PubMed Health⌕ Search

Biomedical subjects

W H Reid

Publications and source records attributed to W H Reid.

At least 37 records · Page 2Linked to original sources
PubMed1996

Chondroitin-6-sulphate incorporated into collagen gels for the growth of human keratinocytes: the effect of cross-linking agents and diamines.

This study demonstrates the effect of the glycosaminoglycans, hyaluronic acid and chondroitin-6-sulphate (Ch6SO4), diamines and a carbodiimide cross-linking agent on the growth of human epidermal cells on collagen gels. Ch6SO4 incorporated into collagen gels stimulated cell growth rate, but the effect was found to be inconsistent. We found that approximately 50% of the incorporated Ch6SO4 in the gels leached out into the growth medium after the first 3 d in culture, and this is thought to lead to the inconsistent cell growth response. In order to minimize the elution of Ch6SO4 from the gels and thereby maximize its effect on the growth of the keratinocytes, 1-100 micrograms ml-1 Ch6SO4 was added in the medium. The results showed that Ch6SO4 at these concentrations in the medium did not stimulate the cell growth on either plain collagen gels or gels containing 20% Ch6SO4. As an alternative strategy, 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide and diamines (putrescine or diaminohexane) were used to immobilize Ch6SO4 onto the collagen gels and to cross-link the gels. The cross-linking process partially prevented the elution of Ch6SO4 from the gels. Interestingly, only putrescine, not diaminohexane, promoted the growth of keratinocytes on the cross-linked plain collagen gels. We proposed to develop an artificial skin substitute containing putrescine as a growth factor for the human epidermal cells.

Analysis of Variance↗
PubMed1996

Water vapour transmission rates in burns and chronic leg ulcers: influence of wound dressings and comparison with in vitro evaluation.

One of the main functions of wound dressings is to control water vapour transmission rate (WVTR) from wounded skin. In this paper, the influence of hydrocolloid, knitted viscose and gauze dressings was evaluated through in vivo measurement of WVTR in burns and chronic leg ulcers utilizing an evaporimeter. The results suggest that the evaporative water vapour loss from exposed skin wounds depends mainly on the wound depth, and that chronic leg ulcers have the same level of the WVTR as full thickness burns. Compared with the knitted viscose and gauze dressings, hydrocolloid dressing has a greater effect on reducing evaporative water loss, with WVTR being 20-30% of that of exposed wounds under the conditions used in this study. This result is in agreement with that obtained in an in vitro evaluation.

Adult↗
PubMed1995

Trends in burn admissions in Scotland during 1970-92.

This retrospective study involved analysis of the data of the inpatients discharged with a diagnosis of burns, from various hospitals in Scotland, during the period 1970-92. There were 51,350 such inpatients all over Scotland, with an average annual rate of 2233 cases. Overall burn incidence in actual numbers was 43.7 per cent in < 15 year olds, 41.2 per cent in 15-64 year olds and 15.1 per cent in > or = 65 year olds. Burn rates per 100,000 population were highest in < 15 year olds and lowest in 16-64 year olds. The pattern of burn admissions has changed. Since 1987 the highest numbers of burn inpatients were the 16-64 year olds, followed by children, then the elderly. There has been a gradual but sustained fall in burns admissions in all age categories. The downward trend was statistically significant (t = 8.48, 21 d.f., P < 0.001). Though the population of the elderly (> or = 65 year olds) increased by about 13 per cent, the burn admissions and all deaths due to burns did not reveal an upward trend. The population of the old (81+ year olds) increased by 60 per cent during the same period. The incidence of burns was above average when > 80 year olds were considered separately, approaching the levels found in children. However the rate and incidence of burns in the 65-80 year olds resembled that of the younger age group (16-64 year olds). The total number of deaths due to burns and/or smoke inhalation has declined in all age groups and the decline has been statistically significant (chi-squared = 19.62, 1 d.f., P < 0.001). Maximum number of deaths occurred in > or = 65 year olds (44 per cent), followed closely by 16-64 year olds (43.5 per cent), and 12.5 per cent of deaths in adolescents and children. The decline was due to improved management of burns and a decrease in the number of patients having large body surface area burns.

Age Distribution↗
PubMed1994

Savings in hospital bed-days related to treatment with clozapine.

OBJECTIVE: The authors' aim was to determine whether clozapine was associated with a decrease in state hospital bed-days for patients with chronic schizophrenia. METHODS: Patients were started on clozapine in a state facility and were followed while taking the medication for 1.5 years (N = 172), two years (N = 86), and 2.5 years (N = 53). Patients' number of bed-days before starting clozapine was compared with those during the follow-up period. RESULTS: Bed-days were reduced by an average of 132 days per year after 1.5 years, 166 days per year after two years, and 201 days per year after 2.5 years (p < .001). During the final 180 days of each follow-up period, only 23 to 30 percent of patients were continuously hospitalized, compared with 56 to 64 percent before clozapine. Forty to 57 percent of patients had no hospital days at all during the last 180 days of follow-up. CONCLUSIONS: Based on hospital costs of $250 per patient per day, this reduction in bed-days could result in gross savings of about $33,000 per patient per year at 1.5 years, $41,500 per patient per year at two years, and $50,250 per patient per year at 2.5 years. Hospital patients are conspicuous targets for clozapine funding, since bed-days represent an easily measured expense. Nevertheless, community treatment should be an even higher priority, since most chronic mentally ill persons are outpatients.

Adult↗
PubMed1994

5-Carboxyfluorescein diacetate as a probe for measuring the growth of keratinocytes.

There is a requirement for a convenient and reliable method for evaluating the growth rate of human keratinocytes cultured on collagen-based substrates. Therefore, three methods of determining cell growth were first used to quantify the growth rate of the well-characterised L929 mouse fibroblast cell line on tissue culture plastic and the results compared. The methods used were the measurement of total cell protein, cell counting using an electronic Coulter counter and a fluorimetric assay employing 5-carboxyfluorescein diacetate (CFDA). The CFDA assay showed the highest correlation with seeding density of the L929 cells, and the lowest standard deviations. It was the most rapid and convenient method for processing large numbers of samples. Only viable cells can deacetylate the non-fluorescent CFDA to carboxyfluorescein, which is fluorescent and accumulates inside the cells. Therefore, the assay specifically quantifies only viable cells. Subsequently, this assay has been successfully applied to the measurement of human keratinocyte growth rate on collagen gels and sponges. We have demonstrated that keratinocytes grow equally well on gels and sponges, and that media containing low calcium concentrations (0.09 mM) favour rapid proliferation of keratinocytes. Our results show that the CFDA assay is an accurate, reliable and convenient method for quantifying cell growth in vitro. It is particularly valuable when growing cells on optically opaque substrata, such as collagen sponges, where growth cannot be monitored daily by microscopy.

Animals↗
PubMed1994

The treatment of psychosis: resetting the drug cost 'thermostat'.

Cost-effective means different, sometimes competing things to different observers. In addition to well-known clinical benefits, large payors such as state governments think clozapine and similarly effective antipsychotic medications will yield immediate dollar savings. They do not consider the need to shift existing resources to community follow-up, the time required to phase out hospital units, and the backlogs of new patients. In today's financial climate, legislators and other elected officials are reluctant to invest in expensive medicines and then wait for long-term savings. We must convince those who hold the purse strings that acceptable antipsychotic drugs will be expensive for at least several years to come, until more new and generic drugs appear. We must tell them firmly that our patients, doctors, and mental health systems cannot afford to rely on older medications, even though they seem inexpensive. The drug cost "thermostat" should be reset so that payors and budget reviewers realize that safe and adequate antipsychotic medications often cost $5 to $25 a day. If new dollars are not available, existing budgets may have to be restructured. For most patients, anything else is substandard.

Antipsychotic Agents↗
PubMed1994

Oral health of institutionalized individuals with mental retardation.

A random 10% (n = 702) of the residents of the Texas Department of Mental Health and Mental Retardation (TXMHMR) institutions were given dental examinations by the first author. Findings were compared with results from a similar survey of 1,077 residents by the same investigator 9 years earlier. Data were analyzed for oral pathology, unmet dental needs, contribution of dental care to habilitation, and effectiveness of the dental service system. Some improvements were found in dental condition, although the results were sometimes difficult to interpret. Some differences may be related to changes in client age and average length of stay and to a shift toward institutionalization of individuals with more severe disabilities. Other differences appear to be the result of better dental care in state institutions.

Adolescent↗
PubMed1993

Clozapine use by state programs: public mental health systems respond to a new medication.

The authors present data from a national survey of state departments of mental health showing that two years after reaching the U.S. market, clozapine is available to only a small fraction of the patients whom it might benefit. The primary continuing hurdle for the public sector, where most schizophrenic patients get their care, is funding. Several arguments support the use of clozapine in state mental health systems: it is the most effective or only effective medication for many patients, it can decrease the enormous costs of schizophrenia and related disorders, and access to the medication has become an important issue for advocacy groups and other mental health activists. Two years of experience with clozapine in the Texas mental health system have shown that availability of clozapine in the community is a vital factor for successful use of the drug in hospitals. The authors discuss ways to encourage outpatient clozapine programs that are critical to successful treatment in both the hospital and the community.

Chronic Disease↗
PubMed1993

Electroconvulsive therapy.

Electroconvulsive therapy (ECT) is a safe, effective, valuable treatment for serious affective disorders (eg, major depression). Sometimes indicated for other, occasionally nonpsychiatric, medical conditions, ECT is a moderately complex procedure for which training is provided routinely during psychiatric residency. Although temporary confusion and amnesia are expected immediately after treatment, no reliable data suggest that permanent memory loss or cognitive deficit is caused by modern ECT. Indeed, because severe depression itself often causes both memory and cognitive deficits, ECT's remarkable therapeutic effectiveness is associated with long-term improvement in cognition, learning ability, and memory for many patients. Controversy over safety and effect on memory is fueled largely by public misinformation.

Adolescent↗
PubMed1992

The use and reliability of psychiatric diagnosis in forensic settings.

The clinical professional encounters conflict whenever he or she enters the courtroom. The psychiatrist's approach must not be simply diagnostic or simply legal. We cannot shed our clinical identity; indeed, the court depends on our clinical identity and expertise in its search for the truth. The psychiatric expert must be able to translate his or her findings for the court, but these findings must come from clinical experience, not some solely legal perspective. The legal system needs our knowledge about the interfaces of mental illness, function, and behavior. After we provide our opinions, however, the legal issues must be left to the lawyers and the final determinations left to the judge or jury.

Criminal Law↗
PubMed1991

Increased airways reactivity after smoke inhalation.

13 fire victims who required treatment after smoke inhalation underwent lung function assessment within 3 days of injury and 3 months later. Initial airways hyperreactivity improved over this period, but FEV1 and airways specific conductance did not change significantly. There was a strong correlation between exposure carboxyhaemoglobin concentration (an indicator of smoke exposure) and initial airways specific conductance (r + 0.79; p = 0.006). Airways obstruction after smoke inhalation in house fires may be more common and more persistent than is generally recognised. Early lung function tests would allow the incidence of pulmonary complications after smoke inhalation and the potential benefits of early use of inhaled antiinflammatory drugs to be assessed.

Adult↗
PubMed1991

Total quality management strategies in mental health systems.

This paper introduces the concept of total quality management (TQM) to top managers of mental health systems. While TQM is a philosophy of management at the cutting edge of U.S. business, it has only recently entered the vocabulary of health care managers. To our knowledge, TQM has yet to be systematically applied to the state mental health service delivery system. After introducing some key concepts and techniques, we develop two extensive examples of how TQM can be integrated into the already existing management structure of the psychiatric hospital.

Hospital Units↗
PubMed1991

Alveolar macrophage chemotaxis in fire victims with smoke inhalation and burns injury.

In vitro migration of alveolar macrophages was studied in 24 fire victims and 19 controls; all subjects were cigarette smokers. Unstimulated (P = 0.01) and stimulated migration towards casein-(P = 0.01) and zymosan-activated serum (P = 0.002) of macrophages from smoke inhalation patients (SI) (n = 19) was increased when compared to control subjects (CS). Migration of alveolar macrophages from patients with burns without smoke inhalation (burns only, BO) was not increased. Patients with smoke inhalation and no burns (smoke only, SO) (n = 9) had increased migration when compared to controls but this was not statistically significant. Patients with smoke inhalation and burns (SB) (n = 10) had increased unstimulated migration (P = 0.01) and increased migration towards casein (P less than 0.005), ZAS (P less than 0.002) and F-met-leu-phe (P less than 0.05) when compared to controls (CS). Lavage fluid from the fire victims displayed chemotactic activity towards normal human neutrophils and its analysis for the components of the complement cascade proved positive (Clq, Clr, Factor B and C3). These data suggest that activation of alveolar macrophages may contribute to the development of pathophysiological changes in patients with smoke inhalation (SI) and particularly those with smoke inhalation and burns (SB).

Burns↗
PubMed1990

Q-switched ruby laser treatment of tattoos; a 9-year experience.

Nine years of clinical experience of the application of the Q-switched ruby laser to the removal of tattoos is presented. This laser achieves optimal removal of blue/black amateur tattoos by its selective interaction with the dermal suspensions of pigment which constitute the tattoos. The scar free cosmesis thus achieved is a considerable improvement on non-specific laser techniques whereby the laser is absorbed to a comparable degree in both pigmented and non-pigmented tissue. Long-term results are analysed and it is noted that a variety of professional tattoos may also respond to treatment. The mechanisms and appearance are discussed and correlated with short-term healing processes. It is found that power densities in the range 1200-2800 GW/m2 are most suitable. Appropriate dosimetry can be witnessed by the appearance of opaque intradermal vacuoles corresponding to the vaporization of the tissue water surrounding the pigment suspensions. Treatment by Q-switched ruby laser offers a viable scar-free option for a wide range of dark tattoos, leading to a more acceptable clinical outcome in most cases than other current therapies.

Dermatologic Surgical Procedures↗
PubMed1990

Changes in alveolar macrophage, monocyte, and neutrophil cell profiles after smoke inhalation injury.

Thirty two fire victims with smoke inhalation, with or without burns, and 26 control subjects had bronchoalveolar lavage performed. Cell yields and differential cell counts were assessed. All patients and controls were cigarette smokers. Patients with smoke inhalation (SI) injury generally showed higher total bronchoalveolar lavage (BAL) cell yields, and this was significant on repeat lavage from 12 patients. The increase was almost entirely due to an increase in the proportion of neutrophils in patients with smoke inhalation alone (S) and those with cutaneous burns as well as smoke inhalation (S + B). On sequential lavage of 12 patients with smoke inhalation (SI) the proportion of neutrophils had increased; this was significantly higher than on initial lavage. Using various macrophage markers, the proportions of macrophage subgroups were determined. There was an increase in UCHM1 and RFD9 positive cells in each subgroup: the increase in UCHM1 positive cells was significant in patients with burns as well as smoke inhalation, and the increase in RFD9 positive cells was significant in patients with smoke inhalation alone. Assessment of the role of such cells in the development of acute lung injury (such as adult respiratory distress syndrome) may be important in our understanding of the mechanisms entailed.

Bronchoalveolar Lavage Fluid↗
PubMed1990

Access to care: clozapine in the public sector.

Clozapine holds great clinical promise for some chronic schizophrenic patients. However, limitations on access to the drug by the largest subgroup who need it, the indigent, are causing frustration for patients, their families, physicians, and public-sector mental health systems. The drug is available only through the manufacturer's proprietary monitoring system; many public-sector professionals and agencies feel that the system is overpriced, is unfairly exclusive, and has thus far kept the drug out of reach of most patients who need it. Arguments that patient improvement will lead to dollar savings in the long run seem overly optimistic. The ethical issue of access to treatment remains. The author discusses these and related issues and reports early experience from several public mental health systems.

Agranulocytosis↗