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Biomedical subjects

P J Hatfield

Publications and source records attributed to P J Hatfield.

At least 19 recordsLinked to original sources
PubMed1998

Testing migration patterns and estimating founding population size in Polynesia by using human mtDNA sequences.

The hypervariable 1 region of human mtDNA shows markedly reduced variability in Polynesians, and this variability decreases from western to eastern Polynesia. Fifty-four sequences from New Zealand Maori show that the mitochondrial variability with just four haplotypes is the lowest of any sizeable human group studied and that the frequency of haplotypes is markedly skewed. The Maori sequences, combined with 268 published sequences from the Pacific, are consistent with a series of founder effects from small populations settling new island groups. The distributions of haplotypes were used to estimate the number of females in founding population of New Zealand Maori. The three-step simulation used a randomly selected founding population from eastern Polynesia, an expansionary phase in New Zealand, and finally the random selection of 54 haplotypes. The results are consistent with a founding population that includes approximately 70 women (between 50 and 100), and sensitivity analysis shows that this conclusion is robust to small changes in haplotype frequencies. This size is too large for models postulating a very small founding population of "castaways," but it is consistent with a general understanding of Maori oral history as well as the results of recent canoe voyages recreating early trans-oceanic voyages.

Base Sequence↗
PubMed1997

Health service reform: the perceptions of medical specialists in Australia (New South Wales), the United Kingdom and New Zealand.

OBJECTIVE: To examine the effect of recent healthcare service changes (including significant resource constraint and a greater role for the non-medical manager) in the United Kingdom, Australia and New Zealand on medical specialists' perceptions of their healthcare organisation goals and service delivery, and their enthusiasm for their work. DESIGN: Postal questionnaire survey, answered anonymously. PARTICIPANTS AND SETTING: Medical specialists employed either part- or full-time in two United Kingdom National Health Service Trusts (one acute, one mental health/community service), an Australian Area Health Service and a New Zealand Crown Health Enterprise in 1995. MAIN OUTCOME MEASURES: Participants' rating of their knowledge of employers' organisational goals, ability to influence management, perceptions of changes in resources and service availability since 1990 and changes in enthusiasm for their work over the past four years. RESULTS: 369 of 521 eligible specialists responded (71%); by country-United Kingdom, 123/186 (66%); New Zealand, 123/160 (77%); Australia, 123/175 (70%). New Zealand specialists were less aware of their employers' organisational goals and had less congruence between these and their own personal goals than United Kingdom or Australian specialists (P < 0.05). Interest in influencing central management was similar in the three countries, but Australian specialists felt management was less likely to follow their advice compared with United Kingdom specialists (P < 0.05). New Zealand specialists perceived that waiting times for non-urgent patients were currently longer than in 1990 compared to United Kingdom specialists (P = 0.02). In all three countries, inpatient beds were perceived to be less available than in 1990, but less so in New Zealand. The ease of replacing equipment was better in New Zealand than in Australia and the United Kingdom (P = 0.00001). More than 50% of participants in all three countries (183/361; 50.7%) reported that their enthusiasm for their work had decreased in the past four years. CONCLUSION: The effects of health service reforms seem to have reduced enthusiasm for work among medical specialists in Australia, the United Kingdom and New Zealand.

Attitude of Health Personnel↗
PubMed1997

Neurotoxicity associated with acyclovir in end stage renal failure.

AIMS: To alert practitioners to the danger of acyclovir neurotoxicity occurring in the presence of renal failure. METHODS: Two case reports of acyclovir neurotoxicity in the patients on continuous ambulatory peritoneal dialysis. RESULTS: In one case neurotoxicity resulted from the use of a dosage regimen that would be appropriate in patients with normal renal function. In the other case, neurotoxicity occurred even though a reduced dose of acyclovir was given. Supportive management resulted in a complete recovery. CONCLUSIONS: In patients with end stage renal failure with varicella zoster infections, when acyclovir is prescribed the loading dose should be 400 mg and the maintenance dose should be 200 mg twice daily.

Acyclovir↗
PubMed1994

Polynesian women are also at risk for hyperuricaemia and gout because of a genetic defect in renal urate handling.

The prevalence of asymptomatic hyperuricaemia among Polynesian women (Maoris, Cook Islanders, Samoans, Tongans) was high--44%. This hyperuricaemia resulted from a reduced fractional uric acid clearance (FEur: uric acid clearance factored by creatinine clearance x 100--6.7 +/- 1.5%) compared with the FEur in healthy UK women (12.8 +/- 2.9%). This reduction in FEur was not as great as that in young UK women with familial juvenile hyperuricaemic nephropathy (FJHN: 5.1 +/- 1.5%) and was not associated with impaired renal function. The FEur in the normouricaemic Polynesians (9.7 +/- 1.9%) was also lower than that in healthy UK women (12.8 +/- 2.9%). The reduced FEur in these Polynesian women supports the hypothesis that indigenous Pacific races share a similar genetic defect in renal urate handling to that reported as the basis for the susceptibility to hyperuricaemia in Maori men. Neither alcohol nor hypertension contributed to this. This study also confirmed that, compared with their European counterparts, Polynesian women have a high purine intake and a strong tendency to obesity which increases with age. These factors, together with the reduced FEur, put them at added risk for gout. However, the reduction in FEur was not as great as that reported for the normouricaemic or asymptomatic hyperuricaemic Maori male (4.9 +/- 1.5% and 3.9 +/- 1.4%, respectively), confirming the same sex difference in renal urate handling in adult Polynesians as in caucasians.

Adult↗
PubMed1993

Cognitive function and quality of life in end-stage renal failure.

The Sickness Impact Profile (SIP) and the Wechsler Memory Scale--Revised (WMS-R) were administered to a small sample of end-stage renal failure patients. The memory test successfully discriminated between patients who were rated by their nurses to be well adjusted or poorly adjusted to dialysis treatment. It is concluded that this instrument may be useful in investigating cognitive function in this patient population.

Adaptation, Psychological↗
PubMed1991

Diabetic end stage renal failure--the Wellington experience 1975-1988.

Since the late 1970s patients with diabetic nephropathy have formed an increasing proportion of new entrants to the Hospital renal dialysis and transplantation programme, reaching 28% for the three year period to December 1988. Between 1 January 1975 and 31 December 1988, 87 diabetic patients were accepted for treatment. Fifty-one per cent were European, predominantly type I diabetics. Maori (9% of the total reference population) accounted for a disproportionately high 47% due to an over-representation by type II diabetic patients (34 of 41 Maori). These findings cannot be explained by the higher prevalence in Maori of type II diabetes but appear to be due to a more prevalent and/or aggressive diabetic renal lesion in this group. On commencing treatment, nearly all patients had retinopathy and the majority had evidence of peripheral vascular disease, hypertension and neuropathy. CAPD was the initial mode of renal replacement therapy in 70% of patients. Overall patient survival was 77% at one year and 42% at three years, and survival on CAPD was 76% and 37% at one and three years, respectively. Patient survival on transplantation was 63% at one year and 58% at three years. Graft survival was 51% at one year and 46% at three years. Although the short term outlook for diabetic patients on renal replacement therapy is encouraging, longer term survival compared to non-diabetic patients is poor. Vascular disease is the major cause of death and an important factor in patient morbidity.

Adult↗
PubMed1991

"Quality of life" for patients with end-stage renal failure.

The assessment of health status and quality of life among chronically ill patients is an area of current scientific interest. This paper considers the utility of a short but comprehensive instrument to assess the quality of life for end-stage renal failure patients. the Spitzer QL-Index was completed by 8 nurses for all patients in the Wellington region currently being treated with home hemodialysis (n = 58); hospital hemodialysis (n = 13); and continuous ambulatory peritoneal dialysis (n = 37). Results indicated that home hemodialysis patients achieve the highest quality of life in comparison to the other two treatment modalities. It is concluded that the QL-Index has some discriminative validity for this patient population, and its use may contribute to informed decision making by both patients and doctors.

Adaptation, Psychological↗
PubMed1986

Endstage renal failure due to polycystic kidney disease managed by continuous ambulatory peritoneal dialysis.

Over a five and one half year period, four of nine patients with endstage renal failure due to polycystic kidney disease managed by continuous ambulatory peritoneal dialysis (CAPD) developed peritonitis following intestinal perforation. Two patients had colonic perforation associated with diverticular disease, one necrosis of the terminal ileum, and one acute appendicitis. Two of the patients died subsequent to these complications. The survivors had early transfer to haemodialysis. In contrast, over the same period, only two of 125 patients with renal failure due to other causes and managed by CAPD had acute intestinal perforation. In both cases this was associated with acute appendicitis. Both patients survived. All episodes of peritonitis in CAPD patients with polycystic kidneys demand very close monitoring, cessation of CAPD, and early surgical intervention. CAPD is relatively contraindicated in such patients.

Female↗
PubMed1986

Continuous ambulatory peritoneal dialysis and acute appendicitis.

Peritonitis in patients on continuous ambulatory peritoneal dialysis while usually due to contamination of the dialysis line by skin organisms may also be due to intra-abdominal pathology. Three cases are described in whom peritonitis was due to acute appendicitis. The recognition of an intra-abdominal source of infection in patients on CAPD is discussed, and surgical management stressed.

Acute Disease↗
PubMed1984

Subclavian vein catheterisation for haemodialysis.

Immediate access to the circulation for haemodialysis may be necessary in patients with acute renal failure or when end stage renal disease presents acutely. Vascular access may be required in patients treated by continuous ambulatory peritoneal dialysis if that technique is interrupted or, following failure of an arteriovenous fistula in patients on maintenance haemodialysis. Haemodialysis via a catheter in the subclavian vein meets these needs. Our experience with 67 patients over two years confirmed the safety and reliability of this means of access. Benefits included easy, rapid catheter placement, full patient mobility, allowing outpatient dialysis where appropriate, and the sparing of peripheral vessels for future access. With careful attention to technique by experienced personnel complications are largely preventable.

Acute Kidney Injury↗
PubMed1984

Acute renal failure following near drowning in salt water.

Two young men swallowed and inhaled salt water, suffered cold exposure and an undertermined degree of body trauma, in separate incidents. Severe acute oliguric renal failure followed in both, requiring dialytic therapy. Single needle subclavian intermittent haemodialysis allowed ambulatory outpatient management. The risk of acute renal failure following even brief sea water immersion is emphasised and the value of ambulant subclavian haemodialysis in the management of acute renal failure illustrated.

Acute Kidney Injury↗
PubMed1984

Living-related renal transplantation: Wellington experience.

Living-related renal transplantation as treatment for end-stage renal failure has not been used widely in Australasia. The results of such treatment in 31 patients at Wellington Hospital are described. The five year graft survival of 80.2% encourages us to continue with an active policy of living related transplantation.

Adult↗