PubMed Health⌕ Search

Biomedical subjects

P Reid

Publications and source records attributed to P Reid.

At least 19 recordsLinked to original sources
PubMed2003

Emergency department investigation of deep vein thrombosis.

OBJECTIVES: To apply a previously validated clinical model for predicting pre-test probability of deep vein thrombosis (DVT) to patients attending an emergency department with symptoms suggestive of DVT and assess its reproducibility in the patient population. To measure the diagnostic value of the SimpliRED D-dimer assay in effectively excluding DVT. METHOD: Prospective study between March 1999 and October 2000 of adult patients attending with suspected DVT. Patients were assessed using Wells' clinical prediction tool and risk stratified. SimpliRED D-dimer estimations were then performed and compression ultrasonography arranged. The pre-test probabilities of DVT in the low, moderate, and high risk groups of Wells' original cohort were compared with the authors' figures and the sensitivity, specificity, and predictive values of the SimpliRED assay calculated for the patient population. RESULTS: Application of Wells' criteria to patients in the department permitted stratification into high, moderate, and low risk groups (prevalence of DVT 58.3%, 8.9%, and 1.5% respectively). SimpliRED D-dimer assay sensitivity was 63.4% with specificity of 74.8%, with a likelihood ratio of 2.52 for a positive test and 0.49 for a negative test. CONCLUSIONS: Clinical risk stratification allowed patients to be categorised into high, moderate, and low risk groups, albeit with less discriminatory power than originally described by Wells. The low sensitivity of the SimpliRED D-dimer assay when used routinely in a busy emergency department raises substantial doubt over the use of this test to rule out DVT, even in low risk patients.

Adult↗
PubMed2002

The scope of guidelines to prevent healthcare-associated infections.

As care is increasingly delivered in the community rather than acute settings, there has been concern that this might be accompanied by a rise in healthcare-associated infection. Consequently, the National Institute for Clinical Excellence (NICE) has commissioned a set of infection prevention guidelines for healthcare workers in community and primary care. The guideline developers were anxious to concentrate this guidance on the areas of most concern to practitioners, particularly in relation to devices. This article describes how a survey and focus groups were employed to identify the areas for guideline development, namely standard principles, long-term indwelling urinary catheters, enteral feeds and central intravascular devices.

Community Health Services↗
PubMed2001

Postexercise facilitation appears durable in normal subjects.

Transcranial magnetic stimulation (TMS) was used to study the postexercise facilitation of 11 normal subjects on eight occasions. Between individuals, there was almost a sixfold difference in facilitation. The greatest positive percentage change for any individual was 61%, and the greatest negative percentage change was 51%. The results suggest that facilitation is a durable individual characteristic of normal subjects. Serial studies may therefore be indicated in monitoring individuals suffering relapsing conditions.

Adult↗
PubMed2001

A randomized controlled trial assessing the health economics of realtime teledermatology compared with conventional care: an urban versus rural perspective.

A randomized controlled trial was carried out to measure the cost-effectiveness of realtime teledermatology compared with conventional outpatient dermatology care for patients from urban and rural areas. One urban and one rural health centre were linked to a regional hospital in Northern Ireland by ISDN at 128 kbit/s. Over two years, 274 patients required a hospital outpatient dermatology referral--126 patients (46%) were randomized to a telemedicine consultation and 148 (54%) to a conventional hospital outpatient consultation. Of those seen by telemedicine, 61% were registered with an urban practice, compared with 71% of those seen conventionally. The clinical outcomes of the two types of consultation were similar--almost half the patients were managed after a single consultation with the dermatologist. The observed marginal cost per patient of the initial realtime teledermatology consultation was 52.85 Pounds for those in urban areas and 59.93 Pounds per patient for those from rural areas. The observed marginal cost of the initial conventional consultation was 47.13 Pounds for urban patients and 48.77 Pounds for rural patients. The total observed costs of teledermatology were higher than the costs of conventional care in both urban and rural areas, mainly because of the fixed equipment costs. Sensitivity analysis using a real-world scenario showed that in urban areas the average costs of the telemedicine and conventional consultations were about equal, while in rural areas the average cost of the telemedicine consultation was less than that of the conventional consultation.

Adolescent↗
PubMed2001

Missed appointments.

Explore the source record for details and available documents.

Appointments and Schedules↗
PubMed2001

Māori women and menopause.

Māori are the indigenous people of New Zealand who in total make up 14.5% of the population. Although this group has a significantly lower life expectancy than non-Māori, coupled with increased rates of mortality and morbidity, very little is known about the menopausal health needs of older Māori women. As the first step in addressing the health needs of this group, older Māori women's definitions, attitudes, symptoms, expectations and health needs at menopause need to be identified and described. The study Ngā Ruahine or "Māori in Menopause" is the foundation study of the Aotearoa Women's Health Initiative (AWHI). AWHI is a women's health programme being developed by the Wellington School of Medicine, which involves a suite of studies. The objective is to describe the journey of older Māori women through menopause and beyond and to compare and contrast the experience of Māori women from both traditional and contemporary upbringings, with reference to the Pākehā (European) population. It is hoped that this work could lead to further studies such as, for example, a longitudinal observational study looking at older New Zealand women. The potential significance of this approach is discussed.

Age Factors↗
PubMed2000

Domestic fire injuries treated in New Zealand hospitals 1988-1995.

AIM: To describe demographic features of people discharged from New Zealand hospitals following injury caused by fire and flame in domestic locations. METHOD: Review of hospital discharge data for the years 1988-1995. RESULTS: From 1988-1995 there were 1493 discharges from New Zealand hospitals with injury as the result of fire and flame in domestic locations. Age-standardised hospitalisation rates for fire related injury over the period have been stable, with an overall discharge rate of 5.45 hospitalisations per 100000 person years. Male discharges exceeded female in all years (RR 1.97, 95% CI 1.73-2.14). Stratification by age indicated that discharge rates were highest among New Zealanders aged over 75 years and under fifteen years. Maori discharge rates exceeded non-Maori over all age groups (RR 3.3, 95% CI 2.82-3.58). CONCLUSION: Maori discharge rates for fire related injury in the home are substantially higher than non-Maori in all age groups, and highlight the importance of developing culturally appropriate injury prevention strategies. Social and material determinants of injury need to be addressed through public policy, provision of quality housing and community development initiatives.

Accidents, Home↗
PubMed2000

E93 directs steroid-triggered programmed cell death in Drosophila.

Steroid hormones coordinate multiple cellular changes, yet the mechanisms by which these systemic signals are refined into stage- and tissue-specific responses remain poorly understood. Here we show that the Drosophila E93 gene determines the nature of a steroid-induced biological response. E93 mutants possess larval salivary glands that fail to undergo steroid-triggered programmed cell death, and E93 is expressed in cells immediately before the onset of death. E93 protein is bound to the sites of steroid-regulated and cell death genes on polytene chromosomes, and the expression of these genes is defective in E93 mutants. Furthermore, expression of E93 is sufficient to induce programmed cell death. We propose that the steroid induction of E93 determines a programmed cell death response during development.

Animals↗
PubMed2000

Genetic analysis of the Drosophila 63F early puff. Characterization of mutations in E63-1 and maggie, a putative Tom22.

The 63F early puff in the larval salivary gland polytene chromosomes contains the divergently transcribed E63-1 and E63-2 ecdysone-inducible genes. E63-1 encodes a member of the EF-hand family of Ca(2+)-binding proteins, while E63-2 has no apparent open reading frame. To understand the functions of the E63 genes, we have determined the temporal and spatial patterns of E63-1 protein expression, as well as undertaken a genetic analysis of the 63F puff. We show that E63-1 is expressed in many embryonic and larval tissues, but the third-instar larval salivary gland is the only tissue where increases in protein levels correlate with increases in ecdysone titer. Furthermore, the subcellular distribution of E63-1 protein changes dynamically in the salivary glands at the onset of metamorphosis. E63-1 and E63-2 null mutations, however, have no effect on development or fertility. We have characterized 40 kb of the 63F region, defined as the interval between Ubi-p and E63-2, and have identified three lethal complementation groups that correspond to the dSc-2, ida, and mge genes. We show that mge mutations lead to first-instar larval lethality and that Mge protein is similar to the Tom22 mitochondrial import proteins of fungi, suggesting that it has a role in mitochondrial function.

Amino Acid Sequence↗
PubMed2000

Socioeconomic deprivation and ethnicity are both important for anti-tobacco health promotion.

The aim of the study was to explore the relative importance of socioeconomic deprivation and ethnicity for smoking in New Zealand in order to assist with the design and evaluation of health promotion programs. Smoking data were derived from the 1996 census. Socioeconomic deprivation was measured using the NZDep96 index of socioeconomic deprivation for small areas, which combines nine variables from the 1996 census. There was a strong and consistent relationship between area-level socioeconomic deprivation and the proportion of regular smokers. In all age-groups, at each level of deprivation, Maöri smoked more than the "European and Other" ethnic group. The findings of this study support the view that effective tobacco control activities should address ethnic differences in smoking behavior as well as socioeconomic deprivation, and must operate at the levels of populations, places and environments, as well as individuals.

Adolescent↗
PubMed2000

Disparities in health: common myths and uncommon truths.

A reappraisal of disparities by deprivation provides new and important information. NZDep96 is an area-based index of socioeconomic deprivation that uses nine variables measured in the 1996 census. The distribution of the Māori ethnic group is sharply skewed towards the most deprived deciles with only three percent in decile 1 and twenty-six percent residing in decile 10 meshblocks. More than half (56%) of Māori live in areas represented by the three most deprived deciles. This pattern is consistent within both sectors of the Māori ethnic group: sole Māori--those who give Māori as their only ethnicity and mixed Māori--those who give Māori as only one of their ethnicities. This is a 'distribution gap'. Within disparities analysis, there is also evidence of an 'outcome gap'. That is, the health outcomes of Māori are different from non-Māori, even after controlling for deprivation. For example, overseas data on life expectancy at birth have demonstrated social class gradients with lower life expectancy among manual workers and increasing life expectancy for trades-people, through to managerial and professional workers. This gradient is also evident in Aotearoa with life expectancy at birth decreasing as deprivation increases. A third dimension is evident in a review of disparities by deprivation,--a 'gradient gap'. This describes the relationship between ethnicity and increasing deprivation. It is as if the effect of increasing deprivation compounds risk for Māori whereas Pākehā do not seem subject to this effect. Analyses that foreground disparities have been portrayed as oppositional or secondary to Māori health development. In such frameworks where a disparity focus intersects with a development focus, the impression is given that the two are interconnected but move past each other in different directions. Our analysis promotes the disparities focus and the development focus as parallel reinforcing variables, each informing the other in the design and provision of services that have as their starting point, Māori needs. These services offer hope and opportunity for Māori but risk the vulnerability of special provision services (e.g. cuts in government expenditure). Furthermore the may delay the imperative of addressing the societal drivers that perpetuate disparities. This tension to engage in remedial reform is an important dilemma in Māori health development.

Censuses↗
PubMed1999

Borrelia burgdorferi-specific immune complexes in acute Lyme disease.

CONTEXT: Diagnosis of infection with Borrelia burgdorferi, the cause of Lyme disease (LD), has been impeded by the lack of effective assays to detect active infection. OBJECTIVE: To determine whether B. burgdorferi-specific immune complexes are detectable during active infection in LD. DESIGN, SETTING, AND PATIENTS: Cross-sectional analysis of serum samples from 168 patients fulfilling Centers for Disease Control and Prevention surveillance criteria for LD and 145 healthy and other disease controls conducted over 8 years. Tests were performed blinded. MAIN OUTCOME MEASURE: Detection of B. burgdorferi immune complexes by enzyme-linked immunosorbent assay and Western blot. RESULTS: The B. burgdorferi immune complexes were found in 25 of 26 patients with early seronegative erythema migrans (EM) LD; 105 of 107 patients with seropositive EM LD; 6 of 10 samples that were seronegative [corrected] with culture-positive EM; 0 of 12 patients who were treated and recovered from LD; and 13 of 13 patients with neurologic LD without EM. Among 147 controls, B. burgdorferi immune complex was found in 0 of 50 healthy individuals; 0 of 40 patients with persistent fatigue; 0 of 7 individuals with frequent tick exposure; and 2 of 50 patients with other diseases. CONCLUSION: These data suggest that B. burgdorferi immune complex formation is a common process in active LD. Analysis of the B. burgdorferi immune complexes by a simple technique has the potential to support or exclude a diagnosis of early as well as active LD infection.

Acute Disease↗
PubMed1999

Antiandrogens in prostate cancer.

Antiandrogens competitively inhibit ligand binding to the androgen receptor (AR), and are used therapeutically in prostate cancer patients. The AR functions as a ligand dependent transcription factor that transduces androgen binding into increased transcription of androgen dependent genes. AR blockade induces programmed cell death in the vast majority of malignant and benign prostate cancer cells that have not previously been exposed to androgen ablation. The antiandrogens are divided structurally into the steroidal and non steroidal agents. The biological effects of the steroidal versus nonsteroidal agents are distinguished by differences in their effects on serum testosterone levels, and by their activity at receptors other than the androgen receptor. There is extensive clinical experience in the palliative and curative therapy of prostate cancer using antiandrogens as monotherapy or antiandrogens in combination with luteinizing hormone agonists or surgical castration. Prolonged therapy with antiandrogens selects for mutations in the AR that change the AR ligand specificity and permits stimulation by ligands that are usually inhibitory. These mutations give insight into one of the means by which prostate cancer progresses despite antiandrogen therapy, and also helps to explain the antiandrogen withdrawal syndrome. Areas of active research that may affect the future use of antiandrogens include the ongoing evaluation of antiandrogens in combination with 5 alpha reductase inhibitors to achieve AR blockade without inducing castrate testosterone levels. There is also interest in developing selective androgen receptor modulators (SARM) that can achieve AR blockade without causing the increased testosterone levels produced by the nonsteroidal antiandrogens currently in use.

Androgen Antagonists↗