Biomedical subjects

M Wiggins

Publications and source records attributed to M Wiggins.

10 recordsLinked to original sources

PubMed2005

Postnatal support for mothers living in disadvantaged inner city areas: a randomised controlled trial.

STUDY OBJECTIVE: To evaluate the effect of two forms of postnatal social support for disadvantaged inner city mothers on maternal and child health outcomes. DESIGN: Randomised controlled trial with economic and process evaluations and follow up at 12 and 18 months. The two intervention groups received either the offer of a year of monthly supportive listening home visits by a support health visitor (SHV), or a year of support from community groups providing drop in sessions, home visiting and/or telephone support (CGS). Each was compared with a control group that received standard health visitor services. SETTING: Two disadvantaged boroughs of London, United Kingdom. PARTICIPANTS: 731 women from culturally diverse backgrounds with infants. MAIN RESULTS: At 12 and 18 months, there was little impact for either intervention on the main outcomes: child injury (SHV: relative risk 0.99; 95% confidence intervals 0.68 to 1.45, CGS: 0.91; 0.61 to1.36), maternal smoking (SHV: 0.86; 0.62 to 1.19, CGS: 0.97; 0.72 to 1.33) or maternal depression (SHV: 0.86; 0.62 to1.19, CGS: 0.93; 0.69 to 1.27). SHV women had different patterns of health service use (with fewer taking their children to the GP) and had less anxious experiences of motherhood than control women. User satisfaction with the SHV intervention was high. Uptake of the CGS intervention was low: 19%, compared with 94% for the SHV intervention. CONCLUSIONS: There was no evidence of impact on the primary outcomes of either intervention among this culturally diverse population. The SHV intervention was associated with improvement in some of the secondary outcomes.

Adult↗

PubMed2004

The Social Support and Family Health Study: a randomised controlled trial and economic evaluation of two alternative forms of postnatal support for mothers living in disadvantaged inner-city areas.

OBJECTIVES: To determine whether increased postnatal support could influence maternal and child health outcomes. DESIGN: This was a randomised controlled trial comparing maternal and child health outcomes for women offered either of the support interventions with those for control women receiving standard services only. Outcome data were collected through questionnaires distributed 12 and 18 months postrandomisation. Process data were also collected. There was also an integral economic evaluation. SETTING AND PARTICIPANTS: Women living in deprived enumeration districts in selected London boroughs were eligible for the trial if they gave birth between 1 January and 30 September 1999. RESULTS: The 731 participants were found to be well matched in terms of socio-economic characteristics and health and support variables (14% of the participants were non-English speaking). Response rates at the two follow-up points were 90% and 82%. At both points there were no differences that could not be attributed to chance on the primary outcomes of maternal depression, child injury or maternal smoking. At the first follow-up, there was reduced use of general practitioners by support health visitor (SHV) children, but increased use of NHS health visitors and social workers by mothers. At the second follow-up, both community group support (CGS) and SHV mothers had less use of midwifery services (fewer were pregnant), and SHV mothers were less worried about their child's health and development. Uptake of the CGS intervention was low: 19%, compared with 94% for the SHV intervention. Satisfaction with the intervention among women in the SHV group was high. Based on the assumptions and conditions of the costing methods, the economic evaluation found no net economic cost or benefit of choosing either of the two interventions. CONCLUSIONS: There was no evidence of impact on the primary outcomes of either intervention. The SHV intervention was popular with women, and was associated with improvement in some of the secondary outcomes. This suggests that greater emphasis on the social support role of health visitors could improve some measures of family well-being. Possible areas for future research include a systematic review of social support and its effect on health; developing and testing other postnatal models of support that match more closely the age of the baby and the changing patterns of mothers' needs; evaluating other strategies for mobilising 'non-professional' support; developing and testing more culturally specific support interventions; developing more culturally appropriate standardised measures of health outcomes; providing longer term follow-up of social support interventions; and exploring the role of social support on the delay in subsequent pregnancy.

Adult↗

PubMed1999

Interpretation of selected accident and emergency radiographic examinations by radiographers: a review of 11000 cases.

Two specially trained radiographers took part in the radiologists' rota for "cold" reporting skeletal radiographs of patients who attended the Accident and Emergency (A&E) Department at times when there was no "hot" reporting service operating, and who were not admitted for treatment or referred to fracture clinics for follow-up. These radiographs had initially been seen by A&E medical staff. At the end of an 18 month period during which the two radiographers reported on 11,322 skeletal examinations, a retrospective search was made to detect interpretive errors. The radiological history of all 11,322 patients was reviewed over a follow-up period of at least 3 months subsequent to the attendance reported by the radiographers. 48% of patients did not re-attend, 42% re-attended for unrelated examinations, and 10% re-attended for repeat examinations of the same anatomical area, or for different procedures (bone scintigraphy or CT) related to the original injury. The second (or subsequent) report was discrepant with that of the first attendance in only 29 cases out of 1103. Of these 29 patients, 13 had occult fractures which were undetectable at first attendance even in retrospect, six had new injuries accounting for the new findings, six had been the subject of false positive calls at an earlier visit, one had a fracture of the hamate missed at first attendance, and in three cases no consensus could be reached as to the cause of the discrepancy, owing to incomplete films or insufficient clinical data. Analysis of the patients' postcodes showed at least 89% were of local origin and only 1% were from outside Yorkshire, suggesting that the review should have identified the great majority of erroneous reports. It is concluded that appropriately trained and supervised radiographers can successfully undertake diagnostic reporting of selected skeletal examinations on A&E patients.

Allied Health Personnel↗

PubMed1998

Waddell signs: distributional properties and correlates.

OBJECTIVE: To determine what percentage of patients have none of the five nonorganic behavioral processes known as Waddell signs, and the relational pattern between Waddell signs and somatic complaints, disturbed functional performance, negative treatment attitudes, physical pathology, depression, generalized anxiety, and MMPI-2 validity scales. DESIGN: Case series survey. SETTING: A referral-based multidisciplinary pain center affiliated with a state medical school. PATIENTS: Seventy-five consecutive patients with chronic back pain. INTERVENTION: Medical evaluation and completion of self-report inventories. MAIN OUTCOME MEASURE: Total number of Waddell signs, physical pathology, and pain intensity ratings were assessed by a physician during an initial medical evaluation. Degree of disturbed functional performance and psychological symptoms were assessed by self-report measures at the initial evaluation. RESULTS: Sixty-four percent of the patients had no Waddell signs. Total number of Waddell signs yielded positive and statistically significant correlations (p < or = .05) with depression, disturbed functional performance, somatic complaints, and pain intensity ratings. Correlations of slightly smaller and statistically nonsignificant magnitudes were revealed for Waddell signs with generalized anxiety, negative treatment attitudes, and physical pathology. Waddell signs were unrelated to age, duration of pain, gender, number of lumbar surgeries, and MMPI-2 validity scales. CONCLUSIONS: Taken together, multiple Waddell signs and some of their correlates present various factors that might interfere with optimal response to treatment.

Activities of Daily Living↗

PubMed1998

Cognitive task analyses for decision centred design and training.

This paper presents three case studies of Cognitive Task Analysis (CTA) for defining systems design and training requirements. The approach taken involves a modification of the critical decision method of Klein et al. The authors utilized the revised CDM to obtain information from expert white-water rafting guides, general aviation pilots, and emergency ambulance dispatchers. The information obtained was used to develop multi-media tools for training rafting guides and general aviation pilots, and to redesign the VDU display requirements for the ambulance dispatchers. The examples demonstrate the utility of an approach to CTA that is closely based on relevant theory, and provides guidance to practitioners wishing to apply CTA techniques.

Adolescent↗

PubMed1998

Combined spinal and epidural anesthesia for cesarean section in a parturient with moyamoya disease.

We present the case of a parturient with moyamoya disease admitted to the hospital for elective cesarean section. Combined spinal and epidural technique was chosen because it allows better analgesia than epidural anesthesia and more hemodynamic stability than either general or spinal anesthesia. Ropivacaine was the local anesthetic of choice for the epidural portion because of the wide sensory-motor dissociation, thus preserving adequate respiration in the case of a high block.

Adult↗

PubMed1997

In vivo biocompatibility and biostability of modified polyurethanes.

Modified segmented polyurethanes were examined for biostability and biocompatibility using an in vivo cage implant system for time intervals of 1, 2, 3, 5, and 10 weeks. Two types of materials were used: polyether polyurethanes and polycarbonate polyurethanes. Two unmodified polyether polyurethanes (PEUU A' and SPU-PRM), one PDMS endcapped polyether polyurethane (SPU-S), and two polycarbonate polyurethanes (SPU-PCU and SPU-C) were investigated in this study. Techniques used to characterize untreated materials were dynamic water contact angle, stress-strain analysis, and gel permeation chromatography. Cellular response was measured by exudate analysis and by macrophage and foreign body giant cell (FBGC) densities. Material characterization, postimplantation, was done by attenuated total reflectance-Fourier transform infrared spectroscopy (ATR-FTIR) in order to quantify biodegradation and scanning electron microscopy (SEM) to qualitatively describe the cellular response and biodegradation. The exudate analysis showed that the acute and chronic inflammatory responses for all materials were similar. Lower FBGC densities and cell coverage on SPU-S were attributed to the hydrophobic surface provided by the PDMS endgroups. The polycarbonate polyurethanes did not show any significant differences in cell coverage or FBGC densities even though the macrophage densities were slightly lower compared to polyether polyurethanes. By 10 weeks, biodegradation in the case of PEUU A' and SPU-PRM was extensive as compared to SPU-S because the PDMS endcaps of SPU-S provided a shield against the oxygen radicals secreted by macrophages and FBGCs and lowered the rate of biodegradation. In the case of polycarbonate polyurethanes, the oxidative stability of the carbonate linkage lowered the rate of biodegradation tremendously as compared to the polyether polyurethanes (including SPU-S). The minor amount of biodegradation seen in polycarbonate polyurethanes at 10 weeks was attributed to hydrolysis of the carbonate linkage.

Animals↗

PubMed1992

The effects of cooling large white turkey embryos on growth and white blood cell development.

In each of two experiments, trays containing 15 developing turkey eggs were cooled for 1 h at 18 C on a specific day of incubation or left within the incubator (controls). Ten embryos from each treatment were bled on Day 23 of incubation, at which time all embryos were killed with CO2 gas, weighed, and sexed. Packed cell volumes and differential white blood cell (WBC) counts were performed on all blood samples. A single, brief cooling episode during incubation did not significantly (P greater than .05) affect BW or hematocrit values in 23-day-old turkey embryos. Based on a differential classification of WBC in the blood smears of these turkey embryos, there were 82, 10, 8, less than 1, and less than 1% of heterophils, lymphocytes, basophils, eosinophils, and monocytes, respectively. Circulating heterophils, the most numerous WBC in turkey embryos, were significantly (P less than or equal to .05) reduced in all embryos cooled during the latter half of incubation. This effect was mirrored in the total WBC numbers counted. The effect of cooling on the other classes of turkey embryonic WBC, which represent about 20% of the circulating WBC, were more variable.

Animals↗

PubMed1990

Normal growth and white blood cell development in large white turkey embryos.

Two experiments were conducted to determine normal growth and hematological values for turkey embryos. In each experiment, differential white blood cell counts, hematocrits, sex, and body weights were recorded for 10 Nicholas Large White turkey embryos beginning at Day 12 and at select days thereafter through Day 25 of incubation. Because there were so few white blood cells present in the turkey embryonic blood, differential white blood cell counts were scored by two observers. Each observer counted for a fixed time, 5 min, rather than to a specific number of cells. A significant difference (P less than or equal to .05) due to embryo age was found for BW, hematocrit, heterophils, lymphocytes, basophils, and total white blood cell counts. Significant differences due to sex of the embryo or day by sex interaction were not found for BW, hematocrit, heterophils, eosinophils, basophils, and total white blood cell counts. A significant day by sex interaction was found for lymphocytes. No significant differences were observed between either of the main effects or their interaction for the monocyte totals. The predominant circulating white blood cell in turkey embryos was the heterophil not the lymphocyte.

Animals↗

PubMed1988

Ovarian follicular growth and maturation in the domestic pigeon and guinea fowl (Numida meleagris).

Yolks of pigeon and guinea fowl eggs were examined for the number of dichromate-staining rings. Estimates of the time for rapid follicular development using this technique were 5.1 and 5.6 days for pigeons and guinea fowl, respectively. Another measure of follicular development based on the incorporation of Sudan dyes into the yolk yielded an estimate of 6.5 and 8.3 days for pigeons and guinea fowl, respectively. Using one and two-egg clutches, no differences due to clutch position were observed in either species. There was a significant difference (P less than or equal to .01) between results obtained with the two techniques for measuring the period of rapid yolk deposition. The dichromate technique can give valuable data relative to yolk deposition, especially in species where it is impractical to daily catch and administer Sudan dyes. But the tendency to underestimate the period of follicular growth means that caution must be exercised in comparing results obtained with that technique and the more labor-intensive Sudan dye incorporation method. The time from the end of yolk deposition until oviposition is defined as the rest period. This interval was 1.5 days for pigeons and 1.7 days for guinea fowl. This is considerably longer than the rest period of Coturnix quail but similar to that found in turkeys and chickens.

Animals↗