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Biomedical subjects

R McCann

Publications and source records attributed to R McCann.

At least 19 recordsLinked to original sources
PubMed2002

Increased stool sampling during a waterborne outbreak of cryptosporidiosis does not increase the detection of other faecal pathogens.

AIMS: To ascertain the effect of enhanced surveillance following an outbreak of waterborne cryptosporidiosis on the number of faecal specimens submitted to the local microbiology laboratory and the number positive for common enteric pathogens. The outbreak provided an opportunity to estimate the extent of routine under ascertainment of common enteric pathogens. METHOD: Retrospective search of the computerised microbiology system database for details of faecal examination requests for the period 26 April to 6 June in 1998 and 1999 (period of outbreak). RESULTS: Specimens were received from 378 community patients during the six week period 26 April to 6 June 1999. This was double that for the same period in 1998 (a non-outbreak year). Oocysts of Cryptosporidium parvum were detected in 59 patients, an eightfold increase compared with the same period in 1998. Despite the greater number of patients tested, the detection of other pathogens in patients with gastroenteritis was not altered when compared with the same period in the previous year. CONCLUSION: This study found no evidence of under ascertainment of gastrointestinal infection (common bacterial pathogens and rotavirus) by local general practitioners.

Adolescent↗
PubMed2002

Achieving national influenza vaccine targets--an investigation of the factors affecting influenza vaccine uptake in older people and people with diabetes.

A survey by postal questionnaire of a random sample of community residents with diabetes mellitus and those aged 75 years was undertaken in one Health Authority area to examine the factors associated with influenza vaccine uptake in these groups. The questionnaire sought: information on vaccine uptake and non-uptake over the previous three winter periods; patient attitudes to and knowledge about influenza and influenza vaccine; sources of patients' information; and patients' views on improving vaccine uptake. Self-reported vaccine uptake had increased in people with diabetes from 53.9% in 1997-98 to 67.6% in 1999-2000, and in people aged 75 years and over from 63.5% in 1997-98 to 70.2% in 1999-2000. Factors significantly associated with vaccine uptake in people with diabetes included a history of previous vaccination OR 40 (95% confidence interval 9,206), recommendation by a health professional OR 14 (2.9, 90) and belief that the vaccine protects against flu OR 5.6 (1.8, 18.9). Factors significantly associated with vaccine uptake in older people included the belief that the vaccine protects against flu OR 23 (8.4, 69.4), a history of previous vaccination OR 10 (3.9, 28.3) and not being concerned about side-effects OR 4 (2.1, 7.9). Information given by a health professional was the only source of information found to significantly influence vaccine uptake. Interventions suggested to increase uptake include provision of more information and better access to influenza vaccination. It is concluded that uptake rates for influenza vaccine have increased over the last three years to 67.4% in people with diabetes and 70.2% in people aged 75 and over. Professionals play a key role in influencing the decision to have influenza vaccine. Information about influenza and its vaccine needs to be combined with improvements in service provision if overall target uptake rates of 70% (65% in those aged 65 years and over) are to be achieved.

Aged↗
PubMed2001

Hemodialysis arteriovenous access: detection of stenosis and response to treatment by vascular access blood flow.

BACKGROUND: Hemodialysis access to the circulation is best provided by native and synthetic arteriovenous fistulae (AVF and AVG). Thromboses caused by venous outflow stenoses prevent the long-term use of AV access. This pilot study was performed to evaluate the ability of ultrasound dilution-derived access blood flows to detect AV access stenosis and to evaluate the response to treatment. METHODS: This pilot study was a single-center, prospective observational intervention trial. The monitoring technique used was ultrasound dilution access blood flow measurements performed monthly and after any intervention. Screening criteria for interventions were decrements in access flow of 20% when the flow value fell under 1000 mL/min or absolute flow of <600 mL/min. The primary intervention when flow criteria were met was biplanar venography of the access with percutaneous transluminal angioplasty (PTA) of detected stenoses. Stenoses unresponsive to PTA were sent for surgical revision. Access thrombosis was considered a study ending event. RESULTS: Baseline access flow at study entry for AVF was 919 and 1237 mL/min for AVG. Sequential measurement of AV access flow detected AV access stenosis. PTA and surgical revision significantly restored AV access flow back toward the baseline flow measurement. Failure to restore access flow by at least 20% following intervention occurred in 14% of AVF and 21% of AVG PTA attempts. Transluminal angioplasty, once successfully performed, was required at a mean of 5.8-month intervals in order to maintain AVG flow. In contrast, AVF flow was restored for a much longer period of time following angioplasty (11.4 month follow-up at the time of study end). Compared with historic controls, which used venous dialysis pressure as the primary monitoring technique, the overall (AVF-AVG) thrombosis rates improved from 25 to 16% per patient year, and AVF thrombosis rates improved from 16 to 7% per patient year. When flow was not successfully restored, thrombosis ensued. Eight of 10 thrombosis episodes were predicted based on inability to improve access flow either as a result of stenosis treatment failure or unsuccessful referral for treatment. CONCLUSION: Sequential measurement of AV access flow is an acceptable means of both monitoring for the development of access stenoses and assessing response to therapy. PTAs of AVF are more durable than PTAs of AV grafts.

Aged↗
PubMed2001

Obstacles to influenza immunization in primary care.

BACKGROUND: General practices undertake annual immunization campaigns to protect susceptible patients against influenza. Many practices, however, do not adopt effective approaches and there is great variation in the immunization rates achieved. This study aimed to assess the attitudes of primary care staff to the annual immunization programme, the obstacles they face, and possible reasons for the wide variation in immunization rates. METHOD: A semi-structured questionnaire survey of general practice groups in Salford &Trafford during winter 1997-1998 was carried out, a total of 104 practices. RESULTS: Respondents perceived influenza vaccine to be effective (93.2 per cent), well received by patients (91.7 per cent) and without significant side-effects (83.6 per cent). The annual immunization programme was seen as being necessary (91.8 per cent), cost-effective (76.7 per cent), reducing hospital admissions (82.2 per cent), but very time consuming (64.4 per cent). Practices were more likely to target patients specified in the Chief Medical Officer's guidelines; however, most (98.6 per cent) targeted the over-75s before their inclusion in the guidelines, and many (61.6 per cent) targeted the over-65s. Practices did not always use the most effective methods of contacting patients, primarily relying on posters (97.3 per cent), opportunistic contacts (95.9 per cent) and reminders on prescriptions (83.6 per cent), rather than letters (39.7 per cent) and telephone calls (11.0 per cent). Practices identified several common obstacles to immunization, relating to the cost and administrative burden of the annual immunization programme, difficulty identifying high-risk patients, and public beliefs about influenza and influenza vaccine. CONCLUSIONS: Although generally positive towards influenza immunization, practice staff differ in their ability to cope with, and the appropriateness of their response to, the pressures of the annual immunization programme. Additional support and co-operation from the Department of Health, Health Authorities and pharmaceutical companies could remove some of the obstacles to immunization of high-risk patients.

Age Factors↗
PubMed2001

Association between insulin-like growth factor status and physical activity levels in rheumatoid arthritis.

OBJECTIVE: To determine if the altered insulin-like growth factor (IGF) status in rheumatoid arthritis (RA) is due to inflammation, altered body composition, or lack of exercise. METHODS: Subjects included 73 patients with RA, 54 patients with other rheumatic diseases, both inflammatory and noninflammatory, and 28 healthy, physically active controls. Serum levels of IGF-I, IGF-II, and IGF binding protein-3 (IGFBP-3) were measured by radioimmunoassay. Body composition was estimated by bioelectrical impedance analysis, and habitual exercise level approximated by questionnaire. Statistical analysis was performed by 2 and 3 way ANOVA and moderated hierarchical regression. RESULTS: Serum IGF-I (p < 0.001), IGFBP-3 (p < 0.001), and the BP-3:total IGF molar ratio (p < 0.001) were depressed in both patient groups relative to controls. In contrast, IGF-II levels were depressed only in patients with RA (p < 0.01). Differences in the IGF proteins between patients and controls could not be attributed to inflammation. Habitual exercise level, but not body composition, was shown to be a significant predictor for IGF-I, IGFBP-3, and BP-3:total IGF molar ratio (p < 0.001). CONCLUSION: Our results indicate that the reduction in circulating IGF proteins observed in our patients is more related to their sedentary lifestyle than to the inflammatory process. This conclusion is in agreement with reports that show that highly active individuals typically exhibit higher levels of systemic IGF proteins than age matched sedentary controls.

Arthritis, Rheumatoid↗
PubMed2001

Second dose of MMR vaccine: health professionals' level of confidence in the vaccine and attitudes towards the second dose.

Public concerns have been raised about the safety of MMR vaccine following the publication of two studies linking the vaccine to inflammatory bowel disease and to a syndrome of Ileal-lymphoid-nodular hyperplasia, non-specific colitis and pervasive developmental disorder. Our study had two aims, to determine whether health professionals' confidence in MMR vaccine was affected and to assess professional knowledge and attitudes towards the second dose of MMR. In July 1998 we undertook a questionnaire survey of general practitioners, practice nurses and health visitors in an inner city area. A significant fall was found in professional confidence following the two publications and the subsequent media coverage (from 59.4% to 40.9%). Forty percent of respondents were unsure about the need for a second dose of MMR vaccine and more than one in ten professionals stated that it was not necessary. It is reasonable to assume that this reduced confidence in the safety of MMR and the professional uncertainty about the second dose have contributed to the observed decline in MMR uptake rates. More professional and public education appears to be needed.

Attitude of Health Personnel↗
PubMed2000

Meningococcal C polysaccharide vaccine induces immunologic hyporesponsiveness in adults that is overcome by meningococcal C conjugate vaccine.

Widespread use of meningococcal AC polysaccharide (MACP) vaccines has raised concerns about induction of hyporesponsiveness to C polysaccharide. Whether meningococcal C conjugate (MCC) vaccine overcomes any immunologic refractoriness following MACP vaccination in adults was investigated. University students vaccinated 6 months previously with MACP vaccine were randomized to receive MACP or MCC vaccine, and antibody responses were compared with those of previously unvaccinated students receiving MACP or MCC vaccine. In students primed with MACP vaccine, MCC vaccine induced significantly higher IgG and serum bactericidal antibody levels than did a second dose of MACP vaccine. Responses to a second dose of MACP vaccine were significantly lower than to the first dose. Previous receipt of MACP vaccine reduced serum bactericidal antibody but not IgG responses to MCC vaccine compared with those in previously unvaccinated students. This confirms that MACP vaccine induces immunologic hyporesponsiveness to C polysaccharide in adults, but this can be overcome with MCC vaccine. Repeated vaccination with MACP vaccine may be ineffective, and MCC vaccines should provide better long-term protection.

Adolescent↗
PubMed1999

Role of cytomegalovirus in the T cell changes seen in elderly individuals.

The effect of prior cytomegalovirus (CMV) infection on the immune system was evaluated in young and elderly volunteers. Prevalence of IgG antibodies to CMV was higher in the elderly volunteers. In both age groups, there was a strong association with CMV seropositivity and increased number of CD28- CD4 or CD8 T cells, as well as with increased numbers of T cells expressing CD56 or DR. Although these changes have previously been reported to be age-related, they were independent of age when CMV serological status was taken into account. In contrast, both age group and CMV status were important determinants of the total number of T cells, the number of CD8 T cells, and the number of CD8 T cells expressing CD45RA or CD28. These findings indicate that prior infection with CMV, as reflected by CMV serological status, has important effects on T cell subsets and surface markers and must be considered whenever evaluating age-related changes in immunological parameters.

Adult↗
PubMed1999

An encyclopedia of mouse genes.

The laboratory mouse is the premier model system for studies of mammalian development due to the powerful classical genetic analysis possible (see also the Jackson Laboratory web site, http://www.jax.org/) and the ever-expanding collection of molecular tools. To enhance the utility of the mouse system, we initiated a program to generate a large database of expressed sequence tags (ESTs) that can provide rapid access to genes. Of particular significance was the possibility that cDNA libraries could be prepared from very early stages of development, a situation unrealized in human EST projects. We report here the development of a comprehensive database of ESTs for the mouse. The project, initiated in March 1996, has focused on 5' end sequences from directionally cloned, oligo-dT primed cDNA libraries. As of 23 October 1998, 352,040 sequences had been generated, annotated and deposited in dbEST, where they comprised 93% of the total ESTs available for mouse. EST data are versatile and have been applied to gene identification, comparative sequence analysis, comparative gene mapping and candidate disease gene identification, genome sequence annotation, microarray development and the development of gene-based map resources.

Animals↗
PubMed1998

Ethnicity and decision-makers in a group of frail older people.

OBJECTIVE: To assess the relationship between ethnicity and decision-makers expressing healthcare wishes in a group of frail older persons enrolled in the Program of All-inclusive Care for the Elderly (PACE). DESIGN: A retrospective chart review of 1193 participants in the PACE program. SETTING: Program of All-inclusive Care for the Elderly, a comprehensive managed care demonstration program serving frail older participants at 10 sites across the nation. PARTICIPANTS: A total of 1193 older adults, all of whom met state criteria for nursing home level of care. Three hundred were non-Hispanic whites, 364 were black, 156 were Hispanic, and 288 were Asian. MEASUREMENTS: Demographic characteristics of the patients and the presence or absence of an alternative decision-maker; the characteristics of alternative decision-makers included the relationship to the participant as recorded in the patient's medical record. RESULTS: Ninety-one percent of white patients expressed their own healthcare wishes in contrast to only 85% of Hispanic, 83% of Asian, and 67% of black patients. An alternative decision-maker was identified for about 15% of Asians and Hispanics and for one-third of blacks, but only about 8% of whites had an alternative decision-maker. Black and Hispanic patients were most likely to have a daughter as an alternative decision-maker, Asians were most likely to have a son, and whites patients were most likely to have a spouse as an alternative decision-maker. Blacks, particularly black men, were the most likely to have a relative other than a spouse or child as an alternative decision-maker. CONCLUSIONS: In this population, we found significant ethnic variation in the person identified to be the decision-maker in a group of frail older people. Ethnic variation reflected sociodemographic as well as cultural differences. However, there are important limitations to this study, and caution should be used in extrapolating the results to other populations or in attributing the results to ethnicity alone. An awareness of cross-cultural patterns in identified or de facto decision-makers can be significant for healthcare workers when they approach patients and their families about issues surrounding end of life decisions.

Advance Directives↗
PubMed1997

Use of store and forward technology for vascular nursing teleconsultation service.

Accurate assessment is critical in planning appropriate therapeutic management of a patient with a vascular wound. However, several factors may inhibit wound assessment by trained professionals or subspecialists. Multiple co-morbidities and lack of transportation and finances contribute to problems with access to specialty clinics for both rural and urban patients with vascular disease. To assess the application of telemedicine in meeting the needs of rural patients with vascular disease, the vascular nurse clinician of a regional medical network was incorporated into a telemedicine research project that used a still-image transmission system known as the Picasso telephone, which allows a diagnostic quality image to be transmitted over a regular telephone line. Telephone consultation between sender and receiver occurs simultaneously at the time of image transmission. Because images can be collected and stored for future reference, this technology is commonly called "store and forward" technology. The application of advanced technology in a rural health care environment has the potential to reduce costs for both patient and managed care insurance plans, allow for expert consultation from distant centers, and promote collegiality and learning among professionals.

Aged↗
PubMed1997

Program of All-inclusive Care for the Elderly (PACE): an innovative model of integrated geriatric care and financing.

OBJECTIVES: The Program of All-inclusive Care for the Elderly (PACE) is a long-term care delivery and financing innovation. A major goal of PACE is prevention of unnecessary use of hospital and nursing home care. SETTING: PACE serves enrollees in day centers and clinics, their homes, hospitals and nursing homes. Beginning at On Lok in San Francisco, the PACE model has been successfully replicated across the country. In 1995, PACE was fully operational in 11 cities in nine states. PARTICIPANTS: To enroll in PACE, a person must be 55 years of age or older, be certified by the state as eligible for care in a nursing home and live in the program's defined geographical catchment area. PACE participants are ethnically diverse. In 1995, the average PACE enrollee was 80.0 years old and had an average of 7.8 medical conditions and 2.7 dependencies in Activities of Daily Living. A significant number have bladder incontinence (55%). Many enrollees (39%) live alone in the community, and 14% have no means of informal support. INTERVENTION: Medicare and Medicaid waivers allow delivery of services beyond the usual Medicare and Medicaid benefits. The PACE service delivery system is comprehensive, uses an interdisciplinary team for care management, and integrates primary and specialty medical care. PACE receives monthly capitation payments from Medicare and Medicaid. Patients ineligible for Medicaid pay privately. RESULTS: Outcomes of PACE programs have been positive. There has been steady census growth, good consumer satisfaction, reduction in use of institutional care, controlled utilization of medical services, and cost savings to public and private payers of care, including Medicare and Medicaid. However, starting up a PACE program requires substantial time and capital, and the model has not yet attracted large numbers of older middle income adults. CONCLUSION: The growing number of older people in the United States challenges healthcare providers and policy makers alike to provide high quality care in an environment of shrinking resources. The PACE model's comprehensiveness of health and social services, its cost-effective coordinated system of care delivery, and its method of integrated financing have wide applicability and appeal.

Aged↗
PubMed1996

The relationship between ethnicity and advance directives in a frail older population.

OBJECTIVE: To assess the relationship between ethnicity and Health Care wishes, including Advance Directives, in a group of frail older persons in PACE (Program For All Inclusive Care Of The Elderly). DESIGN: Retrospective chart review of 1193 participants in the PACE program. SETTING: Program of All Inclusive Care Of The Elderly (PACE), a comprehensive managed care demonstration program serving frail older participants at 10 sites across the nation. PARTICIPANTS: A total of 1193 older adults, all of whom met state criteria for nursing home level of care. There were 385 non-Hispanic whites, 364 blacks, 156 Hispanics, and 288 Asians. MEASUREMENTS: Presence or absence of advance directives, type of health care wishes selected including living will, durable power of attorney, and health care proxy. RESULTS: Frail older white, black, Hispanic and Asian Americans differ significantly in their health care wishes and how they choose to express them. Blacks were significantly more likely to select aggressive interventions and less likely than non-Hispanic whites and Hispanics to utilize a written instrument for expressing health care wishes. Whites were significantly more likely to utilize written documents for advance directives, whereas Asians were more likely to select less aggressive interventions but were unlikely to use written advance directives. CONCLUSIONS: In this population, we found significant ethnic variations in choice of health care wishes. Although health care wishes are an individual decision, an awareness of cross cultural patterns can assist practitioners in addressing the concerns of their patients, as well as assisting Health Care Policy Development.

Advance Directives↗
PubMed1996

Closed-captioned television presentation speed and vocabulary.

This study summarizes an extensive research project on closed-captioned television. Caption data were recorded from 205 television programs. Both roll-up and pop-on captions were analyzed. In the first part of the study, captions were edited to remove commercials and then processed by computer to get caption speed data. Caption rates among program types varied considerably. The average caption speed for all programs was 141 words per minute, with program extremes of 74 and 231 words per minute. The second part of the study determined the amount of editing being done to program scripts. Ten-minute segments from two different shows in each of 13 program categories were analyzed by comparing the caption script to the program audio. The percentage of script edited out ranged from 0% (in instances of verbatim captioning) to 19%. In the third part of the study, commonly used words in captioning and their frequency of appearance were analyzed. All words from all the programs in the study were combined into one large computer file. This file, which contained 834,726 words, was sorted and found to contain 16,102 unique words.

Humans↗
PubMed1994

Transmission of a small round structured virus by vomiting during a hospital outbreak of gastroenteritis.

An outbreak of gastroenteritis due to a small round structured virus (SRSV) (Norwalk-like virus) occurred in an elderly care unit, affecting a total of 126 patients and staff. The outbreak caused major disruption to the provision of health care services by the unit over a 3-week period. Following the outbreak a study was undertaken to explore risk factors for acquisition of SRSV infection by health care workers on the unit. Exposure to patients nearby who were vomiting and the number of close contacts with ill patients were significantly related to the risk of developing gastroenteritis (P < 0.05). No significant increase in risk of developing gastroenteritis was found in nurses who cleaned vomit or faeces from affected patients. The findings suggest that aerosolization of vomit was of major importance in transmission of infection during the outbreak; the implications for infection control are discussed.

Caliciviridae Infections↗
PubMed1994

A hospital outbreak due to Norwalk virus.

An outbreak of diarrhoea and vomiting began at a hospital for the elderly on the 25 October 1991. The symptoms and pattern of spread suggested a viral aetiology from a point source. Electron microscopy confirmed the presence of Norwalk virus. The first wave of illness affected 37 patients and 28 staff. Secondary cases occurred on all wards. Analytical studies of food consumed at three lunchtime meetings by staff and visitors to the hospital demonstrated a clear association between eating sandwiches and subsequent illness. The source of the outbreak was probably a food handler involved in the preparation of sandwiches. Control measures were implemented and the outbreak was declared over on the 11 November 1991. At this time 95 patients and 69 staff (including six visitors) had been affected. The implications for the future investigation and prevention of outbreaks of viral gastroenteritis in closed communities are discussed. An audit of the action taken during the outbreak resulted in the development of standards for the investigation and control of local outbreaks.

Caliciviridae Infections↗