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Biomedical subjects

P Hicks

Publications and source records attributed to P Hicks.

At least 19 recordsLinked to original sources
PubMed2003

Global distribution and outcomes for Candida species causing invasive candidiasis: results from an international randomized double-blind study of caspofungin versus amphotericin B for the treatment of invasive candidiasis.

In a randomized study, caspofungin was compared with amphotericin B for the treatment of invasive candidiasis in a total of 239 adults from 56 sites in 20 countries. This study provided a unique opportunity to assess the frequency and outcome of invasive candidiasis caused by different Candida species worldwide, and the results are presented here. Efficacy was primarily assessed at the end of intravenous therapy using a modified intent-to-treat (MITT) analysis. This analysis was performed on 224 of the 239 patients enrolled in the study. Attempts were made to collect baseline Candida isolates from all patients for species identification at a central laboratory. Yeasts were identified to the species level using two commercial systems and microscopic examination. Viable baseline isolates were recovered from 210 of the 224 (94%) patients included in the MITT analysis. Candida albicans was the most frequently isolated species in all regions and was responsible for 45% of cases overall. Nevertheless, the majority of cases of infection were caused by non- albicans Candida species. In the USA and Canada, Candida glabrata was the second most commonly isolated pathogen (18%). In contrast, Candida parapsilosis and Candida tropicalis accounted for 55% of cases in Latin America. Outcomes were comparable for patients treated with caspofungin (74% overall; 64% and 80% for infections due to Candida albicans and non- albicans species) and amphotericin B (62% overall; 58% and 68% for infections due to Candida albicans and non- albicans species), and were generally similar across continents. The distribution of Candida species isolated from patients enrolled in a clinical trial may not be representative of pathogens causing invasive candidiasis in the general population. Nevertheless, our findings may affect the regional choice of empirical antifungal therapy for seriously ill patients with suspected or documented invasive candidiasis since different Candida species have varying susceptibility to conventional antifungal drugs.

Adult↗
PubMed2001

Use of telehealth technology to extend child protection team services.

OBJECTIVE: In response to increased referrals to Florida's Child Protection Teams and concern regarding statewide availability of medical expertise in the area of child abuse and neglect, Children's Medical Services of the Florida Department of Health established a telemedicine project to facilitate immediate expert medical evaluations of alleged child abuse or neglect. This article describes a baseline examination of the project, including the technique of concept mapping, to examine how larger systematic factors influence the adaptation of telemedicine technology in child abuse examination settings. METHODS: This study included interviews of key staff plus the incorporation of concept mapping, which takes qualitative data (individual statements and opinions) and quantifies them (sorts and ranks them by order of group importance). RESULTS: Findings from interviews revealed that the frequency of use of telehealth services varies across the state as a result of several factors, including space limitations and staff training. Patients, however, seem to be comfortable with the use of the new technology. The concept mapping exercise displayed a progression of issues that are perceived to have an impact on the use of this technology. CONCLUSIONS: Technology use is affected by unforeseen variables, such as physical space limitations and examination room availability. Family concerns about patient privacy issues were rare and were resolved quickly by the health care practitioner. Although using this equipment is not difficult, the search for user-friendliness should be continued. Staff engagement early in the process likely will result in a greater likelihood of use of the technology.telehealth, telemedicine, child protection, child abuse and neglect, concept mapping.

Child↗
PubMed1999

Cost comparison of antibacterial therapies for serious infections. A New Zealand 3-hospital study.

OBJECTIVE: The first aim was to identify and determine the economic costs of the regimens currently used in 3 New Zealand hospitals in the treatment of bacterial infections in haematology patients with febrile neutropenia and in intensive care patients with severe infections. The second was to develop a spreadsheet-based decision analytic model for use by hospital decision-makers as an aid in evaluating the comparative cost of drug regimens. DESIGN AND SETTING: The research utilised time and motion and microcosting techniques. The analytical perspective adopted for the study was that of a hospital administrator or clinical manager. PATIENTS AND INTERVENTIONS: Patients were eligible for inclusion in the study if either they were treated with the imipenem/cilastatin monotherapy, or could have been treated with this regimen. The final analysis considered 360 patient-treatment days and 8 antibacterials. MAIN OUTCOME MEASURES AND RESULTS: Drug acquisition cost ranged from 4.52 New Zealand dollars ($NZ; 1997 values) per patient-treatment day for gentamicin to $NZ104.81 for imipenem. The cost per patient-treatment day (when other cost components such as fluid additives, giving sets and needles were added) ranged from $NZ8.75 for gentamicin to $NZ129.12 for tazobactam. Drug acquisition cost, as a percentage of total drug preparation and administration cost, ranged from 52% for gentamicin to 93% for piperacillin. Giving sets and intravenous (i.v.) fluids were found to be important cost items when they were required specifically for the treatment regimen. There was a mean monitoring rate of 0.40 at a cost of $NZ6.41 per patient-treatment day for gentamicin. It was estimated that nephrotoxicity could add between $NZ23 and $NZ43 per day to the cost of aminoglycoside treatment. CONCLUSIONS: Although the small sample sizes of the study mean that results should be regarded as indicative rather than conclusive, there were sufficient information to construct a working model and show how the total cost of an antibacterial regimen could be evaluated in practical terms. The important cost drivers were found to be drug cost, the use of fluids and giving sets, and monitoring.

Anti-Infective Agents↗
PubMed1998

Development of high-throughput flexible multichannel electron detectors at Daresbury Laboratory.

Continuing demands from Synchrotron Radiation Source (SRS) end-users for higher throughput and improved reliability in photoelectron spectroscopy experiments have driven an intensive development programme for new multichannel electron detectors. The development philosophy focuses on high throughput to match present and future source intensity, flexible structures to allow increased mobility of designs and modular design for easy maintenance and repair. Developments include parallel readout electronics and innovative detector heads for the hemispherical deflection analysers currently in use on the SRS. Novel anode arrays have been implemented in the detector heads and extensive microchannel plate (MCP) characterization has been undertaken to source the MCPs most suited to this application. The present multichannel detection systems provide a significant enhancement to single-channel detection systems. They have also surpassed previous multichannel detection systems due to their high throughput, flexible structure and modular design. Information on these developments and experimental results obtained at Daresbury Laboratory are presented.

Journal Article↗
PubMed1997

Cholesterol granuloma of the breast presenting as an intracystic papilloma.

Cholesterol granuloma of the breast is a rare benign condition. It is often clinically and radiologically indistinguishable from breast carcinoma. A case of cholesterol granuloma which manifested as an intracystic papilloma on ultrasound is described. This unusual ultrasonographic appearance has not previously been reported.

Adenoma↗
PubMed1996

Azithromycin therapy for Cryptosporidium parvum infection in four children infected with human immunodeficiency virus.

Cryptosporidium parvum intestinal infection in immunodeficient patients can cause severe intestinal fluid losses with severe dehydration or chronic diarrhea with malnutrition. Therapies tried in human beings and animals include paromomycin, clarithromycin, azithromycin, octreotide, hyperimmune bovine colostrum, and bovine transfer factor. No specific therapy has been found to be consistently beneficial to children. We report azithromycin treatment of four children with acquired immunodeficiency syndrome who had severe diarrheal illnesses in which Cryptosporidium parvum was the sole pathogen detected. Three of these children had a marked decrease in stool volume and frequency within 36 hours of initiating therapy and resolution of diarrhea within 5 days; Cryptosporidium organisms became undetectable on examination of stool or colonic biopsy or by both after therapy was discontinued. A fourth patient required prolonged therapy with azithromycin to achieve clearance. Azithromycin therapy should be considered for immunocompromised patients with intestinal Cryptosporidium infection.

AIDS-Related Opportunistic Infections↗
PubMed1995

Heterozygosity for long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency and deterioration in liver function in a newborn infant infected with human immunodeficiency virus.

A child with perinatally acquired human immunodeficiency virus infection had rapidly progressive hepatic dysfunction, as had her older sibling who died. Urinary organic acid studies revealed 3-hydroxydicarboxylic aciduria, and cultured skin fibroblasts had reduced activity of 3-hydroxy-coenzyme A dehydrogenase. The introduction of a low fat diet resulted in marked improvement in clinical status and reversal of the liver disease. This case illustrates the necessity of metabolic evaluation in patients with liver dysfunction, even when other causes of liver dysfunction are present.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Tuberculosis in a Tulsa high school.

Following the discovery of a high school student with communicable tuberculosis, the Tulsa City-County Health Department skin tested 1,005 persons in the family, community, and school. Of the 931 persons tested at the school, 10 were reactors in March and 33 more were reactors in May. All 5 family members and 4 community contacts were tuberculin reactive. In all, 52 new tuberculin reactors were identified, evaluated, and considered for treatment or prophylaxis. This situation illustrates the conundrum that tuberculosis remains an important public health issue because of the possibility of transmission from small pockets of diseased persons to the larger community, especially in institutions of all kinds. Physicians and public health agencies must be vigilant and identify new cases for treatment and begin contact tracing to minimize the spread of tuberculosis.

Adolescent↗
PubMed1989

Budd Chiari syndrome, visceral arterial occlusions, recurrent fetal loss and the "lupus anticoagulant" in systemic lupus erythematosus.

A 30-year-old Chinese woman had been diagnosed as having systemic lupus erythematosus (SLE) at age 25 after 4 spontaneous abortions, all between 8 and 12 weeks of gestation. A year later she developed mild jaundice and at laparotomy, nodular enlargement of the right lobe of the liver and splenomegaly were seen. She was found to have a "lupus anticoagulant" and false positive test for syphilis (VDRL), but persistently negative antibodies to cardiolipin. Angiography demonstrated occlusion and stenoses of visceral abdominal arteries and hepatic venography also showed evidence of hepatic venous occlusions. She subsequently developed thyrotoxicosis which was treated with carbimazole, followed by radioactive iodine. The SLE and lupus anticoagulant were treated with systemic steroids (prednisolone) and anticoagulation (warfarin).

Abortion, Spontaneous↗
PubMed1987

Limb muscle compression: an alternative technique for intravenous digital subtraction angiography.

A simple, muscle-compression technique to introduce a bolus of contrast medium from hand or foot injections for intravenous digital subtraction angiography (DSA) is described. Fifty millilitres of the non-ionic contrast medium iopamidol 300 was used for each projection. In 18 out of the 20 examinations an acceptably diagnostic arteriogram was obtained. It is suggested that the compression technique is a useful alternative for intravenous DSA when conventional venous access is impossible.

Adult↗
PubMed1983

Age-related changes in rat brain capillaries.

We have measured several morphological parameters by electron microscopy of the frontal cortex (FC) and hippocampal CA1 (HC) capillaries in male Fischer 344 rats 3-, 9- and 24-months old. The results indicate that with increasing age there is an increase in the cross-sectional area of the basement membrane, increase in the fraction of endothelial cell and pericyte cytoplasmic area occupied by mitochondria in the FC, increase in the size of the pericyte mitochondria in both the FC and HC, increased capillary lumen area in the FC and decreased capillary lumen area in the HC. Also, the cytoplasmic area occupied by mitochondria in capillary pericytes is larger than in the endothelial cells of both FC and HC. These results suggest that there is regional variation in the age-associated changes in capillary morphometrics.

Aging↗
PubMed1982

Theophylline blood levels as a guide to intravenous therapy in children.

A retrospective analysis of the records of 56 children admitted in status asthmaticus was done to assess the impact of serum theophylline levels on subsequent therapeutic decisions. In 39% of the cases, levels obtained following the initial theophylline bolus were below therapeutic range and in 6% they were above therapeutic range. In 31% of instances of theophylline levels obtained during the phase of continuous aminophylline infusion, the physician decided to administer additional theophylline. The median hospital stay was 2.65 days. Monitoring serum theophylline levels following intravenous loading and during continuous infusion provides the physician with a valuable clinical tool and may help to shorten the period of hospitalization for patients in status asthmaticus.

Adolescent↗