicle survival were evident after grafting under the kidney capsule compared with grafting to subcutaneous sites. No increase in follicle development was observed after placing grafts both under the kidney capsule and subcutaneously in the one recipient compared with grafts placed under the kidney capsule alone or subcutaneously alone. Removal of the recipient's own ovaries at the time of grafting accelerated graft follicle development, with antral follicles seen by Week 12 after grafting compared with by Week 16 in recipients that retained their own ovaries. More oocytes were collected from xenograft recipients receiving hormonal stimulation before collection compared with non-stimulated recipients. No oocytes were mature (extruded a polar body) at the time of collection or after a subsequent period of in vitro maturation. This is the first study to demonstrate that antral follicle development can occur and oocytes can be collected from xenografted common wombat ovarian tissue.

Animals↗
PubMed2003

Treatment of plastic bronchitis in acute chest syndrome of sickle cell disease with intratracheal rhDNase.

Plastic bronchitis, a condition associated with widespread mucous plugging of the tracheobronchial tree, is an increasingly recognised bronchoscopic finding in acute chest syndrome of sickle cell disease. Removal of casts by bronchoscopy is technically challenging. We describe a child with acute chest syndrome where bronchoscopic removal of extensive tracheobronchial plastic casts was facilitated by intratracheal rhDNase.

Acute Disease↗
PubMed2003

Suicide and self-harm.

Explore the source record for details and available documents.

Emergency Services, Psychiatric↗
PubMed2002

Phase II study to evaluate combining gemcitabine with flutamide in advanced pancreatic cancer patients.

A phase II study was undertaken to determine the safety of combining flutamide with gemcitabine, with response rate being the primary end point. Twenty-seven patients with histologically proven, previously untreated, unresectable pancreatic adenocarcinoma received gemcitabine, 1 g m(-2) intravenously on days 1, 8 and 15 of a 28 day cycle, and flutamide 250 mg given orally three times daily. Treatment was halted if there was unacceptable toxicity, or evidence of disease progression. Toxicity was documented every cycle. Tumour assessment was undertaken after cycles 2 and 4, and thereafter at least every additional four cycles. One hundred and seventeen cycles of treatment were administered, median four cycles per patient (range 1-18). Gemcitabine combined with flutamide was well tolerated, with most toxicities being recorded as grade 1 or 2 and only nine treatment cycles associated with grade 3 toxicity. The most frequent toxicity was myelosuppression. One case of transient jaundice was recorded. The commonest symptomatic toxicity was nausea and vomiting. The response rate was 15% (four partial responses), median survival 6 months and 22% of patients were alive at 1 year. These results suggest antitumour activity of the combination therapy to be equivalent to single agent gemcitabine.

Adult↗
PubMed2002

Derivation of a toxicity-based model to predict how water chemistry influences silver toxicity to invertebrates.

The effect of altering water chemistry on acute silver toxicity to three invertebrate species, two Daphnids, Daphnia magna and Daphnia pulex, as well as an amphipod Gammarus pulex was assessed. In addition, the physiological basis of Ag(I) toxicity to G. pulex was examined. Daphnia magna and D. pulex were more sensitive than G. pulex and 48 h LC(50) values in synthetic ion poor water were 0.47, 0.65 and 2.1 microg Ag(I) l(-1), respectively. Increasing water [Cl(-)] reduced Ag(I) toxicity in all species, and increasing water [Ca(2+)] from 50 to 1,500 microM reduced Ag(I) toxicity in G. pulex. Whole body Na(+) content, but not K(+) or Ca(2+) was significantly reduced in G. pulex exposed to 6 microg Ag(I) l(-1) for 24 h, but there was no inhibition of whole body Na(+)/K(+)-ATPase activity. Both increasing water [Cl(-)] and [Ca(2+)] reduced this Ag(I)-induced Na(+) loss. For D. magna, the presence of 10 mg l(-1) humic acid or 0.5 microM 3-mercaptoproprionic acid (3-MPA) increased the 48 h LC(50) values by 5.9 and 58.5-fold, respectively, and for D. pulex the presence of 1 microM thiosulfate increased the 48 h LC(50) value by four-fold. The D. magna toxicity data generated from this study were used to derive a Daphnia biotic ligand model (BLM). Analysis of the measured LC(50) values vs. the predicted LC(50) values for toxicity data from the present and published results where water Cl(-), Ca(2+), Na(+) or humic acid were varied showed that 91% of the measured toxicity data fell within a factor of two of the predicted LC(50) values. However, the daphnid BLM could not accurately predict G. pulex toxicity. Additionally, the Daphnia BLM was under-protective in the presence of the organic thiols 3-MPA or thiosulphate and predicted an increase in the LC(50) value of 114- and 74-fold, respectively. The Daphnia toxicity based BLM derived from the present data set is successful in predicting Daphnia toxicity in laboratory data sets in the absence of sulfur containing compounds, but shows its limitations when applied to waters containing organic thiols or thiosulphate.

Amphipoda↗
PubMed2002

Impaired glucose tolerance and impaired fasting glycaemia: the current status on definition and intervention.

A workshop was convened by the International Diabetes Federation to review the latest information relating to the risks associated with impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) for future diabetes and cardiovascular disease (CVD). The workshop sought to address three questions: (i) are the current definitions of IGT and IFG appropriate; (ii) are IFG and IGT risk factors, risk markers or diseases; (iii) what interventions (if any) should be recommended for people with IFG and IGT? The determinants of elevated fasting glucose and 2-h plasma glucose in an oral glucose tolerance test (2-HPG) levels differ. Raised hepatic glucose output and a defect in early insulin secretion are characteristic of the former, and peripheral insulin resistance is most characteristic of the latter. Therefore, it is not surprising that the concordance between the categories of IFG and IGT is limited. In all prevalence studies to date only half or less of people with IFG have IGT, and even a lower proportion (20-30%) with IGT also have IFG. In the majority of populations studied, IGT is more prevalent than IFG, and there is a difference in phenotype and gender distribution between the two categories. IFG is substantially more common amongst men and IGT slightly more common amongst women. The prevalence of IFG tends to plateau in middle age whereas the prevalence of IGT rises into old age. Both IFG and IGT are associated with a substantially increased risk of developing diabetes, with the highest risk in people with combined IFG and IGT. Because IGT is commoner than IFG in most populations it is more sensitive (but slightly less specific) for identifying people who will develop diabetes. In most populations studied, 60% of people who develop diabetes have either IGT or IFG 5 years or so before, with the other 40% having normal glucose tolerance at that time. The limited published data suggest that both isolated IFG (I-IFG) and isolated IGT (I-IGT) are similarly associated with cardiovascular risk factors, such as hypertension and dyslipidaemia, with the highest risk in those with combined IFG and IGT. However, some data have suggested that I-IGT is more strongly associated with hypertension and dyslipidaemia (features of the metabolic syndrome) than I-IFG. In unadjusted analyses both IFG and IGT are associated with CVD and total mortality. In separate analyses for fasting and 2-HPG adjusted for other cardiovascular risk factors (from the DECODE study) there remains a continuous relationship between 2-HPG and mortality, but an independent relationship with fasting glucose is only found above 7.0 mmol/l. Glycated haemoglobin (HbA1c) levels are continuously and positively associated with CVD and total mortality independent of other CVD risk factors. Life style interventions, including weight loss and increased physical activity, are highly effective in preventing or delaying the onset of diabetes in people with IGT. Two randomized controlled trials of individuals with IGT found that life style intervention studies reduce the risk of progressing to diabetes by 58%. The oral hypoglycaemic drugs metformin and acarbose have also been shown to be effective, but less so than the life style measures. Similar data do not yet exist for the effectiveness of such interventions in people with I-IFG. Larger studies are required to evaluate the effects of interventions on cardiovascular outcomes in people with IGT. Cost effective strategies to identify people with IGT for intervention should be developed and evaluated. The use of simple risk scores to assess who should undergo an oral glucose tolerance test is one promising approach, although these will need to be population-specific. In conclusion, IGT and IFG differ in their prevalence, population distribution, phenotype, and risk of total mortality and CVD. The consensus of the workshop was: 1. The diagnostic thresholds for all categories of glucose intolerance should be revisited in the light of the latest evidence. There was no clear consensus (with current evidence) on whether IFG and IGT should be classified as diseases, but they clearly represent risk factors and risk markers for diabetes and CVD, respectively. 2. Both IGT and IFG are similarly associated with an increased risk of diabetes, but IGT is more strongly associated with CVD outcomes. 3. Risks are higher when IGT and IFG coexist. 4. Life style interventions are highly effective in delaying or preventing the onset of diabetes in people with IGT and may reduce CVD and total mortality, but the latter requires formal testing.

Blood Glucose↗
PubMed2001

Global and societal implications of the diabetes epidemic.

Changes in human behaviour and lifestyle over the last century have resulted in a dramatic increase in the incidence of diabetes worldwide. The epidemic is chiefly of type 2 diabetes and also the associated conditions known as 'diabesity' and 'metabolic syndrome'. In conjunction with genetic susceptibility, particularly in certain ethnic groups, type 2 diabetes is brought on by environmental and behavioural factors such as a sedentary lifestyle, overly rich nutrition and obesity. The prevention of diabetes and control of its micro- and macrovascular complications will require an integrated, international approach if we are to see significant reduction in the huge premature morbidity and mortality it causes.

Adolescent↗
PubMed2001

Relativistic effects and two-body currents in (H)((-->)e(')p)n using out-of-plane detection.

Measurements of the (2)H((-->)e,e(')p)n reaction were performed with the out-of-plane magnetic spectrometers (OOPS) at the MIT-Bates Linear Accelerator. The longitudinal-transverse, f(LT) and f(')(LT), and the transverse-transverse, f(TT), interference responses at a missing momentum of 210 MeV/c were simultaneously extracted in the dip region at Q2 = 0.15 (GeV/c)(2). In comparison to models of deuteron electrodisintegration, the data clearly reveal strong effects of relativity and final-state interactions and the importance of two-body meson-exchange currents and isobar configurations. We demonstrate that such effects can be disentangled by extracting these responses using the novel out-of-plane technique.

Journal Article↗
PubMed2001

Schizotypy and the shift from dextrality: a study of handedness in a large non-clinical sample.

Numerous previous studies have reported associations between schizophrenia/schizotypy and atypical handedness. While there is broad agreement that schizophrenia/schizotypy is associated with a shift away from typical (strong right) handedness, it is not entirely clear what aspect of atypical handedness is implicated: 'ambiguous' handedness (the absence of hand preference for given actions) or 'mixed handedness' (different hand preferences for different actions). The present study used several indices of handedness (derived from the Annett scale) to address these questions in 3000 + (mostly) University student subjects recruited by electronic mail. It was found that positive schizotypy (indexed by a scale of 'unusual experiences') was associated with both aspects of atypical handedness. These findings are discussed in the light of various possible explanations of the association between handedness and schizophrenia/schizotypy.

Adolescent↗