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Biomedical subjects

S Richardson

Publications and source records attributed to S Richardson.

At least 19 recordsLinked to original sources
PubMed1997

Do triage nurse-initiated X-rays for limb injuries reduce patient transit time?

Patients with isolated limb injuries are often required to wait a long time for treatment and investigation in emergency departments. It was hypothesized that allowing triage nurses to initiate X-rays would reduce transit times for these patients. A prospective, randomized comparison trial of 175 patients was conducted, comparing transit times between a group of patients who had X-rays initiated at triage and a group which did not. No statistically significant reduction in transit time was demonstrated by this change in practice, either for a group who had sustained fractures or for one which had not. Despite this finding, staff and patient satisfaction with this change in procedure was high. This justifies continuation of the practice and further research.

Adolescent↗
PubMed1997

Modelling the annual risk of tuberculosis infection.

BACKGROUND: Tuberculosis has been declining in developed countries for a long time, as a result of the intrinsic epidemiological characteristics of this disease, combined with improvement in the standard of living and more recently the use of antibiotics. In these low prevalence countries, decisions concerning the objectives of tuberculosis programmes have to be taken and the consequences of short term changes in the sanitary situation have to be assessed. METHODS: A deterministic model, without age structure, of the dynamics of pulmonary tuberculosis is proposed. The model extends that of Waaler and is intended to be more suitable for application to developed countries. The flows between seven subgroups of population, based on the natural history of the disease, are modelled and vaccination is taken into account. Values of model parameters and initial prevalences were deduced from published data. RESULTS: As a first step, qualitative comparisons are performed between the model-predicted decline in the annual risk of infection (ARI) and data from the Netherlands tuberculosis survey. Using parameter values suited to France, our model shows that the predicted decline is slower in France than in the Netherlands; a result which tallies with epidemiological observations. Uses of the model as a decision tool are illustrated in two cases, that of ending systematic BCG vaccination and that of a sudden increase in the number of infectious cases.

Epidemiologic Methods↗
PubMed1996

Cathepsin K, but not cathepsins B, L, or S, is abundantly expressed in human osteoclasts.

Random high throughput sequencing of a human osteoclast cDNA library was employed to identify novel osteoclast-expressed genes. Of the 5475 ESTs obtained, approximately 4% encoded cathepsin K, a novel cysteine protease homologous to cathepsins S and L; ESTs for other cathepsins were rare. In addition, ESTs for cathepsin K were absent or at low frequency in cDNA libraries from numerous other tissues and cells. In situ hybridization in osteoclastoma and osteophyte confirmed that cathepsin K mRNA was highly expressed selecively in osteoclasts; cathepsins S, L, and B were not detectable. Cathepsin K was not detected by in situ hybridization in a panel of other tissues. Western blot of human osteoclastoma or fetal rat humerus demonstrated bands of 38 and 27 kDa, consistent with sizes predicted for pro- and mature cathepsin K. Immunolocalization in osteoclastoma and osteophyte showed intense punctate staining of cathepsin K exclusively in osteoclasts, with a polar distribution that was more intense at the bone surface. The abundant expression of cathepsin K selectively in osteoclasts strongly suggests that it plays a specialized role in bone resorption. Furthermore, the data suggest that random sequencing of ESTs from cDNA libraries is a valuable approach for identifying novel cell-selective genes.

Amino Acid Sequence↗
PubMed1996

Nutrition assessment in long-term care facilities.

Elderly LTCF residents pose a challenging problem in terms of nutrition assessment at all three levels: intake, macronutrient, and micronutrient. In terms of macronutrient status, the focus of this work, newer techniques such as BIA and indirect calorimetry offer the promise of more accurate and widespread assessment in LTCFs. Future work will need to focus on the cost-effectiveness of this approach and on demonstrating that improved nutrition assessment can lead to better nutrition therapy and improved outcome.

Aged↗
PubMed1996

Gamma delta T lymphocyte regeneration after T lymphocyte-depleted bone marrow transplantation from mismatched family members or matched unrelated donors.

The recovery of gamma delta T lymphocytes was studied in 31 recipients of T cell-depleted allogeneic bone marrow (BMT) to determine if the dynamics of reconstitution could be related to graft-versus-host disease (GVHD) or other complications of marrow transplantation. Two distinct patterns of regeneration were apparent. In 12 patients, there was a progressive rise in both the percentage and the absolute number of peripheral blood gamma delta T cells over the first year post-transplantation, but these increases never breached levels found in 14 healthy donors. Each of the 19 remaining patients had abnormally high proportions and numbers of gamma delta T cells on at least two occasions following transplantation. The clinical factor that best explained these observations was the frequency of intercurrent infections. Of 19 patients with abnormally increased percentages and numbers of gamma delta T lymphocytes, 18 had one or more episodes of confirmed viral or fungal infection, contrasted with only two of 12 in the comparison group (P < 0.001). There was no significant association of gamma delta T cell recovery patterns with the presence of GVHD (P = 0.33). We conclude that the recovery of gamma delta T lymphocytes after marrow transplantation may vary. Supranormal levels of this T cell subset are associated with infection and may contribute significantly to cellular immune defenses against fungal or viral disease.

Adolescent↗
PubMed1996

Breastfeeding prevalence among six-week-old infants at University Hospital of the West Indies.

Eight-five (85) mothers attending postnatal and well baby clinics were interviewed at six weeks post-partum regarding breastfeeding. An overall prevalence of 98.8% at six weeks of age was seen, with an exclusive breastfeeding rate of 37.6%. Older maternal age and multiparity favoured exclusive breastfeeding. There was no significant association between pattern of breastfeeding (exclusive versus partial) and employment or union status. Breastfeeding was found to favour good weight gain in normal birthweight babies. Normal birthweight babies who were exclusively breastfed had a higher mean weight gain than the exclusively breastfed low birthweight infants, who in turn had better weight gain when partially breastfed.

Adolescent↗
PubMed1996

Frontier nursing: nursing work and training in Alberta, 1890-1905.

This article analyzes the relationship of nursing work and training from 1890 to 1905 in that part of the North West Territory which in 1905 became the province of Alberta. Primary (archival) and secondary (published) data are analyzed to determine the nature of salaried nursing work, how nurses were recruited, the conditions of employment, how women were prepared for nursing work, and the relationship between hospital training programs and the salaried work of graduate nurses. Prior to 1905, most graduate nurses in Alberta were employed in hospitals. Their work involved administration as well as attending to patients and assisting physicians. Hospital boards had difficulty recruiting graduate nurses and began training programs to remedy their labour shortage. Programs were begun by the Medicine Hat General Hospital in 1894 and the Calgary General Hospital in 1895. Hospitals with training programs soon came to rely on pupil nurses for staffing. The success of these programs stimulated other Alberta hospitals to begin training programs, and by 1915 there were 10 programs in existence. Graduates of hospital programs were expected to be entrepreneurs, seeking employment in private practice and being reimbursed on a free-for-service basis by their patients. Although they were not designed to prepare nurses for private practice, hospital training programs did achieve some integration between hospital and home nursing work, partly because the primitive conditions of Alberta hospitals matched those of the ranches, homesteads, and even town homes. Pupil nurses became oriented to private duty when they were "hired out" during their period of training to care for ill individuals in their homes.

Alberta↗
PubMed1996

[Current developments in biostatistics].

Recent developments in biostatistics in three key areas: survival analysis of censured data, generalised linear models for correlated data, Bayesian modelling of complex data, are presented. Particular emphasis is placed upon illustrating common trends in these areas, in particular advances in computer intensive methods, the development of unifying modelling structures and the increasing variety of complex biomedical problems which can be realistically analysed.

Bayes Theorem↗
PubMed1995

Polyadenylic-polyuridylic acid enhances the natural cell-mediated cytotoxicity in patients with breast cancer undergoing mastectomy.

BACKGROUND: Surgical procedures suppress host antitumor defense mechanisms, which may increase the risk of metastatic tumor dissemination. We have evaluated the effects of the biologic response modifier polyadenylic-polyuridylic acid (PAPU) on natural cytotoxicity in patients with breast cancer undergoing operation. METHODS: PAPU (150 mg) or placebo was given intravenously during the perioperative period (preoperative, days -1 and 0; postoperative, days 1, 3, 5, 7, and 14). The function (chromium release assay) and number (flow cytometry) of natural killer (NK) cells were measured before operation (days -2 and -1), on the day of operation (day 0), and after operation (days 1, 2, 4, 6, and 18). RESULTS: Surgical procedures suppressed NK cell cytotoxicity in the placebo group on postoperative days 1 (p < 0.001), 4, 6, and 18 (p < 0.05), whereas inhibition on postoperative day 2 failed to reach significance. PAPU abolished this immunosuppression after operation. The NK cell activity was elevated when compared with the control group; it was significant (p < 0.05) on postoperative days 1, 2, 4, 6, and 18. Surgical procedures also reduced circulating NK cell numbers during the first postoperative week in the placebo group; the decrease was statistically significant on day 4. The decrease in NK cell numbers in the PAPU group was insignificant. CONCLUSIONS: PAPU prevented the decrease in the circulating number and cytotoxic activity of NK cells that occurred after operation and enhanced NK cell cytotoxicity. This may have important implications for patients with cancer undergoing major operation.

Adult↗
PubMed1995

Production of genetically modified Epstein-Barr virus-specific cytotoxic T cells for adoptive transfer to patients at high risk of EBV-associated lymphoproliferative disease.

EBV-induced lymphoproliferative disease (EBV-LPD) is a disorder most commonly associated with the immunocompromise that follows allogeneic organ transplantation. In patients receiving T cell-depleted bone marrow from HLA-mismatched or HLA-matched unrelated donors, the incidence of EBV-LPD is particularly high, ranging from 5 to 30%. Administration of EBV-specific cytotoxic T lymphocytes may be one means of preventing and treating this disease. We now describe a method that allows the routine and timely preparation of large numbers of such cells to allow their safe administration to bone marrow transplant recipients. We also describe how these cells may be genetically marked before infusion, to determine their fate and disposition in vivo.

Adolescent↗