Biomedical subjects

Karen L Brown

Publications and source records attributed to Karen L Brown.

3 recordsLinked to original sources

PubMed2006

Shared records: towards collaborative working with families.

In response to government policy on integrated records, common assessment and information sharing, health and social care professionals who work with children and young people are reviewing how patient documentation is designed, implemented and evaluated. A survey of members of a multiprofessional team within a regional children's unit was carried out to inform the development of collaborative (shared) patient documentation. A focus group activity using the nominal group technique generated information to construct a questionnaire which was piloted and sent to 125 key informants identified using 'snowballing' technique (Blacktop 1996). Of the 62 respondents (a 50 per cent response rate) only four did not support a patient to be accessed by all who provide care. Sixty per cent strongly agreed or agreed that any new record design should provide space for contributions from the child/young person and the carer/parent. Despite this clear consensus, opposition by some gate keepers may still slow the introduction of shared records in children's services.

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PubMed2005

Referral and experience with genetic testing among women with early onset breast cancer.

The purpose of this study was to determine whether physicians refer women with early onset breast cancer for genetic testing for BRCA1 and BRCA2, and how women respond to being offered testing and use the results. A web-based survey was distributed to 1221 women with early onset breast cancer. The survey included 158 questions divided into the following sections: demographics, family history of cancer, medical history, treatment history, and experience with genetic testing. Of 551 women diagnosed since 1993 who responded to the survey (45.1%), less than half (45%, n = 246) had ever discussed genetic testing with their physician and/or been referred to see a genetic counselor. Women with a family history of cancer (53%) and Ashkenazi Jewish women (81%) were more likely to have been referred. Of those who had discussed testing, 60% had undergone or were interested in testing. Overall 92 women were tested and 19 (20.6%) of these tested positive for a deleterious BRCA1 or BRCA2 mutation. Fourteen (74%) who tested positive subsequently underwent prophylactic surgery. Satisfaction with counseling and the decision to be tested was high. Among women who were not offered testing, the fact that the test had not been offered by their physician (89%), and fear of discrimination (83%) were the two most frequently cited factors for lack of interest in testing. A substantial number of women are not being referred to genetic counseling and/or testing after a diagnosis of early onset breast cancer. Among those who were tested, there was high interest in prophylactic surgery after confirmation of a BRCA1/2 mutation.

Adult↗

PubMed2004

Scrapie transmission following exposure through the skin is dependent on follicular dendritic cells in lymphoid tissues.

BACKGROUND: Transmissible spongiform encephalopathies (TSEs) are chronic infectious neurodegenerative diseases that are characterized by the accumulation in affected tissues of PrP(Sc), an abnormal isoform of the host prion protein (PrP(c)). Following peripheral exposure, PrP(Sc) usually accumulates on follicular dendritic cells (FDCS) in lymphoid tissues before neuroinvasion. Studies in mice have shown that TSE exposure through scarified skin is an effective means of transmission. Following inoculation via the skin, a functional immune system is critical for the transmission of scrapie to the brain as severe combined immunodeficiency (SCID) mice are refractory to infection. Until now, it was not known which components of the immune system are required for efficient scrapie neuroinvasion following skin scarification. OBJECTIVE: To determine which cells are critical for the transmission of scrapie to the brain following inoculation via the skin. METHODS: A chimeric mouse model was used, which had a mismatch in PrP(c) expression between FDCs and other bone marrow-derived cells within lymphoid tissues. These chimeric mice were challenged with scrapie by skin scarification to allow the separate roles of FDCs and lymphocytes in peripheral scrapie pathogenesis to be determined. RESULTS: We show that mature FDCs are essential for the accumulation of scrapie within lymphoid tissues and the subsequent transmission of infection to the brain following TSE exposure by this route. Furthermore, we show that the accumulation of PrP(Sc) and infectivity in the spleen is independent of PrP expression by lymphocytes or other bone marrow-derived cells. CONCLUSION: Following inoculation with scrapie by skin scarification, replication in the spleen and subsequent neuroinvasion is critically dependent upon mature FDCs.

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