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Biomedical subjects

P Bradshaw

Publications and source records attributed to P Bradshaw.

At least 19 recordsLinked to original sources
PubMed2006

Incidence of Clostridium difficile-associated diarrhea before and after autologous peripheral blood stem cell transplantation for lymphoma and multiple myeloma.

Diarrhea is a major cause of morbidity and discomfort for patients undergoing high-dose chemotherapy and autologous peripheral blood stem cell transplantation (APBSCT). There are multiple causes of diarrhea in patients undergoing transplantation including antineoplastic chemotherapy, antimicrobials and infection, including Clostridium difficile as the most common pathogen involved. The purpose of this study was to determine the incidence of C. difficile-associated diarrhea (CDAD) 1 week before and 30 days after APBSCT, and to identify risk factors for the development of CDAD including diagnosis. Two hundred and forty-two patients underwent APBSCT for multiple myeloma and lymphoma between October 1996 and October 2001 in two teaching hospitals. Diarrhea was reported in 157 (64.9%) subjects. One hundred and thirty-five out of the 157 subjects were tested for the presence of C. difficile toxin A. These subjects constitute the study group. The incidence of CDAD was 15%. Two thirds of the patients who developed CDAD had multiple myeloma and one third had lymphoma; this difference did not attain statistical significance. The use of cephalosporins (P = 0.03) and the use of intravenous vancomycin (P = 0.02) were the only identified risk factors associated with the development of CDAD. Patients treated with paclitaxel as part of the mobilization regimen had a lower incidence of CDAD than patients who received hematopoietic growth factor only (P = 0.01).

Adult↗
PubMed2005

Time and PSA threshold model prognosticates long-term overall and disease-specific survival in prostate cancer patients as early as 3 months after external beam radiation therapy.

The specific aim of this analysis was to evaluate the capability of a time and prostate-specific antigen (PSA) threshold model to prognosticate overall survival (OS) and disease-specific survival (DSS) based on early PSA kinetics after radiotherapy for prostate cancer by retrospective review of outcomes in 918 patients. Crossing below analyzed PSA thresholds at specific defined time points reduced disease-specific death hazard ratios to relative to the cohort above threshold. The time and PSA threshold model demonstrates the ability to prognosticate OS and DSS as early as 3 months post-radiotherapy for prostate cancer.

Aged↗
PubMed2004

Granisetron vs ondansetron for prevention of nausea and vomiting in hematopoietic stem cell transplant patients: results of a prospective, double-blind, randomized trial.

The serotonin type-3 (5-HT3) antagonists represent a significant advance in the prevention of acute nausea and vomiting (N/V) from highly emetogenic chemotherapy. We sought to determine if any differences in efficacy or adverse effects exist between two such agents, ondansetron and granisetron, during conditioning therapy for hematopoietic stem cell transplantation (HSCT). Patients were randomized to receive either ondansetron 0.15 mg/kg intravenously every 8 h or granisetron 10 microg/kg intravenously daily. Additionally, all patients received scheduled dexamethasone and lorazepam. Prophylaxis was continued until 24 h after completion of chemotherapy. Nausea and distress were measured subjectively with visual analog scales and emetic episodes were quantified. Of the 110 randomized patients, 96 were evaluable for efficacy and safety. No significant differences in efficacy were observed between the ondansetron- and granisetron-treated patients, evaluated by comparing the degree of nausea and distress, number of emetic episodes and overall control of emesis. The adverse effects were also comparable and no patients were removed from study because of severe toxicities. This trial demonstrates that ondansetron and granisetron are equally effective at preventing acute N/V associated with conditioning therapy frequently used for HSCT. The agent of choice should be based on drug acquisition cost or preference.

Antiemetics↗
PubMed1997

Neutralizing human monoclonal antibodies to conformational epitopes of human T-cell lymphotropic virus type 1 and 2 gp46.

Ten human monoclonal antibodies derived from peripheral B cells of a patient with human T-cell lymphotropic virus (HTLV)-associated myelopathy are described. One monoclonal antibody recognized a linear epitope within the carboxy-terminal 43 amino acids of HTLV gp21, and two monoclonal antibodies recognized linear epitopes within HTLV type 1 (HTLV-1) gp46. The remaining seven monoclonal antibodies recognized denaturation-sensitive epitopes within HTLV-1 gp46 that were expressed on the surfaces of infected cells. Two of these antibodies also bound to viable HTLV-2 infected cells and immunoprecipitated HTLV-2 gp46. Virus neutralization was determined by syncytium inhibition assays. Eight monoclonal antibodies, including all seven that recognized denaturation-sensitive epitopes within HTLV-1 gp46, possessed significant virus neutralization activity. By competitive inhibition analysis it was determined that these antibodies recognized at least four distinct conformational epitopes within HTLV-1 gp46. These findings indicate the importance of conformational epitopes within HTLV-1 gp46 in mediating a neutralizing antibody response to HTLV infection.

Antibodies, Monoclonal↗
PubMed1993

Human T-cell leukemia virus type II infection frequently goes undetected in contemporary US blood donors.

Serologic screening for human T-cell leukemia virus type I (HTLV-I) infection was begun in US blood banks with the licensure of enzyme-linked immunosorbent assays (ELISA) in December 1988. We examined the donation histories of the first 60 Western blot (WB)-confirmed HTLV-I/II positive donors to one blood center and found 8 had made 16 previous donations that scored negative on the screening ELISA. All 16 donations had ELISA absorbance below the cutoff for a positive assay, but still well above that of the average donation (17.6% +/- 5.7% of the cutoff). In a more extensive study, 17 donations from a total of 61,752 at six blood centers were both ELISA-positive and WB-positive for HTLV-I (4) or HTLV-II (13), and 218 samples had ELISA absorbance greater than 50% of the ELISA cutoff. One hundred seventy-eight of the 218 were tested further by WB and 11 were found positive. All 11 positives were confirmed by polymerase chain reaction; 10 had HTLV-II and 1 had HTLV-I. Thus, the HTLV-I-based screening ELISA missed at least 10 of 23, or 43% (95% confidence interval, 23% to 66%), of HTLV-II infections, compared with 1 of 5, or 20%, of HTLV-I infections.

Blood Donors↗
PubMed1993

Spastic ataxia associated with human T-cell lymphotropic virus type II infection.

Human T-cell lymphotropic virus type one (HTLV-1) is associated with tropical spastic paraparesis or HTLV-I--associated myelopathy. We report 2 women with a spastic ataxic illness similar to HTLV-I--associated myelopathy infected solely with HTLV-II. Identification of HTLV-II infection was made serologically, by polymerase chain reaction, and by viral culture (in 1 woman). One woman, treated with 200 mg of danazol orally, three times daily, had pronounced improvement in ambulation, nocturnal spasticity, and nighttime urinary frequency. It appears that infection with HTLV-II may cause an illness similar to HTLV-I--associated myelopathy, but distinguished by the presence of ataxia.

Antibodies, Monoclonal↗
PubMed1993

Evaluation of the conventional stretcher as a support surface.

The conventional wood and canvas stretcher was evaluated with regard to comfort and risk of pressure and ischaemic damage. Sixty subjects were evaluated and results were found to be similar to other support surfaces. A mean sacral interface pressure of 40.7 mmHg was noted. Subjects found the stretchers cold and uncomfortable, particularly over the heels and lower back.

Beds↗
PubMed1993

Pressure effects from the military stretcher.

Attention is drawn to a possible deficiency in the folding pole canvas stretcher. Canvas tensioning and uniformity of support in the variety of stretcher where the canvas is attached by screws and metal strips was noted to be defective. High interface pressures were found on this type of stretcher, a problem not encountered in stretchers where the canvas tensioning is with regularly spaced tacks. Patients supported on the screw and strip variety may be at a higher risk of pressure necrosis.

Ambulatory Care↗
PubMed1989

Human monoclonal antibodies to human cytomegalovirus.

Human monoclonal antibodies (HMAbs) to human cytomegalovirus (HCMV) have been developed by using electric field-induced cell fusion of human B lymphocytes to the human-mouse cell line SBC-H20. By this procedure, multiple hybridomas have been produced that secrete IgG 1 HMAbs with distinct patterns of indirect immunofluorescence on HCMV-infected cells. HMAbs Z01 and X20 immunoprecipitated a major protein at 64 kDa. HMAb Z02 immunoprecipitated a major protein of 48-50 kDa. HMAb Z10 identified a single protein at 65 kDa and HMAb X16 identified proteins at 100, 65, and 36-38 kDa. The HMAbs demonstrated varying degrees of virus-neutralizing activity. The production of HMAbs to HCMV provides an important approach to studying the human host response to HCMV by elucidating biologically relevant antigens and epitopes. In addition, HMAbs are a potentially unlimited source of relevant human antibodies for treating life-threatening HCMV infection.

Antibodies, Monoclonal↗
PubMed1984

Hospital funding constraints: strategic and tactical decision responses to sustained moderate levels of crisis in six Canadian hospitals.

This article reports on a study to ascertain the strategic and tactical responses of policy decision-makers in six Ontario hospitals to moderate levels of 'underfunding' by the provincial government over a 5 year period. The study provides a preliminary test of several theoretical ideas in the current literature on organizational decline. Findings support the hypothesized importance of the decision-makers' subjective interpretation of the causes for cutbacks, and the common initial tendency to 'blame inward' and cut costs through efficiency measures. It also illustrates how prolonged underfunding can bring about a shift in response from one based on techno-economic rationality to political bargaining.

Canada↗
PubMed1980

Home blood glucose concentrations in maturity-onset diabetes.

Blood glucose concentrations during normal daily activities were measured in 106 patients with maturity-onset diabetes from capillary blood samples collected on to filter paper. Samples were taken before and two hours after main meals, before going to bed, and, in 51 cases, during the night. Fasting and mid-morning values were closely correlated with the mean values over 24 hours irrespective of the type of anti-diabetic treatment being given. Postprandial blood glucose concentrations remained below 11.5 mmol/l (207 mg/100 ml) when the fasting blood glucose value was 7.0 mmol/l (126 mg/100 ml) or less, and repeated fasting blood glucose values exceeding 7.0 mmol/l were associated with raised blood glycosylated haemoglobin concentrations. Diabetic control in maturity-onset diabetes may be satisfactorily monitored by regular measurement of fasting or mid-morning blood glucose values.

Adult↗