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Biomedical subjects

R Stanford

Publications and source records attributed to R Stanford.

10 recordsLinked to original sources
PubMed2005

Hyperbaric oxygen therapy for promoting fracture healing and treating fracture non-union.

BACKGROUND: Hyperbaric oxygen therapy (HBOT) consists of intermittently administering 100% oxygen at pressures greater than one atmosphere absolute (ATA) in a pressure vessel. This technology has been used to treat a variety of diseases and has been described as helping patients who have delayed healing or established non-union of bony fractures. OBJECTIVES: The aim of this review was to assess the evidence for the benefit of hyperbaric oxygen treatment (HBOT) for the treatment of delayed bony healing and established non-union of bony fractures. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group trials register (to January week 3, 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2003), MEDLINE (OVID 1966 to January week 3, 2004), CINAHL (OVID 1982 to January week 3, 2004), EMBASE (OVID 1980 to February 2004), the locally developed Database of Randomised Controlled Trials in Hyperbaric Medicine (available at www.hboevidence.com) from inception to March 2004, and reference lists of articles. SELECTION CRITERIA: We aimed to include all randomised controlled trials that compared the effect of HBOT with no HBOT (no treatment or sham). DATA COLLECTION AND ANALYSIS: Two authors using standardised forms attempted to extract data independently. MAIN RESULTS: No trials met the inclusion criteria. We excluded one trial that compared HBOT with no treatment because no clinical outcomes were reported. AUTHORS' CONCLUSIONS: This systematic review failed to locate any relevant clinical evidence to support or refute the effectiveness of HBOT for the management of delayed union or established non-union of bony fractures. Good quality clinical trials are needed to define the role, if any, of HBOT in the treatment of these injuries.

Fracture Healing↗
PubMed2002

The use of a prognostic table to aid decision making on adjuvant therapy for women with early breast cancer.

AIM: Understanding the likely net benefit of chemotherapy for the individual patient helps physicians to give objective information. A prognostic table has been constructed detailing the percentage absolute survival advantage offered by polychemotherapy for patients with early breast cancer, according to their age and the Nottingham Prognostic Index of their tumour. This study aims to assess its first year of use in the Leicestershire Breast Unit. METHOD: Demographic, pathological and treatment data were collected prospectively onto the Leicestershire breast cancer database. Patients with a potential survival advantage of 2% or greater in the year 01/05/99 to 30/04/00 (after the prognostic table was used routinely to determine oncology referrals) were identified. Chemotherapy usage was compared with the previous year's patient group. RESULTS: Two hundred and eighty-eight had early breast cancer, requiring surgery, eligible for consideration of adjuvant therapy. Of these, 98% of women with a potential survival advantage of 6% or more received chemotherapy. Ninety-one percent of those with a survival advantage of 4% or more was seen by an oncologist. Of those with a 2% survival advantage, 48% were referred to discuss the issues with an oncologist. Use of the table resulted in increased chemotherapy rates for women with a 4% potential survival advantage. CONCLUSIONS: We have found the prognostic table to be a useful and workable tool and advocate its use.

Adult↗
PubMed2001

Improvement in health care utilization and pulmonary function with fluticasone propionate in patients with steroid-dependent asthma at a National Asthma Referral Center.

The impact of switching from other inhaled corticosteroids to fluticasone propionate was studied in patients with severe oral-steroid-dependent asthma over a 1-year period. In this open-label prospective study, patients on maintenance doses of oral and inhaled steroids were referred to a national asthma treatment center and were switchedfrom their previous inhaled corticosteroid to fluticasone propionate 880 microg BID. Compared with data collected from the year prior to enrollment, treatment with fluticasone propionate resulted in significant improvements in pulmonary function, oral steroid requirements, and health resource utilization. In addition, five patients were completely weaned off oral steroids.

Administration, Inhalation↗
PubMed2000

Rates of hospitalization for asthma by insurance status.

OBJECTIVE: To compare utilization of emergency department (ED) and inpatient resources for asthmatics across insurance types. METHODS: Retrospective cohort analysis consisting of patients over 18 years of age admitted to the ED of 27 hospitals located throughout the United States for asthma between October 1, 1996 and September 30, 1997. RESULTS: 2738 patients were identified who met all inclusion/exclusion criteria. Approximately 25% of the sample had traditional indemnity insurance, 22% were managed care enrollees, 35% were enrolled in Medicaid or Medicare, and 18% were self-pay. Cost of treatment varied by insurance type in the ED and for inpatient asthma care: Medicare patients tended to have higher ED costs than all other insurance types, while indemnity patients had higher costs than Medicaid and Medicare patients. No significant differences were observed between managed care or indemnity patients for ED or inpatient costs; however, indemnity patients were less likely to be hospitalized for asthma subsequent to visiting the ED than managed care patients (OR: 0.40, 95% CI: 0.31-0.52). CONCLUSION: Significant differences in types and costs of care were observed across differing insurance types, which may suggest an "insurance effect" on asthma-related treatment in the ED and/or hospital.

Adolescent↗
PubMed2000

IgA myeloma of donor origin arising 7 years after allogeneic renal transplant.

We report the case of a 38-year-old man who developed IgA myeloma of donor origin 7 years after allogeneic renal transplant. The diagnosis of multiple myeloma was unequivocal and based on positive results from serum electrophoresis, skeletal survey and bone marrow investigations. The donor origin of the myeloma cells was confirmed by DNA fingerprinting. We believe this is the first reported case of disseminated multiple myeloma of donor origin developing after allogeneic renal transplant and, as such, gives some insight into the natural history and biology of the disease.

Adult↗
PubMed1999

The cost of asthma in the emergency department and hospital.

Treatment of asthma in the emergency department (ED) or hospital accounts for a significant portion of total treatment costs; however, little is known about the specific resources consumed. The purpose of this study was to estimate the type and amount of resources consumed for an asthma event requiring ED visit and/or hospitalization. Between October 1, 1996 and September 30, 1997, occurrences of asthma as a primary diagnosis were identified at 27 hospitals' emergency departments within Premier's Perspective Comparative Database. Patients visiting the ED could either be treated and released or admitted to the hospital. A total of 3,223 patients (age >/= 18 yr) were identified, with 1,074 (33.3%) requiring hospitalization. For the 2,149 patients who visited the ED only, the average visit cost was $234.48. For hospitalized patients, the average length of stay was 3.8 d, and the cost was $3,102.53. Nursing care was the source of the majority of hospital costs for asthma (43.6%), respiratory therapy (13.6%), and medications (10.4%). For adult asthma patients requiring hospitalization, the total cost is high and resources consumed are unavoidable. Thus, a continuum of care aimed at appropriate asthma management, especially in the elderly, could result in substantial cost savings over those aimed at reducing inpatient utilization of care.

Adolescent↗
PubMed1999

Sterilization of contaminated bone-tendon autografts using 10% povidone-iodine solution.

This study evaluates methods of sterilizing contaminated bone-tendon autografts using 10% povidone-iodine solution. Sterile grafts were prepared from human cadavers. Grafts were immersed in a suspension of either Staphylococcus aureus or Pseudomonas aeruginosa, and three sets of sterilization experiments were performed in 10% povidone-iodine for 30 minutes: one each with S. aureus and P. aeruginosa by static soaking and a third with S. aureus by serial washing with agitation. Of grafts inoculated with S. aureus, six of six grew the test organism after soaking at room temperature, as did five of six after soaking at 36 degrees C and also eight of nine after washing with agitation. Of grafts inoculated with P. aeruginosa, five of six grew the test strain after soaking at room temperature, as did six of six after soaking at 36 degrees C. Thirty minutes of exposure to aqueous 10% povidone-iodine does not adequately sterilize an inoculated graft.

Anti-Infective Agents, Local↗
PubMed1980

Plasma cell granuloma of the lung: endobronchial presentation and absence of response to radiation therapy.

Plasma cell granuloma of the lung is an uncommon, slow-growing, benign "pseudotumor" morphologically and clinically distinct from malignant plasma cell tumor (plasmacytoma). Its histopathology is distinct from sclerosing hemangioma and pseudolymphoma. Most are located in lung parenchyma, but a few present as endobronchial lesions. Patients are usually less than 30 years of age. Surgical excision is the preferred treatment and the prognosis is very good. Experience with radiation therapy is limited to one previously reported case. We report a case of plasma cell granuloma of the lung which is unusual because of the patient's age (71 years), endobronchial location, recurrence after local resection, and absence of response to radiation therapy. Ultrastructural features of the lesion are also described.

Aged↗
PubMed1975

Experimental production of granulomatous pneumonitis. Comparison of immunological and morphological sequelae with particulate and soluble antigens administered via the respiratory route.

Rabbits were sensitized with either a soluble protein antigen (BSA) or a particulate thermophilic actinomycete antigen (Micropolyspora faeni) via the respiratory route, followed by monitoring of sequential morphologic changes and the humoral plus cellular immunologic response. Primary respiratory tract sensitization with BSA resulted in a humoral anti-BSA response, Arthus and delayed skin reactivity, and in some cases specific antigen-induced alveolar macrophage migration inhibition, all in the absence of pulmonary lesions. Lesions characterized by mild multifocal perivascular mononuclear cell infiltrates in the lungs developed only after secondary BSA aerosol challenge. In contrast to these findings, "primary" respiratory tract sensitization with M. faeni particulate antigen in saline solution resulted in the gradual development of extensive and progressive pulmonary interstitial and alveolar mononuclear cell infiltrates. These lesions were uniformly associated with specific serum precipitating antibody and delayed skin reactivity. Alveolar macrophage migration was significantly inhibited by Micropolyspora faeni in virtually of these animals. These results, while not excluding a primary irritant effect or Type II or III alergic tissue injury, suggest a role for delayed (cell-mediated) hypersensitivity in the pathogenesis of particulate actinomycete-induced pulmonary lesions. They also indicate that primary immunization with soluble purified protein antigens via the respiratory route can lead to systemic humoral and cell-mediated immunity without production of pulmonary lesions.

Actinomycetaceae↗