PubMed Health⌕ Search

Biomedical subjects

K Grimmer

Publications and source records attributed to K Grimmer.

At least 19 recordsLinked to original sources

Isotype-dependent inhibition of tumor growth in vivo by monoclonal antibodies to death receptor 4.

To explore an approach for death receptor targeting in cancer, we developed murine mAbs to human death receptor 4 (DR4). The mAb 4H6 (IgG1) competed with Apo2L/TNF-related apoptosis-inducing ligand (DR4's ligand) for binding to DR4, whereas mAb 4G7 (IgG2a) did not. In vitro, both mAbs showed minimal intrinsic apoptosis-inducing activity, but each triggered potent apoptosis upon cross-linking. In a colon tumor nude mouse model in vivo, mAb 4H6 treatment without addition of exogenous linkers induced apoptosis in tumor cells and caused complete tumor regression, whereas mAb 4G7 partially inhibited tumor growth. An IgG2a isotype switch variant of mAb 4H6 was much less effective in vivo than the parent IgG1-4H6, despite similar binding affinities to DR4. The same conclusion was obtained by comparing other IgG1 and IgG2 mAbs to DR4 for their anti-tumor activities in vivo. Thus, the isotype of anti-DR4 mAb may be more important than DR4 binding affinity for tumor elimination in vivo. Anti-DR4 mAbs of the IgG1 isotype may provide a useful tool for investigating the therapeutic potential of death receptor targeting in cancer.

Animals↗

Vertical anthropometric measures and low back pain in adolescents.

BACKGROUND AND PURPOSE: The present paper explores aspects of a large dataset of adolescent potentiates of low back pain. Standing, trunk and shoulder height, subischial height, weight and mean leg length are examined in relation to reports of low back pain in the last two weeks, in strata of age and gender. METHOD: The present study examined 1254 adolescents, aged 11-18 years, drawn from 12 Adelaide public high schools during 1998. RESULTS: At each year of age, girls reported significantly more low back pain than boys. Girls and boys at each year of age provided different relationships between low back pain and anthropometric features, highlighting the unique nature of adolescent growth. The most consistent findings were anthropometric differences between 16-year-old boys, and 13- and 15-year-old girls, with and without low back pain, who may be at critical stages of the peak growth curve. CONCLUSION: We suggest a high prevalence of low back pain in adolescents, and that young sufferers with low back pain may be reflecting attributes of their stage of anthropometric growth.

Adolescent↗

Effects of backpacks on students: measurement of cervical and shoulder posture.

The aims of this pilot study were to determine whether the weight of a backpack, its position on the spine or time carried affected adolescents cervical and shoulder posture. Standing posture measured from the sagittal and frontal planes of 13 students was recorded photographically under several load carrying conditions. Cervical and shoulder position angles were calculated and compared. Results revealed that both backpack weight and time carried influenced cervical and shoulder posture. Forward head posture increased when carrying a backpack, especially one with a heavy load. Carrying a backpack weighing 15% of body weight appeared to be too heavy to maintain standing posture for adolescents. These findings have implications for future load carrying studies in adolescents.

Adolescent↗

The effect of a standard activity on the size of the median nerve as determined by ultrasound visualization.

The purpose of this study was to determine whether a standardized hand activity would produce changes in the cross-sectional diameter of the median nerve. Ultrasound measures of proven reliability of the cross-sectional diameter of the median nerve in the wrist were taken. These measures were taken before activity and immediately after the activity, after 5 minutes, and after 10 minutes. The median nerves of 40 normal subjects showed an increase in cross-sectional diameter immediately after hand activity then returned to a size close to the preactivity size within 10 minutes. The cross-sectional area of the carpal canal did not change significantly after the hand activity was performed. Female gender and body mass index over 25 were associated with significantly larger size increases in the median nerve. This preliminary study suggests that ultrasound is sensitive to the effects of activity upon the hand.

Adolescent↗

The development, validity and application of a new instrument to assess the quality of discharge planning activities from the community perspective.

OBJECTIVE: To describe the development, validity and application of a new instrument (PREPARED) for obtaining feedback from community consumers of discharge planning activities. DESIGN: Iterative qualitative and quantitative investigations. SETTING: The community catchment area of a metropolitan Australian tertiary public hospital. STUDY PARTICIPANTS: Patients aged over 65 years, with a range of conditions, recently discharged from hospital, their carers, and hospital nursing staff. ACTIONS: PREPARED was constructed from interviews with patients, carers and hospital staff. It was trialed and modified to ensure sensitive measurement of key attributes of discharge planning process and outcome. This paper explores the patient and carer versions of PREPARED. Data items were reduced to domains of key questions by factor analysis. Instrument performance was assessed by correlation of process and outcome measures, by comparing PREPARED responses with subsequent unstructured interview data, and by testing whether PREPARED responses were independent of health-related quality of life at the time of survey. RESULTS: Four key process domains were identified: information exchange (community services and equipment), medication management, preparation for coping after discharge and control of discharge circumstances. Outcome was measured as overall satisfaction with discharge, whether equipment and community service needs had been met, use of health services and health related costs post-discharge. The instrument performed well when compared with interview data, the process and outcome domains were largely independent of each other, as were responses to PREPARED and SF-36. CONCLUSIONS: PREPARED offers a comprehensive way of closing the quality improvement loop, by providing information from the community perspective on the quality of planning for discharge from the acute hospital setting.

Aged↗

Gender-age environmental associates of adolescent low back pain.

This paper describes adolescent low back pain and tests its associations with environmental features of backpack load, time spent carrying loads, time sitting, and time playing sport, using data from 1269 adolescents in twelve volunteer high schools in Adelaide, South Australia. Backpacks were the preferred method of load carrying, two-thirds of wearers preferring to carry the load over two shoulders. The average load weighed 5.3 kg (approximating 10% of body weight). The youngest students carried approximately the same amount as the oldest students. Girls were more likely than boys to report recent low back pain, and there were gender- and age-specific associations between recent low back pain, the amount of time spent sitting, the backpack load and time spent carrying it, and time playing sport. Body mass was not a confounder of any association. These findings support ongoing concerns regarding environmental contributions to adolescent low back pain.

Adolescent↗

Reliability of adolescents' self-report of recent recreational injury.

PURPOSE: To assess the reliability of adolescents' self-report of recent recreational injury. METHOD: Identical written questionnaires were administered twice in a 3-week period to 75 randomly selected adolescents (aged 11-12 years and 15-16 years) in state primary and secondary schools in South Australia, Australia. The questionnaires sought information on injury sustained in the previous week. Parents of 60 of the adolescents were contacted in the same week as one of the questionnaire administrations, to verify their adolescent's most recent injury self-report. Intraclass and Pearson correlation coefficients provided evidence of agreement between responses, and stability of measure. RESULTS: There was high stability and good agreement between the parent and adolescent responses provided in the same week, suggesting that adolescents accurately reported recent recreational injury. The poor stability and low agreement between repeated adolescent responses over the 3-week period indicated not poor recall, but the changing nature of mostly minor recreational injury. These findings suggest that the nature of the injury reported in the first questionnaire had changed by the time of the second questionnaire administration, and that this was accurately reported. CONCLUSION: Confidence can be placed in adolescents' self-reports of recreational injury in the preceding week.

Adolescent↗

A systematic review of the clinical diagnostic tests for carpal tunnel syndrome.

The purpose of this report was to critically review studies of the clinical diagnostic tests for carpal tunnel syndrome. The reports were located through Medline, Current Contents, related readings, and the reference lists of the articles. They all explored the use of clinical diagnostic tests for carpal tunnel syndrome compared with the results of NCS. Criteria for systematically reviewing the studies were developed, tested for reliability, and applied to the studies. Many studies did not have sufficient detail to allow repetition of the protocol by other researchers. The sensitivities and specificities reported for each can be compared with the quality criteria ratings they each received. The literature supports the use of the wrist flexion and carpal compression test and suggests that 2-point discrimination has low sensitivity for diagnosing carpal tunnel syndrome. Many reports do not include methodology, which makes the results difficult to reproduce and to apply to other populations. (J Hand Surg 2000; 25A:120-127.

Carpal Tunnel Syndrome↗

Frequency of headaches associated with the cervical spine and relationships with anthropometric, muscle performance, and recreational factors.

OBJECTIVE: To investigate headache specifically associated with the cervical spine, and factors associated with it. DESIGN: Cross-sectional, population-based observational study. SETTING: Two agriculturally based municipalities in southern Tasmania, Australia. PATIENTS: Four hundred fifty adults were randomly selected from electoral rolls; after refusals and exclusions, 427 subjects participated. OUTCOME MEASURE: For analysis, subjects were divided into three groups: those who did not have a particular type of headache in the previous month, those reporting fewer than two headaches of this type for the month (occasional headache), and those reporting two or more (frequent) headaches of this type in the month. STUDY FACTORS: Information collected by questionnaire and by objective measurement on anthropometric and functional measurements, wearing glasses or dentures, usual occupation, and usual recreational activities. RESULTS: The monthly prevalence of frequent headaches associated with the cervical spine was 28.3% (95% confidence interval [CI], 24.2-32.9), and another 35.4% (30.9-40.1) of subjects had these headaches occasionally. The frequency of headache occurrence was associated with a difference between front and back neck length of 2 cm or more. Occasional participation in recreational sport by men and wearing glasses by women were significant predictors of headache. CONCLUSION: Headaches of this type were more frequent in subjects with a long anterior neck length relative to their posterior neck length, particularly if they occasionally participated in recreational sports (men) or wore glasses (women).

Adult↗

Staff perceptions of discharge planning: a challenge for quality improvement.

One hundred staff in three acute care public hospitals were asked about their perceptions of successes and failures of their discharge planning activities. The intention was to highlight ways in which the quality of discharge planning could be improved within the acute hospital setting. Generally staff described failures more commonly than successes, with a number of key failures being identified, including problems associated with vacating beds, lack of appropriate staff, patients and career education about discharge activities, general process issues, problems associated with community service provision and patients who are difficult to discharge. Staff identified the lack of feedback on the outcome of their efforts as a source of frustration and a barrier to improving discharge planning activities. The challenges for improving the quality of discharge planning in the acute hospital setting would appear to be in establishing appropriate structures and processes that promote interaction between staff, patients and community providers, and provide incentives for behavioural change.

Attitude of Health Personnel↗

Differences in stakeholder expectations in the outcome of physiotherapy management of acute low back pain.

OBJECTIVE: To compare stakeholder expectations of outcome of physiotherapy management of acute low back pain. DESIGN: Observational design using interviews and questionnaires. SETTING: Practice/workplace. STUDY PARTICIPANTS: The study sample was from South Australia. It comprised 74 physiotherapists randomly selected from professional association listings (49.3% response rate), 121 physiotherapy patients (recruited by participating physiotherapists when attending their first physiotherapy treatment for acute low back pain), 21 general practitioners randomly selected from medical practitioner listings in the metropolitan telephone book (36.2% response rate) and 13 third party payers of a total of 16 available insurers in the metropolitan area (82% response rate). MAIN OUTCOME MEASUREMENTS: Stakeholders reported expectations of outcome at the end of the first treatment session and at the completion of the episode of care. RESULTS: There were differences in expectations between stakeholders, as well as between naive and experienced patients. Overall, patients expected symptom relief at the end of the first treatment. Naive patients decided to return for further treatment based on the relationship established with the therapist, whereas experienced patients also expected some advice on their condition during the first contact. Physiotherapists and referrers expected symptom relief and then long-term management strategies to be provided, and third party payers expected cost-efficient management of the condition and patient satisfaction. CONCLUSION: Physiotherapists need to address potential imbalance of consumer knowledge and foster a quality partnership with their patients on the first visit to physiotherapy. Patients who are in pain may not derive full value from information provided in an untimely manner.

Acute Disease↗

Differences between metropolitan and country public hospital allied health services.

This paper compares patient and episode characteristics in allied health services delivered in country and metropolitan hospitals. Eight public hospitals (46 allied health services) participated in the study (three country and five metropolitan sites, situated in South Australia, Queensland and Tasmania). Standardised rates of patient throughput were similar for country and metropolitan allied health services, despite smaller numbers of country staff providing services to larger geographical areas. Although the differences were not significant, country patients were generally older and had more chronic conditions than metropolitan patients. Fewer country patients than metropolitan patients were eligible for rebates in the private sector. In addition, fewer alternative services were available in country communities, which heightened the role of the public hospital outpatients services within the community. This paper provides an argument for similar funding arrangements for country and metropolitan ambulatory allied health services.

Adolescent↗

The effect of age and chronicity on patient recall of public hospital outpatient clinic use.

This paper reports on an investigation of the effect of age and chronicity on the accuracy of recall by allied health patients of their attendance at outpatient clinics at a public hospital over the previous 12 months. Patients consistently under-reported use of outpatient clinics, when compared with hospital records. Age and chronicity were not found to be determinants of the observed differences. Other potential influences on patient recall were identified to assist future testing.

Adolescent↗

A survey of general practitioners: implications for the hospital/community interface.

This paper presents the results of a survey that was conducted under the auspices of a Commonwealth-funded Ambulatory Care Reform Project. The survey was undertaken in all telephone areas of South Australia (08, 085, 086, 087, 088) to investigate issues of access to, and availability of, clinical allied health outpatient services at the Royal Adelaide Hospital with respect to general practitioners. Six hundred and twenty general practitioners in South Australia received a mailed survey enclosing a reply-paid envelop. Forty-nine per cent of the general practitioners responded. The highest response was from practitioners in the metropolitan area (08 telephone area) and the immediate Adelaide country area (085 telephone area). General practitioners supplied quality and in-depth responses that clearly indicated issues they felt impeded full use of clinical allied health services at the Royal Adelaide Hospital. These issues have implications not only for the clinical allied health outpatient services at the Royal Adelaide Hospital, but for all clinical allied health outpatient services in the public hospital system.

Adult↗

Clinical indicators: a methodological approach.

Clinical indicators offer physiotherapists a tool by which quality of care can be flagged and evaluated. Such a flag requires a measure of the cost of treatment as well as the outcome achieved for that cost. Traditionally, the number of treatments to discharge has been used as a proxy measure of cost as well as outcome of physiotherapy care. However, physiotherapists recognize that the cost of treatment is an inappropriate reflection of the outcome of care in many instances. The challenge for physiotherapists in developing clinical indicators is to set appropriate flags of quality of care. This paper presents a methodological approach to the development of a flag of performance for acute lower back pain.

Acute Disease↗

A multicentre exercise: developing an indicator for the physiotherapy management of acute low back pain.

The collection of information from a number of treatment centres is necessary for the development of diagnosis-specific treatment norms. From these data, realistic outcomes of treatment can be determined and significant risk factors identified. By comparing individual therapists' data with the overall treatment norms, acceptable levels of variation can be established. A prospective pilot study on acute low back pain, which examined both patient characteristics and outcomes of physiotherapy intervention, was conducted among one-third of the private physiotherapy practices in Tasmania. There was no previously developed methodology on which to base the study. As a result, the distribution of treatment numbers was first examined in order to flag the mean number of treatments. The outcome of the patient groups which fell on either side of the mean flag (the normal and outlying patient groups) was then defined. A clinical indicator was developed from both treatment numbers and outcome.

Activities of Daily Living↗

Relationship between occupation and episodes of headache that match cervical origin pain patterns.

The relationship between headache that matches cervical origin pain patterns, occupation, gender, age, and hours of work is examined in a randomly sampled, never-injured population. Although gender was established as a significant factor in the association between occupation and headache, age and hours of work were shown to have no effect. Women working in managerial and professional occupations had a significantly higher risk of cervical origin headache when compared with women working in either clerical or blue collar occupations. A similar association for men was not noted.

Adolescent↗

Public perceptions of a rural emergency medical services system.

INTRODUCTION: To determine the awareness of citizens and physicians concerning the capabilities of a rural emergency medical services (EMS) system. HYPOTHESIS: Citizens and physicians are unaware of the capabilities of the EMS system. METHODS: Residents were selected randomly from the local telephone directory and asked a series of structured questions about their EMS agency. A written survey was distributed to area physicians. Chi-square analysis was used to compare the proportion of respondents who knew the available interventions in their community with the proportion of those who did not. Statistical significance was inferred at p < 0.01. RESULTS: A total of 49% of the citizens were able to identify available skills, and 41.4% of the physicians were able to identify available skills. Physicians were less likely than were the citizens to be able to identify the skills performed by each provider (p < 0.001). CONCLUSION: This study indicates that both physicians and the lay public have little understanding of the capabilities of their EMS system.

Attitude of Health Personnel↗