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Biomedical subjects

K P Jones

Publications and source records attributed to K P Jones.

At least 19 recordsLinked to original sources
PubMed1998

A randomized, prospective analysis of five sperm preparation techniques before intrauterine insemination of husband sperm.

OBJECTIVE: To evaluate pregnancy rates (PRs) in women undergoing artificial insemination with sperm alternately prepared by one of five techniques: sperm washing, Percoll gradient centrifugation, swim-up, swim-down, or refrigeration/heparin treatment. DESIGN: Each treatment group alternated in a different order through the five sperm preparations. Pregnancy rates were compared for each sperm preparation. SETTING: Two infertility centers, one located in an academic institution and the other a regional hospital. PATIENT(S): Three hundred sixty-three women undergoing 898 artificial inseminations with husband semen with a progressive motile sperm count of >20 million sperm per mL were randomly placed in the five treatment groups. MAIN OUTCOME MEASURE(S): Pregnancy rates. RESULT(S): The overall ongoing PR per insemination was 9.7% (87/898), including 6.12% for natural cycles (n = 196), 12.8% for clomiphene citrate-stimulated cycles (n = 101), and 10.3% for gonadotropin-stimulated cycles (n = 601). The highest ongoing PRs for sperm preparations followed the swim-up technique (13.2%, 26/197) and the Percoll gradient centrifugation technique (12.7%, 26/204). CONCLUSION(S): These data suggest that the swim-up and Percoll gradient preparations result in higher PRs than the wash, swim-down, and refrigeration/heparin techniques.

Centrifugation, Density Gradient↗
PubMed1997

The assay of interleukin 4 in the serum of normal subjects and atopic patients using a novel immunoassay.

Interleukin 4 (IL-4) was measured in the serum of normals and mild atopic patients using a high sensitivity ELISA system involving an amplification stage. The method was found to have a limit of detection of 0.02 pg/ml after a square root transformation of the concentration data and to show good reproducibility with coefficients of variation between 11 and 14%. Recoveries of standard IL-4 from serum was greater than 90%. Markedly elevated levels of IL-4 were seen in the atopic groups compared with the normals. No association was found between total white cell counts, lymphocyte or eosinophil counts and serum IL-4 levels. This study demonstrates that serum IL-4 levels can distinguish between atopic subjects and normals, even in mild or symptomless disease. This may prove valuable in the management of atopic disorders.

Adolescent↗
PubMed1996

Interphase fluorescence in situ hybridization detection of t(2;13)(q35;q14) in alveolar rhabdomyosarcoma--a diagnostic tool in minimally invasive biopsies.

The identification of t(2;13)(q35;q14) is a useful aid in the accurate diagnosis of rhabdomyosarcoma, distinguishing it from other small round cell tumours and supporting the distinction between alveolar and embryonal forms. Cytogenetic analysis is difficult and with the increased use of minimally invasive biopsy methods and primary chemotherapy, adequate tumour material is not always available. To overcome these difficulties, two-colour interphase fluorescence in situ hybridization (FISH) to detect t(2;13)(q35;q14) was developed and its utility in assessing minimally invasive biopsies was investigated. Two cosmid clones which mapped proximal or distal to the breakpoint region 13q14 and one yeast artificial chromosome clone that mapped distal to the 2q35 breakpoint were identified. In interphase cells containing t(2;13)(q35;q14), the configuration of cosmid and yeast artificial chromosome signals demonstrated the presence of the translocation. Five cases of rhabdomyosarcoma were analysed by interphase FISH. The t(2;13)(q35;q14) was detected in all four alveolar tumours and was confirmed by cytogenetics in two cases, but was absent in one embryonal tumour. This sensitive detection method is applicable to minimal amounts of fresh or frozen tumour.

Adolescent↗
PubMed1995

Metabolic parameter, bleeding, and weight changes in U.S. women using progestin only contraceptives.

Our objective was to determine the effect of progestin-only contraceptives on metabolic parameters, bleeding patterns, and weight changes during the first year of use. Seventy-one women (> 95% Caucasian), who were advised regarding contraception alternatives, self-selected levonorgestrel implants (n = 44), depo-medroxyprogesterone acetate (n = 22), or oral norethindrone (n = 5). One year later, 11 levonorgestrel implant and five depomedroxyprogesterone acetate patients were randomly selected to compare (pre- and post-progestin use) levels of cholesterol, triglycerides, low density lipoprotein (LDL), high density lipoprotein (HDL), very low density lipoprotein (VLDL), apolipoproteins A-1 and B-100, bilirubin, and sex hormone binding globulin. Monthly bleeding and spotting records were kept in each group. Body weights were also monitored in each group. No statistically significant differences in metabolic parameters were found between pre- and post-progestin use in the levonorgestrel implant and depo-medroxyprogesterone acetate groups. Continued bleeding patterns were more prominent in the levonorgestrel implant and oral norethindrone groups than in patients receiving depo-medroxyprogesterone acetate. No significant weight gain was detected in any group. No changes in metabolic parameters or weight were noted over the one year of use of levonorgestrel implants or depo-medroxyprogesterone acetate. Depo-medroxyprogesterone acetate had the highest incidence of amenorrhea.

Administration, Oral↗
PubMed1995

Lung function measurement in general practice: a comparison of the Escort spirometer with the Micromed turbine spirometer and the mini-Wright peak flow meter.

It is important that new types of spirometer for widespread clinical use are pragmatically evaluated in primary care. This study compared measurements taken by a new portable Fleisch pneumotachograph spirometer (known as the Escort) with those of the commonly used mini-Wright peak flow meter and the Micromed Pocket turbine spirometer. A pragmatic study was conducted in two phases during routine surgeries at Aldermoor Health Centre, Southampton. Phase I compared the new spirometer with the mini-Wright peak flow meter and Phase 2 compared the new spirometer and the turbine spirometer. One hundred patients aged 5-88 years (56 patients with a history of chronic respiratory complaints and 44 patients without) entered Phase 1, and 100 patients aged 6-82 years (62 patients with a history of chronic respiratory complaints and 38 patients without) entered Phase 2. Each patient contributed only once to each phase, but some entered both phases on separate occasions. Ninety-five percent limits of agreement (mean +/- SD) were wide for all comparisons. Graphical plots revealed trends towards higher Escort values as mean values rose compared with both mini-Wright and turbine readings for peak expiratory flow rate and forced expiratory volume in one second. Possible over-reading of peak expiratory flow rate with the mini-Wright meter at low mean values was also seen. Readings taken with these different types of meter cannot be interchanged with confidence in clinical practice. The clinical significance of the theoretically more accurate measures of lung function produced with the new meter, and indeed of spirometry itself, needs further investigation.

Adolescent↗
PubMed1995

The role of measuring forced expiratory volume in one second in determining therapeutic changes made in an asthma clinic in general practice.

In order to determine whether spirometric measurements in a primary care asthma clinic added useful information to symptom assessment and peak flow recordings, a retrospective audit of manual case records was conducted on patients attending an urban general practice asthma clinic. Sixty-three patients were identified in whom 108 increases in treatment at the clinic had been recorded and the associated determinants of these changes were extracted from their case notes. Therapeutic changes associated with the following determinants alone were only found in single instances: presence of or changes in symptoms, inhaler technique deficiency, forced expiratory volume in 1 s (FEV1) less than 75% of the predicted value and peak expiratory flow (PEF) rate less than 75% of the predicted value. In no instance did changes in FEV1 or in PEF alone occur. The addition of spirometric measurements in this sample of patients only made an obvious difference to decision-making in four instances (4%). Therefore, the role of spirometers in the management of asthma in general practice needs further consideration and clarification on a wider scale before limited resources, whether in terms of time or money, are committed to their use.

Adolescent↗
PubMed1995

Peak flow based asthma self-management: a randomised controlled study in general practice. British Thoracic Society Research Committee.

BACKGROUND: Peak flow based asthma self-management plans have been strongly advocated in consensus statements, but convincing evidence for the effectiveness of this approach has been largely lacking. METHODS: A randomised controlled trial was conducted in 25 general practices comparing an asthma self-management programme based on home peak flow monitoring and surgery review by a general practitioner or practice nurse with a programme of planned visits for surgery review only over a six month period. RESULTS: Seventy two subjects (33 in the self-management group and 39 in the planned visit group) completed the study protocol, but diary card data for at least three months were available on a total of 84 (39 in the self-management group and 45 in the planned visit group). Teaching self-management took longer than the planned visit review. In the self-management group home peak flow monitoring was felt to be useful by doctors and patients in 28 (85%) and 27 (82%) cases, respectively. There were no between group differences during the study period in terms of lung function, symptoms, quality of life, and prescribing costs. Only within the self-management group were improvements noted in disturbance of daily activities and quality of life. Possible explanations for these negative results include small numbers of subjects, the mild nature of their asthma, and inappropriate self-management strategies for such patients. CONCLUSIONS: Rigid adherence to long term daily peak flow measurement in the management of mild asthma in general practice does not appear to produce large changes in outcomes. Self-management and the use of prescribed peak flow meters need to be tailored to individual circumstances.

Adolescent↗
PubMed1995

Interleukin-8. Differential expression in lone fibrosing alveolitis and systemic sclerosis.

Fibrosing alveolitis may occur alone (CFA) or in association with systemic sclerosis (FASSc). FASSc was recently shown to have a prognostic advantage over CFA. Because interleukin-8 (IL-8) is likely to be a major determinant of neutrophil alveolitis, we evaluated IL-8 expression in patients with CFA and FASSc and compared it with that in normal individuals and sarcoidosis and systemic sclerosis patients without pulmonary involvement (SSc no FA). IL-8 protein in bronchoalveolar lavage fluid (BALF) was assessed by immunoassay, and IL-8 mRNA expression was assessed using Northern analysis and reverse transcription-polymerase chain reaction (RT-PCR) and in situ hybridization of lung parenchyma. Compared with normal subjects, IL-8 concentration was significantly greater in both CFA (p < 0.001) and FASSc groups (p < 0.05) but no different in sarcoidosis. The IL-8 concentration in CFA was higher than in FASSc (p < 0.01) and was related to BAL % neutrophils (rs = 0.48, p < 0.01). IL-8 mRNA expression evaluated by Northern analysis was seen only in patients with CFA and FASSc and was related to BAL % neutrophils (rs = 0.63, p < 0.01). We suggest that IL-8 is a key factor in the pathogenesis of fibrosing alveolitis and that the poorer prognosis of CFA compared with FASSc is related to higher levels of IL-8 within the lower respiratory tract.

Adult↗
PubMed1995

Proactive, nurse-run asthma care in general practice reduces asthma morbidity: scientific fact or medical assumption?

Nurse-run asthma care in general practice in the United Kingdom has become extremely common, particularly since the introduction of the 1990 contract for general practitioners, but there have been few controlled trials of the clinical effectiveness of this approach to asthma care. A study attempted to compare the outcome of asthma care over three years in two similar practices when one practice provided proactive, nurse-run care and the second continued with a traditional (reactive) approach, and to examine the process of care when such changes were introduced. Despite the investment of considerable resources, statistically significant differences could not be shown between the two practices using a comprehensive variety of outcome measures. This could be interpreted as meaning that nurse-run asthma care may be ineffective, but the negative outcome is much more likely to reflect difficulties in the manner in which the intervention practice sought to develop its service and in the research process. There were extensive methodological problems leading to a potential type 2 error. A randomized controlled trial of nurse-run asthma care would now be difficult to conduct, and so it may be necessary to accept nurse-run asthma care without definitive proof of its clinical effectiveness.

Adolescent↗
PubMed1995

The effects on prescribing patterns and costs of having a special interest in asthma.

To define the characteristics of general practices with a special clinical interest in asthma and to estimate the resulting extra prescribing costs, we sent a postal questionnaire to all English practices containing members of the General Practitioners in Asthma Group. Item and cost comparisons for 24 PACT (prescribing analysis and cost) aggregates were made between practices who had operated an agreed, written management plan for asthma before 1 April 1990 and all other practices in their respective Family Health Services Authorities. One hundred and sixty-three practices with GPIAG members responded (70%), of which 26 filled the management plan requirement. These 26 practices showed evidence of significantly better asthma care provision than the remainder of the sample. Their prescribing costs were significantly higher for respiratory drugs (median 37% higher) but lower in other drug categories. For respiratory drugs, costs were significantly higher for inhaled adrenoceptor stimulants, steroid inhalers, large spacers, and peak flow meters, but lower for cough medicines and systemic nasal decongestants: the number of items prescribed showed similar patterns. The prescribing costs of practices claiming a special interest in asthma are likely to show higher respiratory drug costs, but overall prescribing costs showed no increase in the practices studied.

Anti-Asthmatic Agents↗
PubMed1994

General practitioners' views about the statutory annual practice report.

OBJECTIVE: To ascertain the views of primary care professionals about the current purpose, uses, potential, and workload implications of the statutory general practice annual report. DESIGN: Postal questionnaire survey. SETTING: General practices in the Northern region. SUBJECTS: All practices in the region that were singlehanded, fundholding, non-fundholding and with more than five partners, and a one in three random sample of all non-fundholding practices (n = 318). RESULTS: 263 practices responded (83%). The report took a median of 12 hours to produce (95% confidence interval 11 to 15 hours; interquartile range 7-35). The main perceived purpose of the report was to monitor practice activity (165 respondents; 63% (95% confidence interval 57% to 69%)), but 44 respondents (17%; 13% to 22%) produced it only because it was contractually required. Practices included statutory and non-statutory data in these reports and would have liked comparative practice activity information (155 respondents; 59%) and "good ideas" (165 respondents; 63%) fed back to them. Respondents would have liked the annual report used to improve practice development planning (122 respondents; 46% (40% to 52%)), to facilitate audit (115 respondents; 44% (38% to 50%)), and to influence resource allocation (104 respondents; 40% (34% to 46%)). One hundred and eighteen practices (45%; 39% to 51%) would produce an annual report even if not contractually required. Data collected were perceived to be already available elsewhere. CONCLUSIONS: Primary care professionals have concerns about the current annual report. They would prefer to collect relevant, standardised data which could lead to better audit, planning, and resource allocation.

Annual Reports as Topic↗
PubMed1994

Salivary PAF in acute myocardial infarction and angina: changes during hospital treatment and relationship to cardiac enzymes.

Salivary levels of platelet activating factor (PAF) were measured together with serum CPK and interleukin 2 receptor in 30 patients admitted to the coronary care unit, 9 patients with pulmonary tuberculosis, 10 with acute severe asthma and 8 normal controls. 16 of the 30 C.C.U. patients had sustained a acute myocardial infarction (M.I.) 5 had acute angina and the remaining 9 had non cardiac chest pain. Salivary PAF on admission was significantly higher in the M.I. Patients than in the normal subjects, asthmatics, tuberculosis patients and those with non cardiac chest pain (p < 0.001 in all cases) but not those with angina. After 48 hours PAF levels fell in the subjects with M.I. (p < 0.01) and no significant difference was seen between any group. PAF levels did not show any relationship with CPK levels or site of infarct in the M.I. patients. Interleukin 2 receptor was not significantly raised in the M.I. group as a whole but some individual patients showed markedly increased serum levels, but these levels did not correlate with either salivary PAF or serum CPK.

Angina Pectoris↗
PubMed1994

GnRH agonist therapy in human ovarian epithelial carcinoma (OVCAR-3) heterotransplanted in the nude mouse is characterized by latency and transience.

We have previously documented the responsiveness of a cell line of human ovarian epithelial carcinoma (Bowman Gray 1) heterotransplanted in nude mice to treatment with the GnRH agonist Lupron-SR. In this study we used another human ovarian epithelial carcinoma cell line, OVCAR-3, and the human endometrial carcinoma cell line HEC-1A. After a latent period, OVCAR-3 tumors showed significant inhibition of growth on Days 17, 21, and 24 (P < 0.03) compared to controls. The effect was transient and did not persist beyond Day 24. HEC-1A tumors showed no inhibition of growth. Radioreceptor assay studies utilizing native radiolabeled GnRH and [D-Lys6]-GnRH revealed no specific GnRH receptors in any of the tumor samples (BG-1, OVCAR-3, HEC-1A, University of Nebraska cell line, and two fresh human ovarian epithelial tumor samples) compared to male rat anterior pituitary cells. Binding studies and the latency and transience of effect would suggest that the mechanism of action in this animal model may be indirect. This activity may be via altered circulating steroids, gonadotropins, cell-cycle regulatory events, or some other as-yet-undefined action related to GnRH agonist administration or indirectly via effects of the metabolic products of degraded GnRH agonist such as D-amino acids, which are incorporated into the cells by constitutive or adsorptive pinocytosis. This study confirms latency and transience of effect of GnRH agonist therapy on an in vivo model of ovarian cancer.

Animals↗
PubMed1994

Contraception for patients with psychiatric or medical disorders.

The increased risk that pregnancy carries for women with medical disorders must be weighed against the risks of reversible contraception. In the absence of prospective randomized trials of various contraceptive methods and their effect on a given disease process, the clinician must use information regarding the risk of pregnancy in a woman with medical problems, the well-documented failure rates of various methods, and the probability that the patient will use the method (or any other method) effectively. The possible effects of contraceptive methods on cardiovascular, endocrinologic, neurologic, and other medical disorders are discussed as are appropriate contraceptive options and considerations for these women.

Cardiovascular Diseases↗
PubMed1994

Ovulation induction with gonadotropins and intrauterine insemination compared with in vitro fertilization and no therapy: a prospective, nonrandomized, cohort study and meta-analysis.

OBJECTIVES: To determine whether one to four cycles of ovulation induction with hMG and IUI or one cycle of IVF results in the highest pregnancy rate and is least expensive and whether published pregnancy rates for one to four cycles of hMG and IUI results in a higher pregnancy rate than rates for one cycle of IVF, zygote intrafallopian transfer (ZIFT), or GIFT. DESIGN: Prospective, nonrandomized, cohort study. Patients were excluded who were infertile for < 18 months, had a significant male factor, had greater than mild endometriosis, or had bilateral nonpatency of the fallopian tubes. Cohort groups included 47 hMG and IUI patients (99 cycles), 19 IVF patients (19 cycles), and 21 patients (210 cycles) receiving no treatment. A meta-analysis on accumulated hMG and IUI data using similar entry criteria was also performed. Theoretical calculations were performed and stable fecundity assumed to compare with national data on IVF, ZIFT, and GIFT. SETTING: Fertility Center, Division of Reproductive Endocrinology, University of Utah, Salt Lake City, Utah. RESULTS: A course of therapy with one to four cycles of hMG and IUI was just as effective as one cycle of IVF in achieving pregnancy. No significant difference in pregnancy rates was found between one IVF cycle and one to four cycles of hMG and IUI in our population. In vitro fertilization was more expensive than four cycles of hMG and IUI. Both IVF and hMG and IUI were more effective than no therapy. Published data also suggest that four cycles of hMG and IUI theoretically result in higher pregnancy rates than one cycle of IVF, ZIFT, or GIFT. CONCLUSION: Cost-benefit analysis comparing hMG and IUI, IVF, and no therapy in infertility patients may favor a course of four cycles of hMG and IUI as the first line of therapy. Using meta-analysis and theoretical assumptions, the pregnancy rate for one cycle of hMG and IUI is inferior to IVF, GIFT, or ZIFT; two cycles are comparable to IVF or ZIFT and inferior to GIFT; three cycles are superior to IVF or ZIFT and comparable to GIFT; and four cycles are theoretically superior to all techniques.

Adult↗