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Biomedical subjects

S M Underwood

Publications and source records attributed to S M Underwood.

At least 19 recordsLinked to original sources
PubMed2005

Influence of changing work patterns on training in anaesthesia: an analysis of activity in a UK teaching hospital from 1996 to 2004.

BACKGROUND: We aimed to assess the influence of reduced working hours on training in a UK teaching hospital as the specialist registrar grade was introduced in 1996, the New Deal was implemented in 2001 and the Working Time Directive (WTD) took effect for doctors in training in 2004. METHODS: We analysed data from operating theatres in our hospital looking at grade of anaesthetist, time of day, emergency category, and specialty for more than 50,000 cases. RESULTS: Although direct supervision of trainees increased from 32 to 37 to 47%, senior house officer (SHO) and specialist registrar (SpR) caseload reduced by 20 and 21%, respectively, while that of the consultants rose. CONCLUSIONS: The reduction in total operating theatre cases for our trainees was evident across the epochs analysed, case numbers fell after introduction of the New Deal as well as more recently following the WTD, particularly for SHOs who are now doing a larger proportion of their work at night. SHOs and SpRs are doing more obstetric cases than in previous times but these are regional and not general anaesthetics.

Anesthesia, Obstetrical↗
PubMed2000

Minority recruitment in the prostate cancer prevention trial.

PURPOSE: African American men have a higher prostate cancer risk profile than that of other men in the United States. The purpose of this manuscript is to summarize the challenges associated with enrolling and randomizing African American and other minority participants in the Prostate Cancer Prevention Trial (PCPT). METHODS: The PCPT is a randomized trial of finasteride versus placebo for preventing prostate cancer in healthy men age 55 years and older; it is coordinated by the Southwest Oncology Group. The manuscript describes demographic and lifestyle characteristics of the PCPT randomized sample (18,882 men) by four racial and ethnic groups (Caucasian, African American, Hispanic, and other). African American men comprised 4% of the total randomized sample compared to our goal of 8%. Minority recruitment was emphasized through the Study Manual and training that occurred at trial activation. Supplemental minority recruitment activities were initiated a year after study activation and continued through the end of the accrual period. Minority recruitment was emphasized as follows: minority recruitment presentations at PCPT training seminars (held during twice yearly Southwest Oncology Group meetings); distribution of additional minority recruitment materials; engagement of four consultants for minority recruitment; production of a Minority Recruitment Manual; and a small pilot study involving minority outreach recruiters at five PCPT sites. RESULTS: The consultants were helpful in implementing the pilot project and in suggesting and reviewing materials for minority recruitment. The five-site pilot project did not increase either enrollment or randomization of minorities (with a possible exception at one site). CONCLUSIONS: We suggest that a long-term perspective is required for successful recruitment of minority participants in clinical trials. Likewise, extensive minority recruitment efforts must be ready to implement at trial activation.

Aged↗
PubMed2000

Minorities, women, and clinical cancer research: the charge, promise, and challenge.

Significant progress has been made since the war against cancer was launched. Discoveries in molecular medicine, genetics, and epidemiology have led to the recognition that certain cancers are potentially preventable and that elements of lifestyle, along with genetic, hormonal, and metabolic factors can be altered to reduce cancer risk. Advances in medical technology have led to the development of new imaging methods and computer technologies that can aid in efforts to detect, diagnosis, and treat cancer. Since the offensive against cancer was initiated, cancer treatments have become more powerful, more precise, less drastic, and safer. As a result, cancer incidence and mortality have begun to decline. Yet, while the nation boasts of the progress being achieved relative to cancer incidence and mortality, and federal research agencies retort that research applies to all populations, it is apparent that the declines do not translate to all populations in the United States. Clinical research is essential to cancer prevention and control. Within the oncology community, clinical cancer research trials are viewed as an efficient and economical way for patients to secure state-of-the-science medical care. Recognizing the need to improve access to state-of-the-science cancer treatment and control programs, minority and female participation in clinical cancer research trials has been encouraged. This recommendation is based on the belief that increased participation in well-designed clinical cancer research trials adhering to strict protocols and quality controls will, not only help validate the application of research findings to minority and female populations, but also result in better patient outcomes. Born out of a commitment to social equity, justice, beneficence, and the desire to ensure that data relevant to cancer prevention and control are both valid and generalizable to populations across the United States, several programs of research aimed toward increasing the representation of women and minorities in clinical cancer research have been pursued by the National Cancer Institute. This issue of the Annals of Epidemiology Minorities, Women, and Clinical Cancer Research presents issues and challenges that face the research community and descriptions of effective models, strategies, and practices that may be used to increase the participation of minorities and women in clinical cancer research trials and facilitate the conduct of research directed toward reducing the cancer burden within the United States.

Cost of Illness↗
PubMed2000

A detailed analysis of theatre training activity in a UK teaching hospital.

We examined the placement of anaesthetists in our department over a 2 yr period. Data were collected from an in-theatre system to provide details of caseload and supervision for 34,856 operations. There was wide variation between anaesthetic sub-specialties with overall supervision levels of 35% of cases for senior house officers (SHOs) and 32% for specialist registrars (SpRs). The consultant data showed the size and areas of teaching reserve in the department. We then examined individual logbooks in order to validate our data, and departmental rotas to put these data into perspective with previous attempts to quantify trainee supervision. Supervision data derived from the rota allocations showed that 86% of SHO lists and 62% of SpR lists were scheduled to be supervised. This study has described our training activity and facilitated departmental changes, as well as highlighting the need for great care in interpreting trainee supervision data acquired from different sources, particularly when comparisons are being made.

Anesthesiology↗
PubMed1999

Breast cancer screening among African American women: addressing the needs of African American women with known and no known risk factors.

Breast cancer is the single most common form of cancer observed in African American women. Yet, in spite of the advances that have been made in the area of breast cancer detection and treatment, breast cancer continues to be their leading cause of cancer death. Many experts believe that breast cancer mortality among African American women could be significantly reduced if breast cancer screening recommendations were more effectively used. However, little is known about the breast cancer screening behaviors of women with known and no known risk factors. An exploratory study was therefore undertaken to gain a broader understanding of the breast cancer screening behaviors of African American women. Attempts were also made to determine if age, type of medical services used, breast cancer risk factors, or provider discussions influenced compliance with screening guidelines. Breast cancer screening procedures were found to be markedly under-used by the African American women in the study sample. However, the data suggested that if health care providers provide women with information regarding their personal breast cancer risk and make a personalized recommendation for their breast cancer screening, greater compliance with screening guidelines would occur.

Adult↗
PubMed1994

Increasing nursing involvement in cancer prevention and control among the economically disadvantaged: the nursing challenge.

The American Cancer Society sponsored a series of hearings to document the magnitude of the problems faced by the poor in seeking cancer care. The findings reflected that economically disadvantaged Americans are often forced to accept substandard health care services and face numerous problems when seeking preventive care and treatment. The glimpse from inside the circle of poverty (statements from the hearings) provides an opportunity to better understand the problems faced by the poor in accessing health care and to better recommend strategies for effecting a positive change.

Attitude to Health↗
PubMed1993

Isradipine and the coronary circulation.

Isradipine has been shown to be an effective vasodilator in different vascular beds. Experimental evidence suggests that isradipine is a potent coronary vasodilator, and this is supported by clinical studies in both cardiology and cardiac surgery. Furthermore, in these studies, coronary vasodilation was not accompanied by evidence of any significant effect on cardiac contractility or conduction. It can be concluded that the cardiac effects of isradipine will ultimately prove to be beneficial in patients undergoing myocardial revascularization.

Animals↗
PubMed1993

Time-course of free radical activity during coronary artery operations with cardiopulmonary bypass.

Myocardial and pulmonary impairment after cardiopulmonary bypass may be caused by oxygen free radicals produced by reperfusion and by activated neutrophils. Free radical activity was assessed by assays for lipid peroxidation (thiobarbituric acid-reactive material) and phospholipid-esterified diene conjugation (18:2[9,11]/18:2[9,12] molar ratio) in 25 patients during coronary artery operations. Arterial blood samples were obtained before, during the ischemic period, and for 24 hours thereafter. There were no significant changes in free radical indices during the ischemic periods, but after cessation of bypass they increased significantly. Ten minutes after bypass thiobarbituric acid-reactive material rose from 96 (median; range 65 to 145) nmol/gm albumin to 138 (85 to 200) nmol/gm albumin (p < 0.001), and molar ratio rose from 2.23% (0.45% to 7.70%) to 2.51% (0.39% to 7.93%) (p < 0.02). Values of thiobarbituric acid-reactive material subsequently decreased, but molar ratio reached a peak at 4 hours after bypass, 2.64% (0.55% to 10.08%) (p < 0.001), thereafter returning to baseline. The postoperative increases in thiobarbituric acid-reactive material and in molar ratio were correlated (r = +0.53; p = 0.006). These increases in thiobarbituric acid-reactive material and in molar ratio were not related to age, preoperative left ventricular function, or the number of grafts performed. Increase in thiobarbituric acid-reactive material correlated with the duration of cardiopulmonary bypass (r = +0.43; p = 0.03). In 10 patients in whom cardiopulmonary bypass was performed using a bubble oxygenator, the increases in thiobarbituric acid-reactive material were significantly greater than in the 15 in whom a membrane oxygenator was used (p < 0.02). These data show that after apparently uncomplicated coronary operations with bypass there is an increase in lipid peroxidation and diene conjugation, indicating increased free radical activity. This increase varies between patients and does not relate to patient or surgical factors but may depend on the type of oxygenator employed during bypass.

Adult↗
PubMed1992

Anaesthesia for myocardial revascularisation. A comparison of fentanyl/propofol with fentanyl/enflurane.

We studied the effects on myocardial performance and metabolism of fentanyl/propofol and fentanyl/enflurane anaesthesia in 20 patients before coronary artery bypass grafting. Anaesthesia was induced with fentanyl 20 micrograms.kg-1 and pancuronium 0.15 mg.kg-1. Patients received, by random allocation, either propofol by infusion, 6 mg.kg-1.h-1 reduced by half after 10 min then adjusted as necessary (mean rate 2.8 mg.kg-1.h-1), or enflurane 0.8% inspired concentration for 10 min reduced to 0.6% and adjusted as required (mean 0.7%). Measurements were made before induction, after tracheal intubation, after skin incision and after sternotomy. There were no significant differences between the groups in any haemodynamic variables during the study. Following intubation both groups showed a rise in heart rate (p < 0.01) and cardiac index (p < 0.05). Systemic vascular resistance decreased after intubation (p < 0.05) then returned to baseline during surgery; stroke index was unchanged after intubation but was reduced during surgery (p < 0.01) as systemic vascular resistance increased. Regional and global coronary blood flow were maintained in both groups, as were myocardial oxygen consumption and lactate extraction ratio. However, lactate production did occur in one patient receiving enflurane and Holter monitoring confirmed ischaemia. One patient receiving propofol showed lactate production not accompanied by any ECG changes. This study suggests that propofol may be a suitable alternative to enflurane as an adjunct to opioids in anaesthesia for coronary artery bypass grafting.

Anesthesia, Inhalation↗
PubMed1991

Comparison of isradipine with nitroprusside for control of blood pressure following myocardial revascularization: effects on hemodynamics, cardiac metabolism, and coronary blood flow.

The effects of isradipine (ISR) on cardiac performance, myocardial metabolism, and coronary blood flow were compared with those of sodium nitroprusside (SNP) when used to control blood pressure following myocardial revascularization. Twenty patients were randomized to receive either intravenous ISR or SNP if arterial blood pressure increased above 130 mm Hg systolic. Hemodynamic and metabolic parameters were studied using radial, pulmonary arterial, and coronary sinus catheters. Cardiac output and coronary blood flows were measured by thermodilution and blood was taken for calculation of myocardial oxygen consumption and lactate extraction. Electrocardiographic changes were recorded by Holter monitoring throughout the study. ISR and SNP both produced a satisfactory reduction in blood pressure accompanied by a decreased systemic vascular resistance (P less than 0.001). ISR infusion was associated with increases in cardiac output and stroke index (P less than 0.01), which were not apparent in the SNP group. Tachycardia occurred with SNP (P less than 0.01) but not with ISR therapy. Right and left ventricular stroke work indices and myocardial oxygen consumption were reduced with SNP. The ISR group showed unchanged myocardial oxygen consumption with increased right ventricular stroke work index. Coronary vascular resistance decreased (P less than 0.01) during ISR infusion but decreased only slightly in the SNP group. Great cardiac vein blood flow was significantly increased with ISR but not with SNP, resulting in a significant difference between the groups (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

The haemodynamic effects of bronchoscopy. Comparison of propofol and thiopentone with and without alfentanil pretreatment.

The haemodynamic response to bronchoscopy under general anaesthesia was investigated. Forty patients were allocated at random to receive either thiopentone or propofol; half the patients in each group received in addition 18 micrograms/kg of alfentanil one minute before induction of anaesthesia. The heart rate, noninvasive blood pressure and Holter ECG was monitored in all patients. Significant increases in heart rate (p less than 0.05), systolic and diastolic arterial pressures (p less than 0.01) occurred in the thiopentone only group, following bronchoscopy. Systolic and diastolic arterial pressure decreased in patients receiving thiopentone plus alfentanil, following induction of anaesthesia and laryngoscopy (p less than 0.05). No significant haemodynamic changes were seen in either of the groups which received propofol. ST segment changes on subsequent Holter analysis were seen in four patients, but there were no significant differences between the groups. Anaesthesia with propofol alone provides adequate haemodynamic stability for bronchoscopy and the addition is superfluous.

Aged↗
PubMed1991

African-American men. Perceptual determinants of early cancer detection and cancer risk reduction.

Research has shown that African-American men have a higher incidence, a higher death rate, and a lower survival rate for most cancers. But currently there are few studies addressing factors influencing the health care trends of this high-risk population. A study focused on identifying factors that contribute to early cancer detection and cancer risk-reduction health behavior in African-American men was therefore implemented. There is evidence to support the conclusion that perceptions do significantly contribute to the health behavior of African-American men. Those having the greatest impact were related to methods of early cancer screening. Clearly, if the National Cancer Institute's goal to reduce the mortality from cancer in the general population by 50% from the base rate in 1984 is to be met by the year 2000, there must be an increase in programs targeting African-American men. Every day African-American men can take steps to help protect themselves from cancer. Our charge as health care clinicians, educators, and researchers is to pinpoint ways to encourage them to do so.

Adolescent↗
PubMed1991

Intramuscular injections through indwelling cannulae.

A study was performed to establish the feasibility of an indwelling intramuscular cannula for the administration of post-operative analgesic and anti-emetic medication. One-hundred cannulae were inserted for periods up to 7 days (mean = 2.4). A mean of five and maximum of 15 injections were made through each cannula with a maximum volume in any patient of 29 ml. On 18 occasions cannulae were removed for minor complications; no serious complications were seen. This technique may be useful for administration of intramuscular analgesic and anti-emetic medications in the post-operative period.

Adolescent↗
PubMed1990

Systemic pattern of free radical generation during coronary bypass surgery.

Diffuse impairment of ventricular function after cardiac surgery may be related to the generation during reperfusion of the myocardium of free radicals derived from oxygen. Fifteen patients undergoing elective coronary bypass surgery were studied by previously described assays for peroxidised lipids and for isomerised lipids which were used as indices of free radical activity. Serial blood samples were obtained from systemic arterial, mixed venous, and coronary sinus catheters before, during, and after the ischaemic period. The patients underwent coronary artery surgery on cardiopulmonary bypass with a membrane oxygenator, relative hypothermia 30-34 degrees C, and intermittent cross-clamping of the aorta. During the ischaemic periods there were no significant changes in the indices of free radical activity. During the reperfusion phase there was a significant increase in free radical indices in arterial and mixed venous blood. A small rise in free radical indices in coronary venous blood was not statistically significant. These data indicate that free radical activity is increased in patients shortly after the cessation of cardiopulmonary bypass. The pattern of distribution between the different sampling sites suggests that much of the observed increase in isomerised and peroxidised lipids originates from tissues other than the myocardium.

Adult↗