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Biomedical subjects

Sharon Levy

Publications and source records attributed to Sharon Levy.

At least 19 recordsLinked to original sources
PubMed2006

Perfusion with lipopolysaccharide differently affects the secretion of tumor necrosis factor-alpha and interleukin-6 by term and preterm human placenta.

This study has compared the functional capacity of term and preterm placentas in terms of production of pro-inflammatory cytokines in a perfusion system reflecting their ability to react to inflammatory agents, such as lipopolysaccharide (LPS), mimicking the situation of chorioamnionitis. We have demonstrated that term placentas secrete higher levels of tumor necrosis factor (TNF)-alpha compared with preterm placentas. Moreover, TNF-alpha secretion was significantly higher after exposure to LPS in the maternal and fetal sides of term placentas. In contrast, in preterm placentas, only the fetal side responded with a significant increase in secretion of TNF-alpha after exposure to LPS. The maternal side of term placentas secreted significantly higher amounts of interleukin (IL)-6 compared with preterm placentas. Exposure to LPS significantly decreased IL-6 secretion from the maternal side in both term and preterm placentas. Moreover, the fetal side of term placentas secreted significantly lower amounts of IL-6 compared with preterm placentas. In summary, this study has indicated that term and preterm placental tissues have a differing responsiveness to LPS stimulation, with term placentas disposed to a higher TNF-alpha:IL-6 ratio. Release of cytokines into fetal circulation is less than into the maternal side. However, TNF-alpha is released into fetal circulation after LPS stimulation and this may be relevant to the etiology of chorioamnionitis.

Enzyme-Linked Immunosorbent Assay↗
PubMed2006

Drug testing of adolescents in ambulatory medicine: physician practices and knowledge.

OBJECTIVE: To determine physicians' knowledge of urine drug testing and usual practices when performing drug testing on adolescent patients at a time when interest in drug testing of adolescents is on the rise and physicians may be consulted for advice and requests to perform tests. DESIGN AND PARTICIPANTS: Multimodal survey conducted April to July 2004 consisting of 42 forced-choice response items. Participants were practicing physicians randomly selected from the national membership rolls of the American Academy of Pediatrics, Society of Adolescent Medicine, and American Academy of Family Physicians who provided care for 10 or more adolescents per week. We computed simple frequencies and sample design-adjusted 95% confidence intervals for each item. RESULTS: The survey was completed by 359 eligible physicians (response rate, 42%). More than 95% of respondents had ever ordered urine drug tests. Only 23% used an effective urine sample collection procedure, and only 7% used specific gravity and measurement of urine creatinine level to ensure validity of the sample, as recommended. When asked which drugs can be detected in routine panels, only 10% answered all items correctly, 47% did not know for 1 or more items, and 75% responded incorrectly for 1 or more items. CONCLUSIONS: Primary care physicians do not always use proper urine sample collection and validation procedures, and they are not aware of important limitations of drug testing. The primary care workforce is not prepared to assist with drug testing programs. Physicians who order these tests need more training and access to consultation with experts.

Adolescent↗
PubMed2006

Long-term results of "chemical sphincterotomy" for chronic anal fissure: a prospective study.

INTRODUCTION: Pharmacologic anal sphincter relaxants promote fissure healing; however, their effect is transient and the risk of late recurrence remains uncertain. METHODS: From August 1997 to August 2002, patients with chronic anal fissure attending our outpatient clinic were treated with a protocol that included: topical isosorbide dinitrate, 2.5 mg, or nifedipine, 0.2 percent t.i.d., or the combination of both. Botulinum toxin 20 units was injected to the internal anal sphincter to those who failed. All the patients were contacted and interviewed during November to December 2002. RESULTS: Follow-up was a median of 47.43 +/- 13 (range, 4.7-60) months. A total of 455 patients completed the study; 323 patients (71 percent) healed at follow-up ending: 170 of the healed patients had one or more recurrences that responded to further treatment (37.4 percent), whereas 153 patients (33.6 percent) healed and had no recurrences. One hundred thirty-two patients (29 percent) did not heal and were referred to lateral sphincterotomy. Long intervals between symptoms appearance and treatment initiation decreased healing and increased recurrence rates (P = 0.03 and 0.01 respectively). CONCLUSIONS: Topical treatment is effective for patients with chronic anal fissure, at short-term and long-term periods. Because for many patients it is not a definitive treatment, it can be offered to those who are ready to receive repeated treatments. Longer intervals between symptom appearance and treatment initiation negatively affects fissure healing and recurrence rate.

Adolescent↗
PubMed2006

Drug testing of adolescents in general medical clinics, in school and at home: physician attitudes and practices.

PURPOSE: To determine (1) whether physicians agree with recommendations for home and school drug screening, (2) under what circumstances physicians recommend urine drug tests for adolescents, and (3) how physicians manage adolescent patients with positive results. Few clinical practice guidelines have been published on urine drug testing of adolescents, and it is not known when physicians recommend this procedure or how they manage positive results. METHODS: Multi-modal survey of a nationally representative sample of physicians conducted April-July 2004. We computed simple frequencies and used backwards selection logistical regression to determine if there were differences in agreement or practices among physicians from different specialties (pediatrics, family medicine, adolescent medicine) or by demographic factors (physician age, gender, practice type or location). RESULTS: A total of 359 physicians (43% after eliminating ineligibles) completed the survey. Thirty-eight percent would recommend a drug test if were required to return to school, 41% if a parent was concerned, and 46% based on history (without a parent's concern). Forty-eight percent of physicians would share a positive drug test result with parents. A large majority (83%) disagreed with high school drug testing programs. CONCLUSIONS: There is little consensus among physicians regarding the indications for drug testing in the general medical clinic. However, most disagree with school drug testing programs. There is little consistency among physicians in how to proceed when a urine drug test is positive. Professional organizations should consider publishing clinical practice guidelines in order to assist physicians in using this procedure effectively.

Adolescent↗
PubMed2006

Recent trends in adolescent substance use, primary care screening, and updates in treatment options.

PURPOSE OF REVIEW: To provide a brief overview on trends in common substances of abuse in adolescents, a summary of tools to evaluate adolescent substance abuse in an outpatient setting, and an update of outpatient and inpatient treatment options. RECENT FINDINGS: Recent national data suggest an overall slight decline in the use of tobacco, crystal methamphetamine, heroin, and club drugs. No significant change was noted in the use of alcohol, marijuana, and cocaine. Yearly screening of all adolescents for substance use is recommended. This can be accomplished in an office setting using mnemonics, structured interview techniques, and brief screens for substance abuse. If a problem is identified, various outpatient and inpatient treatments are available. Individual, family, and group therapy methods are available. Other options include acute detoxification programs, partial hospitalization, acute residential treatment, residential treatment centers and wilderness programs. Pharmacological treatments are available for nicotine, alcohol, and opioid addiction. SUMMARY: Tobacco, alcohol, marijuana, and other drugs remain a significant problem among adolescents in the United States. Pediatricians should screen and assess all adolescents on a yearly basis. If a problem is identified, there are many options for treatment, including pharmacologic treatment as well as individual, family, or group therapy in an inpatient or outpatient setting.

Adolescent↗
PubMed2006

A Tartan Warning: Results from the Royal College of Nursing (Scotland) on-line surveys.

Rapid advancements in Information and communication technologies are set to revolutionise the National Health Service across UK and billions of pounds are spent on modernising the service. The technology enabled service in Scotland will have a considerable impact on the working lives of care providers. Nursing professionals, being the largest single professional group in the care service, are likely to be the most affected by it. Early consultations, dissemination of appropriate information and involvement of nurses, health visitors and midwives is vital for a successful Scottish e-Health programme. However, results from the Royal College of Nursing 2004/5 on-line surveys, reported here, suggest that the majority of respondents remain unaware of Scottish e-Health developments. The authors argue that more focused action is needed to enable more nurses to get involved in the design and implementation of new clinical systems.

Awareness↗
PubMed2005

Motivational interviewing for adolescent substance use: a pilot study.

We developed and pilot tested a 2-session motivational interviewing intervention for substance use among 14- to 18-year-old medical patients. Recruitment and retention were more challenging than anticipated. A substantial number of completers reduced their use of substances and risk of driving after drinking during the 3-month follow-up period.

Adolescent↗
PubMed2005

Teaching paediatric residents about learning disorders: use of standardised case discussion versus multimedia computer tutorial.

BACKGROUND: We developed a standardised case-based educational exercise on the topic of childhood learning disorders, and a multimedia computerised adaptation of this exercise, as part of a national curriculum project based on the Bright Futures guidelines. OBJECTIVE: To explore resident perceptions of the facilitated case discussion (FCD) and the computerised tutorial (CT). DESIGN: Quasi-randomised comparison of two educational interventions. SETTING: Preclinic teaching conferences at a large urban children's hospital. PARTICIPANTS: A total of 46 paediatric residents years 1-3 assigned to either FCD (n = 21) or CT (n = 25). INTERVENTIONS: FCD residents met in groups of 8-12 with a trained facilitator for a structured case discussion, while CT residents worked in groups of 2-3 at a computer station linked to an interactive website. OUTCOME MEASURES: Participant responses during semistructured focus group interviews. ANALYSIS: Focus group transcripts, field notes and computer logs were analysed simultaneously using qualitative grounded theory methodology. RESULTS: Residents experienced CT as fun, offering flexibility, greater auditory and visual appeal and more opportunities for active learning. FCD allowed greater contact with expert faculty and made the material more relevant to clinical practice. FCD participants emphasised the clinical skills gleaned and stated that the learning experience would change their future patient management. Both groups reported that case discussion was more interactive than computer learning. Median time spent on learning was slightly shorter for the CT group. All groups of learners arrived at the correct final diagnosis. CONCLUSIONS: FCD and CT stimulate different types of learning among paediatric residents. Future studies are needed to determine how to integrate these two techniques to meet the learning needs of residents in diverse settings.

Boston↗
PubMed2005

An online survey of nurses' perceptions, knowledge and expectations of the National Health Service modernization programme.

We conducted an online survey to investigate nurses' perceptions, knowledge and expectations of the National Health Service (NHS) modernization programme in the UK. The questionnaire was available for 28 days via the Website of the Royal College of Nursing. The questionnaire was completed by 2020 nurses, midwives and health visitors working in all sectors of the health service in a wide range of specialties and environments of care. Less than one-quarter of respondents felt that they had adequate information about NHS information technology (IT) developments. In all, 528 (26%) said this was the first they had heard of the initiatives. Only 383 respondents (19%) felt adequately informed about the development of electronic health records; 470 (23%) felt inadequately informed and 456 (23%) had only heard something about it. The findings of this survey suggest that nursing staff are not widely aware of current IT plans and programmes in the NHS. They suggest that nurses also lack confidence in using advanced IT, which is compounded by lack of training.

Attitude of Health Personnel↗
PubMed2005

Asserting the right to life--a challenge to medical guidance on withdrawing treatment.

This paper analyses the English High Court decision of R (on the application of Burke) v General Medical Council and considers its implications for the future. Mr. Burke, relying on common law and the European Convention on Human Rights, succeeded in a challenge to the General Medical Council's Guidance on Withholding and Withdrawing Life-prolonging Treatment. He asserted his right to choose to be given treatment so as to live and condemned the Guidance as centred on the right to refuse treatment.

Fluid Therapy↗
PubMed2004

Test-retest reliability of adolescents' self-report of substance use.

BACKGROUND: Adolescent substance abuse is a serious problem for which effective interventions are needed. To conduct trials of new therapies, investigators need reliable means of identifying potential participants and of measuring outcomes. The objective of this study was to determine the 1-week test-retest reliability of the CRAFFT screening test and of the timeline follow-back (TLFB) calendar method for measuring alcohol, cannabis, and other drug use. METHODS: Ninety-three 12- to 18-year-old patients presenting for routine medical care to three urban adolescent clinics were administered the CRAFFT screen in both lifetime and past-year versions and a 90-day TLFB. Both measures were completed on the day of the clinic visit and again 1 week later. We computed kappa coefficients and the intraclass correlation coefficient (ICC) for the CRAFFT and computed the ICC separately for TLFB self-reports of alcohol and cannabis. RESULTS: For the CRAFFT, kappa for individual items ranged from 0.31 to 0.86, and the ICC was 0.93 (95% confidence interval, 0.90-0.95). However, the total score of the lifetime CRAFFT at time 2 was significantly lower than at time 1; there was no difference in time 1 and time 2 total scores for the past-year version. The ICCs for past-90-days TLFB variables were as follows: drinking days, 0.92; drinks per occasion, 0.87; cannabis days, 0.83; and joints per occasion, 0.76. Past-30-day and past-60-day intervals compared favorably to past-90-day intervals. CONCLUSIONS: The CRAFFT screen is a reliable means of screening adolescents for substance abuse, although we recommend using the past-year version. The TLFB is a reliable method of quantifying adolescents' alcohol and cannabis use at intervals of 30, 60, or 90 days.

Adolescent↗
PubMed2004

Double-blind, randomized, vehicle-controlled clinical trial of once-daily benzoyl peroxide/clindamycin topical gel in the treatment of patients with moderate to severe rosacea.

BACKGROUND: Systemic antibiotics such as tetracycline are well accepted as effective in treating the inflammatory papular/pustular phase of rosacea but may be associated with systemic side-effects. Few controlled data on the use of topical antibiotics in rosacea are available. OBJECTIVE: We evaluated the efficacy and tolerability of a fixed combination of 5% benzoyl peroxide and 1% clindamycin in a topical gel for the treatment of rosacea. Methods This was a 12-week, double-blind, vehicle-controlled, randomized, prospective, parallel-group study in 53 patients with moderate to severe rosacea. RESULTS: The mean percentage reduction in papules and pustules from baseline to the end of treatment was 71.3% in the benzoyl peroxide/clindamycin group (n = 26) and 19.3% in the vehicle group (n = 26; P = 0.0056). A significant (P = 0.0141) difference in favor of benzoyl peroxide/clindamycin was evident by the third week of treatment. Severity scores for erythema, papules/pustules, and flushing/blushing decreased more with benzoyl peroxide/clindamycin than with vehicle. Overall rosacea severity, Physician Global Assessment, and Patient's Global Assessment at the end of treatment were all significantly improved with benzoyl peroxide/clindamycin compared with vehicle (P = 0.0101, 0.0026, and 0.0002, respectively). Application site reactions were reported in four patients (14.8%) in the benzoyl peroxide/clindamycin group. CONCLUSION: A once-daily topical application of a combination of 5% benzoyl peroxide and 1% clindamycin is effective and well tolerated in patients with moderate to severe rosacea.

Administration, Cutaneous↗
PubMed2004

A review of Internet-based home drug-testing products for parents.

OBJECTIVE: To review home drug-testing products and the Internet-based recommendations intended for parents. METHODS: A qualitative review of drug-testing products and structured analysis of information presented on company Internet sites were conducted. Eight Internet sites that sold home drug-testing products and contained a "parent's section" were identified by Ixquick using the search term "home drug testing." Description and prices of products sold by each Internet site and recommended indications for testing, consent, collection procedures, and follow-up of positive and negative test results were researched. RESULTS: A variety of drug-testing products were available, including breath and saliva tests for alcohol, a multidrug panel hair test, and a variety of laboratory and instant urine tests. Prices ranged from 2.75 dollars for a single alcohol test to 89.00 dollars for a multidrug combination urine/hair package. A total of 14 indications for home drug-testing were cited; all sites claimed that drug testing was a way to know with certainty whether a child has used drugs. Only 1 web site made a clear statement against testing an adolescent against his or her will. Little information was presented on valid specimen collection procedures and the risks of false-positive and false-negative tests. Only half of the sites recommended that parents consult a professional if a test is positive. CONCLUSIONS: Pediatricians should advise parents of the limitations and potential risks associated with home drug-testing products.

Adolescent↗
PubMed2003

Perspectives on telecare: the client view.

We explored the attitudes and responses of older people to telecare technologies. Questionnaires were given to subjects in three locations: two day hospitals in Tayside (a region of north-east Scotland); five units of sheltered housing run by West Lothian local authority (in central Scotland); and five schemes of a private housing association across Tayside. There were 199 returned questionnaires (a 42% response rate). The sample was divided into two groups according to whether the subjects did agree or did not agree with the statement 'I would welcome technology that helps me to stay in my home even if it means losing some of the freedom and control I currently have'. 'Tele-receptive' individuals (n=127) were found to be significantly more likely both to feel excited about new technology and to feel that their age was not a barrier to further learning. The present study suggests that individuals receptive to telecare will tend to be younger (under 80 years) and will be satisfied clients of current health services. They are likely to express a wish to stay at home for as long as possible, even when they would need a lot of help or have to pay for care. They are also keen to use an interactive mode of communication for both social interaction and medical consultation.

Age Factors↗
PubMed2003

The lesser of two evils: a contextual view of the English case of the conjoined twins.

In 2000 conjoined twin girls were born in Manchester, England. They were joined in such a way that it was impossible to separate them to enable both twins to survive. Their bodies were fused at the lower abdomen and they shared an aorta and a bladder. Their arms and legs were at right angles to their conjoined trunk. The situation of the conjoined twins is of supreme importance as a private tragedy for their family. The resulting litigation also presents an important landmark in English law. In deciding the fate of the two children, the Court of Appeal provided an authoritative review, analysis and application of family law and medical law with regard to neonates. The most significant legal legacy of the case, however, may well be in the field of criminal law by way of the court's interpretation and application of the defences of necessity and self-defence.

Aorta, Abdominal↗
PubMed2002

Office-based intervention for adolescent substance abuse.

Because substance use is highly prevalent among teens, primary care clinicians may not be able to refer all adolescents to drug counselors or mental health care professionals. Pediatricians may therefore find it useful to use the basic principles of office intervention and reserve referral for those patients with the most significant drug and alcohol problems. Brief interventions have proven effective in reducing problematic drinking among adults, and early work among adolescents is promising. Effective interventions include feedback on risks and problems, an emphasis on personal responsibility, a menu of alternatives for change, an empathetic approach, and reinforcement of patient self-efficacy. Motivational interviewing is an effective means of enhancing success in counseling. When a referral is necessary, motivational interviewing can be used to maximize adherence.

Adolescent↗