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Biomedical subjects

M Beach

Publications and source records attributed to M Beach.

At least 19 recordsLinked to original sources
PubMed2001

Survey of infections due to Staphylococcus species: frequency of occurrence and antimicrobial susceptibility of isolates collected in the United States, Canada, Latin America, Europe, and the Western Pacific region for the SENTRY Antimicrobial Surveillance Program, 1997-1999.

Between January 1997 and December 1999, bloodstream isolates from 15,439 patients infected with Staphylococcus aureus and 6350 patients infected with coagulase-negative Staphylococcus species (CoNS) were referred by SENTRY-participating hospitals in the United States, Canada, Latin America, Europe, and the Western Pacific region. S. aureus was found to be the most prevalent cause of bloodstream infection, skin and soft-tissue infection, and pneumonia in almost all geographic areas. A notable increase in methicillin (oxacillin) resistance among community-onset and hospital-acquired S. aureus strains was observed in the US centers. The prevalence of methicillin (oxacillin)-resistant S. aureus varied greatly by region, site of infection, and whether the infection was nosocomial or community onset. Rates of methicillin resistance were extremely high among S. aureus isolates from centers in Hong Kong and Japan. Uniformly high levels of methicillin resistance were observed among CoNS isolates. Given the increasing multidrug resistance among staphylococci and the possible emergence of vancomycin-resistant strains, global strategies are needed to control emergence and spread of multiply resistant staphylococci.

Anti-Bacterial Agents↗
PubMed2001

Evaluating telemedicine in an accident and emergency setting.

This paper outlines the methodology of an evaluation of telemedicine in an Accident and Emergency (A&E) setting. Telemedicine technology consisting of ISDN 2 based videoconferencing and 'store & forward' software has been installed and is currently being evaluated in two minor injury units (MIUs) and a District General Hospital (DGH) A&E department in Lincolnshire. A cost-benefit analysis will be conducted using a pragmatic prospective case-control study with both a concurrent and retrospective control group. Any differences in resource use (including direct and indirect costs) between the intervention (Telemedicine) and the control (No Telemedicine) groups will be identified from both a patient and NHS perspective. A variety of health and non-health outcome measures will be recorded including staff and patient acceptability of the new technology.

Accidents↗
PubMed2000

Effect of cigarette promotions on smoking uptake among adolescents.

BACKGROUND: The purpose of this study was to evaluate the association between receptivity to cigarette promotions and smoking uptake in a cohort of adolescents. METHODS AND MEASURES: This was a prospective cohort study of 480 4th- to 11th-grade students conducted in three rural Vermont K-12 schools. Cigarette use was determined by self-report at baseline, 12 months (survey 2), and 21 months (survey 3). Proportional odds models were used to evaluate smoking uptake as a function of baseline measures of cigarette use, receptivity to cigarette promotions, and confounding factors, including grade, parental education, peer smoking, and family smoking. Adolescents were receptive to cigarette promotions if they owned or were willing to use a personal item bearing a cigarette brand logo [cigarette promotional item (CPI)]. Smoking status was measured using a 6-point ordinal index that combined experience and attitudes: 0 = never smoker/not susceptible to smoking, 1 = never smoker/susceptible to smoking, 2 = puffer (1 cigarette or less in lifetime), 3 = non-current experimenter (2-99 cigarettes in lifetime/none in past 30 days), 4 = current experimenter, and 5 = smoker (> or =100 cigarettes in lifetime). RESULTS: The 480 students were equally distributed across grade at baseline. Environmental exposure to smoking was high, and 30% were receptive to cigarette promotions at baseline. Higher levels on the smoking index at baseline were associated with higher grade in school, peer smoking, and receptivity to cigarette promotions. One hundred eighty-five students (38.5%) had moved to a higher category on the smoking index by survey 3, of whom 30 had become smokers. Receptivity to cigarette promotions at baseline was significantly associated with higher smoking uptake, with 48.7% of receptive students moving up one or more categories on the smoking index [adjusted proportional odds 1.9 (95% CI 1.3, 2.9)]. Acquisition of receptivity to cigarette promotions was also associated with increased smoking uptake, with those becoming receptive in surveys 2 or 3 having significantly higher odds of progression [3.6 (1.8, 7.0) and 2.9 (1.5, 5.5), respectively] compared with those who did not change. Conversely, those who were receptive at one point but became non-receptive in surveys 2 or 3 had lower odds of progression [0.4 (0.2, 0.9) and 0.5 (0.3, 1.1), respectively]. CONCLUSIONS: This study supports a close linkage between tobacco promotional activities and uptake of smoking among adolescents beyond baseline descriptions of receptivity to cigarette promotions. Over time, the likelihood of smoking uptake is increased when an adolescent acquires a CPI or becomes willing to use one and is decreased when an adolescent who owns a CPI loses it or becomes unwilling to use it. This provides strong evidence that elimination of cigarette promotional campaigns could reduce adolescent smoking.

Adolescent↗
PubMed2000

Emergence characteristics of sevoflurane compared to halothane in pediatric patients undergoing bilateral pressure equalization tube insertion.

STUDY OBJECTIVE: To compare the emergence characteristics of sevoflurane with halothane in pediatric patients having bilateral myringotomy and pressure equalization tube insertion using a highly standardized and common anesthetic technique. DESIGN: Prospective, randomized, double-blind study. SETTING: University hospital. PATIENTS: 43 ASA physical status I and II healthy pediatric outpatients scheduled for initial ear tube placement by one surgeon. INTERVENTIONS: Patients were randomized to receive either halothane or sevoflurane as their sole anesthetic drug for ear tube insertion. All patients as well as the research nurse grading emergence agitation were blinded to group assignment. No premedication was administered, and all patients received a standard dose of rectal acetaminophen for postoperative pain control. MEASUREMENT AND MAIN RESULTS: The primary outcome was the percentage of patients with emergence agitation, defined as thrashing behavior requiring physical restraint for greater than three minutes. Time to discharge from the postanesthesia care unit (PACU) and from the hospital were also compared. Sevoflurane patients had a greater incidence of emergence delirium: 57% versus 27% [95% CI (1.7%-58.1%) p = 0.047]. Time to discharge from the PACU and the hospital were longer for patients who received sevoflurane: 62 versus 50 min [95% CI (1.4-23.6) p = 0.02] and 102 versus 79 mins [95% CI (9.6-37.1) p = 0.003]. CONCLUSION: In our institution there is a trend toward greater emergence agitation in ear tube placement patients given sevoflurane versus halothane anesthesia. Further, (with our discharge criteria) patients are actually discharged from the PACU and the hospital faster when given halothane as a sole anesthetic when compared to sevoflurane.

Anesthesia, Inhalation↗
PubMed2000

Effect of disagreement between refractive, keratometric, and topographic determination of astigmatic axis on suture removal after penetrating keratoplasty.

BACKGROUND/AIMS: Post-keratoplasty astigmatism can be managed by selective suture removal in the steep axis. Corneal topography, keratometry, and refraction are used to determine the steep axis for suture removal. However, often there is a disagreement between the topographically determined steep axis and sutures to be removed and that determined by keratometry and refraction. The purpose of this study was to evaluate any difference in the effect of suture removal, on visual acuity and astigmatism, in patients where such a disagreement existed. METHODS: 37 cases (from 37 patients) of selective suture removal after penetrating keratoplasty, were included. In the first group "the disagreement group" (n=15) there was disagreement between corneal topography, keratometry, and refraction regarding the axis of astigmatism and sutures to be removed. In the second group "the agreement group" (n=22) there was agreement between corneal topography, keratometry, and refraction in the determination of the astigmatic axis and sutures to be removed. Sutures were removed according to the corneal topography, at least 5 months postoperatively. Vector analysis for change in astigmatism and visual acuity after suture removal was compared between groups. RESULTS: In the disagreement group, the amount of vector corrected change in refractive, keratometric, and topographic astigmatism after suture removal was 3.45 (SD 2.34), 3.57 (1.63), and 2.83 (1. 68) dioptres, respectively. In the agreement group, the amount of vector corrected change in refractive, keratometric, and topographic astigmatism was 5.95 (3.52), 5.37 (3.29), and 4.71 (2.69) dioptres respectively. This difference in the vector corrected change in astigmatism between groups was statistically significant, p values of 0.02, 0.03, and 0.03 respectively. Visual acuity changes were more favourable in the agreement group. Improvement or no change in visual acuity occurred in 90.9% in the agreement group compared with 73.3% of the disagreement group. CONCLUSIONS: Agreement between refraction, keratometry, and topography was associated with greater change in vector corrected astigmatism and was an indicator of good prognosis. Disagreement between refraction, keratometry, and topography was associated with less vector corrected change in astigmatism, a greater probability of decrease in visual acuity, and a relatively poor outcome following suture removal. However, patients in the disagreement group still have a greater chance of improvement than worsening, following suture removal.

Astigmatism↗
PubMed2000

Exposure to cigarette promotions and smoking uptake in adolescents: evidence of a dose-response relation.

OBJECTIVE: To assess whether a dose-response relation exists between the number of cigarette promotional items (CPIs) owned by an adolescent, and smoking behaviour. DESIGN AND SETTING: Voluntary, self administered survey of 1265 sixth through to 12th grade students (ages 10-19 years), representing 79-95% of all students attending five rural New Hampshire and Vermont public (state funded) schools in October 1996. The association between the number of CPIs owned by students and smoking behaviour was examined using multivariate regression methods. OUTCOME MEASURES: Adjusted odds of being a smoker (>/= 100 cigarettes lifetime) and, among never and experimental smokers, adjusted cumulative odds of having higher levels on a smoking uptake index given the number of CPIs owned. RESULTS: One third of students owned a CPI (n = 406). Among owners, 211 owned one, 82 owned two, 57 owned three, 24 owned four, 23 owned five, and 7 students owned six CPIs. The number of CPIs owned by students was not associated with grade in school but was significantly higher in males, those with poorer school performance, those who perceived high prevalence of peer smoking, and those with higher exposure to peer and family smoking. The more items a student owned, the greater the chances of being a smoker. For example, smoking prevalence was 11.2% for those not owning a CPI, 41.5% for those owning two, 58.5% for those owning four, and 71.4% for those owning six CPIs. The dose-response relation remained after controlling for confounding; compared with those who did not own a CPI, the likelihood of being a smoker was significantly higher for those who owned one CPI, with an adjusted odds ratio (OR) of 2.7 (95% confidence interval (CI) 1.7 to 4.1); OR was 3.4 (95% CI 1.9 to 5.9) for those owning two CPIs, and 8.4 (95% CI 5.0 to 14.2) for those owning three or more CPIs. After excluding smokers, there was a crude dose-response association between CPI ownership and higher rates of experimentation with cigarettes among sixth to ninth graders (ages 11-15 years) only (n = 543). After controlling for confounding influences, the dose-response relation remained, with the likelihood of being higher on the smoking uptake index rising with the number of CPIs owned: one CPI, adjusted cumulative OR 1.7 (95% CI 1.1 to 2.60); two CPIs, OR 2.5 (95% CI 1.2 to 5.1); and three or more CPIs, OR 4.8 (95% CI 1.9 to 12.2). CONCLUSIONS: This study offers evidence of a dose-response relation between the number of CPIs owned by adolescents and higher likelihood of experimental and established smoking. The dose-response relation persists after controlling for confounding influences. These data provide further support of a causal relation between tobacco promotional campaigns and smoking behaviour among adolescents.

Adolescent↗
PubMed2000

Evaluating telemedicine for minor injuries units.

Low-cost telemedicine equipment consisting of ISDN videoconferencing units and a store-and-forward system was installed in two minor injuries units (MIUs) and a hospital accident and emergency department in Lincolnshire. Over six months, 45 patients were treated using telemedicine in one MIU and 26 in another. Anecdotally, there were no reported radiograph discrepancies or missed diagnoses. Data collected during teleconsultations by both referring and consulting clinicians suggested that in some cases teleconsultation had helped to avoid transfer or onward referral. There were some changes in diagnosis and treatment after using telemedicine, indicating some decision-making value for the remote practitioners. In the context of minor injuries telemedicine, videoconferencing in realtime may prove to be more valuable than store-and-forward interactions. A cost-benefit analysis is being conducted using a pragmatic prospective case-control study.

Case-Control Studies↗
PubMed1999

Calcium supplements for the prevention of colorectal adenomas. Calcium Polyp Prevention Study Group.

BACKGROUND AND METHODS: Laboratory, clinical, and epidemiologic evidence suggests that calcium may help prevent colorectal adenomas. We conducted a randomized, double-blind trial of the effect of supplementation with calcium carbonate on the recurrence of colorectal adenomas. We randomly assigned 930 subjects (mean age, 61 years; 72 percent men) with a recent history of colorectal adenomas to receive either calcium carbonate (3 g [1200 mg of elemental calcium] daily) or placebo, with follow-up colonoscopies one and four years after the qualifying examination. The primary end point was the proportion of subjects in whom at least one adenoma was detected after the first follow-up endoscopy but up to (and including) the second follow-up examination. Risk ratios for the recurrence of adenomas were adjusted for age, sex, lifetime number of adenomas before the study, clinical center, and length of the surveillance period. RESULTS: The subjects in the calcium group had a lower risk of recurrent adenomas. Among the 913 subjects who underwent at least one study colonoscopy, the adjusted risk ratio for any recurrence of adenoma with calcium as compared with placebo was 0.85 (95 percent confidence interval, 0.74 to 0.98; P=0.03). The main analysis was based on the 832 subjects (409 in the calcium group and 423 in the placebo group) who completed both follow-up examinations. At least one adenoma was diagnosed between the first and second follow-up endoscopies in 127 subjects in the calcium group (31 percent) and 159 subjects in the placebo group (38 percent); the adjusted risk ratio was 0.81 (95 percent confidence interval, 0.67 to 0.99; P=0.04). The adjusted ratio of the average number of adenomas in the calcium group to that in the placebo group was 0.76 (95 percent confidence interval, 0.60 to 0.96; P=0.02). The effect of calcium was independent of initial dietary fat and calcium intake. CONCLUSIONS: Calcium supplementation is associated with a significant - though moderate - reduction in the risk of recurrent colorectal adenomas.

Adenoma↗
PubMed1999

Survey of bloodstream infections due to gram-negative bacilli: frequency of occurrence and antimicrobial susceptibility of isolates collected in the United States, Canada, and Latin America for the SENTRY Antimicrobial Surveillance Program, 1997.

During 1997, a total of 4,267 nosocomial and community-acquired bloodstream infections due to gram-negative organisms were reported from SENTRY hospitals in Canada (8 sites), the United States (30 sites), and Latin America (10 sites). Escherichia coli was the most common isolate (41% of all gram-negative isolates), followed by Klebsiella species (17.9%), Pseudomonas aeruginosa (10.6%), and Enterobacter species (9.4%). For all gram-negative isolates combined, the most active antimicrobials tested were meropenem, imipenem, and cefepime. The quinolones levofloxacin (MIC90, 2 microg/mL), ciprofloxacin (MIC90, 1 microg/mL), gatifloxacin (MIC90, 2 microg/mL), sparfloxacin (MIC90, 2 microg/mL), and trovafloxacin (MIC90, 2 microg/mL) were also active against most isolates. Bloodstream infection isolates from Latin America were uniformly more resistant to all classes of antimicrobial agents tested than were isolates from Canada or the United States. Resistance phenotypes consistent with extended-spectrum beta-lactamase production were also most common among E. coli and Klebsiella species from Latin America. Further investigation of the reasons for regional differences in resistance patterns is needed, as is ongoing surveillance to detect resistance trends and to guide antimicrobial use.

Bacteremia↗
PubMed1999

Insulin infusion improves neutrophil function in diabetic cardiac surgery patients.

UNLABELLED: Diabetic patients are at increased risk of wound infection after major surgery, but the effect of perioperative glucose control on postoperative wound infection rates after surgery is uncertain. We tested the effect of an insulin infusion on perioperative neutrophil function in diabetic patients scheduled for coronary artery bypass surgery. Participants (n = 26) were randomly allocated to receive either aggressive insulin therapy (AIT) or standard insulin therapy (SIT) during surgery. Blood was drawn for neutrophil testing before surgery, 1 h after the completion of cardiopulmonary bypass, and on the first postoperative day. Neutrophil phagocytic activity decreased to 75% of baseline activity in the AIT group and to 47% of baseline activity in the SIT group (P < 0.05 between groups). No important differences in neutrophil antibody-dependent cell cytotoxicity were found. This study documents a potentially beneficial effect of continuous insulin therapy in diabetic patients who require major surgery. IMPLICATIONS: A continuous insulin infusion and glucose control during surgery improves white cell function in diabetic patients and may increase resistance to infection after surgery.

Aged↗
PubMed1999

Calcium supplements and colorectal adenomas. Polyp Prevention Study Group.

Experimental and observational findings suggest that calcium intake may protect against colorectal neoplasia. To investigate this hypothesis, we conducted a randomized, double-blind trial of colorectal adenoma recurrence. Nine hundred thirty patients with a recent history of colorectal adenomas were randomly given calcium carbonate (3 gm daily; 1200 mg elemental calcium) or placebo, with follow-up colonoscopies one and four years after the qualifying examination. The main analysis focused on new adenomas found after the first follow-up endoscopy, up to (and including) the second follow-up examination. Risk ratios of at least one recurrent adenoma and ratios of the average numbers of adenomas were calculated as measures of calcium effect. There was a lower risk of recurrent adenomas in subjects assigned calcium. Eight hundred thirty-two patients had two follow-up examinations and were included in the main analysis; the adjusted risk ratio of one or more adenomas was 0.81 (95% CI 0.67 to 0.99); the adjusted ratio of the average numbers of adenomas was 0.76 (95% CI 0.60 to 0.96). Among subjects who had at least one follow-up colonoscopy, the adjusted risk ratio of one or more recurrent adenomas was 0.85 (95% CI 0.74 to 0.98). The effect of calcium seemed independent of initial dietary fat and calcium intake. No toxicity was associated with supplementation. These findings indicate that calcium supplementation has a modest protective effect against colorectal adenomas, precursors of most colorectal cancers.

Adenoma↗
PubMed1998

Sequential CD34+ and CD4+ cell selection from leukapheresis components.

We tested the feasibility of sequential selection of CD34+ and CD4+ cell-enriched fractions from aliquots of five autologous leukapheresis components. CD34+ cells were selected from a median 8.0 x 10(8) mononuclear cells using the CellPro CEPRATE LC cell separation system. All cells in the CD34-depleted fraction (median 4.8 x 10(8), range 0.6-10.0 x 10(8) were then incubated with the appropriate antibodies for CD4+ cell selection and passed through a second LC column. Median target cell purities of the CD34+ cell-enriched fraction and CD4+ cell-enriched fraction were 90.5% and 86.0%, respectively. This study demonstrates that high purity CD34+ and CD4+ cell-enriched fractions can be isolated sequentially from leukapheresis components. In addition, CD8+ lymphocytes, implicated in graft-versus-host disease, were depleted in the course of both positive selection procedures. This approach could decrease the number of donor procedures by providing separate CD34(+)-enriched and CD4(+)-enriched populations for allogeneic peripheral blood progenitor cell transplantation and subsequent donor lymphocyte infusion from the same leukapheresis component.

Antigens, CD34↗