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Biomedical subjects

Julie A Simpson

Publications and source records attributed to Julie A Simpson.

8 recordsLinked to original sources
PubMed2003

Secondary prevention clinics for coronary heart disease: four year follow up of a randomised controlled trial in primary care.

OBJECTIVES: To evaluate the effects of nurse led clinics in primary care on secondary prevention, total mortality, and coronary event rates after four years. DESIGN: Follow up of a randomised controlled trial by postal questionnaires and review of case notes and national datasets. SETTING: Stratified, random sample of 19 general practices in north east Scotland. PARTICIPANTS: 1343 patients (673 intervention and 670 control) under 80 years with a working diagnosis of coronary heart disease but without terminal illness or dementia and not housebound. INTERVENTION: Nurse led secondary prevention clinics promoted medical and lifestyle components of secondary prevention and offered regular follow up for one year. MAIN OUTCOME MEASURES: Components of secondary prevention (aspirin, blood pressure management, lipid management, healthy diet, exercise, non-smoking), total mortality, and coronary events (non-fatal myocardial infarctions and coronary deaths). RESULTS: Mean follow up was at 4.7 years. Significant improvements were shown in the intervention group in all components of secondary prevention except smoking at one year, and these were sustained after four years except for exercise. The control group, most of whom attended clinics after the initial year, caught up before final follow up, and differences between groups were no longer significant. At 4.7 years, 100 patients in the intervention group and 128 in the control group had died: cumulative death rates were 14.5% and 18.9%, respectively (P=0.038). 100 coronary events occurred in the intervention group and 125 in the control group: cumulative event rates were 14.2% and 18.2%, respectively (P=0.052). Adjusting for age, sex, general practice, and baseline secondary prevention, proportional hazard ratios were 0.75 for all deaths (95% confidence intervals 0.58 to 0.98; P=0.036) and 0.76 for coronary events (0.58 to 1.00; P=0.049) CONCLUSIONS: Nurse led secondary prevention improved medical and lifestyle components of secondary prevention and this seemed to lead to significantly fewer total deaths and probably fewer coronary events. Secondary prevention clinics should be started sooner rather than later.

Adult↗
PubMed2003

A randomized controlled trial of spiritual healing in restricted neck movement.

OBJECTIVE: To investigate the clinical effectiveness of visiting a spiritual healer in restricted neck movement. DESIGN: Pragmatic randomized controlled trial. SETTING/LOCATION: Spiritual-healing clinic in Aberdeen, Scotland. SUBJECTS: Sixty-eight (68) volunteers over the age of 18 years with restricted neck movement not currently receiving spiritual healing. INTERVENTION: Three weekly sessions of spiritual healing treatment lasting approximately 30 minutes each. Control group received normal care (no spiritual healing). OUTCOME MEASURES: Range of neck movement in three directions. Visual analog scales of pain and overall well-being, Short Form 36 (SF-36) Health Survey general health questionnaire, Hospital Anxiety and Depression Scale, and Chronic Pain Grade were also measured. RESULTS: After treatment, the change from baseline in rotation and flexion-extension was significantly greater in the treatment group compared to the control group (mean standard deviation [SD]: 26.3 degrees (21.0 degrees) versus 2.1 degrees (15.1 degrees), p < 0.001 and 20.7 degrees (23.0 degrees) versus -0.03 degrees (15.2 degrees), p < 0.001, respectively). Subjects from the treatment group were also observed to have reduced their pain severity scores after 3 weeks of treatment compared to those of the control group (median change from baseline [range], -2.25 [-8, 2] versus 0 (-6, 4), p = 0.03). For SF-36, the treatment group had significantly improved their scores more than the control group for physical function and energy and vitality. There was a shift in the treatment group toward milder chronic pain grades but this was not significant. There were no significant differences between treatment and control groups in the other outcome measures. CONCLUSION: This study tentatively supports the effectiveness of visiting a spiritual healer in restricted neck movement. However, larger studies over longer periods, with placebo interventions, are required for corroboration and to gauge the scale of treatment effect.

Adult↗
PubMed2003

Delayed visual maturation in Karen refugee infants.

Thirty-eight babies born to Karen mothers living in camps for displaced persons in north-western Thailand have delayed visual maturation (DVM type 1) that recovers within 6 months. Vitamin A concentrations were deficient in 16% of breast-milk samples from lactating mothers and vitamin B(1) concentrations were deficient in 60% of plasma samples. Infantile beriberi was common in this population. The levels of fatty acids in plasma and milk in Karen women were excellent at birth and in the postpartum period. The degree of deficiencies in these vitamins and the concentration of essential fatty acids in cord blood and maternal breast-milk did not correlate significantly with visual impairment in the infants. DVM might be caused by nutritional deficiency or toxic effects during critical periods of gestation that lead to delayed cortical myelination or structural defects which impinge on parietal cortex function.

Adolescent↗
PubMed2003

Size does matter.

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Biomedical Research↗
PubMed2003

An ultrastructural study of the brain in fatal Plasmodium falciparum malaria.

Cerebral malaria (CM) is a major cause of death in severe Plasmodium falciparum malaria. We present quantitative electron microscopic findings of the neuropathologic features in a prospective clinicopathologic study of 65 patients who died of severe malaria in Thailand and Vietnam. Sequestration of parasitized red blood cells (PRBCs) in cerebral microvessels was significantly higher in the brains of patients with CM compared with those with non-cerebral malaria (NCM) in all parts of the brain (cerebrum, cerebellum, and medulla oblongata). There was a hierarchy of sequestration with more in the cerebrum and cerebellum than the brain stem. When cerebral sequestration was compared with the peripheral parasitemia pre mortem, there were 26.6 times more PRBCs in the brain microvasculature than in the peripheral blood. The sequestration index was significantly higher in CM patients (median = 50.7) than in NCM patients (median = 6.9) (P = 0.042). The degree of sequestration of P. falciparum-infected erythrocytes in cerebral microvessels is quantitatively associated with pre-mortem coma.

Adolescent↗
PubMed2002

Evaluation of the World Health Organization standard tourniquet test and a modified tourniquet test in the diagnosis of dengue infection in Viet Nam.

OBJECTIVES: A positive tourniquet test is one of several clinical parameters considered by the World Health Organization to be important in the diagnosis of dengue haemorrhagic fever, but no formal evaluation of the test has been undertaken. As many doctors remain unconvinced of its usefulness, this study was designed to assess the diagnostic utility of both the standard test and a commonly employed modified test. METHODS: A prospective evaluation of the standard sphygmomanometer cuff tourniquet test, compared with a simple elastic cuff tourniquet test, was carried out in 1136 children with suspected dengue infection admitted to a provincial paediatric hospital in southern Viet Nam. RESULTS: There was good agreement between independent observers for both techniques, but the sphygmomanometer method resulted in consistently greater numbers of petechiae. This standard method had a sensitivity of 41.6% for dengue infection, with a specificity of 94.4%, positive predictive value of 98.3% and negative predictive value of 17.3%. The test differentiated poorly between dengue haemorrhagic fever (45% positive) and dengue fever (38% positive). The simple elastic tourniquet was less sensitive than the sphygmomanometer cuff, but at a threshold of 10 petechiae (compared with the WHO recommendation of 20) per 2.5 cm2 the sensitivity for the elastic tourniquet rose to 45% (specificity 85%). Other evidence of bleeding was frequently present and the tourniquet test provided additional information to aid diagnosis in only 5% of cases. CONCLUSION: The conventional tourniquet test adds little to the diagnosis of dengue in hospitalized children. The simple, cheap elastic tourniquet may be useful in diagnosing dengue infection in busy rural health stations in dengue endemic areas of the tropics. A positive test should prompt close observation or early hospital referral, but a negative test does not exclude dengue infection.

Adolescent↗
PubMed2002

A new approach for neurological evaluation of infants in resource-poor settings.

Research assessing the neurological development of infants in developing countries is scanty as no suitable standardised tests are available for field-use in constrained circumstances. We describe the development and application of two simple assessments. Firstly, we aimed to develop a test suitable for assessing acute neurological disturbances caused by such diverse effects as infections, drugs or toxins. This test (Shoklo Neurological Test) is aimed at infants between 9 and 36 months. The second test (Shoklo Developmental Test) is aimed not only to follow the evolution of the signs tested initially in the acute phase but also to evaluate later neurodevelopmental sequelae which might be caused by the same events. The latter test is suitable for infants aged from 3 to 12 months. Both tests can be performed easily in non-optimal conditions. The examinations were tested in a cohort of infants from a Karen refugee camp and administered in a rural setting by health workers, after appropriate training. In order to validate the tests we also applied them to a cohort of London infants. The Griffiths Developmental Scales were applied in the same infants and both the Shoklo Neurological and the Shoklo Developmental Tests showed good correlation with this standardised neurodevelopmental assessment.

Child Behavior Disorders↗