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Biomedical subjects

S E Sutherland

Publications and source records attributed to S E Sutherland.

At least 19 recordsLinked to original sources
PubMed2001

Prophylaxis of oral mucositis in irradiated head-and-neck cancer patients: a proposed classification scheme of interventions and meta-analysis of randomized controlled trials.

PURPOSE: To identify, classify, and evaluate agents used in the prophylaxis of oral mucositis in irradiated head and neck cancer patients. METHODS: Data sources included multiple databases and manual citation review of relevant literature. Based on the eligibility criteria, 59 studies were independently reviewed by two reviewers. Forty-two studies were included in the classification scheme, of which 15 met the criteria for inclusion in the meta-analysis. Data were extracted by duplicate independent review, with disagreement resolved by consensus. RESULTS: Overall, the interventions reduced the odds of developing severe oral mucositis, when assessed by clinicians, by 36% (OR: 0.64; 95% CI: 0.46, 0.88). Subgroup analysis suggested that only the narrow-spectrum antibacterial lozenges were effective (OR: 0.45; 95% CI: 0.23, 0.86); however, the power of the aggregated data in the other classes may have been insufficient to detect differences. When the outcome was assessed by patients, no significant difference was seen in the outcome between the treatment and the control groups (OR: 0.79; 95% CI: 0.56-1.12). CONCLUSIONS: Overall, interventions chosen on a sound biologic basis to prevent severe oral mucositis are effective. In particular, when oral mucositis is assessed by clinicians, narrow-spectrum antibiotic lozenges appear to be beneficial. Methodologic limitations were evident in many of the studies. Further research using validated measurement tools in larger, methodologically sound trials is warranted.

Confidence Intervals↗
PubMed2001

Rod contributions to the electroretinogram of the dark-adapted developing zebrafish.

Anatomical studies of the developing zebrafish retina have shown that rods approach maturity at about 15 days postfertilization (dpf). Past work has examined the photopic spectral sensitivity function of the developing zebrafish, but not spectral sensitivity under dark-adapted conditions. This study examined rod contributions to the dark-adapted spectral sensitivity function of the ERG b-wave component in developing zebrafish. ERG responses to stimuli of various wavelengths and irradiances were obtained from dark-adapted fish at 6-8, 13-15, 21-24, and 27-29 dpf. The results show that dark-adapted spectral sensitivity varied with age. Spectral sensitivity functions of the 6-8 and 13-15 dpf groups appeared to be cone dominated and contained little or no rod contributions. Spectral sensitivity functions of the 21-24 and 27-29 dpf groups appeared to have both rod and cone contributions. Even at the oldest age group tested, the dark-adapted spectral sensitivity function did not match the adult function. Thus, consistent with anatomical findings, the rod contributions to the ERG spectral sensitivity function appear to develop with age; however, these contributions are still not adult-like by 29 dpf, which is contrary to anatomical work. These results illustrate that the zebrafish is an excellent model for visual development.

Animals↗
PubMed2001

Adverse outcomes in a controlled trial of pergolide for cocaine dependence.

We conducted a double-blind, multiple dose comparison study of pergolide versus placebo for the treatment of cocaine dependence. In the present study, we examined patients who met criteria for cocaine dependence without comorbid alcohol dependence (N = 255). Study completion rates favored placebo (48.9%) over the low dose (33.3%) and high dose (21.5%) pergolide subjects (chi2(2) = 14.17, p < or = 0.001). Treatment effectiveness scores (TES) were significantly higher for the placebo group (31.7) than the low dose (25.2) and high dose (14.2) pergolide groups (F2,252 = 6.21, p = 0.002). There were no significant differences in side effect profiles after first dose of pergolide or placebo, or at study termination. Results of this study suggest that pergolide was not efficacious in the treatment of cocaine dependence due to reduced study participation. Caution regarding the outpatient use of pergolide in similar populations is warranted.

Adolescent↗
PubMed2001

Evidence-based dentistry: Part I. Getting started.

This article is the first in a 6-part series on the methods of evidence-based dentistry. To practise in an evidence-based manner, practitioners must be able to formulate a clear question, find the best available evidence efficiently, evaluate the evidence systematically and, if it is relevant and credible, apply the results of the appraisal to their practice. In this paper, we will look at the process of building a clinical question using key elements. Examples of questions most commonly encountered in everyday dental practice are provided.

Concept Formation↗
PubMed2001

Evidence-based dentistry: Part II. Searching for answers to clinical questions: how to use MEDLINE.

The ability to conduct efficient literature searches is fundamental to the practice of evidence-based dentistry. In the second part of this series on evidence-based dentistry, strategic literature search techniques are discussed. MEDLINE, because of its breadth, depth and continuous maintenance by the U.S. National Library of Medicine (NLM), is the best source of evidence for health care. Although there are many gateways to MEDLINE, this paper highlights the user-friendly versions of MEDLINE offered free on the Internet by the NLM. The use of well-established search tactics and the unique features of the NLM sites facilitate rapid, effective literature searches.

Canada↗
PubMed2001

Evidence-based dentistry: Part III. Searching for answers to clinical questions: finding evidence on the Internet.

The Internet is rapidly becoming a valuable source of information for all health care professionals, as well as for the consumers of health care--patients and their families and friends. Information on the Internet is uncontrolled and generally unevaluated. The quality filter of peer review, present in published dental journals, is usually lacking in Internet-based health sources. There are, however, a number of well-developed, highly-credible and useful resources available online that provide evidence-based information. In this paper, the third in a 6-part series on evidence-based practice, we discuss some of the sites that we have found to be most helpful for learning, teaching and practising evidence-based care.

Clinical Trials as Topic↗
PubMed2001

Evidence-based dentistry: Part V. Critical appraisal of the dental literature: papers about therapy.

Evidence-based dentistry involves defining a question focused on a patient-related problem and searching for reliable evidence to provide an answer. Once potential evidence has been found, it is necessary to determine whether the information is credible and whether it is useful in your practice by using the techniques of critical appraisal. In this paper, the fifth in a 6-part series on evidence-based dentistry, a framework is described which provides a series of questions to help the reader assess both the validity and applicability of an article related to questions of therapy or prevention.

Dental Care↗
PubMed2001

Clinical practice guidelines in dentistry: Part II. By dentists, for dentists.

There is a growing interest in clinical practice guidelines (CPGs) for all health care providers. As discussed in the first paper of this 2-part series, there are many misperceptions about guidelines and their potential risks and benefits. The dental profession in Canada, cognizant of both the importance and the challenges of developing sound, credible and relevant guidelines for dentists, has created a unique, autonomous collaboration of multiple stakeholders, the Canadian Collaboration on CPGs in Dentistry (CCCD). This paper discusses the history, structure and processes of the CCCD and introduces the first guideline under development by and for Canadian dentists.

Canada↗
PubMed2001

Evidence-based Dentistry: Part VI. Critical Appraisal of the Dental Literature: Papers About Diagnosis, Etiology and Prognosis.

Critical appraisal methods assist the reader in assessing the validity (closeness to the truth) and the relevance (usefulness in everyday practice) of research findings. The specific techniques of critical appraisal can vary somewhat, depending on the nature of the research question. In this paper, the final in a 6-part series on evidence-based dentistry, frameworks are presented to enable the judicious reader of the dental literature to apply sensible questions to the evaluation of papers related to diagnosis, etiology and prognosis.

Causality↗
PubMed2000

The building blocks of evidence-based dentistry.

The practice of dentistry is becoming more complex and challenging. Changing socio-demographic patterns, patients as knowledgeable health care consumers, rapid technical advances and the information "explosion" all place greater demands on clinical decision making. The need for reliable information and the electronic revolution have come together to allow the "paradigm shift" towards evidence-based health care to progress swiftly. Evidence-based dentistry closes the gap between clinical research and real world dental practice and provides dentists with powerful tools to interpret and apply research findings. Central to evidence-based practice is the systematic literature review, which synthesizes the best evidence and provides the basis for clinical practice guidelines.

Dental Care↗
PubMed1999

Port-access coronary artery bypass grafting: technique and comparative results.

BACKGROUND: Interest in minimally invasive coronary artery bypass grafting (CABG) continues to grow, and the techniques evolve. Our study examines the technical strategies of port-access (PA) CABG and compares results between PA CABG and conventional CABG. METHODS: Two hundred and twenty-nine consecutive patients underwent PA CABG from December 1996 through July 1998. Postoperative complications were compared with a matched cohort of conventional access patients. Operative technique and times were reviewed in the PA group. RESULTS: The average Society of Thoracic Surgeons (STS) risk assessment was 1.3 in both groups. Observed mortality was 0.9%. Complications of stroke, perioperative myocardial infarction, and atrial fibrillation were not significantly different between the two groups. Reoperation for bleeding was more likely in the PA group, while infections were more likely in the sternotomy group (p < 0.05). Transfusion requirements and postoperative length of stay were lower in the PA group (p < 0.05). CONCLUSIONS: Early results were similar between these two low-risk cohort groups. These findings support continued careful use of port-access revascularization in low-risk patients. Close follow-up of outcomes is essential to define the appropriateness of port-access techniques in patients requiring surgical revascularization.

Aged↗
PubMed1999

Solvent oriented hobbies and the risk of systemic sclerosis.

OBJECTIVE: To examine whether those participating in solvent oriented hobbies (SOH) are at greater risk of developing systemic sclerosis (SSc), and if the association is modified by the presence of the anti-Scl70 antibody. METHODS: Patients with SSc and controls were recruited from a university hospital rheumatology clinic. Recreational hobby and occupational histories were obtained along with blood samples. Cumulative scores were created for participation in SOH. Logistic regression was used to calculate odds ratios associated with SOH exposure after adjustment for sex, age at diagnosis, and occupational solvent exposure, and to examine the association between SOH exposure and the presence of anti-Scl70. RESULTS: Solvent exposure based on hobbies and occupations was determined for 178 cases (141 women, 37 men) and 200 controls (138 women, 62 men). Overall participation in SOH was not associated with SSc. However, odds of high cumulative SOH exposure was 3 times greater in those patients with SSc testing positive for the anti-Scl70 antibody compared to patients testing negative (OR 2.9, 95% CI 1.1, 7.9), and twice as great as controls (OR 2.5, 95% CI 1.1, 5.9). CONCLUSION: While patients with SSc did not participate more often in SOH than controls over all, odds of high cumulative SOH exposure was greater among patients with SSc testing positive for anti-Scl70 compared to those testing negative and compared to controls. These results provide further evidence that environmental agents may play a role in the development of Ssc.

Female↗
PubMed1998

Is occupational organic solvent exposure a risk factor for scleroderma?

OBJECTIVE: The primary objective was to determine whether occupational exposure to organic solvents is related to an increased risk of systemic sclerosis (SSc; scleroderma). METHODS: Occupational histories were obtained from 178 SSc patients and 200 controls. Exposure scores were computed for each individual using job exposure matrices, which were validated by an industrial expert. RESULTS: Among men, those with SSc were more likely than controls to have a high cumulative intensity score (odds ratio [OR] 2.9, 95% confidence interval [95% CI] 1.1-7.6) and a high maximum intensity score (OR 2.9, 95% CI 1.2-7.1) for any solvent exposure. They were also more likely than controls to have a high maximum intensity score for trichloroethylene exposure (OR 3.3, 95% CI 1.0-10.3). Among men and women, significant solvent-disease associations were observed among SSc patients who tested positive for the anti-Scl-70 autoantibody; these trends were not observed among the men and women who tested negative for anti-Scl-70. CONCLUSION: These results provide evidence that occupational solvent exposure may be associated with an increased risk of SSc.

Adult↗
PubMed1997

Cytokine concentrations in bronchoalveolar lavage fluid of patients with systemic sclerosis.

OBJECTIVE: The pathophysiology of pulmonary fibrosis in patients with systemic sclerosis (SSc) is poorly understood, but a number of recent studies have demonstrated an inflammatory process involving the lower respiratory tract. The objective of the present study was to determine the concentrations of several cytokines in the bronchoalveolar lavage (BAL) fluid of patients with SSc and to assess whether the enhanced expression of certain cytokines is associated with the presence of alveolitis. METHODS: BAL was performed on patients with SSc (with or without alveolitis) and on normal control subjects. Lyophilized BAL fluid samples were assayed by enzyme-linked immunosorbent assay for tumor necrosis factor alpha (TNF alpha), interleukin-1alpha (IL-1alpha), IL-4, IL-6, IL-8, macrophage inflammatory protein 1alpha (MIP-1alpha), and RANTES. RESULTS: There were significant differences between groups in the BAL fluid concentrations of TNF alpha (P = 0.0005, with levels in SSc patients with alveolitis higher than those in normal controls), IL-8 (P = 0.006, with levels in both SSc groups higher than those in normal controls), MIP-1alpha (P = 0.009, with levels in SSc patients with alveolitis higher than those in SSc patients without alveolitis and than those in normal controls), and RANTES (P = 0.03, with levels in SSc patients without alveolitis higher than those in normal controls). With the exception of RANTES, the highest levels were detected in SSc patients with alveolitis. CONCLUSION: Each of these cytokines, either alone or in combination, may play an important role in the pathogenesis of pulmonary fibrosis in SSc.

Adult↗
PubMed1997

Racial differences in operation for peripheral vascular disease: results of a population-based study.

Operation for non-coronary atherosclerotic peripheral vascular occlusive disease may vary among race and gender groups. Using a state-wide registry, the authors identified all operations performed for infrarenal peripheral vascular disease over a 12-month period in a single south-eastern state. Procedures performed included reconstruction for aortoiliac (n=641) and infrainguinal (n=1129) disease and major amputation (n=1077). The incidence for patients over age 50 was calculated using census data. Operation for aortoiliac disease was significantly more likely for white patients (relative risk 3.79, 95% C.I. 2.84-5.15), but less likely for infrainguinal peripheral vascular disease (relative risk 0.64, 95% C.I. 0.56-0.73) and amputation (relative risk 0.17, 95% C.I. 0.15-0.19). Trends toward lower operative mortality in blacks with aortoiliac disease (10.6% versus 12.0%), PVD (3.2% versus 3.5%), and amputation (5.5 versus 8.7%) failed to attain statistical significance. Patient race was associated with the type and location of operation performed for peripheral vascular disease.

Aged↗
PubMed1997

Protease inhibitors and urolithiasis.

PURPOSE: We discuss the specific urological abnormalities associated with protease inhibitor therapy. MATERIALS AND METHODS: We report on a human immunodeficiency virus positive patient who was on protease inhibitor therapy and presented with renal colic. RESULTS: The stone passed spontaneously. Stone analysis was not consistent with any known composition of urinary calculus. CONCLUSIONS: The positive effects of protease inhibitors in human immunodeficiency virus positive patients mandate that the urological community become familiar with these drugs and the specific urological complications as the use of these drugs becomes widespread.

Adult↗