The pre-eclampsia community guideline (PRECOG): how to screen for and detect onset of pre-eclampsia in the community.
Explore the source record for details and available documents.
Adolescent↗
Biomedical subjects
James Walker
Publications and source records attributed to James Walker.
Target-determined expression of alpha3 isoform of the Na+,K+-ATPase in the somatic nervous system of rat.
Factors that determine the differential expression of isoforms of Na(+),K(+)-ATPase in the nervous system of vertebrates are not understood. To address this question we studied the expression of alpha(3) Na(+),K(+)-ATPase in the L5 dorsal root ganglia (DRG) of developing rat, the normal adult rat, and the adult rat after peripheral axotomy. During development, the first alpha(3) Na(+),K(+)-ATPase-positive DRG neurons appear by embryonic day 21. At birth, the L5 DRG have a full complement (14 +/- 2%) of these neurons. By 15 days after sciatic nerve transection in adult rat, the number of alpha(3) Na(+),K(+)-ATPase-positive DRG neurons and small myelinated L5 ventral root axons decreases to about 35% of control counts. These results combined with data from the literature suggest that the expression of alpha(3) Na(+),K(+)-ATPase by rat somatic neurons is determined by target-muscle spindle-derived factors.
Animals↗
Coagulopathy in massive transfusion.
Explore the source record for details and available documents.
Acidosis↗
Predicting vascular risk in Type 1 diabetes: stratification in a hospital based population in Scotland.
AIMS: To estimate the absolute cardiovascular risk of patients with Type 1 diabetes attending hospital diabetes clinics in Scotland and to develop a method for identifying those at highest risk, thus enabling therapy to be targeted. METHODS: Baseline information was collected for 2136 patients with Type 1 diabetes using the Royal College of Physicians of Edinburgh Diabetes Register. These records were then linked to diagnoses of macrovascular disease in databases of the Information Statistics Division of the Common Services Agency. RESULTS: During six to nine years of follow up 110 patients (5%) developed macrovascular disease. There were significant associations between baseline age (P < 0.00001), blood pressure (P < 0.00001), albuminuria (P < 0.0002), HbA1c (P < 0.001), cholesterol (P < 0.00001) and smoking status (P < 0.00001) with the development of macrovascular disease. A scoring system for future macrovascular risk was developed from a multivariate analysis of this data. CONCLUSIONS: The data confirm the high vascular risk of patients with Type 1 diabetes. The relationship with age is such that those patients above 50 years require only one additional risk factor to reach such a high vascular risk that intervention is indicated. Using these data many patients between the age of 40 and 49 years are also likely to be identified to be at high risk.
Adult↗
Lipid-modifying effects of rosuvastatin in postmenopausal women with hypercholesterolemia who are receiving hormone replacement therapy.
OBJECTIVE: To evaluate the efficacy and safety of rosuvastatin in postmenopausal women with hypercholesterolemia who are receiving hormone replacement therapy (HRT) in a randomized, double-blind, placebo-controlled trial. METHODS: After a 6-week dietary lead-in period, 135 postmenopausal women who had been taking a stable HRT regimen for at least 3 months were randomized to receive rosuvastatin 5 mg, 10 mg or placebo for 12 weeks. Fasting levels of low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), and triglycerides (TG) were assessed at weeks 0, 2, 6, 10, and 12; apolipoprotein (Apo) B and Apo A-I were measured at weeks 0 and 12. RESULTS: Rosuvastatin 5 mg and 10 mg significantly reduced LDL-C by 38% (SE = 2.1) and 49% (SE = 2.1), respectively, compared with placebo (1% [SE = 2.1]; p < 0.001). TC, TG, Apo B, and all lipid ratios examined (LDL-C/HDL-C, TC/HDL-C, non-HDL-C/HDL-C, and Apo B/Apo A-I) were also reduced significantly by both rosuvastatin doses (p < 0.001). HDL-C levels increased significantly in the rosuvastatin groups (11% and 8% for 5 mg and 10 mg, respectively, vs. -0.5% for placebo; p < 0.001), as did Apo A-I levels (p < 0.05). The combination of rosuvastatin plus HRT was well tolerated with no apparent differences among treatments in the numbers or types of adverse events reported. CONCLUSIONS: Rosuvastatin 5 mg or 10 mg once daily is a well-tolerated and highly efficacious lipid-lowering therapy in postmenopausal women receiving HRT.
Administration, Oral↗
All-cause and cause-specific mortality by socioeconomic status among employed persons in 27 US states, 1984-1997.
OBJECTIVES: We investigated mortality differences according to socioeconomic status (SES) for employed persons in 27 states during 1984-1997. METHODS: SES was determined for persons aged 35-64 years according to the "usual occupation" listed on their death certificates. We used US Census denominator data. RESULTS: For all-cause mortality, rate ratios from lowest to highest SES quartile for men and women were 2.02, 1.69, 1.25, and 1.00 and 1.29, 1.01, 1.07, and 1.00, respectively. Percentage of all deaths attributable to being in the lowest 3 SES quartiles was 27%. Inverse SES gradients were strong for most major causes of death except breast cancer and colorectal cancer. Heart disease mortality for highest and lowest SES quartiles dropped 45% and 25%, respectively, between 1984 and 1997. CONCLUSIONS: Mortality differences by SES were sustained through the 1990s and are increasing for men.
Adult↗
Sleep and cognitive performance of flight nurses after 12-hour evening versus 18-hour shifts.
BACKGROUND: Inadequate rest can result in disastrous medical and aviation errors. Using a prospective within-subjects design, this study compared the amount of daily sleep and the cognitive performance in flight nurses working 12-hour evening versus 18-hour shifts during a 72-hour duty schedule. METHODS: Ten flight nurses who worked two different duty schedules participated in the study. The first duty schedule consisted of three back-to-back 12-hour (7:00 pm to 7:00 am) evening shifts. The second duty schedule consisted of two 18-hour (7:00 am to 1:00 am) shifts separated by a 24-hour rest period. Pre- and duty sleep times were monitored using actigraphy. The flight nurses were tested using a battery of neuropsychological tests before and immediately after completing 12- and 18-hour duty schedules. After the conclusion of both duty schedules, nurses were asked to rate the 12- versus 18-hour duty schedules via questionnaire. RESULTS: Daily sleep times for the 12- versus 18-hour were not different for the pre-duty schedule (8.9 +/- 2.3 vs. 9.0 +/- 2.3 hours) or during duty schedule (7.0 +/- 1.4 vs. 6.9 +/- 1.3 hours). A significant decline was seen in the amount of pre- versus duty sleep for both the 12-hour (8.9 +/- 2.3 vs. 7.0 +/- 1.4 hours; P < .05) and the 18-hour (9.0 +/- 2.3 vs. 6.9 +/- 1.3 hours; P = .04) duty schedules. During the 72-hour duty schedule, the 12-hour vs. 18-hour duty schedules, the nurses had less pre-shift sleep (3.2 +/- 1.2 vs. 6.2 +/- 0.6; P = .001) and more on-shift (4.4 +/- 1.7 vs. 2.1 +/- 0.8; P = .002) sleep. Despite the decline in daily sleep during both duty schedules, no significant decline in the before versus after cognitive test scores were observed for either the 12- or 18-hour duty schedule. A questionnaire given to the 10 nurses indicated that the 18-hour duty schedule was more compatible with their non-work lifestyle (P = .04). CONCLUSIONS: Provided adequate daily sleep (at least 7 hours/day) is obtained, we found no difference or decline in the cognitive function of flight nurses working either a 12-hour evening or 18-hour shift during a 72-hour duty schedule. Eighteen-hour duty shifts may be a practical economical means of expanding the period of helicopter site coverage without adversely affecting cognitive performance in medical crewmembers. Actigraphy may be a useful tool for air medical programs that want to objectively assess whether adequate sleep is occurring in individuals working extended (>12 hours) or unusual duty shifts.
Air Ambulances↗
Sedation using dexmedetomidine in pediatric burn patients.
Maintaining appropriate sedation and analgesia in pediatric burn patients can be quite challenging and often requires high doses of analgesics and anxiolytics because tolerance quickly develops. Escalating doses of opioids and benzodiazepines provide little additional benefit while increasing the incidence of side effects. Dexmedetomidine (DEX) is a novel alpha2-adrenergic agonist that provides sedation, anxiolysis, and analgesia with much less respiratory depression than other sedatives. In addition, DEX stimulation of alpha2 receptors on pancreatic beta cells may inhibit insulin secretion. Hyperglycemia has not been studied specifically in patients receiving DEX. Therefore, we hypothesized that DEX would improve sedation compared with our standard sedation regimen. In addition, we studied the effects of DEX on blood glucose levels. We performed a retrospective chart review of 65 pediatric burn patients (42 boys, 23 girls) in the intensive care unit admitted between 2001 and 2004 who received DEX infusion because of failure to achieve adequate sedation with our standard regimen of opioids and benzodiazepines. We recorded age, TBSA burn size, weight, dose and duration of infusion, adequacy of sedation before and after initiation of DEX, blood glucose levels before and after DEX, and the presence or absence of mechanical ventilation. The mean age was 5 years (range, 0.6-17), burn size was 36% TBSA (range, 3-94), and weight was 26 kg (range, 8-100). All patients were rated "inadequately sedate" before DEX infusion was initiated at 0.2 mug/kg/hr and titrated to effect. Twenty-six patients received a loading dose of 1 mug/kg. The average duration of DEX infusion was 11 days (range, 2-50), and no tachyphylaxis was noted. The mean dose was 0.5 mug/kg/hr (range, 0.1-2). Infusions were weaned over the course of 12 to 24 hours without evidence of rebound hypertension or withdrawal. With DEX titration, all patients were rated "adequately sedate," even though all were sedation failures with opioids and benzodiazepines. Eleven of 42 patients receiving ventilatory support were extubated while on DEX infusion, and no patient showed evidence of DEX induced respiratory depression. Patient's blood glucose levels averaged 121.2 +/- 8.9 mg/dl while on DEX infusion and 117.1 +/- 12.1 mg/dl while off, a nonsignificant difference.
Adolescent↗