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Biomedical subjects

P Whitaker

Publications and source records attributed to P Whitaker.

15 recordsLinked to original sources

Remuneration for blood donation and attitudes towards blood donation and receipt in Leeds.

In a survey of attitudes towards remuneration for blood donation in Leeds, the following questions were completed by 489 adults (N), of whom 89 were regular donors, 105 were lapsed donors and 295 had never donated: 'If you needed blood, would you be content if the donor had been paid: yes/no'. 'If I were paid enough I would be less/equally/more likely to donate blood '. The majority (67.7%) of potential recipients would be content if the donor had been paid. The prospect of remuneration made 16.4% of respondents more likely and 14.5% less likely to donate. As the difference is less than 2% of N, offering remuneration may not lead to a significant increase in the number of donations. A statistical comparison (chi2 = 45, d.f. = 2, P << 0.001) showed associations between the responses 'more likely to donate if paid' and 'content to receive blood from a paid donor', and between the responses 'less likely to donate if paid' and 'not content to receive blood from a paid donor'. Age distributions are presented for the donor status categories and the responses to the main questions. Of 129 people who stated a minimum, nonzero payment that would persuade them to donate, 103 (80%) suggested pound sterling 10 or less.

Adolescent↗

Inhibition of the contractile responses of isolated human and rat bladders by clenbuterol.

PURPOSE: We investigated the inhibition of the contractile responses of human continent and unstable detrusor muscle by the beta2 agonist clenbuterol as well as the inhibition of electrical field stimulation evoked contractile responses of isolated rat bladder muscle strips by orally administered clenbuterol. MATERIALS AND METHODS: The contractile responses of human continent and unstable detrusor muscle strips to electrical field stimulation (0.05 milliseconds, 0.5 to 80 Hz.) were measured before and after adding 10(-9) to 10(-4) M. clenbuterol in vitro. In addition, 6 rats per group were dosed orally with 2 microg x kg(-1) clenbuterol daily acutely (1 dose) or chronically (1 dose daily for 8 days), or with distilled water to serve as controls. The contractile response to electrical field stimulation of strips of isolated detrusor muscle was then measured. Serum clenbuterol levels were analyzed in duplicate by enzyme-linked immunosorbent assay and high performance liquid chromatography. RESULTS: In vitro clenbuterol significantly inhibited the electrical field stimulation evoked contractile responses of detrusor muscle strips from unstable but not continent human bladders. A significant inhibitory effect of clenbuterol on the electrical field stimulation evoked contractile response of rat detrusor muscle was observed after chronic but not acute oral dosing (p <0.01). Serum clenbuterol levels measured by enzyme-linked immunosorbent assay and high performance liquid chromatography were not significantly different. CONCLUSIONS: Clenbuterol or related beta2-adrenoceptor agonists may represent a useful therapeutic strategy for detrusor muscle overactivity.

Adrenergic beta-Agonists↗

Neutrophil alkaline phosphatase (NAP) score in the diagnosis of hypophosphatasia.

Hypophosphatasia is an inherited disease characterised by low tissue non-specific alkaline phosphatase (TNSALP) levels and skeletal defects. Diagnosis is usually made by measurement of serum total alkaline phosphatase (TALP, reference range 40-130 iu/l) and pyridoxal-5'-phosphate (PLP), and urine phosphoethanolamine (PEA). Neutrophil alkaline phosphatase (NAP) scores (reference range 20-150) have been reported to be low in isolated cases, but no comparison has been made of the diagnostic value of NAP, TALP, PEA and PLP in hypophosphatasia. We undertook such a comparison in six families with hypophosphatasia. In four families (Families 1, 2, 5, 6) with the adult type of hypophosphatasia, inherited as autosomal dominant, the NAP score and TALP (<40 iu/l), were low, <20 and <40 iu/l respectively, in all affected subjects, though the PEA and PLP were not consistently abnormal. In one of the two families (Family 3) with the autosomal recessive type of hypophosphatasia an affected subject had low NAP as well as low TALP, PLP and PEA. In another family (Family 4) one of the heterozygotes had a low NAP while the other had a normal NAP score (45). A child in this family had a normal TALP level. Her low NAP score (15) supported her to be a possible heterozygote. NAP score is readily available from most laboratories and may be diagnostically helpful in hypophosphatasia.

Adult↗

Comparison of serum catalytic activity and immunoreactivity of bone alkaline phosphatase in hypophosphatasia.

Hypophosphatasia is a rare bone disorder characterised by low levels of tissue non-specific alkaline phosphatase (TNSALP). Although TNSALP is widespread in virtually all tissues the clinical effects, when produced, seem only to affect the mineralizing tissue such as teeth and skeleton. The skeleton is severely affected in the perinatal form of the disease, when death may occur in utero, or may not be affected in the adult type variety of the disease. We therefore compared the catalytic (cBALP) and immunoreactivity (iBALP) of bone alkaline phosphatase isoenzyme in six families with hypophosphatasia. iBALP was measured using an IRMA method. cBALP was measured after electrophoretic separation of serum alkaline phosphatase isoenzymes on lectin containing agarose gel. The percentage of different isoenzymes was calculated using densitometric scanning and cBALP calculated from the known total serum alkaline phosphatase activity. Results showed cBALP=0.796+3. 269iBALP, r=0.9 p<0.01, in cases of hypophosphatasia. In general, the lower the iBALP and cBALP the more severe the skeletal disease. The bone isoenzyme level predicts the clinical severity of bone disease.

Adult↗

Albumin as an outcome measure in haemodialysis in patients: the effect of variation in assay method.

BACKGROUND: Serum/plasma albumin is an important predictor of future mortality/morbidity in haemodialysis (HD) patients and has been proposed as an important audit measure. Different methods of albumin assay give different results and the bias between methods may be greater in renal failure patients. METHODS: Albumin concentration in plasma was measured by three methods, two dye-binding methods (bromocresol green (BCG) and bromocresol purple (BCP)) and an immuno-turbidimetric (ITM) method, in 143 HD patients (group I) and 49 non-renal patients (group II). Comparisons were made between means, variation in differences across a range of albumin concentrations and on the percentage of patients within the normal range. RESULTS: In HD patients (group I), BCG over-estimated plasma albumin compared with the other two methods. The difference could be as much as 10 g/l and was more marked in hypoalbuminaemic patients. The BCP method gave results closer to the ITM method, particularly in HD patients. These differences were less marked in group II patients but both methods overestimated albumin compared with the ITM method. Using the BCG local laboratory normal range, 84% of HD patients had plasma albumin concentrations within the normal range but this fell to 57% if the BCP results were used. CONCLUSIONS: The method for determining albumin concentration has a marked effect on the results particularly in HD patients. BCG, the most commonly used method, gives higher results than other methods and correlates poorly with an immunological method. These differences make comparative audit between nephrology units difficult and have implications for other biochemical variables and other specialties.

Biomarkers↗

Effects of clozapine and typical antipsychotic drugs on plasma 5-HT turnover and impulsivity in patients with schizophrenia: a cross-sectional study.

OBJECTIVE: To compare the efficacy of clozapine with typical antipsychotic drugs in controlling impulsivity and to explore the possible correlation of impulsivity with plasma 5-hydroxytryptamine (5-HT) levels, plasma 5-hydroxyindoleacetic acid (5-HIAA) levels and plasma 5-HT turnover. DESIGN: Prospective, cross-sectional study open to medication and blinded to biochemical analyses. PARTICIPANTS: Healthy control subjects (n = 24) and 46 inpatients and outpatients meeting the DSM-IV criteria for schizophrenia; 20 were being treated with clozapine and 26 were taking typical antipsychotic drugs. INTERVENTIONS: All psychotropic drugs other than clozapine or typical antipsychotic drugs were discontinued for at least 5 days and subjects fasted overnight before they were assessed. OUTCOME MEASURES: Coccaro Impulsivity Scale scores, plasma 5-HT levels, 5-HIAA levels and 5-HT turnover. RESULTS: Patients treated with clozapine and those treated with typical antipsychotics had significantly higher impulsivity scores than the control group, and the mean impulsivity score of the typical antipsychotic group was significantly higher than that of patients treated with clozapine. The mean concentration of 5-HT of the typical antipsychotic group was significantly lower than that of the control group and patients treated with clozapine; however, mean plasma levels of 5-HIAA were significantly higher for the clozapine group than the other 2 groups. 5-HT turnover was significantly higher for the 2 drug-treatment groups than for the control group. CONCLUSIONS: These results suggest that treatment with clozapine should be considered for patients with schizophrenia who are impulsive and aggressive.

Adult↗

Treatment of male urethral strictures: is repeated dilation or internal urethrotomy useful?

PURPOSE: We evaluate the efficacy of repeated dilation or urethrotomy as treatment of male urethral strictures. MATERIALS AND METHODS: Between January 1991 and January 1994, 210 men with proved urethral strictures were prospectively randomized to undergo filiform dilation (106) or internal urethrotomy (104). Followup was scheduled at 3, 6, 9, 12, 24, 36 and 48 months. Dilation or internal urethrotomy was repeated at the first and second stricture recurrence. The Kaplan-Meier method was used to estimate survivor function for the treatment methods (survival time being the time to first stricture recurrence) and the log rank test was used to compare the efficacy of different treatments. RESULTS: Followup (mean 24 months, range 2 to 63) was available in 163 patients (78%). After a single dilation or urethrotomy not followed by re-stricturing at 3 months, the estimated stricture-free rate was 55 to 60% at 24 months and 50 to 60% at 48 months. After a second dilation or urethrotomy for stricture recurrence at 3 months the stricture-free rate was 30 to 50% at 24 months and 0 to 40% at 48 months. After a third dilation or urethrotomy for stricture recurrence at 3 and 6 months the stricture-free rate at 24 months was 0 (p <0.0001). CONCLUSIONS: Dilation and internal urethrotomy are useful in a select group (approximately 70% of all patients) who are stricture-free at 3 months, and of whom 50 to 60% will remain stricture-free up to 48 months. A second dilation or urethrotomy for early stricture recurrence (at 3 months) is of limited value in the short term (24 months) but of no value in the long term (48 months), whereas a third repeated dilation or urethrotomy is of no value.

Catheterization↗

Polymerase chain reaction in the diagnosis of urinary tract tuberculosis.

The polymerase chain reaction (PCR) is a technique that can be used to amplify a specific DNA genomic sequence, whereby the presence of an extremely small number of bacteria can be detected. The high sensitivity of PCR is particularly useful in paucibacillary situations such as non-pulmonary tuberculosis (TB). The aims of the present study were to establish a PCR assay for the rapid detection of Mycobacterium tuberculosis (MTb) in urine, to compare the sensitivity of PCR with routine culture technique (Bactec) and to determine the optimal type of urine specimen for PCR detection of MTb. In the first phase of the study, a total of 92 urine specimens were collected from 83 patients with suspected urinary tract TB. Two urine specimens in 2 patients were positive for TB by both PCR and Bactec, while 90 specimens from 81 patients were negative by both methods. Inhibition of PCR was present in nine urine specimens (10%). In the second phase of the study, a further seven patients were selected for intensive investigation to determine the optimal urine sampling for PCR detection of MTb. The conclusions of the study are that PCR can provide much faster confirmation of urinary TB (within 24-48 h) than Bactec urine culture (which may take several weeks). About 10% of urine specimens could not be evaluated by PCR due to the presence of inhibitory substances of unknown nature. MTb organisms were found to be excreted intermittently in the urine of infected patients, and single specimens were more likely to be false negative than a 24-h sample. The best method appeared to be the concentration of a large volume of urine, for instance 11 concentrated to 2 ml.

Adult↗

Laparoscopy for the non-palpable testis--look before you cut!

Before definitive surgery laparoscopies were performed to define the position of 24 non-palpable testes in 21 patients. The anatomical site of the testes was confirmed by surgery in all cases. Laparoscopy is helpful in planning the definitive procedure in these cases.

Adolescent↗

Fluid noncompliance and symptomatology in end-stage renal disease: cognitive and emotional variables.

Fluid noncompliance in patients with end-stage renal disease (ESRD) is a widespread problem with severe consequences for health. In addition, ESRD patients report considerable stress in relation to their illness and dialysis treatment. The present study examined the role of cognitive and emotional variables in fluid noncompliance, symptomatology, and stress. Fifty hemodialysis patients were assessed (a) on the cognitive variables of locus of control, self-evaluations of their past compliance, and self-efficacy to resist fluid intake and (b) on the emotional variables of depression, anger, and anxiety. Results showed that cognitive variables accounted for fluid noncompliance and predicted future adherence. Patients high in negative emotions complied equally as well as patients low in negative emotions but were found to report substantially more symptomatology and distress associated with their treatment. The implications of these findings for treatment of ESRD patients and future research are discussed.

Adult↗

Resource allocation: a plea for a touch of realism.

The problem of resource allocation in health has stimulated much thought and research, in attempts to provide objective, rational methods by which necessary choices can be made. One such method was proposed in a paper in this journal. The authors argued for a utilitarian approach, which they claimed to demonstrate was acceptable to society at large. This paper argues that the evidence supporting such a claim was flawed; such a utilitarian approach is not socially acceptable, and is therefore not relevant. Rather more relevant directions for research are discussed, based on the assertion that a degree of realism is essential when considering the problems of resource allocation.

England↗

Education to meet the challenge of AIDS.

Studies of health care providers' attitudes have revealed that many have misconceptions and fears about AIDS and possess negative attitudes about caring for people with the disease. Merely transmitting the basic facts about AIDS is insufficient to prepare health care workers to deal with AIDS patients. This article discusses the need for continuing education for health care professionals and educators and offers a model for the development of educational programs. The model is being developed in the School of Allied Health Professions, State University of New York at Stony Brook. Principles of "andragogy"--involvement of both the learner and the educator in identifying students' needs, planning learning experiences, and ongoing evaluation of the learning process--are discussed.

Acquired Immunodeficiency Syndrome↗