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Biomedical subjects

R Freeman

Publications and source records attributed to R Freeman.

At least 181 records · Page 10Linked to original sources
PubMed1994

Rapid characterisation of Candida albicans by pyrolysis mass spectrometry.

Clinical isolates (41) of Candida spp. from three possible outbreaks of nosocomially-acquired infection were compared by pyrolysis mass spectrometry (PMS) and by a combined morphotyping and resistotyping (M-R typing) method. Both systems characterised all the isolates and distinguished one isolate of C. tropicalis and another of C. glabrata from the 39 isolates of C. albicans. Results from both systems suggested that cross-infection with a single strain contributed to two of the outbreaks. In several instances, more than one strain of C. albicans was found amongst multiple isolates from the same patient. PMS is a simple, rapid and objective technique capable of characterising C. albicans isolates; discrimination was similar to M-R typing.

Candida albicans↗
PubMed1994

Crystal violet reactions of coagulase negative staphylococci.

Twenty four reference strains and 112 clinical isolates of coagulase negative staphylococci (CNS) were examined for their reactions in the crystal violet test. Some species gave a white reaction and others a purple reaction. Results were consistent and reproducible and each species gave only one pattern of crystal violet reaction. Within the limited variety of species represented in the clinical isolates, Staphylococcus saprophyticus and S haemolyticus gave crystal violet purple reactions, in contrast to S epidermidis, which always gave a white reaction. Investigations suggested that the mechanism of the crystal violet test in S haemolyticus may be similar to that previously described in S aureus. Further work is needed to characterise the ability of crystal violet to modify S epidermidis and other central nervous system species. The crystal violet reaction, which has strong associations with invasiveness, phage group susceptibilities, colonisation persistence abilities, and nosocomial origin in S aureus may also be useful in studies of CNS disease.

Coagulase↗
PubMed1994

Psychological aspects of patient management in dental practice.

Failure to achieve good patient management will result in poor patient co-operation and potential failure of treatment. In this article, ways of establishing and maintaining good communication between the dental team and the patient are discussed.

Attitude of Health Personnel↗
PubMed1994

Dental health. 2. Working together in dental health education.

Dental caries affects three quarters of five-year old children in Northern Ireland. It should be seen as a priority target for health education and health promotion initiatives, argue Grainne Quinn and Ruth Freeman. A study to investigate co-operation between health visitors and community dental officers demonstrates the importance of the frequent sharing of knowledge and expertise between the two professionals in the promotion of dental health.

Community Dentistry↗
PubMed1993

Cytomegalovirus immune globulin prophylaxis in liver transplantation. A randomized, double-blind, placebo-controlled trial.

OBJECTIVE: To study the effect of cytomegalovirus immune globulin (CMVIG) on prevention of cytomegalovirus (CMV) disease and its complications in patients receiving liver transplants. DESIGN: Randomized, multicenter, placebo-controlled, double-blind trial. SETTING: Four university-affiliated transplant centers in Boston (Boston Center for Liver Transplantation). PATIENTS: One hundred forty-one liver transplant recipients completed the study. INTERVENTION: CMVIG or placebo (1% albumin) given in a dose of 150 mg/kg body weight within 72 hours of the transplant, then at weeks 2, 4, 6, and 8, and at 100 mg/kg at weeks 12 and 16. MEASUREMENTS: Patients were observed for 1 year after transplantation for the development of CMV infection, disease, pneumonia, as well as for opportunistic fungal infections, graft survival, and mortality. Weekly cultures were taken of urine, buffy coat, and throat wash for CMV for 2 months, then monthly, and at any clinical illness. RESULTS: Using a Cox proportional hazards model, CMVIG was shown to reduce severe CMV-associated disease (multi-organ CMV disease, CMV pneumonia, or invasive fungal disease associated with CMV infection) from 26% to 12% (relative risk, 0.39; 95% CI, 0.17 to 0.89). When we controlled for the use of monoclonal antibodies to T cells (OKT3), CMVIG use was still protective (relative risk, 0.39; CI, 0.17 to 0.90). Rates of CMV disease were reduced from 31% to 19% (relative risk, 0.56; CI, 0.3 to 1.1) in CMVIG recipients although no effect on rates of CMV infection, graft survival, or patient survival at 1 year were shown. When we controlled for the urgency of transplantation and OKT3 use, a reduction in CMV disease (relative risk, 0.22; CI, 0.06 to 0.81) was shown for globulin recipients for all serologic groups except for the highest risk group (the CMV-seropositive donor, CMV-seronegative group). CONCLUSION: CMVIG reduced the rate of severe CMV-associated disease in patients undergoing orthotopic liver transplantation. No effect of CMVIG on CMV donor-positive, recipient-negative liver transplant recipients was shown, suggesting a need for additional prophylactic strategies.

Acyclovir↗
PubMed1993

Occupational stress factors in hospital dentists.

This investigation examined perceived stress levels, personality characteristics and stress outcomes in a group of hospital dentists working in Belfast. Mean scores for this group were also compared with normative values. The occupational stress indicator was distributed to 45 hospital dentists; 40 returned the completed questionnaire. The mean score for each stress-related factor was analysed and compared with normative values. In addition the ranked scores for sources of stress were examined, and no significant differences could be demonstrated between the two groups. However, for external locus of control this group of hospital dentists demonstrated a significantly higher mean score of 42.3 than the mean normative value of 38.6. The dentists' score for their perception of their state of physical ill health was 23.9 and was significantly lower than the normative value of 27.8 but no differences could be demonstrated between the groups for mental health, Type A personality or mean stress levels.

Administrative Personnel↗
PubMed1993

Determining heart-rate variability: comparing methodologies using computer simulations.

Heart rate variation due to respiration is a window onto autonomic nervous system function and many measures exist that quantify this variability. Computer-based simulations of 1-minute deep-breathing tests, along with common artifacts, were used to compare the most frequently used measures. We found distinct differences in the performance of the measures. Some measures (e.g., SDRR and MSSD) are strongly influenced by the underlying mean heart rate while others (e.g., Max-Min and SDHR) are not. All of the measures tested, except R, were influenced by both shifting mean heart rate and single-beat anomalies. R, on the other hand, is strongly influenced by test duration and breathing asynchronies. Sensitivity to phenomena unrelated to ANS function can reduce the diagnostic discrimination of these measures. We suggest simple improvements to the measures and discuss how some measures may be theoretically superior to others.

Computer Simulation↗
PubMed1993

Crystal violet reactions of Staphylococcus aureus strains colonizing infants in the first six weeks.

Nasal colonization with Staphylococcus aureus occurred in 18% of babies leaving a maternity unit and had risen to 40% by 6 weeks after birth. S. aureus was first acquired by 34.5% of babies after discharge. Female infants were more likely to be colonized than males. Colonization was not significantly different between babies receiving standard postnatal care and those nursed on the Special Care Baby Unit. Crystal violet (CV) tests showed that purple-reacting isolates accounted for approximately 60% of strains, whether first detected at hospital discharge or subsequently acquired. Purple-reacting strains, once acquired, were significantly better able to persist than non purple-reacting strains and formed a cumulatively higher proportion of the strains isolated at 6 weeks after birth than at hospital discharge. CV purple-reactions were significantly associated with lysis by phages of groups III and I and non-purple-reactions were significantly associated with lysis by phages of group II and/or 94/96. Maternity units remain a significant route whereby strains of S. aureus with some characteristics associated with a hospital origin gain access to the community.

Bacterial Typing Techniques↗
PubMed1993

The treatment of autonomic dysfunction.

Autonomic dysfunction is responsible for much of the morbidity associated with frequently encountered neurological disorders, such as Parkinson's disease, multiple sclerosis, cerebrovascular disease, and peripheral neuropathies, as well as with the rarer primary autonomic nervous system degenerations. We review the treatment of those aspects of autonomic dysfunction that often present to the neurologist, including orthostatic hypotension, urinary incontinence and retention, and bowel dysmotility syndromes. Pathophysiology is discussed in each instance as it relates to a rational approach to therapy. For management of orthostatic hypotension, we review the use of mineralocorticoids, direct and indirect sympathomimetic agents, other pressors, dopamine-blocking agents, vasopressin receptor agonists, and others. Treatment of urinary incontinence and retention is addressed, with attention to drugs that modulate bladder contractility and bladder outlet resistance. Therapies for bowel dysmotility syndromes (such as gastroparesis, diarrhea, and fecal incontinence) are described, including bulk agents, laxatives, prokinetic agents, and antidiarrheal drugs.

Autonomic Nervous System Diseases↗
PubMed1993

Nutrition care for children with special health needs: a chart review.

A random sample of 182 client charts at local agencies serving children with special needs were reviewed to identify any children at nutrition risk and determine if they had access to nutrition services. A standardized protocol was used to review data on clinical and dietary variables. The findings indicate a need for improved data collection, better use of collected data, and greater agency use of registered dietitians.

Adolescent↗
PubMed1993

Transcranial Doppler assessment of the cerebral circulation during postprandial hypotension in the elderly.

OBJECTIVE: The aim of the present study was to evaluate whether alterations in postprandial hemodynamics in the elderly were associated with changes in cerebral perfusion assessed by transcranial Doppler ultrasonography. DESIGN: Time series, ie, post-intervention compared to pre-intervention with no-intervention controls. PARTICIPANTS: Ten elderly institutionalized subjects (4 women, 6 men, mean age 84.9 years). Three subjects had a history of syncope. SETTING: A 725-bed academic long-term care facility. INTERVENTION: A 400-kcal mixed meal. MEASUREMENTS: Heart rate, blood pressure, and blood flow velocity in the middle cerebral artery by transcranial Doppler recording, before the test meal and at 5-minute intervals for 60 minutes afterwards. RESULTS: Systolic, diastolic, and mean arterial blood pressure declined significantly from baseline between 30 and 55 minutes after the meal (P < 0.05, ANOVA); however, maximum and mean blood flow velocity did not change. The pulsatility index (end diastolic to peak systolic amplitude divided by mean velocity) increased significantly (P < 0.05, ANOVA) between 30 and 55 minutes after the meal, suggesting increased arteriolar resistance. There were no significant changes in blood pressure, blood flow velocity, and pulsatility index during a control study conducted with four subjects under identical conditions but without a meal. CONCLUSIONS: The results of this study suggest a small, unexpected increase in resistance of the intracranial circulation following a meal in elderly people with postprandial hypotension. Although the clinical significance of this finding is not known, the occurrence of postprandial arteriolar vasoconstriction may lead to cerebral ischemia during periods of marked blood pressure decline.

Aged↗
PubMed1993

Hemodynamic and autonomic nervous system responses to mixed meal ingestion in healthy young and old subjects and dysautonomic patients with postprandial hypotension.

BACKGROUND: Although postprandial hypotension is a common cause of falls and syncope in elderly persons and in patients with autonomic insufficiency, the pathophysiology of this disorder remains unknown. METHODS AND RESULTS: We examined the hemodynamic, splanchnic blood pool, plasma norepinephrine (NE), and heart rate (HR) power spectra responses to a standardized 400-kcal mixed meal in 11 healthy young (age, 26 +/- 5 years) and nine healthy elderly (age, 80 +/- 5 years) subjects and 10 dysautonomic patients with symptomatic postprandial hypotension (age, 65 +/- 16 years). Cardiac and splanchnic blood pools were determined noninvasively by radionuclide scans, and forearm vascular resistance was determined using venous occlusion plethysmography. In healthy young and old subjects, splanchnic blood volume increased, but supine blood pressure remained unchanged after the meal. In both groups, HR increased and systemic vascular resistance remained stable. Forearm vascular resistance and cardiac index increased after the meal in elderly subjects, whereas these responses were highly variable and of smaller magnitude in the young. Young subjects demonstrated postprandial increases in low-frequency HR spectral power, representing cardiac sympatho-excitation, but plasma NE remained unchanged. In elderly subjects, plasma NE increased after the meal but without changes in the HR power spectrum. Patients with dysautonomia had a large postprandial decline in blood pressure associated with no change in forearm vascular resistance, a fall in systemic vascular resistance, and reduction in left ventricular end diastolic volume index. HR increased in these patients but without changes in plasma NE or the HR power spectrum. CONCLUSIONS: 1) In healthy elderly subjects, the maintenance of blood pressure homeostasis after food ingestion is associated with an increase in HR, forearm vascular resistance, cardiac index, and plasma NE. In both young and old, systemic vascular resistance is maintained. 2) Dysautonomic patients with postprandial hypotension fail to maintain systemic vascular resistance after a meal. This impairment in vascular response to meal ingestion may underlie the development of postprandial hypotension. 3) The measurement of mean HR or plasma NE does not adequately characterize autonomic cardiac control. Power spectral analysis suggests an impairment in the postprandial autonomic modulation of HR in healthy elderly and dysautonomic subjects, possibly predisposing to hypotension when vascular compensation is inadequate.

Adult↗
PubMed1993

Cost-control issues within the hospital environment in the United Kingdom.

Health care in the United Kingdom is dominated by the National Health Service, which operates under a system in which care is delivered free at the point of need and is funded by taxation. Experimentation with a number of different models has occurred since 1980 and has culminated in recent National Health Service reforms characterized by the separation of purchaser and provider functions. An inescapable result of this is the formal definition of the relationship between need and service provision (contracts or performance arrangements), and the equally unavoidable costing of "patient episodes" or equivalent as a tool for estimating both supply and demand. This change has completely altered the way in which individual capital and revenue costs are viewed in the National Health Service. With regard to drugs, costs can now be seen as part of a patient's consumption of resources as opposed to a hospital budget heading. The new system acknowledges that higher drug costs can be incurred if the overall patient-episode cost is reduced as a result. Such a reduction in average patient costs might then lead to more contract work and a higher revenue for the hospital. Quality of care specifications by purchasers may also affect drug costs.

Anti-Bacterial Agents↗