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Biomedical subjects

J Unsworth

Publications and source records attributed to J Unsworth.

At least 19 recordsLinked to original sources
PubMed2000

Management of bladder problems in patients with multiple sclerosis.

Bladder problems are a common feature in patients with multiple sclerosis (MS). Many patients experience distressing symptoms such as frequency, urgency and incontinence, unaware of the range of treatments which are available to either overcome or manage their bladder problems. While patients with MS may experience many types of bladder dysfunction, certain types of problem are more common in this patient group. These problems can be grouped under the headings of storage, emptying or combined dysfunction. Community nurses are well-placed to offer methods of containment by providing first-line treatment as well as identifying which patients need to be referred to other members of the multidisciplinary team.

Adult↗
PubMed1999

Access all areas: wound care resources on the Internet.

The World Wide Web provides access to a plethora of information on every conceivable topic. More and more, the Internet is been used to access health information, making service users better informed about their conditions and the choice of treatment. It is essential that healthcare professionals embrace this technology so that they are able to access information from around the world. Ideally, access to such technology should be as close as possible to the point of care delivery. The expansion of the NHSnet over the next 3-5 years should make this a reality for more and more practitioners.

Computer User Training↗
PubMed1998

An evaluation of current risk assessment scales for decubitus ulcer in general inpatients and wheelchair users.

OBJECTIVES: To study the components of two risk assessment scales for decubitus ulcer risk, Waterlow and Braden, and of the Chailey score for the same purpose. DESIGN: Experimental study of patients at risk of developing decubitus ulcers. SETTING: The West Midlands and Yorkshire. SUBJECTS: One hundred and fifty wheelchair users from the West Midlands and 9022 patients from a District General Hospital in York, the latter consisting of all admissions to the hospital in a four-month period. INTERVENTIONS: Braden, Chailey scores (wheelchair users) and Waterlow scores (all subjects) measured. MAIN OUTCOME MEASURES: Development of a pressure sore, receiver operating characteristic (ROC) curves. RESULTS: Waterlow outperformed Braden for classification of wheelchair patients with respect to decubitus ulcer. The Chailey score performed randomly in this group. The sensitivity and specificity as seen in ROC curves was different for Waterlow scores for wheelchair users and general patients, the latter being much better classified. Only three items out of 11 in the Waterlow score appeared to have any classification ability in the wheelchair group. CONCLUSIONS: Risk indicators used for general patients are probably poorly suited for wheelchair users. There is a need for large-scale predictive studies of wheelchair users and other groups to allow regression analysis of the subscales of risk indicators. From the provisional data of this study it appears that splitting patients by gender and into full- and part-time wheelchair users classifies almost as well the much more complicated risk assessment tools currently available.

Case-Control Studies↗
PubMed1996

Systemic lupus erythematosus presenting as congenital nephrotic syndrome.

A male Caucasian infant developed nephrotic syndrome at 10 weeks of age. He had high titres of antinuclear antibody (ANA) and anti-double-stranded DNA antibody, with hypocomplementaemia, antiplatelet antibodies and anticardiolipin antibodies. There were no detectable antibodies to extractable nuclear antigens (ENA). His mother was consistently seronegative for anti-ENA (anti-Ro) antibodies and ANA. He developed severe, progressive multisystem involvement, however renal function has remained stable. Immunosuppression has been the mainstay of therapy in this rare presentation of systemic lupus erythematosus.

Antibodies, Antinuclear↗
PubMed1995

Patient satisfaction: an indicator of quality in disablement services centres.

OBJECTIVES: To develop a patient satisfaction system for disablement services centres and to report on how the initial findings have been used in audit to improve their quality of care and services. DESIGN: Interview survey of randomly selected users attending in three centres: Birmingham (centre X), Oxford (centre Y), and Cambridge (centre Z) to establish core topics for developing a patient satisfaction questionnaire with incorporation into a computer patient satisfaction system (PATSAT) to enable collation of responses to the questionnaire. A pilot of the questionnaire was undertaken in the centres to assess the sensitivity of the questionnaire, which was subsequently used as part of clinical audit process during June 1991 and April 1992 in centre X and the patient satisfaction system used to monitor changes in routine practice. PATIENTS: 123 amputees in the development phase, selected by cluster sampling, and 1103 amputees in the pilot study. MAIN MEASURES: Satisfaction scores for components of the service. RESULTS: The questionnaire included 16 core topics contributing to quality of care and services, including comfort of limbs, appointments, interpersonal aspects of care, a system of support and counselling, and organisation. The pilot survey demonstrated high satisfaction scores for aspects of interpersonal care, organisation, and physical surroundings of the centres and lower satisfaction for counselling services, comfort of the limb and the number of alterations made before the limb was considered acceptable. During the audit in centre X these results prompted changes to care and services which produced significant improvements in satisfaction. CONCLUSIONS: The early results suggest that the questionnaire, coupled with PATSAT software system, enable users' views to be expressed, collated, and fed back to staff; the information provided has already prompted change, and the system is sufficiently sensitive to measure changes in satisfaction with the service.

Adolescent↗
PubMed1989

Hypoxic-reperfusion injury in the inflamed human joint.

A series of experiments showed that, on exercise of the inflamed human knee, intra-articular pressure rises above synovial capillary perfusion pressure, causing intra-articular hypoxia; and that, on cessation of exercise, there is oxidative damage to lipids and IgG within the joint. These findings are consistent with the hypothesis that persistence of synovial inflammation can be due to exercise-induced hypoxic-reperfusion injury mediated by reactive oxygen species.

Adult↗
PubMed1988

The role of calcium ions in the activation of rabbit psoas muscle.

This study tested the effects of free Ca++ on both the small-amplitude mechanical behaviour (dynamic stiffness and phase between 1 and 500 Hz) and the large-scale filament-sliding behaviour (Vmax) of single fibres of chemically-activated glycerol-extracted rabbit psoas muscle. Small-amplitude vibrations (0.1% peak-to-peak of initial length L0) were used to elicit fw, the frequency for maximum oscillatory work-production per cycle. The unloaded contraction velocity Vmax was measured during the same contractions, using the slack-test method with shortening length steps of up to 10% L0. These produced nonlinear length-time plots demonstrating that the unloaded contraction velocity was not constant as contraction progressed, but fell with time. This behaviour was approximated by two velocities, V1 the velocity observed for about the first 15 ms and V2 the velocity after this time. V1 and V2 were found to have different sensitivities to Ca++. The value of V2 fell as the level of [Ca++] was reduced, and was linearly proportional to the active tension over the range 0.2 Pmax to Pmax (where Pmax is the isometric tension for saturating amounts of Ca++). In contrast to this V1 remained insensitive to changes in [Ca++] for levels of activation corresponding to active tensions ranging from Pmax to 0.6 Pmax, and then fell as the level of activation was further reduced. It was found that the level of [Ca++] did not affect the magnitude of fw over the range of concentrations yielding active tensions from 0.2 Pmax to Pmax. These results are discussed in terms of the kinetic processes underlying transient readjustments to perturbations from isometric equilibrium.

Animals↗
PubMed1988

Specific acoustic impedances of piezoelectric ceramic and polymer composites used in medical applications.

The specific acoustic impedance of the piezoelectric composites over the frequency range of 0.5-7.5 MHz was measured using the reflection, the echo-shift, and the resonance techniques. There was a significant difference between the values obtained by the reflection technique in comparison with the other two techniques. It is argued that the difference is inherent in the measurement techniques and they measure different properties of the composite such as acoustic impedance and reflectivity. The specific acoustic impedance and the reflectivity were found to be a function of the volume fraction of the ceramic and not a function of frequency.

Acoustic Impedance Tests↗
PubMed1987

Renal impairment associated with non-steroidal anti-inflammatory drugs.

We have compared the renal function on admission and discharge of 22 patients routinely admitted to our rheumatology ward. None had previously diagnosed renal failure. Of 11 patients in whom we stopped long term non-steroidal anti-inflammatory drug (NSAID) therapy, all showed a rise in creatinine clearance (Ccr) after three to 28 days. In contrast, a control group comprising 11 similar patients who continued to receive NSAIDs showed no significant change. Recent work has suggested that it is possible to identify patients at risk of developing nephrotoxic side effects with NSAIDs. Based on these criteria (but excluding age alone as a risk), six patients from the first group and 10 from the second group would have been without risk. We infer from this that asymptomatic, reversible impairment of renal function is common, and that the potential clinical benefit from the use of NSAIDs should be balanced against this predictable toxicity.

Adult↗
PubMed1987

Serum salicylate levels in a breast fed infant.

All drugs should be given with caution to pregnant or breast feeding women. Recent concern about the role of salicylates in the aetiology of Reye's syndrome has prompted the DHSS to restrict the use of aspirin in children. The case of a 9 week old breast fed infant whose serum contained 0.47 mmol/l of salicylate is reported. Her mother was taking aspirin 2.4 g/day, and it is concluded that salicylates must not be taken by breast feeding mothers.

Adult↗
PubMed1986

Protracted diarrhoea of infancy: evidence in support of an autoimmune variant.

Circulating autoantibodies to enterocytes were detected by indirect immunofluorescence in 14 out of 25 patients with idiopathic protracted diarrhoea of infancy. Similar specificities were not found in 50 control children with nongastroenterological disorders. The immunofluorescence pattern was more accentuated on the apical border of mature enterocytes. Enterocyte autoantibodies were mainly of IgG class (13/14), but 11 sera were positive for IgM and IgA classes, and five out of 14 positive sera also had the ability to fix complement. Absorption of sera positive for autoantibodies with an IgA coupled immunoabsorbent did not modify the intensity of the staining, indicating that these antibodies were not directed against secretory IgA. High titres and the complement fixing ability of enterocyte autoantibodies indicated a poorer prognosis despite the use of immunosuppressive drugs. Organ specific and non-organ specific autoimmune diseases or corresponding autoantibodies or both were often found in children with enterocyte autoantibodies and their family. These data show the existence of an autoimmune variant of protracted diarrhoea of infancy, despite the rare occurrence of autoimmune diseases in childhood.

Adolescent↗
PubMed1985

The use of single photon emission computed tomography in lung imaging with aerosols.

The use of technetium-99m labelled diethylenetriaminopentaacetic acid (99Tcm-DTPA) aerosol and single photon emission computed tomography (SPECT) to obtain sectional ventilation images of the lung is demonstrated in a limited series of patients. SPECT perfusion and planar ventilation and perfusion are also obtained and the SPECT studies compared with the planar views to assess the efficacy of SPECT aerosol ventilation images when used in conjunction with SPECT perfusion studies. The problems encountered in SPECT aerosol lung imaging, particularly the image noise associated with the limited number of detected counts, are described. On the basis of the results it is concluded that the technique is worth further assessment.

Adult↗
PubMed1985

Fatal unresponsive villous atrophy of the jejunum, connective tissue disease and diabetes in a girl with intestinal epithelial cell antibody.

The patient presented with a diabetes at the age of 3 years. At the age of 5 years she got persistent diarrhoea, lost weight and showed symptoms or arthritis and pericarditis. She was found to have total villous atrophy of the jejunum, which did not respond to dietary treatment, total parental nutrition, prednisone and cyclophosphamide medication. She had high titres of antinuclear antibodies and elevated serum IgG, but antibodies to DNA and to ribonuclearprotein were negative. A low titre of antibodies to human intestinal epithelial cells was found. The patient died of overwhelming fungal sepsis. We propose that the intestinal damage is part of the autoimmune disease. Careful study of jejunal biopsy specimens is helpful in distinguishing this type of patient from patients with coeliac disease.

Antibodies↗
PubMed1985

Enalapril in the treatment of hypertension associated with impaired renal function.

This pilot study was undertaken to examine the safety and efficacy of enalapril in the treatment of hypertension associated with impaired renal function. Forty-one patients with glomerular filtration rate (GFR) < or = 50 ml/min received enalapril for up 12 weeks. Blood pressure, renal function, biochemistry and haematology were monitored weekly for 4 weeks and then monthly. Blood pressure was effectively reduced within 4 weeks; this reduction was maintained for at least 12 weeks. Renal function remained stable and there was no significant sustained alteration in any biochemical or haematological parameter. Requirement for additional antihypertensive drugs was reduced during enalapril therapy. These data suggest that enalapril may have a useful role in the management of hypertension associated with renal impairment.

Adult↗