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Biomedical subjects

R Fitzpatrick

Publications and source records attributed to R Fitzpatrick.

At least 127 records · Page 7Linked to original sources
PubMed1995

Specialist and general practice views on routine follow-up of breast cancer patients in general practice.

The practice of routinely following-up breast cancer in hospital clinics is of widespread concern: studies have shown that it is not an effective way of detecting recurrent disease and it places great strain on cancer services which are already overstretched. A general practice centred system of routine follow-up may be a solution to this problem in those countries which have a strong primary care base. Such a system would have other benefits such as continuity of care for the patient. The objective of this study was to determine the views of general practitioners and specialists on follow-up of patients with breast cancer in remission, with special emphasis on their views on the transfer of routine follow-up from the hospital to general practice. A postal questionnaire survey of British breast cancer specialists (response rate 77.0%) and a personal interview survey of British general practitioners (response rate 81.8%) were conducted. The results show that British general practitioners are willing to take on greater responsibility for the routine follow-up care of their patients with breast cancer. However, there was frequently a mis-match between specialists' and general practitioners' views on this subject.

Aftercare↗
PubMed1994

Stable human standing with lower-limb muscle afferents providing the only sensory input.

1. This study investigated the sources of sensory information upon which normal subjects' ability to stand depends. 2. An 'equivalent body' was used to simulate the physical properties of each subject's body during standing. The modulation of ankle torque required to support the equivalent body in an upright position was similar to that required to support the subject's own body when standing. However, when balancing the equivalent body, vestibular inputs were excluded from directing the appropriate changes in ankle torque. Thus, stability of stance could be studied with (normal stance) and without (balancing equivalent body) modulation by vestibular inputs. Vision could be excluded by closing the eyes. Sensory input from the feet and ankles could be removed by local anaesthesia from prolonged ischaemia, induced by occluding blood flow with inflated pneumatic cuffs just above the ankles. With vestibular, visual and peripheral sensory inputs negated, standing could rely only upon remaining sensory inputs, notably those from sensory receptors in the leg muscles. 3. Unlike the human body, the equivalent body used to negate vestibular inputs is not segmented. Therefore, the effects on stability of having a segmented body were determined by splinting subjects during standing so that only ankle movement was possible. This was done in the presence and absence of visual stabilization. 4. For each experimental task, either standing or balancing the equivalent body, sway was recorded while posture was unperturbed. Root mean square values of sway amplitude and power spectra were used to compare conditions. 5. Every subject could balance the equivalent body in a stable way when the eyes were closed, and when the feet were anaesthetized.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Task-dependent reflex responses and movement illusions evoked by galvanic vestibular stimulation in standing humans.

1. To identify the vestibular contribution to human standing, responses in leg muscles evoked by galvanic vestibular stimulation were studied. Step impulses of current were applied between the mastoid processes of normal subjects and the effects on the soleus and tibialis anterior electromyograms (EMGs), ankle torque, and body sway were identified by post-stimulus averaging. The responses were measured when subjects stood on a stable platform or on an unstable platform and the effects of eye closure were also assessed. Responses were also recorded during voluntary contraction of the leg muscles and when subjects balanced a load equivalent to their own body in a situation where vestibular postural reflexes would not be useful. 2. At a mean post-stimulus latency of 56 ms, there were reciprocal changes in soleus and tibialis anterior muscle activity followed, at 105 ms, by larger responses of opposite sign. These were termed the short- and middle-latency responses, respectively. Both responses increased with stimulus intensity, but the short-latency response had a higher threshold. The early response had a similar latency to EMG responses evoked by rapid postural perturbations. Both responses were larger when the eyes were closed, but eye closure was associated with increased sway and EMG activity, and the responses were of similar magnitude when scaled to background EMG level. 3. Both short- and middle-latency EMG responses in soleus and tibialis anterior muscles produced small transient postural sways. The transient changes in EMG activity were followed by a larger prolonged sway which was not attributable to the activity in these muscles but rather to reflex or volitional adjustments to movements at other body segments. When subjects were prevented from swaying, the galvanic stimulus produced illusory movements in the opposite direction to the sway evoked when standing, and it is possible that the prolonged sway is a reaction to the illusion of sway. 4. The short- and middle-latency responses were modified during different postural tasks according to the dependence on vestibular reflexes. When the support platform was unstable, the EMG responses to galvanic stimulation were larger. There were no vestibular-evoked responses when seated subjects made voluntary contractions of the leg muscles or when they stood upright with the trunk supported, using the ankles to balance a body-like load.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1994

Proprioceptive, visual and vestibular thresholds for the perception of sway during standing in humans.

1. Thresholds for the perception of postural sway induced by gentle perturbations were determined for five normal standing subjects. In this context we understand 'perception' to mean 'able to give a subjective report'. The thresholds for the perception of movements that were equivalent to sway in velocity and amplitude were determined when the available sensory input was limited to only one, or a pair, of the vestibular, visual, and proprioceptive systems. To examine vestibular inputs alone, vision was excluded and the whole body was moved with the ankles in a fixed position. To examine visual inputs alone, the body was kept stationary and a 'room' was moved around the subjects to simulate the relative visual-field movement that occurs during standing. To limit the available sensory input to proprioception from the legs, subjects were held stationary and balanced a load that was equivalent to their own body using their ankles. In this situation, perturbations were applied to the 'equivalent body' and these could only be perceived from the resulting ankle movements. Thresholds for perceiving ankle movements were also determined in the same posture, but with the leg muscles bearing no load. 2. The thresholds for the perception of sway during standing were very small, typically 0.003 rad at a velocity of 0.001 rad s-1, and even smaller movements were perceived as the mean velocity of the sway increased up to 0.003 rad s-1. No difference was found between the thresholds for perceiving forward sway and backward sway. Eye closure during standing did not affect the threshold for perceiving sway. 3. When sensory input was limited to proprioception from the legs, the thresholds for the perception of passive ankle movements were equivalent to the thresholds for the perception of sway during standing with all sensory inputs available. When the leg muscles were relaxed, the thresholds for perceiving ankle movements increased approximately twofold. 4. The visual thresholds for perceiving movement were higher than the proprioceptive thresholds at slower velocities of movement, but there was no difference at higher velocities. 5. Both the proprioceptive and visual thresholds were sufficiently small to allow perception of the sway that was recorded when the subjects stood normally in a relaxed manner. In contrast, the vestibular thresholds were an order of magnitude greater than the visual or proprioceptive thresholds and above the largest sway movements that were recorded during normal standing.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1994

A sequence from a tryptophan-hyperproducing strain of Corynebacterium glutamicum encoding resistance to 5-methyltryptophan.

A cloned DNA fragment containing the trp gene cluster from the tryptophan-hyperproducing strain Corynebacterium glutamicum ATCC21850 was found to increase the resistance of Escherichia coli to the tryptophan analogs 5-methyltryptophan and 6-fluorotryptophan. A sequence sufficient to mediate resistance to 5-methyltryptophan in E. coli was mapped to a 582-bp sequence located immediately upstream of the C. glutamicum trp operon. The equivalent fragment from the related wild type strain C. glutamicum AS019 was found to contain sequence differences at two positions and had no effect on the sensitivity of E. coli to 5-methyltryptophan.

Amino Acid Transport Systems↗
PubMed1994

Construction and characterization of recA mutant strains of Corynebacterium glutamicum and Brevibacterium lactofermentum.

An internal fragment of the Corynebacterium glutamicum recA gene was amplified by the polymerase chain reaction (PCR) using degenerate primers corresponding to two short sequences that are well conserved in procaryotic RecA proteins. The deduced amino acid sequence of the amplified fragment shared significant homology with RecA sequences from other bacteria including the "invariant" and functionally conserved amino acids Leu-126, Asp-144, Gly-157, Arg-169 and Asn-193. Highest identity (91%) was shared with the gram-positive Mycobacterium tuberculosis RecA sequence. The amplified fragment was cloned into a conditional suicide vector, pBGS, and used to generate recA deficient strains of C. glutamicum and Brevibacterium lactofermentum by insertional inactivation. These strains exhibited classical RecA phenotypes including reduced recombinational activity and increased sensitivity to DNA-damaging agents such as UV irradiation, mitomycin C and methyl-methanesulphonate.

Amino Acid Sequence↗
PubMed1994

Regular partners and risky behaviour: why do gay men have unprotected intercourse?

Studies in both the UK and the USA continue to show that gay and bisexual men put themselves at risk of exposure to HIV through unprotected intercourse, most often with regular partners. As part of a larger study of homosexually active men, 310 men who had had unprotected anal intercourse with a man in the previous year were asked to describe the last occasion on which this had happened. The majority of men had had unprotected intercourse with a regular partner and did not perceived it as risky, although most did not know the HIV status of their partner. Regular and non-regular partners were perceived differently. Men were more likely to be emotionally involved in regular partners and to perceive unprotected penetrative sex with a regular partner as not risky. Future health education initiatives must take into account men's emotional involvement in regular partners and their perception of unprotected intercourse with such partners as not risky.

Adolescent↗
PubMed1994

Perceptions of general practice among homosexual men.

BACKGROUND: Primary care has an important role to play in the prevention and management of the human immunodeficiency virus (HIV). It has been suggested that homosexual men experience a variety of problems in relation to primary care. AIM: As part of a larger study, it was decided to examine the extent to which a sample of homosexually active men experienced difficulties in general practice and whether they consulted their general practitioner for problems related to HIV or the acquired immune deficiency syndrome (AIDS). METHOD: Homosexual men were recruited for interview in 1991-92 from a variety of sources including genitourinary clinics and homosexual organizations. RESULTS: Of 623 men registered with a general practitioner 44% had not informed their general practitioner of their sexual orientation and 44% of the 77 men who were HIV antibody positive, as confirmed by the study, had not informed their general practitioner of this fact. Men who viewed their practice as unsympathetic towards homosexual men were less likely to have informed their general practitioner of their sexual orientation or HIV status. The majority of men (87%) nevertheless viewed primary care as an appropriate source of HIV/AIDS advice. CONCLUSION: There is considerable scope for improvement in the acceptability of general practice to homosexual men.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Tacit models of disability underlying health status instruments.

In recent years much attention has been paid to the development of measures of subjective health status yet, although statistical criteria of reliability and validity have been quite rigourously tested, there has been little consideration of the different theories of disability which underlie the design. The sociology of disability may illuminate such tacit theories. It is suggested that the development of health status questionnaires has not been one of simple rational accumulation in response to methodological advances. Through an examination of the content of health assessment questionnaires, four distinct models of disability are identified. These are shown to influence not only the focus of the content and phrasing of the questions but also, crucially, the way that they perform and how responsive they are to change. The models (the functional, subjective distress, comparative and dependence) are illustrated and discussed in terms related to research design.

Activities of Daily Living↗
PubMed1993

Transition questions to assess outcomes in rheumatoid arthritis.

The importance of patient-based assessments of outcomes of care in RA is increasingly recognized. There are a number of methods of gaining such data. One method is to request patients to assess change in health status by means of transition questions. This is considered advantageous to other methods because is directly addresses perceptions of change over time and is short and simple. One hundred patients with RA completed a range of clinical, laboratory and health status assessments on two occasions 3 months apart. On the second occasion they also completed a transition question. Results show the question to be valid and to correlate with a number of different changes obtained from assessments. Psychological mood did not appear to influence transition judgements. A small minority of patients experienced changes for specific dimensions of health status in the opposite direction of the transition item. Transition judgements may have an important role in evaluation studies and audit.

Activities of Daily Living↗
PubMed1993

A comparison of the sensitivity to change of several health status instruments in rheumatoid arthritis.

We carried out a study to compare the sensitivity to change of disease specific compared with more generic health status instruments in relation to rheumatoid arthritis (RA). A sample of 102 patients was recruited and assessed by means of 4 health status instruments and standard rheumatological measures on 3 occasions separated by 3 monthly intervals. Sensitivity to change for mobility, activities of daily living, household, pain, emotions and social dimensions were calculated. For some dimensions disease specific health status instruments performed less well. However overall there was no evidence of consistent differences between the 2 approaches. We conclude that generic instruments have a role in the assessment of RA.

Adult↗
PubMed1992

Quality of life measures in health care. I: Applications and issues in assessment.

Many clinicians remain unsure of the relevance of measuring quality of life to their clinical practice. In health economics quality of life measures have become the standard means of assessing the results of health care interventions and, more controversially, the means of prioritising funding; but they have many other applications. This article--the first of three on measuring quality of life--reviews the instruments available and their application in screening programmes, audit, health care research, and clinical trials. Using the appropriate instrument is essential if outcome measures are to be valid and clinically meaningful.

Clinical Protocols↗