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Biomedical subjects

L Donaldson

Publications and source records attributed to L Donaldson.

At least 37 records · Page 2Linked to original sources
PubMed1999

The medical expert witness: time to regulate conflicts of interest.

Doctors are often asked to provide expert evidence for the courts. Whilst there is a considerable body of work in the legal literature, there is relatively little discussion and guidance in general medical literature. This is important as more doctors are drawn into the legal arena, and their ability to assist the court is a matter of consequence. The potential adverse effects in terms of the human, psychological and financial costs to the litigant parties, and the speed of access to justice, are considerable if the work is not done properly. Possible solutions to the present system are discussed and a set of guiding principles for acting as an expert witness is proposed.

Adult↗
PubMed1999

Association between outcome and telomere DNA content in prostate cancer.

PURPOSE: To perform an initial retrospective investigation of the relationship between outcome in patients with organ confined prostate adenocarcinoma and the tumor cells' content of telomere DNA. MATERIALS AND METHODS: The case-controlled study group was composed of eighteen men diagnosed with prostatic adenocarcinoma prior to 1993. The group was selected so that approximately one half died within ten years of diagnosis and one half survived ten years or longer. Archival, paraffin-embedded tumor tissue was recovered for each patient. DNA was extracted from newly cut sections, fixed to nylon membranes and hybridized with P32-labeled centromere- and telomere-specific probes. Telomere DNA contents were quantitated from the hybridized radioactivities. The relationships between telomere DNA content and survival, and telomere DNA content and disease recurrence in men receiving prostatectomies were determined. RESULTS: Death and disease recurrence were associated with reduced telomere DNA content (p <0.0001, p <0.0001, respectively). CONCLUSIONS: Telomere DNA content may differentiate high-risk patients with metastatic prostate cancer from men with indolent disease who can be spared the unnecessary side effects and expense of treatment by management with "watchful waiting."

Adenocarcinoma↗
PubMed1999

Steady improvement in short-term graft survival of pediatric renal transplants: the NAPRTCS experience.

This report of pediatric renal transplantation covers the years 1987-1998. Since its inception in 1987, the NAPRTCS has collected data on 6,038 transplants performed in 5,516 patients provided by 73 renal centers across the country. FSGS, together with developmental lesions of dysplasia and obstructive uropathy, account for 40% of all transplants. There has been a steady increase in the use of LD donors among children with 54% of all transplants in 1996 and 1997 being live-related. About 72% of LD transplants are performed in Caucasian children, with African-American children unfortunately receiving a disproportionate percentage of CD kidneys. There has been a steady decline in the use of CD kidneys recovered from young individuals and a gradual decline in the number of transplants performed in young recipients (< 6 years old). Graft survival for LD recipients was 91%, 84% and 79% at one, 3 and 5 years, respectively, and the comparative figures for CD recipients were 81%, 72% and 64%, respectively. Acute and chronic rejections account for most of the graft losses, with chronic rejection accounting for more than 30%. There has been a steady improvement in one-year graft survival of CD recipients with the 1997-1998 cohort exhibiting an improvement of 16% over the 1987-1988 cohort. This improvement has been brought about by eliminating the use of infant donor kidneys, reducing the number of random transfusions and increasing the maintenance dose of cyclosporine. Posttransplant growth continues to be poor, with catch-up growth being exhibited only in children under age 6.

Adolescent↗
PubMed1998

Acute amiodarone-induced lung toxicity.

OBJECTIVE: To investigate any relationship between the pathological features of amiodarone-induced pulmonary toxicity (APT) and clinical use of amiodarone in patients dying from acute respiratory distress syndrome (ARDS). DESIGN: Retrospective study. Review of clinical and pathological findings of patients dying from ARDS. SETTING: Intensive Care Unit (ICU) and Pathology Department of University hospital. SUBJECTS: Ten patients with clinical diagnosis of ARDS, who died in ICU and underwent post mortem examination. INTERVENTIONS: Case note review of clinical details; independent review of histological specimens. MEASUREMENT AND RESULTS: Over a 3-year period, ten patients underwent post mortem examination, of whom seven had received amiodarone. Three patients who received longer than 48 h of amiodarone had histological changes of widespread lipoid pneumonia, a recognised pattern of APT. CONCLUSIONS: Acute amiodarone pulmonary toxicity is a definite pathological entity in ICU patients. High oxygen concentrations may be a risk factor, while pre-existing pathology, e. g. ARDS, may mask its development. Amiodarone should be used with caution in this group of patients.

Adult↗
PubMed1998

White, European, Western, Caucasian, or what? Inappropriate labeling in research on race, ethnicity, and health.

The request for scientifically appropriate terminology in research on race, ethnicity, and health has largely bypassed the term White. This and other words, such as Caucasian, are embedded in clinical and epidemiological discourse, yet they are rarely defined. This commentary analyzes the issue from the perspective of the epidemiology of the health of minority ethnic and racial groups in Europe and the United States. Minority groups are usually compared with populations described as White, Caucasian, European, Europid, Western, Occidental, indigenous, native, and majority. Such populations are heterogeneous, the labels nonspecific, and the comparisons misleading. Terminology that reflects the research purpose-for examples, reference, control, or comparison--is better (unlike White, these terms imply no norm, allowing neither writers nor readers to make stereotyped assumptions about the comparison populations. This paper widens the debate on nomenclature for racial and ethnic groups. Many issues need exploration, including whether there is a shared understanding among the international research community of the terms discussed.

Control Groups↗
PubMed1995

Stool composition in factitial diarrhea: a 6-year experience with stool analysis.

OBJECTIVE: To evaluate the utility of stool water analysis in the management of patients with chronic diarrhea. DESIGN: Retrospective analysis of 6 years of experience. SETTING: A specialized laboratory in a major referral center. PATIENTS: 325 patients with diarrhea who were referred for stool chemistry analysis. Fecal analysis was requested by many internists and gastroenterologists. Patient records were reviewed to establish the final and most likely cause of diarrhea. RESULTS: One third of patients provided samples that were inappropriate for analysis, but data from 202 persons were available. The usefulness of the general separation of cases of chronic diarrhea into those in which patients had predominantly osmotic pathophysiologies and those in which patients had predominantly secretory pathophysiologies was confirmed, but overlap and intra-individual variability limited the usefulness of this approach in individual patients. Thirty-five patients (17%) had a diagnosis of factitial diarrhea (30 because of laxative use and 5 because of fluid added to stools). CONCLUSIONS: Among selected subpopulations, the chemical analysis of fresh stools has a role in the evaluation of obscure examples of chronic diarrhea. It is especially useful in identifying factitial diarrhea.

Adolescent↗
PubMed1995

Stroke units.

Explore the source record for details and available documents.

Cerebrovascular Disorders↗
PubMed1993

Appointment as a staff grade doctor: success or failure?

This paper describes the characteristics of applicants for the first cohort of staff grade posts in an English health Region based on extraction of data from the curricula vitae and application forms of all doctors who applied for such posts over a two year period. 374 doctors applied for 34 staff grade posts in the 16 health Districts of the Northern Region from 1 January 1989 to 31 December 1990. The mean number of applicants for each post was 11, with a mean age of 43 years and a mean time since qualification of 18 years. One-third of the applicants had a higher qualification; about a quarter had passed the first part of an examination for such a qualification or had a Diploma, and nearly one-fifth of applicants did not possess any higher qualification. Between specialties there was wide variation in the time spent by applicants in each grade of their previous posts. Applying the criteria to identify 'stuck doctors' as set out in the national medical manpower plan Hospital Medical Staffing: Achieving a Balance: Plan for Action revealed wide variations within and between specialties. The criteria proposed in Achieving a Balance may not be adequate to identify 'stuck doctors', a finding which has clear implications for national medical manpower policy.

Age Distribution↗
PubMed1992

Purification and characterization of the carboxyl-terminal transactivation domain of Vmw65 from herpes simplex virus type 1.

A glutathione S-transferase fusion to the COOH-terminal acidic transactivation domain of Vmw65 from herpes simplex virus type 1 was overexpressed in Escherichia coli and isolated by affinity chromatography on glutathione-Sepharose. Following cleavage of the fusion protein with thrombin, the transactivation domain was purified to homogeneity by ion exchange chromatography yielding approximately 0.6 mg of protein/liter of bacterial culture. Equilibrium sedimentation analysis showed the purified polypeptide to be monomeric; however, it displayed aberrant electrophoretic and chromatographic properties. Contrary to secondary structure predictions, circular dichroism spectroscopy demonstrated that this transactivation domain was devoid of significant alpha-helical structure at physiological conditions. The polypeptide, however, became notably more structured under hydrophobic conditions or at low pH, suggesting that it was sensitive to its environment. Near-UV circular dichroism suggested that phenylalanyl and tyrosyl residues were under influence from tertiary structure.

Amino Acid Sequence↗