Biomedical subjects
M Thorpe
Publications and source records attributed to M Thorpe.
Micellization of hydrocarbon surfactants in supercritical carbon dioxide.
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Estimating progression to cirrhosis in chronic hepatitis C virus infection.
To gain a clearer understanding of the rate of progression to cirrhosis and its determinants in chronic hepatitis C virus (HCV) infection, a systematic review of published epidemiologic studies that incorporated assessment for cirrhosis has been undertaken. Inclusion criteria were more than 20 cases of chronic HCV infection, and information on either age of subjects or duration of infection. Of 145 studies examined, 57 fulfilled the inclusion criteria. Least-squares linear regression was employed to estimate rates of progression to cirrhosis, and to examine for factors associated with more rapid disease progression in 4 broad study categories: 1) liver clinic series (number of studies = 33); 2) posttransfusion cohorts (n = 5); 3) blood donor series (n = 10); and 4) community-based cohorts (n = 9). Estimates of progression to cirrhosis after 20 years of chronic HCV infection were 22% (95% CI, 18%-26%) for liver clinic series, 24% (11%-37%) for posttransfusion cohorts, 4% (1%-7%) for blood donor series, and 7% (4%-10%) for community-based cohorts. Factors that were associated with more rapid disease progression included older age at HCV infection, male gender, and heavy alcohol intake. Even after accounting for these factors, progression estimates were much higher for cross-sectional liver clinic series. Selection biases probably explain the higher estimates of disease progression in this group of studies. Community-based cohort studies are likely to provide a more representative basis for estimating disease progression at a population level. These suggest that for persons who acquire HCV infection in young adulthood, less than 10% are estimated to develop cirrhosis within 20 years.
Foster care: an update.
OBJECTIVE: To inform child and adolescent psychiatrists about the almost 500,000 children now residing in the American foster care system. This overview surveys the pediatric, developmental, and psychiatric needs of these children. METHOD: Child and adolescent psychiatrists, pediatricians, a child welfare researcher, a social worker, and a psychologist developed a consensus paper from their experience with child welfare and a review of the literature in their respective fields. RESULTS: Being in foster care is a defining experience in these children's lives. They are at risk in myriad ways: for instance, being poor, having chronic health deficits, experiencing the trauma of abuse and neglect, and suffering from a gamut of emotional challenges. Evolutionary developments in foster care such as therapeutic foster homes, kinship care, and changes in Medicaid funding will continue to alter the system. CONCLUSIONS: Foster children are a huge reservoir of unmet pediatric and psychiatric needs; research on them is spotty at best. It is hoped that child and adolescent psychiatrists will meet the challenges these youngsters present and will advocate for them.
Surgical practice is evidence based.
BACKGROUND: The quality of surgical research, and particularly the reluctance of surgeons to perform randomized controlled trials, has been criticized. The proportion of surgical treatments supported by satisfactory scientific evidence has not been evaluated previously. METHODS: A 1-month prospective audit was performed of 100 surgical inpatients admitted under two consultants in a general surgical/vascular unit at an urban teaching hospital; the main illness and interventions were agreed through group discussions in each case. The literature concerning the efficacy of each treatment was reviewed, and the evidence was categorized as: (1) supported by randomized controlled trial evidence; (2) sufficient other evidence of efficacy to make a placebo-controlled trial unethical; or (3) neither of the above. RESULTS: Of the 100 patients studied, 95 (95 per cent confidence interval (c.i.) 89-98) received treatment based on satisfactory evidence (categories 1 and 2) and, of these, 24 patients (95 per cent c.i. 17-35) received treatments based on randomized controlled trial evidence and 71 had treatments based on other convincing evidence (95 per cent c.i. 62-80). CONCLUSION: Inpatient general surgery is 'evidence based', but the proportion of surgical treatments supported by randomized controlled trial evidence is much smaller than that found in general medicine. Some reasons for this are clear, but the extent to which surgical practice needs to be reevaluated is not. Current methods for classifying and describing evidence in therapeutic studies need improvement.
Keeping the circle of love alive.
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Chronic carbon monoxide poisoning.
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VIP and NPY in canine hearts. Distribution and effect of total and selective parasympathetic denervation.
The hypotheses that vasoactive intestinal peptide (VIP) is evenly distributed throughout atrial and ventricular myocardium and is present in postganglionic parasympathetic neurons in the regions of the sinoatrial and atrioventricular nodes were tested in three groups of dogs. Neuropeptide Y (NPY) tissue concentrations were determined in each group. In six sham dogs VIP and NPY concentrations were evenly distributed and were higher in atria compared with ventricles. In nine parasympathectomized dogs, VIP concentrations in sample sites from regions of the sinoatrial and atrioventricular nodes were comparable to those in sham-operated controls. In nine denervated dogs VIP concentrations were significantly decreased in three adjacent sample sites along the atrioventricular groove. In these dogs NPY concentrations were not detectable or were significantly decreased at all sample sites of both atria and ventricles. These data suggest that VIP neurons are evenly distributed in atrial and ventricular myocardium but do not originate in parasympathetic ganglia supplying the sinoatrial and atrioventricular nodes. The data also demonstrate the possible presence of extrinsic VIP neurons in the canine right ventricle and indicate that NPY may be a useful marker of myocardial adrenergic innervation.
Emergency psychiatric consultation to a children's aid society.
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Is borderline personality disorder a post-traumatic stress disorder of early childhood?
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Operative management of displaced femoral head fractures: case-matched comparison of anterior versus posterior approaches for Pipkin I and Pipkin II fractures.
Because of the controversy surrounding the selection of the surgical approach for the operative management of femoral head fractures, we retrospectively reviewed the combined experience with femoral head fractures at two major trauma centers. Forty-three femoral head fractures in 41 patients were identified. Twenty-six of the 43 fractures were Pipkin types I and II, and were managed operatively. Of the 26 patients, 12 with > 2 years of follow-up were managed with posterior surgical approaches and 12 with anterior surgical approaches. These patients were assessed with respect to operative time, estimated blood loss and function, and the radiographs for reduction, avascular necrosis, and heterotopic ossification. There was a significant decrease in operative time, estimated blood loss, and improved visualization and fixation with the anterior approach; however, there was a significant increase in functionally significant heterotopic ossification. The functional results in the two groups were identical; 67% good and excellent in each. There were no cases of avascular necrosis of the femoral head associated with an anterior approach. Because of the greater ease of access to the fracture, the anterior approach is recommended when operative reduction of a displaced Pipkin type I or II is indicated, but newer methods of minimizing heterotopic ossification must be developed.
A unique mental health network for Victorian aboriginal people.
The Victorian Aboriginal Mental Health Network (VAMHN) is a unique mental health programme for Aboriginal people in Australia. The network was set up in 1987. The services and programmes developed include a community consultation service, a psychiatric inpatient unit; and educational, evaluative and research programmes. Utilisation of the network has steadily increased and the demand for both primary and secondary consultations continues to grow.
Pancreatic cancer: nursing challenges.
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A secure isolation unit in Manchester.
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