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Biomedical subjects

M Mansfield

Publications and source records attributed to M Mansfield.

At least 19 recordsLinked to original sources
PubMed2004

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Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2002

Elevated fibrinogen in the healthy male relatives of patients with severe, premature coronary artery disease.

AIMS: To assess the possible role of certain coagulation factors and associated genetic polymorphisms in families in which coronary disease has occurred prematurely. METHODS AND RESULTS: One hundred and eighty-five healthy male relatives aged 65 or less were recruited following the identification of 125 patients with confirmed, premature coronary artery disease and compared to a control group of 185 healthy, age-matched volunteers. None of the control subjects had a personal or family history of coronary artery disease. The relatives and controls were similar in terms of conventional coronary artery disease risk factors. Fibrinogen levels were elevated in relatives compared with controls and remained higher after adjustment for significant correlates, 3.0 g.l(-1) (2.9-3.1) vs 2.8 g.l(-1) (2.8-2.9),P =0.004. Factor VII coagulant activity and von Willebrand factor antigen did not differ between the groups nor were there any differences in genotype frequency for the fibrinogen beta-455 G/A polymorphism or the factor VII promoter deletion/insertion and Arg-Gln coding polymorphisms. CONCLUSIONS: A significant increase in fibrinogen levels was demonstrated in the healthy, male, first-degree relatives of patients with severe coronary artery disease. Fibrinogen may be of particular importance in subjects who, other than their family history, appear to be at low risk in terms of conventional coronary artery disease risk factors.

Adolescent↗
PubMed2000

A randomised controlled pilot study of the management of gestational impaired glucose tolerance.

OBJECTIVE: To determine whether a study of a less intensive form of management for impaired glucose tolerance in pregnancy is feasible and whether women would accept randomisation. DESIGN: Prospective randomised controlled study. SETTING: A large district general hospital and a large teaching hospital in West Yorkshire. SAMPLE: Seventy women with impaired glucose tolerance in pregnancy. METHODS: One group monitored plasma glucose up to four times daily. The other group did not monitor plasma glucose at all. MAIN OUTCOME MEASURES: The number of women recruited of those approached and neonatal admissions to special care baby units in each group. RESULTS: Sixty-eight of 70 women approached entered the study. There were no statistically significant differences between the groups in neonatal outcome measures. The median number of plasma glucose measurements in the monitored group was 118 (range 0-500), and 19% of women in the monitored group were treated with insulin. CONCLUSIONS: This study fails to demonstrate any benefit from intensive management of impaired glucose tolerance in pregnancy with additional maternal inconvenience. This pilot study has shown that a large randomised controlled study of the management of impaired glucose tolerance in pregnancy is not only feasible but necessary.

Adult↗
PubMed1999

Dispelling the stigma of schizophrenia: II. The impact of information on dangerousness.

This study addressed a relatively neglected topic in schizophrenia: identifying methods to reduce stigma directed toward individuals with this disorder. The study investigated whether presentation of information describing the association between violent behavior and schizophrenia could affect subjects' impressions of the dangerousness of both a target person with schizophrenia and individuals with mental illness in general. Subjects with and without previous contact with individuals with a mental illness were administered one of four "information sheets" with varying information about schizophrenia and its association with violent behavior. Subjects then read a brief vignette of a male or female target individual with schizophrenia. Results showed that subjects who reported previous contact with individuals with a mental illness rated the male target individual and individuals with mental illness in general as less dangerous than did subjects without previous contact. Subjects who received information summarizing the prevalence rates of violent behavior among individuals with schizophrenia and other psychiatric disorders (e.g., substance abuse) rated individuals with a mental illness as less dangerous than did subjects who did not receive this information. Implications of the findings for public education are discussed.

Adult↗
PubMed1999

Why don't emergency department patients have advance directives?

OBJECTIVES: In 1997 the authors determined that only 27% of their adult ED patients had advance directives (ADs). The purpose of this follow-up study was to determine the reasons why their adult ED patients do not have ADs. METHODS: This prospective study enrolled patients from a convenience sample of representative shifts in the ED selected over a three-month period. Survey questions included demographic information, whether the patients had a life-threatening medical problem, whether they had an AD, with whom they had discussed their ADs, and the reasons why they did not have an AD. We excluded those who refused participation or who were incapacitated (i.e., any patient with a condition that precluded him or her from answering the questionnaire himself or herself, such as an altered level of consciousness, dementia, mental retardation, or inability to understand English). RESULTS: Four hundred seventy-six subjects were enrolled during the study period from an ED census of 816 adult patients. Three hundred forty patients were not included in the study for the following reasons: inability to complete the survey, refusal to participate, or not being approached by the interviewers. Of those enrolled, 77% of the patients did not have an AD (females, 73%; males, 80%). The most frequent reasons given for not having an AD were: 40% never thought about it, 24% preferred family to make the decision, and 23% were procrastinating. Factors jointly predictive of having an AD were older age, having a specialist, having a life-threatening medical problem, and not being Catholic. Patients who had ADs were discussing their ADs with their primary care physicians (PCPs) only 5% of the time. CONCLUSION: Many patients, even when they have life-threatening medical problems, do not have an AD, and several reasons for this have been identified. Few of these ED patients who had ADs had discussed them with their physicians. Further studies should assess whether more physician intervention would increase the percentage of patients who have ADs.

Adolescent↗
PubMed1997

An investigation of the effect of ondansetron on time to induction of anaesthesia with thiopentone and propofol.

In two consecutive, randomized, double-blind studies the effect of ondansetron on the time to induction of anaesthesia with propofol and, subsequently, thiopentone was assessed. In each study 40 patients received either ondansetron 8 mg or placebo immediately before induction of anaesthesia with a standardized dose of propofol (2.5 mg kg-1) or thiopentone (5 mg kg-1). Times to induction of anaesthesia were determined by assessing loss of verbal response, motor power and eyelash reflex. There was no difference in either study in times to induction of anaesthesia between immediate pre-treatment with ondansetron or placebo. Side effects were minor and of similar incidence in the ondansetron and placebo groups.

Adult↗
PubMed1996

A comparison of ibuprofen arginine with morphine sulphate for pain relief after orthopaedic surgery.

In a randomized, double-blind, double-dummy, single-dose, parallel-group study, oral ibuprofen arginine (400 mg) was compared with intramuscular (i.m.) morphine sulphate (5 or 10 mg) for post-operative pain relief after orthopaedic surgery in 120 patients. The study medication was administered post-operatively at the time when each patient first requested pain relief for moderate to severe pain. Assessment of pain intensity and pain relief was made using standard visual analogue scales and verbal rating scores. In all three groups, there was a reduction in pain compared with baseline, measured by visual analogue scales and verbal rating scores, at all time points up to completion of the study at 240 min. For example, visual analogue scales decreased by 35 (10-52) mm at 1 h in the morphine 5 mg group, 24 (12-39) mm in morphine 10 mg group and 21 (8-38) mm in the ibuprofen arginine group (median and inter-quartile range). Verbal rating scores showed a similar pattern. Comparing the groups over the whole study period using the sum of pain intensity differences showed no significant differences in pain experience between the groups. Assessment of total pain relief also showed no significant differences. The incidence and types of side effect seen were similar in the three groups.

Administration, Oral↗
PubMed1994

A trial of pre-emptive analgesia. Influence of timing of peroperative alfentanil on postoperative pain and analgesic requirements.

The influence of timing of administration of peroperative alfentanil on pain and analgesic requirements after surgery was studied in 60 patients undergoing total abdominal hysterectomy with or without bilateral salpingo-oophorectomy. Thirty patients received alfentanil 7.5 micrograms.kg-1 on induction of anaesthesia, followed by alfentanil 7.5 micrograms.kg-1 90 s before surgical incision (group A). Thirty control patients received alfentanil 15 micrograms.kg-1, 10 min after abdominal incision (group B). In addition, 10 min after surgical incision both groups received morphine 0.2 mg.kg-1, given over a 10 min period. The visual analogue scores (median, interquartile range) for pain 24 h after operation were 28.5 mm (11.25-47.0) in group A and 21.0 mm (10.5-47.5) in group B, p = 0.76. There were no differences in visual analogue scores at intermediate times. Morphine consumption in the first 24 h after surgery (median, interquartile range) was 53.5 mg (37.25-60.0) in group A and 52.0 mg (39.75-71.0) in group B, p = 0.52. We conclude that postoperative morphine consumption and pain scores are no different when alfentanil 15 micrograms.kg-1 is given before or after skin incision for abdominal hysterectomy.

Adult↗
PubMed1989

A strategy for the investigation of immunodeficiency.

In any patient who suffers from frequent infections or from a clinical disorder caused by opportunistic organisms, the possibility of an underlying defect in immune defense should be considered. The purpose of this review is to outline a strategic approach towards screening for immunodeficiency in such patients. It should be apparent that the majority of serious immune deficiency states can be detected using a series of relatively simple and readily available investigations. The detection and further definition of other immunodeficiencies may require more sophisticated tests to be performed. The development of new biological tools now permits many of these disorders to be defined at the genetic and molecular level. Finally, early diagnosis of immunodeficiency is important, since it may permit the introduction of corrective measures which can reduce the morbidity and mortality of these disorders.

Humans↗
PubMed1985

Suspected and clinically definite multiple sclerosis: the relationship between CSF immunoglobulins and clinical course.

CSF immunoglobulins were examined in 103 patients with clinically definite multiple sclerosis, 106 patients with either suspected or progressive possible multiple sclerosis and 72 patients with other neurological diseases. Raised CSF IgG index and oligoclonal banding were found in 71% and 75% of clinically definite multiple sclerosis patients respectively and both tests were abnormal in 11% of patients with other neurological diseases. The CSF IgG index and the presence of oligoclonal IgG did not relate to the severity or duration of established disease in these patients. In patients with suspected and progressive possible multiple sclerosis, both a raised IgG index and the presence of oligoclonal banding were found significantly more frequently than in the OND group. Abnormalities of these parameters were significantly correlated with the presence of an abnormal evoked response in these patients (chi 2 = 10.16 p less than 0.01). When 47 patients with suspected multiple sclerosis were studied prospectively the presence of oligoclonal banding at presentation was associated with development of further disease activity.

Brain Stem↗
PubMed1983

Visual evoked responses and immunoglobulin abnormalities in the diagnosis of multiple sclerosis.

Visually evoked responses (VERs), CSF IgG/albumin ratio and CSF oligoclonal IgG were examined in 136 patients with multiple sclerosis (MS) admitted to hospital for investigation, and compared to the CSF findings in 87 patients with other neurological diseases (OND). 33% of patients with OND had abnormal CSF IgG/albumin ratios but only 9% had CSF oligoclonal IgG banding. In clinically definite MS, VERs were abnormal in 87% and CSF oligoclonal banding was found in 80% of patients, but CSF oligoclonal banding was found significantly more frequently than abnormal VERs in patients with suspected MS. We were unable to show any relationship between benign MS and the absence or presence of CSF oligoclonal IgG. The significance of CSF oligoclonal IgG in the less clinically definite forms of MS will only emerge with prolonged follow-up.

Albumins↗
PubMed1983

Micro-costing analysis: a measure of accountability.

A description of a micro-costing analysis conducted by the Psychiatric Occupational Therapy Department at Rush-Presbyterian St. Luke's Medical Center is reported. Analysis enabled a department manager to establish cost estimates for the services provided by the department. Included are data reflective of both costs and overhead. The analysis generates information concerning the relative amount of labor used, projected annual volumes, costs for direct and indirect labor, overtime, direct and indirect supplies, allocated cost, and cost for each identified evaluation and/or treatment. Access to cost information enables the department manager to realistically establish charges and to assess efficient use of personnel and supplies. The micro-costing analysis provides a vehicle to communicate departmental needs to the hospital administration based upon documented use of resources, and justified by a thorough cost breakdown.

Computers↗