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Biomedical subjects

L Lloyd

Publications and source records attributed to L Lloyd.

17 recordsLinked to original sources
PubMed1997

HIV, hepatitis B, and hepatitis C in the Code One trauma population.

The resuscitation of a trauma patient is a very hectic and seemingly chaotic situation. The nature of the situation increases the likelihood that a health care worker will receive an accidental needle stick while caring for the patient. There is also a common belief that there is a higher prevalence of communicable bloodborne diseases in the trauma population, and human immunodeficiency virus (HIV) causes the greatest amount of fear. This belief of higher prevalence communicable diseases in the trauma population is supported by the literature. We sent blood from our Code One (life-threatening) trauma population for analysis for HIV, hepatitis B surface antigen, and hepatitis C antibodies. We found that 0.52% of our trauma population had HIV. We also found that 1.5 per cent had hepatitis B surface antigen, and 13.8 per cent had hepatitis C antibodies. Our prevalence of HIV and hepatitis B is similar to that found in other studies of the trauma populations and higher than the general population. Our hepatitis C prevalence is surprising, considering the very low reported prevalence in the general population. Hepatitis C may be a more significant threat to the health of medical personnel than previously believed.

HIV Infections↗
PubMed1996

Laparoscopic training in residency program.

The use of laparoscopy in general surgery has provided surgeons with a new approach to multiple procedures. New techniques are being developed daily. Laparoscopic training for surgical residents must be incorporated into their curriculum. To decrease the risks of training residents on patients and to decrease operative time, a program of videoscopic "bench" training exercises, to improve eye-hand coordination, was instituted for junior residents. Between July and September 1995, nine surgical residents participated in this proficiency videoscopic study. At the end of the study, there was a statistically significant improvement in the residents performance by an average of 37% (P = 0.0109). This program proved to be both effective and economical. It can be reproduced and easily incorporated into any surgical residency program.

Clinical Competence↗
PubMed1996

HIV prevention in U.S. Asian Pacific Islander communities: an innovative approach.

Few HIV prevention efforts have focused on Asian Pacific Islander communities in the United States. Prevention messages developed for the general U.S. population have failed to reach many Asian Pacific Islanders. This article describes the development of an HIV prevention strategy for Asian Pacific Islanders through health care workers. This strategy was based on the ecological disease theory and action research methodology. The prevention program comprised four components: (1) a symposium for the health care workers, (2) a culturally sensitive and appropriate HIV-related video for the health care workers and their patients, (3) ongoing training of the health care providers, and (4) ongoing liaison and consultative services for the health care providers. The intervention is intended to encourage HIV risk-reduction behaviors among the patients, to encourage the HIV testing of those who may be at risk for HIV, and to facilitate access to services for those found to be infected.

Adult↗
PubMed1995

Handpiece asepsis: a survey of the attitudes of dental practitioners.

The methods of handpiece asepsis employed by general dental practitioners (GDPs) in England and the problems considered to be associated with handpiece sterilisation were investigated by means of a postal questionnaire distributed to a random sample of 500 GDPs during July 1993. A total of 267 replies were received (53.4% response). The results indicated that at the time of the survey, autoclavable handpieces were possessed by 90.6% of the respondents (n = 242), with 45.9% (n = 111) of these respondents indicating that they autoclaved their handpieces routinely after every patient. Reasons given by respondents for not autoclaving handpieces routinely included insufficient handpieces, fear of handpiece damage, cost, and the consideration that sterilisation was not necessary. Handpiece asepsis procedures had been upgraded by 89% (n = 237) of respondents in the 5 years preceding the survey. Media coverage was found to have exerted influence on the respondent dentists' behaviour, with the overall incidence of routine handpiece autoclaving increasing by 20.6% after media coverage of the subject.

Attitude of Health Personnel↗
PubMed1995

Effect of resuscitation solutions on the immune status of dogs in hemorrhagic shock.

The purpose of this study is to examine the effects of three different types of fluid resuscitation on the immune system of dogs in hemorrhagic shock. Using a modified Wigger shock model, 18 conditioned male dogs were bled to mean arterial blood pressure of 60 mm Hg for 90 minutes and placed into three groups based on the resuscitative method. Group I: Crystalloid Resuscitation; Group II: Autotransfusion; Group III: Banked Blood. Laboratory methods for immune status evaluation included total lymphocyte count, T4/T8 ratio, total serum immunoglobulins, and immunoglobulin electrophoresis. These values were obtained pre-hemorrhagic shock, just before resuscitation, and subsequently on days 1, 4, and 7. Humoral immunity, represented by total serum immunoglobulin levels (IgA, IgG, IgM), was higher in Groups II and III when compared with group I on all post-resuscitation days. IgA and IgM levels were higher in Group III compared with Groups I and II. IgG level was higher in Group II compared with Groups I and III. Cellular immunity was also affected by transfusion. Total lymphocyte count was increased in Group II on Day 1; however, the three groups were similar with respect to this variable on subsequent days. The absolute T4 helper cell level in Group II was similar to Groups I and III until Day 7, at which time the level became higher in Group II.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

Effect of social networks on cancer-screening behavior of older Mexican-American women.

BACKGROUND: Previous studies have determined that Hispanic women and, in particular, Mexican-American women have the lowest rates of cancer screening of any race and ethnic group in the United States. In the development of cancer control strategies for this population, little attention has been given to factors that encourage Mexican-American women to seek cancer preventive care. Recent studies suggest that social networks can have a positive influence on cancer-screening participation. PURPOSE: We determined the extent to which differences in social networks account for variations in breast and cervical cancer-screening practices among low-income Mexican-American women. METHODS: The data analyzed in this study were obtained from a baseline survey of knowledge, attitudes, and cancer-screening practices conducted prior to implementation of community interventions designed to improve Pap smear and mammography screening in low-income Mexican-American women 40 years old and older living along the U.S.-Mexican border in El Paso County, Texas. A random selection of 1300 households served as a sampling frame to identify Mexican-American women 40 years old and older for personal interviews. Of the 549 households identified as having at least one eligible female, 450 women completed the personal interviews that provided the data for this study. Personal interviews solicited information on age, income, marital status, place of birth, education, health insurance coverage, Pap smear- and mammogram-screening practices, and six questions relating to social network. A social network score was assigned to each woman by summation of the following six variables: number of confidants, number of close friends, number of close relatives, frequency of contact with these close friends or relatives per month, church membership, and church attendance. Women were grouped into three linear strata of social network (low, medium, high) based on tertiles of the scores. Cancer-screening history was also ascertained during the interview. RESULTS: The 2-year prevalence of Pap smear and mammography use increased with social network. For each gain in social network level (low, medium, high), adjusted for sociodemographic factors, the odds ratio for Pap smear use was 1.33 (95% confidence interval = 1.02-1.73); it was 1.40 (95% confidence interval = 1.02-1.93) for mammogram use. Of the six social network components, the number of close friends was the most important predictor of mammography (P = .002) and Pap smear (P = .025) screening. CONCLUSION: Social networks appear to be an important determinant of cancer-screening behavior among low-income, older Mexican-American women.

Adult↗
PubMed1994

Setting standards for a school nursing service.

School nurses in Airedale have developed a set of standards and procedures for their service using British Standard BS 5750* as a framework. Liz Lloyd et al describe this innovative approach to achieving an effective, client-responsive quality management system.

Humans↗
PubMed1993

MHC-extended haplotypes in families of patients with Graves' disease.

MHC-extended haplotypes were investigated in multiplex families of patients with hyperthyroid GD. Using a combination of both phenotypic (serology and protein electrophoresis) and genotypic (DNA-RFLP) markers, 159 MHC-extended haplotypes extending from HLA-A across the MHC class III (C2, Bf, C4A, and C4B) toward the HLA-DR/DQ complex were deduced from 217 (51 and 166 affected and unaffected) members of 21 families of patients with GD. Thyroid autoantibodies were measured and found positive in 27.1% of 166 clinically euthyroid unaffected members. Extended haplotypes were classified into four categories--affected (n = 40), Aff/Ab + ve (shared haplotype between affected and Ab + ve members, n = 31), Ab + ve (n = 29), and Ab - ve (n = 59)--based on the presence and absence of these haplotypes in 51 affected members with GD and 45 and 121 unaffected members who were respectively positive and negative for thyroid autoantibodies. Five recombinations were detected: three were found between HLA-A and B and two between HLA-B and the MHC class III. No recombination was found between or within the MHC class III and class II complex. Though the HLA-DR17 (DR beta 17(1) and DR beta 17(2)) allele was found to be significantly increased in both the affected and the Aff/Ab + ve when compared with the Ab - ve haplotypes (p < 0.042 and p < 0.018), the frequency of the HLA-B8, 2.7-kb SstI-4.5-kb TaqI/C2 Bf*S, 6.4-kb TaqI/C4A*Q0C4B*1, HLA-DR beta 17(1)/DQ alpha 2-DQ beta 2a extended haplotype was found to be significantly increased only in the affected haplotype (p < 0.05). These results suggest that while HLA-DR17 is a susceptibility allele shared between GD and individuals with positive thyroid autoantibodies, the HLA-B8, 2.7-kb SstI-4.5-kb TaqI/5'-3'C2 Bf*S, 6.4-kb TaqI/C4A*Q0B*1, DR beta 17(1)/DQ alpha 2-DQ beta 2a is a disease susceptibility-extended haplotype for Graves' disease.

Adult↗
PubMed1993

Laparoscopic cholecystectomy: morbidity and mortality in a community teaching institution.

From November 1989 to December 1990, 474 elective laparoscopic cholecystectomies were performed. This study analyzes the first year's experience with regard to complications, postoperative response in terms of pain and nausea, and time back to activity and work. There were 369 females and 105 males in the group. The average age was 51.5 years. Of these, 394 were discharged within 23 h and 80 required admission postoperatively. Of the group requiring hospitalization, there were 10 (2.1%) major complications, 37 (7.8%) minor complications, 14 (3.0%) aborted laparoscopic cholecystectomies, and 19 (4.0%) others. Major complications occurred early in the surgeon's experience, all but two within the surgeons' first 25 cases. Patients in the short stay group were followed-up with a phone questionnaire. In this group, most patients experienced minimal abdominal pain following surgery, with an average score of 2.4 (SD = 1.38) on a scale of 1 (absent) to 5 (extreme). At home, 48.6% of patients experienced some form of postoperative discomfort. Of these, 38.2% experienced abdominal pain, 18.7% shoulder pain, and 32.7% nausea. The average postoperative time to resume normal daily activity was 7.9 days (SD = 8.2) and to return to work was 11.6 days (SD = 9.9).

Adolescent↗
PubMed1993

The role of endoscopic retrograde cholangio-pancreaticrogram in laparoscopic cholecystectomy.

Four hundred and fifty-nine patients were studied to evaluate the role of diagnostic and therapeutic endoscopic retrograde cholangio-pancreaticrogram (ERCP) in their management before laparoscopic cholecystectomy (LC) when choledocholithiasis is suspected. Using bilirubin, liver function tests (LFTs) (alkaline phosphatase, SGOT, SGPT) and findings on ultrasound of a dilated common bile duct (CBD), 37 patients (8.1%) were suspected of having concomitant common bile duct stones preoperatively. These patients were subjected to the following diagnostic and therapeutic procedures: 25 ERCPs, 20 laparoscopic cholangiograms, and three extracorporeal shock wave lithotripsies. Preoperative ERCP was done on 19 patients, intraoperative ERCP-sphincterotomy was done on one patient, and postoperative ERCP-sphincterotomy was done on five patients. Fifteen laparoscopic cholangiograms were done as primary tests and five after preoperative ERCP. Sixteen patients (3.5%) had stones in their CBD. Four patients had their laparoscopic cholecystectomy cancelled, and one patient had laparoscopic common duct exploration that was converted to an open procedure. Three groups were identified: group I, patients with a high index of suspicion, included elevated bilirubin with elevation of all three LFTs, or normal bilirubin with elevation of all three LFTs with or without dilated CBD. Seventy-five per cent of this group had CBD stones. Group II, patients with a low index of suspicion, included normal bilirubin and normal CBD by ultrasound with elevation of the alkaline phosphatase alone or elevation of two of the three LFTs. Six per cent of this group had CBD stones. Group III, patients with no index of suspicion, were patients with normal preoperative laboratory test results and CBD. Two patients (0.47%) in this group had elevated LFTs postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Cholangiography↗
PubMed1991

Oxygenation of cardioplegic solutions: a note of caution.

The merits of oxygenated crystalloid cardioplegic solutions have been well established in experimental animals. The positive effects of oxygenation of Plasmalyte B (Sabax Ltd) and St. Thomas Hospital solution (Plegisol) were achieved by gassing with 95% O2/5% CO2 and 100% O2, respectively. In view of the marked pH differences induced by these gas mixtures, we evaluated the effect of mode of oxygenation on myocardial recovery during reperfusion after hypothermic cardioplegic arrest. Oxygenation with 100% O2 of Plasmalyte B containing high K+ levels caused marked deterioration in myocardial recovery, whereas the mode of oxygenation did not affect recovery after arrest with St. Thomas Hospital solution. Because the major differences between these solutions reside in their respective K+, Mg2+, and HCO3- contents, the effects of variations in the levels of these ions were investigated. The results showed that oxygenation with 100% O2 was deleterious only in the presence of high K+ (29 mmol/L), low Mg2+ (3 mmol/L), and high NaHCO3 (28 mmol/L) levels. The marked decline in mechanical recovery during reperfusion was associated with significant changes in myocardial adenosine triphosphate and intracellular Ca2+ levels. Although an explanation for these findings is not readily available, it is suggested that complex ionic interactions and possibly oxygen free radical generation may lead to intracellular Ca2+ overload, depression in mitochondrial adenosine triphosphate generation, and, hence, deterioration in mechanical recovery.

Acid-Base Equilibrium↗
PubMed1991

Beliefs about the prevention of dengue and other febrile illnesses in Mérida, Mexico.

A series of open interviews and a survey were conducted in several neighbourhoods in the city of Mérida, Mexico to find out whether poor response to government dengue control programmes might be related to the explanatory models about dengue and its prevention held by community members. Dengue was grouped by informants with other mild febrile illnesses, all of which were thought to be inevitable and capable of converting into more serious illnesses. Although vector control personnel think of prevention in terms of eliminating the larval habitats of mosquito vectors, the form of prevention most commonly described involved looking after oneself once sick, so that mild fevers do not evolve into serious fevers. Due to the prevalence of this different model of prevention, it is argued that simple messages about dengue may be misinterpreted. Vector control programmes need to take into account local models of febrile illnesses and their prevention in order to be effective.

Adult↗
PubMed1989

C4A gene deletion: association with Graves' disease.

The association of HLA class I and class II antigens, particularly HLA-B8,DR3, with a variety of autoimmune diseases has been well documented. The C4A*Q0 (non-expressed C4A) allele which is in linkage disequilibrium with HLA-B8,DR3 has also been reported to be associated with systemic lupus erythematosus, insulin-dependent diabetes mellitus and Graves' disease. However, the number of studies has been limited by the requirement of family data for the assignment of the C4A*Q0 allele based on C4 protein typing. Recently, with the availability of a C4 cDNA probe, a C4A gene deletion associated with HLA-B8,DR3 has been reported in normal individuals. We have tried to resolve the problem of assigning the C4A*Q0 allele by using both phenotypic and genotypic approaches and have determined the significance of the C4A*Q0 allele in 80 unrelated patients with Graves' disease and in 50 normal control subjects. Our results demonstrate a strong association of the C4A*Q0 allele with Graves' disease (56 versus 26%; P less than 0.002, relative risk = 3.7) and in particular in association with HLA-B8 and/or DR3 (92 versus 70.6%; P less than 0.04) when compared with normal controls. All the C4A*Q0 alleles that were associated with HLA-B8 and/or DR3 were due to a C4A gene deletion. Of the C4A*Q0 alleles, in Graves' disease, 94% (compared with 82% in the control group) could be detected by C4 DNA analysis using either TaqI or EcoRI restriction endonucleases. It is suggested that a combination of C4 protein typing with C4 DNA analysis is the best approach for the determination of the C4A*Q0 allele in unrelated individuals without access to family data.

Alleles↗
PubMed1989

The use of ketoconazole in prophylaxis of Candida sepsis.

Candida sepsis has become an increasing problem in ICU patients with up to 50 per cent mortality rate. Ketoconazole, an oral antifungal agent, was used prophylactically in guinea pigs to see if this would prevent Candida sepsis. Absorption of ketoconazole has been stated to increase in an acid environment. Thirty-six guinea pigs were divided into three equal groups: group I received 1 cc normal saline, p.o.; group II received 10 mg/kg ketoconazole dissolved in 1 ml Maalox (Rorer Consumer; Fort Washington, PA); group III received 10 mg/kg ketoconazole in 1 ml in HCl, all given daily. Each animal received 10(8) colony forming units intravenously. The viability of the innoculum was confirmed by culture both pre- and postinjection. Each animal was observed daily for weight and ocular and skin lesions. Half of the animals were sacrificed on day seven and the remaining were sacrificed on day 14. Cultures, complete blood count (CBC), ketoconazole levels, and specimen histology were obtained. There was no difference between groups as to weight, leukocyte counts, skin or ocular lesions, or ketoconazole levels. Histologic analysis and quantitative cultures revealed little Candida invasion. In conclusion, Candida sepsis cannot be induced in healthy guinea pigs. The blood levels of ketoconazole were not affected by pH.

Animals↗
PubMed1987

Suicide in Texas: a cohort analysis of trends in suicide rates, 1945-1980.

Recent clusters of teenage suicides in Texas suburban communities have focused national attention on the rise in teenage suicidal behavior. This study sought to clarify the teenage suicide phenomenon by using a cohort method of data analysis. Beginning with suicide rates for white males aged 15-19 in 1945, suicide rates were calculated and plotted for each 5-year age cohort entering the late teenage years, when suicide risk factors dramatically increase. Our analysis of these cohort patterns confirmed the ever-rising risk factor associated with the ages of 15-19. This trend is consistent with many studies suggesting that teenage suicide is a function of socioeconomic and psychological factors operating across community and national boundaries. In addition, our study revealed that as white males 15-19 years of age in 1945 aged, their suicide rates also increased, confirming earlier findings that the suicide risk factor increases with age. In fact, Texas data for 1980 revealed that older persons, not teenagers, had the highest suicide rates-a finding that confirms other studies' results. Finally, Texas cohort patterns for suicide revealed the recent curvilinearity tendencies of older adult male suicide rates. By 1980 Texas data revealed a bimodal distribution of high suicide risk, with white males in their late 20s and ages 55 and over having the highest rates.

Adolescent↗
PubMed1986

Bilateral transection of ureters secondary to gunshot wound to abdomen.

An unusual case in which a complete bilateral ureteral transection due to a single low velocity gunshot wound occurred. This case illustrates that in gunshot wounds to the abdomen involving the retroperitoneum, ureteral inspection is imperative especially in view of the fact that preliminary diagnostic workup during trauma resuscitation may be inadequate.

Abdominal Injuries↗