Pyoderma gangrenosum preceding the onset of cutaneous T-cell lymphoma.
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Aged, 80 and over↗
Biomedical subjects
K Baxter
Publications and source records attributed to K Baxter.
Effect of a cannabinoid agonist on gastrointestinal transit and postprandial satiation in healthy human subjects: a randomized, placebo-controlled study.
Cannabinoid receptor (CBR) stimulation inhibits motility and increases food intake in rodents. Effects of CBR stimulation in human gastrointestinal (GI) tract are unclear. We compared effects of dronabinol (DRO) and placebo (PLA) on GI transit, gastric volume and satiation in humans. In a double-blind, randomized study, 30 healthy volunteers were randomly assigned to DRO 5 mg b.i.d. or PLA for three doses. We measured GI functions noninvasively: day 0, Ensure satiation test to measure maximum tolerated volume (MTV) and 30-min post-Ensure symptoms; day 1, scintigraphic transit ((111)In-egg meal) and fasting and postprandial gastric volume ((99Tcm)-SPECT); day 2, 24-h colonic transit and repeat satiation test. ancova was used to compare treatment groups with gender, age, and, for the satiation test, the baseline MTV, as covariates. A log-rank test was used to assess treatment effects on gastric emptying. Planned sample size had 80% power to detect 25-30% differences in primary end points. There was an overall retardation of gastric emptying with DRO (P = 0.018); this was more pronounced in females (P = 0.011), than in males (P = 0.184). No significant treatment differences were detected for gastric volumes, MTV, post-Ensure(R) symptoms, small bowel and colonic transit. Fasting gastric volume was greater in males receiving DRO compared with PLA (238 +/- 17 vs 185 +/- 16, P = 0.04). DRO retards gastric emptying in humans; effects are gender-related. Dronabinol also increases fasting gastric volumes in males.
Age Factors↗
A randomized controlled trial of a probiotic combination VSL# 3 and placebo in irritable bowel syndrome with bloating.
AIM: To evaluate the effects of a combination probiotic on symptoms and colonic transit in patients with irritable bowel syndrome (IBS) and significant bloating. METHODS: Forty-eight patients with Rome II IBS were randomized in a parallel group, double-blind design to placebo or VSL# 3 twice daily (31 patients received 4 weeks and 17 patients 8 weeks of treatment). Pre- and post-treatment colonic transit measurements were performed using scintigraphy with (111)In charcoal. Symptoms were summarized as an average daily score for the entire period of treatment and separately for the first 4 weeks of treatment. Weekly satisfactory relief of abdominal bloating was assessed. RESULTS: Treatment with VSL# 3 was associated with reduced flatulence over the entire treatment period (placebo 39.5 +/- 2.6 vs VSL# 3 29.7 +/- 2.6, P = 0.011); similarly, during the first 4 weeks of treatment, flatulence scores were reduced (placebo 40.1 +/- 2.5 vs VSL# 3 30.8 +/- 2.5, P = 0.014). Proportions of responders for satisfactory relief of bloating, stool-related symptoms, abdominal pain and bloating scores were not different. Colonic transit was retarded with VSL# 3 relative to placebo (colon geometric center 2.27 +/- 0.20 vs 2.83 +/- 0.19, P = 0.05 respectively). CONCLUSION: VSL# 3 reduces flatulence scores and retards colonic transit without altering bowel function in patients with IBS and bloating.
Adult↗
Allergic contact dermatitis to henna tattoo.
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Allergens↗
The imPaCT study: a randomised controlled trial to evaluate a hospital palliative care team.
A randomised controlled trial was undertaken to assess the effectiveness of a hospital Palliative Care Team (PCT) on physical symptoms and health-related quality of life (HRQoL); patient, family carer and primary care professional reported satisfaction with care; and health service resource use. The full package of advice and support provided by a multidisciplinary specialist PCT ('full-PCT') was compared with limited telephone advice ('telephone-PCT', the control group) in the setting of a teaching hospital trust in the SW of England. The trial recruited 261 out of 684 new inpatient referrals; 175 were allocated to 'full-PCT', 86 to 'telephone-PCT' (2 : 1 randomisation); with 191 (73%) being assessed at 1 week. There were highly significant improvements in symptoms, HRQoL, mood and 'emotional bother' in 'full-PCT' at 1 week, maintained over the 4-week follow-up. A smaller effect was seen in 'telephone-PCT'; there were no significant differences between the groups. Satisfaction with care in both groups was high and there was no significant difference between them. These data reflect a high standard of care of patients dying of cancer and other chronic diseases in an acute hospital environment, but do not demonstrate a difference between the two models of service delivery of specialist palliative care.
Activities of Daily Living↗
Withdrawal times for medicines on organic farms.
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Animals↗
Heart preservation with celsior solution improved by the addition of nitroglycerine.
BACKGROUND: Preservation of rat hearts was extended to 16 hr when nitroglycerine (NTG) was added to colloid-free University of Wisconsin solution (MUW). This study examined the effectiveness of Celsior solution (CEL) and whether adding NTG to CEL would improve and extend cardiac preservation. METHODS: Two studies were conducted: (a) 9-hr preservation with either CEL or MUW, (b) 16-hr preservation with CEL, CEL+NTG, or MUW+NTG. Rat heart isografts were flushed and stored at 0 degrees C before heterotopic transplantation with an indwelling externalized intraventricular balloon-tipped catheter. One and 7 days after transplantation, quantitative functional studies were performed. RESULTS: After 9-hr preservation, all (6/6) grafts preserved with MUW beat for 7 days, whereas only 1/6 hearts preserved with CEL continued to beat. After 16-hr preservation, 6/10 CEL+NTG hearts beat for 7 days compared with 7/8 MUW+NTG hearts; none of the hearts preserved with CEL survived. Function was similar in CEL+NTG and MUW+NTG groups on day 1 (left ventricular developed pressure (LVDP): CEL+NTG=64+/-16, MUW+NTG=104+/-16 mmHg; maximum dP/dt: CEL+ NTG=2024+/-551, MUW+NTG=3582+/-513 mmHg/sec) and day 7: (LVDP: CEL+NTG=126+/-25, MUW+NTG=177+/-24 mmHg; maximum dP/dt: CEL+NTG=3835+/-848, MUW+ NTG=5639+/-670 mmHg/sec). Function in both groups improved significantly (P<0.05) on day 7 compared with day 1. CONCLUSIONS: Celsior was not as effective as MUW for rat heart preservation. The addition of NTG to both CEL and MUW provided similar effective preservation for 16 hr. NTG should be added routinely to both solutions.
Adenosine↗
Measuring the success of primary care organizations: is it possible?
Primary care in the UK has been the subject of numerous changes and reorganizations since 1990. Each innovation in organization, with the exception of fundholding, has been the subject of evaluation. However, the complexities of some innovations make the evaluation process problematic and this is further complicated by the trend towards central policy decision making being subject to local interpretation and implementation, by means of simultaneous devolution and centralization. This paper discusses the challenges and problems posed by attempting to evaluate these new organizations, particularly with regard to whether or not they can be considered to be "successful". It draws specifically on the national evaluation of the total purchasing pilots and indicates how the findings can be applied to primary care groups.
Contract Services↗
Influence of buprenorphine analgesia on post-operative recovery in two strains of rats.
The objective of this study was to establish an effective post-operative analgesic regimen for Sprague-Dawley (SD) and Dark Agouti (DA) rats. Buprenorphine (0.01 or 0.05 mg/kg), a partial mu opioid agonist, was administered subcutaneously immediately on completion of a standardized surgical procedure, involving anaesthesia, laparotomy and visceral manipulation. Two of the four treatment groups and the saline control group received a second injection 9 h later. Behavioural observations by three independent observers provided no information in assessing pain in this model. All rats lost weight, consumed less food and water after surgery. On the first day, both SD and DA rats receiving buprenorphine lost less weight than untreated control groups. Using weight loss as an efficacy criterion, low-dose buprenorphine, given once or twice, provided effective analgesia in SD rats. A higher single dose provided no additional benefit and a second dose was detrimental, reducing body weight and food intake. In DA rats, the high dose, given twice, appeared to be more effective than the lower dose. All DA cage cohorts consumed < 10% pre-operative food despite buprenorphine treatment, suggesting a higher dosage may be necessary. However, all SD and 80% DA rats who received no buprenorphine gained body weight on the second day, whereas most of the buprenorphine-treated rats continued to lose weight for another 2 days, despite increased food consumption by both strains. Buprenorphine may adversely affect intestinal function over a number of days due to its enterohepatic circulation; this effect may be more severe in DA rats. Adverse metabolic effects of buprenorphine and other opioids may preclude their use in the future if it can be shown that non-steroidal anti-inflammatory drugs (NSAIDs) provide equally effective analgesia.
Age Factors↗
A guide to undertaking economic evaluations within randomized controlled trials of treatments for lower urinary tract symptoms.
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Cost-Benefit Analysis↗
Development of injury in a rat model of chronic renal allograft rejection: effect of dietary protein restriction.
Non-allogeneic factors such as increased nephron "workload" may contribute to chronic renal allograft rejection. Reducing dietary protein from 20% to 8% was tested in a model of chronic rejection: Dark Agouti kidney to Albino Surgery recipient, "tolerised" by previous donor blood transfusions. Survival, weight gain, serum creatinine concentration and creatinine clearance were similar for both groups at all times. Urinary protein was significantly (P < 0.05) lower in the low-protein (LP) group 1 month after transplantation. After 3 and 6 months, both groups demonstrated mild chronic rejection. After 6 months, tubular atrophy was significantly (P < 0.05) less in the LP group and interstitial fibrosis was marginally reduced. Glomerular hypertrophy, glomerular sclerosis, tubular dilatation, leucocyte infiltration, adhesion molecule expression and TGF-beta1 mRNA expression were similarly increased in both groups. Thus, reducing dietary protein to 8% lowered urinary protein, but did not significantly affect the development of chronic rejection in renal allografts beyond affording a degree of protection from tubulointerstitial damage.
Animals↗
Improved cardiac preservation by the addition of nitroglycerine to colloid-free University of Wisconsin solution (MUW).
BACKGROUND: This study examines whether the addition of nitroglycerine, a known coronary vasodilator and nitric oxide donor, to colloid-free University of Wisconsin solution will improve and extend cardiac preservation. METHODS: Rat hearts were flushed and stored in colloid-free University of Wisconsin solution with or without the addition of nitroglycerine for 12, 16 or 20 hours at 0 degrees C before heterotopic transplantation with an indwelling externalized intraventricular balloon-tipped catheter. One and 7 days after transplantation of the heart the catheter was connected to a pressure transducer and quantitative functional studies were performed. RESULTS: After 12 hours preservation with nitroglycerine in colloid-free University of Wisconsin solution 6/6 grafts continued to beat for 7 days compared to 3/6 without nitroglycerine. After 16 hours preservation the addition of nitroglycerine 5/7 hearts continued to beat for 7 days compared to 0/6 without nitroglycerine (p < .05). Only 1/6 hearts beat for 7 days after 20 hours preservation with nitroglycerine. On Days 1 and 7, the left ventricular developed pressure (LVDP), contractility (max dP/dt) and rate of relaxation (peak -dP/dt) of 12 hour preserved hearts was better (p < .05) when nitroglycerine was present. The function of hearts preserved with the addition of nitroglycerine was similar after 12 and 16 hours preservation. CONCLUSION: Nitroglycerine is a valuable additive to colloid-free University of Wisconsin solution, extending effective preservation of the rat heart to 16 hours and significantly improving left ventricular function after 12 and 16 hours preservation. The addition of nitroglycerine, however, did not extend preservation to 20 hours.
Adenosine↗
Anxiety amongst women with mild dyskaryosis: costs of an educational intervention.
BACKGROUND: A randomized controlled trial in primary care investigated whether a structured educational intervention had an impact on the psychological morbidity associated with a 6-month period of surveillance for mild dyskaryosis. In the context of high levels of sustained distress, and few differences in terms of objective measures of anxiety, the intervention led to a greater proportion of women who were comfortable with a 6-month interval before their next smear test. OBJECTIVE. The aim of this paper is to evaluate the implications to general practices and the NHS, in terms of both costs and numbers of patient contacts, of a change from current policy to one of actively inviting all women with mild dyskaryosis to consult the practice nurse for the intervention. METHODS: We conducted a pragmatic, cluster-randomized controlled trial, comparing the intervention with standard care. The setting was general practices in Avon and South Glamorgan, UK. The subjects were women under surveillance following their first ever mildly dyskaryotic cervical smear result. The main outcome measures were as follows. Costs were reported according to randomization group, from the viewpoint of general practices and the NHS. The main elements which were costed were those attributable to production of the package and training in its use, and the costs of consultations subsequent to the woman receiving her smear test result. In addition, since in practice the intervention might be applied in different circumstances to those prevailing in the trial, a sensitivity analysis was performed to assess the costs of the educational package as realistically as possible. RESULTS: Almost twice as many women in the intervention group compared with the control group visited their practice to discuss their result. From the perspective of the practices, a change from current policy to the intervention policy led to potential (negligible) savings of around pound sterling 3.50 per partner per year. From the NHS perspective, the intervention would lead to slightly increased costs of between pound sterling 1000 and pound sterling 2500 per year for an area performing 60000 tests per year. CONCLUSIONS: It is both feasible and acceptable for practice nurses to deliver the educational package. Moreover, from the perspective of a practice, the policy is effectively cost-neutral. The main implication for general practices is the change in the pattern of care provided: fewer women consulted their GP about their smear result and many more, following active encouragement, consulted the practice nurse.
Anxiety↗
An economic model to estimate the relative costs over 20 years of different hip prostheses.
STUDY OBJECTIVE: To determine the relative costs of prostheses and factors associated with changes in these cost rankings. DESIGN AND SETTING: Economic model using published data. MAIN RESULTS: The main cost drivers are current costs and revision rates. Expected revision costs are a small proportion of the expected total costs. There are few competitors to the "gold standard" Charnley in terms of total expected costs over 20 years. There is no monetary advantage in using higher cost prostheses in older patients even if they were to have lower revision rates. There may be a monetary case for using prostheses with higher costs and lower revision rates in younger patients. CONCLUSIONS: The most cost effective prosthesis in older patients is the Stanmore. The Charnley, Exeter Polished and Muller Straight Stem are marginally more costly than the Stanmore. The study inevitably lacks good data on survival for newer prostheses. This does not affect the ability to make choices for older patients. Data are needed, however, on survival of cemented prostheses for younger patients.
Age Factors↗
Anxiety among women with mild dyskaryosis: a randomized trial of an educational intervention.
BACKGROUND: Women with mild dyskaryosis are currently managed by six-month cytological surveillance. While there is good evidence that women suffer psychological distress on receipt of an abnormal test, and that this is amenable to educational intervention, it remains uncertain whether this distress is prolonged and, if so, how it should best be managed. AIM: To investigate whether a structured educational intervention containing a risk communication package impacts upon psychological sequelae associated with this surveillance. METHOD: A pragmatic cluster-randomized controlled trial during 14 months in 1995 and 1996, based in general practices in Avon and South Glamorgan, that compared the intervention with standard care. Follow-up was by postal questionnaire at six weeks and four months after the screening laboratory had reported the test result. The intervention was an invitation to attend the general practice to consult with a practice nurse trained to deliver the package. The main outcome measures were Spielberger state-anxiety, SF-36 Mental Health dimension, four condition-specific questions regarding concerns about gynaecological health and timing of the repeat smear test, and attendance for the repeat test. RESULTS: Of 514 eligible women, 270 were recruited, of whom 240 returned the six-week questionnaire and 181 returned the four-month questionnaire. On all but one outcome measure, the differences between the groups were not statistically significant. At six-week follow-up, the proportion who preferred the repeat test to be sooner than six months was statistically significantly higher among controls (74% versus 53%; 95% CI = 9% to 33%). At the four-month follow-up, the difference was 7% (95% CI = -7% to 21%). CONCLUSION: There appear to be high levels of anxiety during surveillance for mild dyskaryosis that were not reduced by the intervention. Given that a personally delivered educational intervention designed to reduce anxiety could be viewed as the best available practice, it is of concern that women in the intervention group demonstrated sustained anxiety over a four-month period. The research agenda therefore seems to return to the fundamental question of whether surveillance should be the management of choice.
Adult↗
Mildly dyskaryotic smear results: does it matter what women know?
BACKGROUND: As of 1992, all women in the UK who have a first mildly dyskaryotic cervical smear are placed under surveillance for 6 months rather than being referred for immediate colposcopy. OBJECTIVES: We aimed to explore the relationship between anxiety and understanding about mild dyskaryotic, and to propose and discuss a method of analysing free text comments written by participants in studies based on structured questionnaires. METHODS: The freely scripted text of 236 women who had completed a questionnaire as part of a randomized controlled trial to assess the impact of an educational package was analysed. Randomization group status was concealed. Texts expressing similar views were grouped together and categorized. A matrix was drawn up to encompass the categories, and the comments were reallocated accordingly. RESULTS: Examination of the free text revealed two dimensions, concern and knowledge. There were no differences with respect to the apparent level of concern between the two randomization groups. However, comments from the intervention group were significantly more likely to have been classified as expressing good or vague knowledge than those from women in the control group. CONCLUSION: Although the educational intervention improved women's knowledge about the meaning of an abnormal smear result, this better knowledge was not correlated with less anxiety about the result. The free text analysis was a useful supplement to the main trial questionnaires. It demonstrated the existence of a range of understanding about cervical dyskaryosis, of anxieties relating to the receipt of such a result and the degree of interest women showed in acquiring further information.
Anxiety↗
Studies in a modified auxiliary abdominal rat heart transplantation model: preservation with colloid-free University of Wisconsin solution.
BACKGROUND: Current clinical heart preservation is still limited to 6 hours. A suitable heart transplantation model to rapidly screen the effectiveness of new solutions is essential. This study examines a new screening test-a modification of the conventional abdominal rat heart transplantation model that overcomes its serious limitation of lack of quantitative evaluation of function. METHODS: Rat hearts, with an externalized intraventricular balloon-tipped catheter, were transplanted immediately (controls) or flushed and stored in colloid-free University of Wisconsin solution in ice for 6, 9, or 12 hours before transplantation. One and 7 days later this catheter was connected to a pressure transducer and a calibrated syringe. Heart rate, maximum developed pressure, and maximum rate of left ventricular pressure rise were determined. Grafts were prepared for histologic study on day 7. RESULTS: All preserved hearts commenced beating within 2 minutes (controls beat within 20 seconds). On day 1 the heart rate and chamber stiffness (deltaP/deltat) were similar in all groups. The 9- and 12-hour-preserved hearts had significantly (p < 0.05) diminished developed pressure and contractility. On day 7 contractility and developed pressure improved in 9- and 12-hour-preserved grafts. There was extensive muscular atrophy and necrosis, with extensive cellular infiltrate in the 9- and 12-hour-preserved grafts; other grafts showed no damage. CONCLUSION: This quantitative model provides an ischemia-related gradation of function and greater discrimination than conventional methods. It has refuted previous studies suggesting effective preservation for 20 hours and demonstrated that functional testing is essential in evaluating preservation regimens.
Adenosine↗