PubMed Health⌕ Search

Biomedical subjects

S P Kelly

Publications and source records attributed to S P Kelly.

At least 19 recordsLinked to original sources
PubMed2006

Attitudes and behaviour of ophthalmologists to smoking cessation.

AIMS: Growing evidence suggests a causal association between smoking and eye disease. This study explores the current beliefs and practice among UK consultant ophthalmologists towards delivering smoking cessation advice to eye clinic attenders. METHODS: A cross-sectional survey using a postal questionnaire of all UK NHS hospital based consultant ophthalmologists was conducted. The questionnaire explored whether: ophthalmologists identify the smoking status of their patients, advise about the increased risk of eye diseases among smokers, and deliver smoking cessation advice. The availability of departmental smoking cessation resources was also ascertained. RESULTS: The response rate was 55% (485/886). Of the responders 79% were males. Only 35% of responders asked about smoking status every time or most times for new patients and 5% for follow-up patients. In all, 40% claimed to always or usually advise patients to quit smoking and 61% claimed to always or usually mention eye disease as a reason to quit. Only 14% assessed motivation to quit and 22% provided advice and assistance about how to stop smoking to smokers who wished to quit. Female ophthalmologists were more likely to undertake most aspects of smoking assessment and intervention. Only 18% of responders stated that their departments provide information about smoking for patients and 6% stated that support is available for patients wanting to quit smoking. CONCLUSION: The assessment of smoking status and provision of targeted support for smokers to quit could be substantially improved in UK ophthalmology departments. There is a need to introduce smoking cessation support into routine ophthalmic practice and provide the resources to support this.

Attitude of Health Personnel↗
PubMed2006

Cigarette smoking and thyroid eye disease: a systematic review.

PURPOSE: To evaluate the epidemiological evidence for a causal association between tobacco smoking and thyroid eye disease (TED). METHODS: Systematic review, including quality assessment, of published epidemiological studies and evaluation of the evidence using established causality criteria. RESULTS: Fourteen papers describing 15 studies were included. There was a positive association between smoking and TED in four case-control studies when compared with control patients with Graves' disease but no ophthalmopathy (odds ratio (OR) 1.94-10.1) and in seven case-control studies in which control subjects did not have thyroid disease (OR 1.22-20.2). Two cohort studies examined the occurrence of new cases of TED; one study found an increased incidence of TED with smoking. Four cohort studies investigated progression or outcome of treatment in patients with established TED, three finding an association between smoking and poorer outcome. The quality of the studies was variable, but the association with smoking was strong in the most methodologically rigorous studies. Other evidence supporting a causal link was a consistent association across studies, a dose-response effect, a reduced risk of TED in ex-smokers, and a temporal relationship. CONCLUSION: This systematic review provided strong evidence for a causal association between smoking and development of TED. Current-smokers were also more likely to experience disease progression or poorer outcome of treatment. Patients with Graves' disease and the general public should be educated about the risk of smoking and TED. These findings suggest that patients with Graves' disease or TED who are smokers should be given effective support to stop smoking.

Disease Progression↗
PubMed2006

Patient safety in cataract surgery.

PURPOSE: The recent focus on healthcare errors and safety suggest that practitioners and policy makers might appraise their cataract surgical care from a patient safety perspective. This paper reviews patient safety issues relevant to cataract care. Causation and consequences of incidents in cataract surgery, with implications for policy, are discussed. METHODS: Models of accident causation from other domains were drawn on and empirically applied to cataract care. Consultation was undertaken with experts in cataract surgery, patient safety, and in risk management. Feedback on patient safety was included from presentations made to staff and patients and from personal insights. RESULTS: Ophthalmology teams should embrace steps to improve patient safety. The role of incident reporting is advanced, including the provision of a prompt menu of cataract patient safety incidents as suggested by the Royal College of Ophthalmologists. CONCLUSIONS: Strict attention to detail, risk assessment, and careful consideration of the patient pathway is needed to enhance cataract care. Clinical errors, near misses and complications happen, and may provide an opportunity for learning to reduce the risk of similar events in the future. Investment in staffing and training, appropriate equipment, and development of a safety culture with patient involvement are key elements of safe cataract surgical care. Patients and the public expect that safe cataract care should be commissioned for them. Critical patient safety incidents, including incidents that have led to permanent harm, require careful analysis of underlying systems and/or root causes.

Cataract Extraction↗
PubMed2005

Reflective consideration of postoperative endophthalmitis as a quality marker.

PURPOSE: To study the incidence of acute postoperative presumed infectious endophthalmitis (PIE) in a UK district general hospital over a 10-year period. Consideration of such departmental healthcare-associated infection frequency rates as part of reflective and comparative quality practice in the light of local concerns. METHODS: Hospital-based retrospective case series: 12 831 cataract extraction operations from 01/01/1995 to 31/12/2004 were studied. All cases of PIE within 6 weeks of cataract surgery were ascertained and investigated in a standardised format. PIE incidence rate per 1000 cataract surgical procedures was contrasted with the existing literature. RESULTS: Seven isolated PIE cases occurred following phacoemulsification. None followed extra-capsular extractions. The PIE rate was 0.55 [95% CI; 0.22 to 1.12] cases per 1000 cataract extractions, or one PIE case within 6 weeks of surgery in every 1833 [95% CI; 893 to 4545] cataract operations undertaken. Five cases were culture positive. Details of PIE cases are presented. CONCLUSION: PIE incidence rates in our department are slightly lower than reported case series in similar settings. Whether this is due to a variety of preventive measures deployed locally and/or methods of case ascertainment in published studies is problematic and is discussed. Departmental benchmarking data is important in relation to rare, but critical, patient safety incidents. Collection and monitoring of endophthalmitis outcomes is of merit and may inform patient choice. Surgical site infection surveillance systems of relevance are discussed. Implications for making healthcare safer, including reflective practice are, discussed in relation to cataract care.

Aged↗
PubMed2005

Ethnic aspects of acute primary angle closure in a UK mulicultural conurbation.

AIM: To investigate the incidence and ethnic distribution of patients with symptomatic acute primary angle closure (APAC) who presented to a UK hospital serving a multicultural conurbation by a population-wide case series investigation. METHODS: Case series chart review of patients aged 30 years and above, who required laser peripheral iridotomy (LPI) for a primary acute angle closure event over a 7-year period. Demographic data for cases were compared to the local resident census data. RESULTS: A total of 46 local residents aged > or =30 years required LPI for APAC. In all, 96% of patients were Caucasian compared to the local resident population of 89% Caucasian. The overall annual APAC rate for Bolton was 4.14 cases per 100 000 population (95% CI 3.03-5.52). The standardised incidence ratio for the South Asian population was 0.78 (95% CI 0.02-4.34) and 26.6 (95% CI 0.67-148.40) for the Chinese population. CONCLUSIONS: APAC incidence in South Asians was similar to that among Caucasians. The incidence of APAC patients treated in this UK department is consistent with international experience. Individuals of Chinese ethnicity were at an enhanced risk of APAC. However, these results should be interpreted with caution, as patient numbers are small.

Acute Disease↗
PubMed2005

Perceptions of blindness related to smoking: a hospital-based cross-sectional study.

AIMS: Smoking is associated with several serious eye diseases. Awareness of smoking and blindness, and its potential to act, as a stimulus to assist stopping smoking has not been investigated. METHODS: A cross-sectional survey using a structured interview of adult patients attending district general hospital ophthalmology, general surgery, and orthopaedic clinics. The interview investigated the awareness and fear of blindness for three established smoking-related diseases, and a distractor condition (deafness), and the likelihood that smokers would quit on developing early signs of each condition. RESULTS: Response was 89.1% (358/402). In all, 183 (51.1%) of responders were male and 175 (48.9%) female. Only 9.5% of patients believed that smoking was definitely or probably a cause of blindness, compared with 92.2% for lung cancer, 87.6% for heart disease, and 70.6% for stroke. Patients ranked their fear of each of the five conditions, scoring five for the most feared and one for the least feared. Patients were significantly (P<0.01) less fearful of blindness (mean score 2.80) than lung cancer (3.89), heart disease (3.58), and stroke (3.35). About one-half of smokers stated that they would definitely or probably quit smoking if they developed early signs of blindness or the three established smoking-related conditions, with no significant differences in proportions for these four conditions. CONCLUSION: The findings suggest that awareness of the risk of blindness from smoking is low, but that the fear of blindness is as compelling a motivation to quit as fear of lung cancer, heart disease, and stroke. The link between smoking and eye disease should be publicised to help reduce smoking prevalence.

Adult↗
PubMed2005

Smoking and age-related macular degeneration: a review of association.

PURPOSE: Age-related macular degeneration (AMD) is the leading cause of severe and irreversible vision loss in the Western world. As there is no effective treatment for all types of AMD, identifying modifiable risk factors is of great importance. This review evaluates the epidemiological evidence associating smoking with AMD. METHODS: Systematic review of published epidemiological studies evaluated against established criteria for evidence of a causal relationship. RESULTS: In total, 17 studies (cross-sectional studies, prospective cohort studies, and case-control studies) were included in the review. A total of 13 studies found a statistically significant association between smoking and AMD with increased risk of AMD of two- to three-fold in current-smokers compared with never-smokers. Five studies found no association between smoking and AMD. There was also evidence of dose-response, a temporal relationship and reversibility of effect. CONCLUSION: The literature review confirmed a strong association between current smoking and AMD, which fulfilled established causality criteria. Cigarette smoking is likely to have toxic effects on the retina. In spite of the strength of this evidence, there appears to be a lack of awareness about the risks of developing eye disease from smoking among both healthcare professionals and the general public.

Aged↗
PubMed2005

Direct costs of glaucoma and severity of the disease: a multinational long term study of resource utilisation in Europe.

BACKGROUND: Resource utilisation and direct costs associated with glaucoma progression in Europe are unknown. As population progressively ages, the economic impact of the disease will increase. METHODS: From a total of 1655 consecutive cases, the records of 194 patients were selected and stratified by disease severity. Record selection was based on diagnoses of primary open angle glaucoma, glaucoma suspect, ocular hypertension, or normal tension glaucoma; 5 years minimum follow up were required. Glaucoma severity was assessed using a six stage glaucoma staging system based on static threshold visual field parameters. Resource utilisation data were abstracted from the charts and unit costs were applied to estimate direct costs to the payer. Resource utilisation and estimated direct cost of treatment, per person year, were calculated. RESULTS: A statistically significant increasing linear trend (p = 0.018) in direct cost as disease severity worsened was demonstrated. The direct cost of treatment increased by an estimated 86 for each incremental step ranging from 455 euro per person year for stage 0 to 969 euro per person year for stage 4 disease. Medication costs ranged from 42% to 56% of total direct cost for all stages of disease. CONCLUSIONS: These results demonstrate for the first time in Europe that resource utilisation and direct medical costs of glaucoma management increase with worsening disease severity. Based on these findings, managing glaucoma and effectively delaying disease progression would be expected to significantly reduce the economic burden of this disease. These data are relevant to general practitioners and healthcare administrators who have a direct influence on the distribution of resources.

Adult↗
PubMed2004

Neuropeptides and the control of food intake in fish.

The brain, particularly the hypothalamus, integrates input from factors that stimulate (orexigenic) and inhibit (anorexigenic) food intake. In fish, the identification of appetite regulators has been achieved by the use of both peptide injections followed by measurements of food intake, and by molecular cloning combined with gene expression studies. Neuropeptide Y (NPY) is the most potent orexigenic factor in fish. Other orexigenic peptides, orexin A and B and galanin, have been found to interact with NPY in the control of food intake in an interdependent and coordinated manner. On the other hand cholecystokinin (CCK), cocaine and amphetamine-regulated transcript (CART), and corticotropin-releasing factor (CRF) are potent anorexigenic factors in fish, the latter being involved in stress-related anorexia. CCK and CART have synergistic effects on food intake and modulate the actions of NPY and orexins. Although leptin has not yet been identified in fish, administration of mammalian leptin inhibits food intake in goldfish. Moreover, leptin induces CCK gene expression in the hypothalamus and its actions are mediated at least in part by CCK. Other orexigenic factors have been identified in teleost fish, including the agouti-related protein (AgRP) and ghrelin. Additional anorexigenic factors include bombesin (or gastrin-releasing peptide), alpha-melanocyte-stimulating hormone (alpha-MSH), tachykinins, and urotensin I. In goldfish, nutritional status can modify the expression of mRNAs encoding a number of these peptides, which provides further evidence for their roles as appetite regulators: (1) brain mRNA expression of CCK, CART, tachykinins, galanin, ghrelin, and NPY undergo peri-prandial variations; and (2) fasting increases the brain mRNA expression of NPY, AgRP, and ghrelin as well as serum ghrelin levels, and decreases the brain mRNA expression of tachykinins, CART, and CCK. This review will provide an overview of recent findings in this field.

Animals↗
PubMed2004

Can ophthalmic requests for neuroimaging be improved?

AIM: To review and set guidelines for all neuroradiological referrals from the ophthalmic service in a typical UK district general hospital. METHOD: Patients referred for diagnostic neuroimaging were identified from the radiology database over a 1-year period. A case note review was undertaken. The clinical indication for and results of neuroimaging performed were ascertained. The justification for neuroimaging was determined. RESULTS: Of the total 31,411 patients that were seen in the eye department, 103 (0.32%) had diagnostic neuroradiological imaging performed. The indications for imaging were: suspected compressive lesion of the anterior visual pathway in 57 patients (55.3%), acquired ocular motility disturbance in 20 patients (19.4%), suspected orbital pathology in 11 patients (10.6%), cerebrovascular accident in nine patients (8.7%), and six patients (5.8%) were imaged for either headache or sinusitis. Radiological lesion detection rate was highest for cerebrovascular accident (88.8%) and lowest acquired for ocular motility disturbance (4.9%). CONCLUSION: Ophthalmic requests for diagnostic neuroimaging were found to be unnecessary in only 9% of patients. Guidelines for the referral of ophthalmic patients for neuroimaging are discussed.

Eye Diseases↗
PubMed2002

Cultured gill epithelia from freshwater tilapia (Oreochromis niloticus): effect of cortisol and homologous serum supplements from stressed and unstressed fish.

Procedures for the preparation and culture of branchial epithelia from dispersed gill cells of freshwater tilapia (Oreochromis niloticus) are described. Epithelia were cultured on permeable supports (terephthalate membranes, "filters") and bathed on both the apical and basolateral side with isotonic media containing 6% fetal bovine serum (FBS). When the apical medium was replaced with freshwater (pseudo in vivo asymmetrical culture conditions), transepithelial resistance (TER) increased markedly, transepithelial potential became negative, and paracellular permeability decreased. The physiological effects of cortisol and 10% homologous (tilapia) serum were investigated. Tilapia serum (TS) was prepared from unstressed and stressed fish and therefore allowed comparison between the effects of homologous serum derived from fish in differing physiological states. Under both symmetrical and asymmetrical culture conditions, cortisol significantly elevated TER across cultured tilapia gill epithelia, indicative of a significant increase in epithelial "tightness." Cortisol reduced transepithelial Na + and Cl? movement and paracellular permeability. The glucocorticoid agonist dexamethasone elicited a similar response, which was inhibited by the glucocorticoid antagonist (receptor blocker) RU486. Cortisol did not stimulate active ion transport across epithelia under either symmetrical or asymmetrical culture conditions. In epithelia supplemented with TS from stressed fish, physiological changes in cultured preparations were consistent with those observed in FBS + cortisol-supplemented epithelia. Differences between the physiological status of epithelia supplemented with TS from unstressed and stressed fish could be abolished with RU486. Using TS as a medium supplement did not stimulate active ion transport under asymmetrical culture conditions, although Na +-K +-ATPase activity increased in TS-supplemented epithelia relative to FBS-supplemented preparations.

Animals↗
PubMed2002

Evaluation of the management of optic neuritis: audit on the neurological and ophthalmological practice in the north west of England.

The management of acute optic neuritis by neurologists and ophthalmologists in the north west of England was assessed in the light of the Optic Neuritis Treatment Trial (ONTT) recommendations. A questionnaire on a fictitious case of typical unilateral optic neuritis was mailed to all consultant ophthalmologists and neurologists working in the North West and Merseyside Health Authorities. They were then asked to comment on management of the case. Fifty two out of 86 ophthalmologists and 20 out of 28 neurologists replied. The overall response rate was 63%. Sixty five per cent of neurologists and 46% of ophthalmologists would investigate a typical case of acute optic neuritis further. Forty six per cent of neurologists and 36% of ophthalmologists were likely to arrange MRI of the brain or orbit. Significantly more neurologists (55%) than ophthalmologists (9%) chose to treat with intravenous methylprednisolone (p<0.005). Significantly more ophthalmologists (64%) than neurologists (32%) chose not to give steroids (p<0.025). Oral prednisolone alone was rarely selected for treatment. Respondents were more likely to discuss multiple sclerosis with the referring doctor than with the patient. Only 32% of ophthalmologists and 20% of neurologists would clearly mention the possibility of improvement to the patient. Clear differences in practice between ophthalmologists and neurologists remain. A consensus on practice guidelines on the issues raised might be useful.

Acute Disease↗
PubMed2001

The physiological effects of 3,5',3'-triiodo-L-thyronine alone or combined with cortisol on cultured pavement cell epithelia from freshwater rainbow trout gills.

The effects of 3,5',3'-triiodo-L-thyronine (T3; 10 or 100 ng ml(-1)), alone or combined with cortisol (500 ng ml(-1)), on the physiological properties of cultured pavement cell epithelia from freshwater rainbow trout gills were assessed. T3 had dose-dependent effects on electrophysiological, biochemical, and ion transporting properties of cultured epithelia in both the absence and the presence of cortisol. These included reduced transepithelial resistance (TER), increased net Na(+) and Cl(-) movement (basolateral to apical) under asymmetrical culture conditions (freshwater apical/L15 media basolateral), and elevated Na(+)-K(+)-ATPase activity. However, paracellular permeability was elevated only in high-dose T3-treated preparations. In T3 + cortisol-treated epithelia, similar T3-induced alterations in TER, net Na(+) and Cl(-) movement, and paracellular permeability were observed, whereas the activity of Na(+)-K(+)-ATPase was further elevated. Under symmetrical culture conditions (L15 medium apical/L15 medium basolateral), T3 had no effect on transepithelial Na(+) and Cl(-) transport, which was passive. However, T3 + cortisol treatment resulted in active Na(+) extrusion (basolateral to apical). Under asymmetrical conditions, hormone treatment did not change the pattern of ion movement (active Na(+) extrusion, active Cl(-) uptake). These experiments demonstrate that cultured pavement cell epithelia from freshwater rainbow trout are T3-responsive and provide evidence for the direct action of T3 and the interaction of T3 and cortisol on the physiology of this preparation.

Animals↗
PubMed2001

Effect of cortisol on the physiology of cultured pavement cell epithelia from freshwater trout gills.

Cortisol had dose-dependent effects on the electrophysiological, permeability, and ion-transporting properties of cultured pavement cell epithelia derived from freshwater rainbow trout gills and grown on cell culture filter supports. Under both symmetrical (L15 media apical/L15 media basolateral) and asymmetrical (freshwater apical/L15 media basolateral) culture conditions, cortisol treatment elevated transepithelial resistance, whereas permeability of epithelia to a paracellular permeability marker (polyethylene glycol-4000) decreased. Cortisol did not alter the Na(+)-K(+)-ATPase activity or the total protein content of the cultured preparations. During 24-h exposure to asymmetrical conditions, the net loss rates of both Na(+) and Cl(-) to the water decreased with increasing cortisol dose, an important adaptation to dilute media. Unidirectional Na(+) and Cl(-) flux measurements and the application of the Ussing flux-ratio criterion revealed cortisol-induced active uptake of both Na(+) and Cl(-) under symmetrical culture conditions together with an increase in transepithelial potential (positive on the basolateral side). Under asymmetrical conditions, cortisol did not promote active ion transport across the epithelium. These experiments provide evidence for the direct action of cortisol on cultured pavement cell epithelia and, in particular, emphasize the importance of cortisol for limiting epithelial permeability.

Animals↗
PubMed2001

A maxi Cl- channel in cultured pavement cells from the gills of the freshwater rainbow trout Oncorhynchus mykiss.

Primary cultures of pavement cells from the gills of a freshwater fish, the rainbow trout Oncorhynchus mykiss, have been studied for the first time using the patch-clamp technique. Gigaohm seals were obtained in approximately 95% of cells studied, and channel activity was evident in a high proportion (>90%). A large-conductance Cl- channel was evident in 6 % of cell-attached and in 31% of inside-out patches. Single-channel conductance in inside-out patches was 372 pS, and current/voltage relationships were linear over the range -60 to +60 mV. The channel was activated by patch excision, and activation was often associated with polarization of the patch. The mean number of channels per patch was 1.9, and there were several subconductance states. The relationship between channel activity (NP(o)) and voltage was in the form of an inverted U, and channel activity was highest between 0 and +20 mV. Large-conductance Cl- channels showed a progressive time-dependent reduction in current in response to sustained polarization to voltages outside the range -20 mV to +20 mV. Permeability ratios (P) of Cl- to other anions were P(HCO3)/P(Cl)=0.81, P(SO4)/P(Cl)=0.31 and P(isethionate)/P(Cl)=0.53. The channel was blocked by Zn2+, SITS, DIDS and diphenylamine carboxylate. This is the first description of a large-conductance Cl- channel in gill cells from freshwater or marine species. Possible functions of the channel are discussed.

4,4'-Diisothiocyanostilbene-2,2'-Disulfonic Acid↗
PubMed2001

The cultured branchial epithelium of the rainbow trout as a model for diffusive fluxes of ammonia across the fish gill.

A novel branchial epithelial preparation grown in L-15 medium in culture was used as a model system for understanding the diffusion of ammonia across the gills of the rainbow trout Oncorhynchus mykiss. The epithelium is known to contain both respiratory and mitochondria-rich cells in the approximate proportion in which they occur in vivo and to exhibit diffusive fluxes of Na+ and Cl- similar to in vivo values, but does not exhibit active apical-to-basolateral transport of Na+. Transepithelial resistance and paracellular permeability are also known to increase when the apical medium is changed from L-15 medium (symmetrical conditions) to fresh water (asymmetrical conditions). In the present study, net basolateral-to-apical ammonia fluxes increased as basolateral total ammonia concentration, basolateral-to-apical pH gradients and basolateral-to-apical P(NH(3)) gradients were experimentally increased and were greater under asymmetrical than under symmetrical conditions. The slope of the relationship between ammonia flux and P(NH(3)) gradient (i.e. NH(3) permeability) was the same under both conditions and similar to values for other epithelia. The higher fluxes under asymmetrical conditions were explained by an apparent diffusive flux of NH(4)+ that was linearly correlated with transepithelial conductance and was probably explained by the higher electrochemical gradient and higher paracellular permeability when fresh water was present on the apical surface. In this situation, NH(4)(+) diffusion was greater than NH(3) diffusion under conditions representative of in vivo values, but overall fluxes amounted to only approximately 20% of those in vivo. These results suggest that branchial ammonia excretion in the intact animal is unlikely to be explained by diffusion alone and, therefore, that carrier-mediated transport may play an important role.

Ammonia↗
PubMed2000

Hypercortisolemia does not affect the branchial osmoregulatory responses of the marine teleost Sparus sarba.

The effect of cortisol treatment on branchial Na(+)-K(+)-ATPase subunit mRNA abundance, enzyme activity, chloride cell number/morphometrics and serum electrolyte levels were investigated for the marine teleost Sparus sarba. Groups of fish received intraperitoneal injections of cortisol at a concentration of 4 micrograms/g body weight, daily, over a seven-day period. This dose of cortisol was sufficiently high enough to maintain a condition of hypercortisolemia as serum cortisol levels in treated fish were eleven fold higher than controls at time of sacrifice. By using branchial Na(+)-K(+)-ATPase alpha- and beta-subunit cDNA clones we were able to demonstrate that cortisol administration to S. sarba caused a significant elevation in the abundance of alpha-mRNA whereas the levels of beta-mRNA were unchanged. In addition Na(+)-K(+)-ATPase activity remained unaltered by cortisol administration. Branchial chloride cell number, exposure, apical area as well as serum Na+ and Cl- levels remained unchanged after cortisol administration. The results of this study suggest that elevated cortisol level may not necessarily translate into modulated branchial Na(+)-K(+)-ATPase activity and chloride cell function in hypo-osmoregulating marine fish.

Animals↗