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Biomedical subjects

A Campbell

Publications and source records attributed to A Campbell.

At least 325 records · Page 18Linked to original sources
PubMedDate not supplied

Suppressed natural killer cell activity in patients with silicone breast implants: reversal upon explantation.

We have previously shown that natural killer (NK) cell activity is significantly suppressed in patients with silicone breast implants. These patients were symptomatic and the suppression of natural killer cell activity was associated with additional significant immunological abnormalities (Vojdani et al., 1992a). Our studies have recently been confirmed by Smith et al. (1994), who described natural killer cell activity suppression following exposure to silicone gel, and reversal upon removal of the gel. This study has been designed to evaluate natural killer cell activities in symptomatic women with silicone breast implants and again after explantation of the implants. Each patient served as her own control. Our findings show a marked significant increase in previously suppressed natural killer cell activity in 50% of the patients. In the other 50%, no change or suppressed NK activity was observed. These findings are compatible with recent studies in experimental animals, which show that administration of silicone reduces natural killer cell activity, and that this is reversible upon removal of the silicone. Since NK cells are important in the control of tumor cell growth, we propose here that patients with reduced NK cell activity are at a higher risk of developing cancer, a concept recently described in experimental animals (Potter et al., 1994; Salhon et al., 1994).

Breast Implants↗
PubMedDate not supplied

Norplant: systemic immunological complications--case report.

The Norplant* system is composed of a set of six Silastic* (silicone polydimethysiloxane) capsules measuring 34 mm by 2.4 mm, each containing 36 mg of levonorgestrel and sealed at either end with a medical grade silicone elastomer adhesive. Levonorgestrel is a synthetic progestin, widely used in combination oral contraceptives and in single-agent "mini-pills". In a procedure completed in less than 15 minutes by an experienced physician, the six capsules are surgically implanted subdermally, most commonly on the inside of the left upper arm. The levonorgestrel diffuses through the Silastic material into the blood stream and is carried to the target organs. Ovulation is suppressed in the majority of the cycles during the first years of use, and cervical mucus is thickened, inhibiting sperm penetration. During use, the effective delivery of levonorgestrel is about 30 mcg/day from day 500 to day 2300. Recently, we have seen patients with complications from Norplant, and we describe here a patient who presented with systemic complications resulting from both the endocrinological aspects of Norplant and the immunological aspects of the Silastic implants. To our knowledge this is the first case report in the western medical literature describing systemic immunological complications as a result of a failed Norplant device.

Adult↗
PubMedDate not supplied

Are we listening to children's views about their treatment?

This article examines how the recommendations of a recent report 'Listening to Children's Views: The Findings and Recommendations of Recent Research' (O'Quigley, 2000) can be used within the healthcare environment in order to obtain successfully children's views about their medical treatment. Sometimes, the treatment proposed is objected to by the child and, occasionally, the approval of the courts is sought in order to allow treatment to proceed. At times like this, the child's voice seems muted. These are exceptional cases, but every day children's nurses have to look after children of all ages and act as advocate, adviser, counsellor and nurse. Autonomy, confidentiality and cultural sensitivity are dominant themes in the O'Quigley report. Using these themes, this article examines how, and why, children's nurses should adopt these recommendations to help ensure that the voices of adolescent children, in particular, are both heard and listened to by decision makers.

Communication↗
PubMedDate not supplied

Reliability and validity of a parent questionnaire on childhood motor skills.

OBJECTIVE: As the consequences of clumsiness in children become better understood, the need for valid measurement tools is apparent. Parent report has the potential for providing historical knowledge of the child's motor skills, as well as perceptions of their children's motor difficulties. The objective was to develop a parent questionnaire to identify motor difficulties in children. METHOD: A sample of 306 children participated in the development of a 17-item parent questionnaire, called the Developmental Coordination Disorder Questionnaire (DCDQ). Internal consistency, concurrent and construct validity were examined. RESULTS: The DCDQ proved capable of distinguishing children who had motor problems (as measured by standardized tests) from children without motor problems. Correlations with standardized tests were significant. Two other studies confirmed the construct validity of the DCDQ. Factor analysis revealed four distinct factors, useful in defining the nature of the difficulties. CONCLUSION: The DCDQ is a succinct and useful measure for use by occupational therapists.

Adolescent↗
PubMedDate not supplied

The CQI pathway.

The use of CQI to identify issues, processes, and methods of quality management was a favorable learning experience for the Botsford General rehabilitation staff. They experienced improved interdepartmental communication and enhanced understanding of the roles and responsibilities of other disciplines, as well as the overall CQI process. The use of the CQI process accomplished the objective of decreasing the length of stay of patients with amputations by 6 to 8 days, thereby reducing costs. Use of flowcharting to outline a typical patient stay from admission to discharge helped to clarify potential problems, eliminate unnecessary steps, and reduce documentation time. Although rehabilitation services are currently exempt from diagnosis-related group application, in order to maintain cost efficiency and service effectiveness, it behooves us to continually track and stay in line with the competition. In light of anticipated health care reforms, the rehabilitation industry must be proactive in its management of service delivery with an emphasis on functional outcomes. Botsford General's success with using a critical pathway for the amputee program as part of a program evaluation system will lead to the development of critical pathways for additional diagnoses.

Algorithms↗
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What's wrong with strategy?

Why is it that successful strategies are rarely developed as a result of formal planning processes? What is wrong with the way most companies go about developing strategy? Andrew Campbell and Marcus Alexander take a common sense look at why the planning frameworks managers use so often yield disappointing results. Companies often fail to distinguish between purpose (what an organization exists to do) and constraints (what an organization must do in order to survive), the authors say. Many executives mistakenly believe, for example, that satisfying stakeholders is an objective that drives thinking about strategy. In fact, it's a constraint, not an objective. Companies that don't win the loyalty of stakeholders will go out of business. Strategy is not about plans but about insights, the authors add. Strategy development is the process of discovering and understanding insights and should not be confused with planning, which is about turning insights into action. Furthermore, because executives develop most of their insights while actually doing the real work of running a business, it is important for companies not to separate strategy development from implementation. Is there a better way? The answer is not new planning processes or more effort. Instead, managers must understand two fundamental points: the benefit of having a well-articulated, stable purpose and the importance of discovering, understanding, documenting, and exploiting insights about how to create value.

Commerce↗
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Desperately seeking synergy.

Corporate executives have strong biases in favor of synergy, and those biases can lead them into ill-advised attempts to force business units to cooperate--even when the ultimate benefits are unclear. But executives can separate the real opportunities from the mirages, say Michael Goold and Andrew Campbell. They simply need to take a more disciplined approach to synergy. These biases take four forms. First comes the synergy bias, which leads executives to overestimate the benefits and underestimate the costs of synergy. Then comes the parenting bias, a belief that synergy will be captured only by cajoling or compelling business units to cooperate. The parenting bias is usually accompanied by the skills bias--the assumption that whatever know-how is required to achieve synergy will be available within the organization. Finally, executives fall victim to the upside bias, which causes them to concentrate so hard on the potential benefits of synergy that they overlook the possible downside risks. In combination, these four biases make synergy seem more attractive and more easily achievable than it truly is. As a result, corporate executives often launch initiatives that ultimately waste time and money and sometimes even severely damage their businesses. To avoid such failures, executives need to subject all synergy opportunities to a clear-eyed analysis that clarifies the benefits to be gained, examines the potential for corporate involvement, and takes into account the possible downsides. Such a disciplined approach will inevitably mean that fewer initiatives will be launched. But those that are pursued will be far more likely to deliver substantial gains.

Cooperative Behavior↗
PubMedDate not supplied

Tailored, not benchmarked. A fresh look at corporate planning.

In today's competitive markets, every company has an action plan. Yet for most managers, the processes used to create these plans don't work. The root of the problem, suggests Campbell, may be that too many companies benchmark their processes and by doing so, prevent managers from focusing on what is unique to their situation. Good planning processes, the author argues, are not generic processes but ones in which both analytic techniques and organizational processes are carefully tailored to the needs of individual businesses and to the skills of corporate managers. The author cites examples of three companies that have successfully individualized their processes: Granada, Dow Chemical Company, and Emerson Electric. A mature electrical-products business such as Emerson, he says, has different planning needs than a fast-growing entertainment business like Granada or a highly cyclical chemicals business like Dow. Different chief executives may have different insights about how to go about adding value. Take the CEOs of Granada and Dow. Both set tough targets to stretch their businesses, but the way each CEO gets his managers to commit to his targets differs considerably. Bad planning can actively destroy value, the author says. It wastes people's time and money. It sends the wrong signals to managers. It can even lead managers to follow bad advice. That's why managers should go to the effort of reexamining and possibly changing their company's planning process.

Benchmarking↗
PubMedDate not supplied

Immune functional impairment in patients with clinical abnormalities and silicone breast implants.

Silicone, previously thought to be a biologically inert and harmless material, has now been reported to elicit antibody response and to be responsible for adjuvant disease in humans. The present study was designed to evaluate the immune function of forty individuals who had undergone silicone breast augmentation for a period of longer than ten years and who were compared with 40 sex and age-matched controls. The following immunological functions were studied: lymphocyte subset analysis, lymphocyte mitogenic response, NK cytotoxic activity and markers for autoimmunity such as ANA, rheumatoid factor immune complexes such as smooth muscle, myelin, and thyroid, and tissue antibodies. Results of lymphocyte subpopulation analysis showed significantly elevated T helper/suppressor ratio in 60% and significantly decreased T helper/suppressor ratio in 7.5% of the silicone implant group, while the control group showed increased helper/suppressor ratio only in 10% of tested individuals and no significant decrease in the T helper/suppressor ratio. There was 20% inhibition in T cell mitogenic responses in the silicone implant group, which is significant when compared to the controls. When NK cytotoxic activity was compared between the two groups, significant inhibition in the ability of lymphocytes to kill tumor target cells was observed in the silicone implant group. This inability of target cell lysis was attributed to the demonstrated lack of granularity of NK cells from the silicone implant group. There was significant increase in: immune complexes, anti-nuclear antibodies, anti-thyroid antibodies, anti-striated muscle cell antibody, and anti-myelin basic protein antibodies. These immunological abnormalities in individuals who underwent silicone breast augmentation indicate a mechanism of tissue injury to these patients, causing autoimmune diseases or syndromes. Since autoimmunity in some other conditions is associated with abnormalities in the HLA serotyping system, and since some collagen vascular diseases have been associated with a higher incidence of the HLA serotyping system, it is recommended that HLA studies be included in future investigations of immune-mediated abnormalities associated with silicone breast augmentation. Our findings here show definite abnormalities of the T helper/suppressor ratio, increased autoimmunity, as well as increased production of immune complexes. Silicone implants have been used in cosmetic and reconstructive surgery more than 30 years (Brown et al., 1960). The gel used in the implant is produced from silicone, which is then related with methyl chloride and polymerized to form stable polydimethylsiloxane (Brown, et al., 1960). There have been a number of reports describing the occurrence of connective tissue disease in patients after the implantation of silicone.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMedDate not supplied

Distance no object for learning and treatment.

Telemedicine has up to now been mainly concerned with the application of new technology to the practice of medicine. However, there are potential applications for nursing and midwifery. This paper describes how it has been employed and looks at potential applications being investigated at the Institute for Telemedicine and Telecare at the Queen's University in Belfast. The use of video conferencing within a college of nursing is also explored. With the reorganisation of nursing education, institutions may need to coordinate activities over a wide geographical ares. To date, the use of video links from the nursing and midwifery school in Nottingham has resulted in less time spent travelling between sites for staff and students.

Computer Communication Networks↗