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Biomedical subjects

A Henderson

Publications and source records attributed to A Henderson.

At least 73 records · Page 4Linked to original sources
PubMed1996

Nature of decision-making in the terminally ill patient.

The increasing emphasis on the consumer's choice in health care treatment has contributed to the growing trend for decision-making to be shared between the patient and the health care team. If responsibility is to be shared, then it is important that health professionals identify the degree to which patients wish to participate in the decision-making process, in order that they can assist patients to achieve this goal. The seven patient case studies in this pilot study explored terminally ill patients' perceptions of their own participation in the decision-making process. A simple strategy, through the use of picture cards, established patients' actual and preferred forms of decision-making. These cards were presented to the patients at various stages of their illnesses, which permitted a longitudinal analysis of the decision-making process. Patients initially stated that they did not want much input into the decision-making process. In this study, however, as patients became more knowledgeable about their conditions, they desired greater input into the decision-making process. These findings also revealed that, although there was consistency between patients' preferred and actual forms of decision-making when they were initially admitted to hospital, discrepancies became apparent during the later phases of their illness. This emphasises the need for communication between all parties involved in health care decisions.

Adolescent↗
PubMed1996

The use of the lidocaine-monoethylglycinexylidide test in the liver transplant recipient.

The lidocaine-monoethylglycinexylidide (MEGX) test is used to monitor liver function in liver transplant recipients. Serial studies have been undertaken after 155 allografts. The initial MEGX concentration is significantly correlated with the donor MEGX concentration. It is also influenced by the recipient's pretransplant bilirubin concentration, being lowest among patients with very high bilirubin levels. Use of segmental grafts is also accompanied by low MEGX concentrations. The flow-dependent clearance of lidocaine makes it a sensitive indicator of disturbed liver blood flow, with decreased MEGX concentrations occurring in hepatic artery thrombosis and rejection and as a result of cardiac failure and pulmonary effusions. Significant hepatic ischemia resulting in delayed initial function or cholestasis also is associated with low MEGX concentrations. The initial median MEGX concentrations were lowest among patients who required retransplantation or who died within 2 months of allografting.

Adolescent↗
PubMed1996

Becoming an orthopaedic surgeon: background of trainees and their opinions of selection criteria for orthopaedic training.

A questionnaire survey of registrars in training in Australia in orthopaedic surgery was used to profile successful applicants and to ascertain what entry criteria they considered appropriate for the Orthopaedic Training Scheme. Typically, trainees were male, average age 31 years, married with children, born in Australia, privately educated and from a traditional family background. Respondents believe that referees' reports, performance as a resident and a registrar, and experience as a non-accredited registrar are the most appropriate selection criteria. Trainees held the opinion that too much emphasis may currently be placed on the support of influential surgeons and hospitals, and too little emphasis on medical school performance and surgical expertise. Academic achievement was considered to be of little relevance. The implications of these findings are discussed.

Adult↗
PubMed1996

The smoke-free policies of Lanarkshire general practices.

A telephone survey was performed to examine the smoke-free policies at Lanarkshire general practices sited outwith health centres. Forty-nine practices were contacted and all agreed to take part. Thirty-three practices (67%) reported that there was a complete ban on smoking within the building. The remaining 16 practices (33%) reported that the building was largely no-smoking with smoking by staff restricted to designated smoking areas. No practices permitted patients to smoke within the main practice premises. Few practices reported experiencing any difficulties with either the implementation or operation of the smoke-free policies. Although it is possible that problems may not have been recognised or not reported, these results are encouraging. They suggest that smoking in surgeries is the exception rather than the rule. The finding that patients largely respect the smoking ban in practice premises also suggests that the health service exemplar role is being recognised by the public. Practices that currently have no smoking restrictions should review their policy. Practices that do impose restrictions must recognise the needs of staff who smoke and offer appropriate support to help them to stop.

Family Practice↗
PubMed1995

Ig/EBP (C/EBP gamma) is a transdominant negative inhibitor of C/EBP family transcriptional activators.

Analysis of cDNA and genomic clones shows that the murine Ig/EBP (C/EBP gamma) gene encodes a small protein with a predicted molecular weight of 16.4 kDa which contains C/EBP family basic and leucine zipper domains but lacks the transcriptional activation domains present in C/EBP (C/EBP alpha) and NF-IL6 (C/EBP beta). In transfection assays Ig/EBP is neither an activator nor a repressor of transcription; however, Ig/EBP inhibits the transcriptional ability of NF-IL6 (C/EBP beta) and C/EBP (C/EBP alpha), acting as a transdominant negative regulator. Thus Ig/EBP resembles LIP, another negative regulator of the C/EBP family, in both structure and transcriptional activity. Of the three known C/EBP family inhibitors, Ig/EBP, LIP and CHOP-10, only Ig/EBP is ubiquitously expressed. Therefore, Ig/EBP may act as a general buffer for C/EBP activators in many cell types.

Animals↗
PubMed1995

Morbidity and mortality after abdominal aortic surgery in a population of patients with high cardiovascular risk.

Postoperative myocardial infarction is a major risk factor in patients undergoing abdominal aortic surgery. Correction of cardiac ischaemia prior to abdominal aortic surgery improves outcome. The morbidity and mortality of 639 consecutive patients were reviewed from an area with poor access to cardiac surgery, operated upon in a single tertiary referral hospital for aortic aneurysm or aortobifemoral grafting. A total of 101 patients with ruptured aortic aneurysm who survived to reach the intensive care unit experienced a hospital mortality of 29%. Multiorgan failure was the cause of death in 48% and postoperative myocardial infarction in 31%. Of the 253 patients with intact aortic aneurysm, which included elective and urgent resection, the mortality was 9%. There was a high incidence of uncorrected pre-operative ischaemic heart disease and myocardial infarction was the major cause of death (62%). Pre-operative myocardial infarction was predictive of postoperative cardiac morbidity and mortality. Of the 285 patients undergoing aortobifemoral grafting the mortality was 3% despite a high incidence of pre-operative ischaemic heart disease. Further reductions in postoperative death from ruptured aortic aneurysm must await improved screening to diagnose and treat the aneurysm before rupture. In patients operated upon electively, improved pre-operative cardiac screening and coronary bypass grafting where appropriate, especially for patients with aortic aneurysm and previous myocardial infarction, may further reduce peri-operative mortality.

Aged↗
PubMed1995

Post-heparin plasma lipase activity in hypopituitary adults.

Twenty-six hypopituitary patients on conventional replacement therapy were compared with 31 matched normal controls. Plasma lipoprotein lipase (LPL) and hepatic lipase (HL) activities were measured 15 min after a bolus of intravenous heparin (100 IU/kg body weight). Fasting plasma lipids, lipoproteins, glucose and insulin and triceps to subscapular skin fold ratio and waist to hip circumference ratio were also measured. Total and low density lipoprotein cholesterol were significantly higher in patients than in controls. Plasma activity of both LPL and HL was significantly higher in hypopituitary patients than in controls (p < 0.005 and p < 0.04 respectively). When men and women were analysed separately, significant differences between HP patients and controls remained for total cholesterol and LPL in women and for HL in men.

Adult↗
PubMed1995

The effects of short and long-term growth hormone replacement therapy in hypopituitary adults on lipid metabolism and carbohydrate tolerance.

The effects of replacement with biosynthetic human GH on carbohydrate tolerance and lipid metabolism were studied in 40 hypopituitary adults during a randomized double blind, placebo-controlled trial for 6 months, followed by a 12-month open trial. The daily GH dose was 0.04 +/- 0.01 IU/kg. Fasting plasma glucose, serum fructosamine, plasmid lipids, lipoproteins, and plasma C-peptide concentrations were measured, and an oral glucose tolerance test was performed every 6 months. There was no change in fasting triglyceride levels at any stage of the study. There was no significant change in fasting total or LDL cholesterol, total HDL cholesterol, high density lipoprotein2 (HDL2) cholesterol, HDL3 cholesterol, apoprotein-A1, or apoprotein-B during GH or placebo treatment in the placebo-controlled 6-months study. In the open phase of the trial, total and low density lipoprotein cholesterol showed a sustained downward trend during GH therapy. Compared to the pretreatment level, the HDL cholesterol concentration was significantly higher at 18 months. Cholesterol subfractions HDL2 and HDL3 and apoprotein-A1 and -B were not different from the pretreatment levels. The total/HDL cholesterol ratio decreased significantly at 12 and 18 months. During the controlled phase, fasting plasma glucose was similar during GH and placebo administration, but fasting insulin and C-peptide increased during GH therapy, but not during placebo treatment. The mean area under the curve (AUC) for glucose increased by a small, but significant, extent over the 6 months of GH treatment and was higher at 6 months than during placebo treatment. The AUC for insulin also increased during GH treatment. During the open trial, the fasting plasma glucose level increased at 6 and 12 months, and the fasting plasma insulin level increased at 6, 12, and 18 months of GH treatment. The plasma glucose AUC during the oral glucose tolerance test was significantly higher at 6 months, and the plasma insulin AUC was significantly higher at 6, 12, and 18 months of GH therapy. In conclusion, GH therapy has some metabolic effects that are considered beneficial and others that are less desirable.

Adult↗
PubMed1994

Effect of postoperative low-dose dopamine on renal function after elective major vascular surgery.

OBJECTIVE: To determine the effect on renal function of postoperative low-dose dopamine in volume-replete patients after elective, major vascular abdominal surgery. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Intensive care unit of a referral hospital in Brisbane, Australia. PATIENTS: 37 patients having elective repair of an abdominal aortic aneurysm or having aortobifemoral grafting; 18 received dopamine, and 19 received placebo. Two patients were excluded from the 5-day analysis because of perioperative death. INTERVENTIONS: Patients were randomly assigned to receive either placebo or a low-dose infusion of dopamine (3 micrograms/kg per minute) in saline. Patients in both groups were given sufficient crystalloid to maintain a urine flow of more than 1 mL/kg per hour during the first 24 postoperative hours. Care in the intensive care unit was otherwise usual and was the same for each group. MEASUREMENTS: Plasma creatinine levels, urea levels, and creatinine clearance were measured preoperatively and postoperatively (at 24 hours and 5 days). Urine flow and the volume of crystalloid during the first 24 hours were recorded. RESULTS: Two postoperative deaths occurred in the dopamine group (from renal failure and myocardial infarction). Four patients had myocardial infarction, three of whom received dopamine. Plasma creatinine levels remained unchanged in both groups. At 24 hours, the mean plasma urea level decreased by 1.07 mmol/L in the dopamine group compared with 1.84 mmol/L in the placebo group, a difference of 0.77 (95% CI, -0.12 to 1.67). The mean 24-hour creatinine clearance increased by 0.165 mL/s (9.89 mL/min) in the dopamine group and by 0.199 mL/s (11.98 mL/min) in the placebo group (P > 0.2). Urine volumes were slightly higher in those receiving dopamine (1.83 mL/kg compared with 1.6 mL/kg, a difference of 0.23 [CI, -0.18 to 0.64]). None of these differences were statistically or clinically significant. CONCLUSIONS: Within the limits of the small size of the study, low-dose dopamine appeared to offer no advantage to euvolemic patients after elective abdominal aortic surgery. However, patients with acute oliguric renal failure were not included in the study.

Acute Kidney Injury↗
PubMed1994

The significance for critical care nurses of the "dying with dignity" legislation.

This paper examines the potential contribution of the critical care nurse to ethical decisions made with respect to the dying with dignity legislation. The literature to date on ethics in nursing has largely focused on increasing nurses awareness thereby encouraging their contribution to the ethical decision-making process. By accentuating the 'art of nursing' where forms of knowing encompass an understanding of the patient's experience, this article describes the unique contribution that the nurse can make to the specific area of 'dying with dignity' in the acute care setting. On a theoretical level this knowledge is invaluable as it ensures a range of constituents are accommodated in this decision-making process, however, in practice this ideal is not readily attainable. Firstly, tradition seeks to curtail the value of this form of nursing knowledge in the decision-making process and secondly, nurses need to recognise their own prejudices in order to make an appropriate contribution to this legitimate body of knowledge.

Australia↗
PubMed1994

Failure of intravenous low dose midazolam to influence memory recall in drug paralysed post-operative patients sedated with papaveretum.

Sedation of ventilated patients in the Intensive Care Unit generates a tension between adequate sedation to maintain comfort and ease of ventilation and over sedation with undesirable prolongation of ventilation and delays in discharge. Studies in animals suggest very low dose midazolam, but not higher doses, potentiate the sedative effects of opiates. We undertook a trial of opiate sedation versus opiate sedation plus low dose midazolam (1 mg/hour) to determine whether a similar effect could be demonstrated in man. Although ventilator time and the duration of admission to Intensive Care was not prolonged by the addition of midazolam, we were unable to demonstrate any statistically significant benefit with regard to memory recall.

Procedural Sedation↗
PubMed1994

Power and knowledge in nursing practice: the contribution of Foucault.

This paper explores the implications of Michel Foucault's philosophical analyses for understanding nursing practice. Foucault describes power within a given society as unfolding not through large-scale events but rather through a complex 'micro-physics'. Power operates upon the human body. With the increasing use of observation, in understanding both the natural and social world, the body has become the subject of the 'gaze'. The body as object, however, is neither a universal belief nor truth but a product of ways of perceiving and examining it. In relation to nursing, the subjection of the body to the 'gaze' and the practices of the institutional environment of the hospital are important for understanding the knowledge formulated. The power of practice is in the generation of knowledge. The nature and form of knowledge is instrumental in establishing the quality of nurse-patient relationships. This paper explores, through the particular exemplar of the patient in intensive care, the power of present practices to shape knowledge, and thereby dictate and limit the quality of the nurse-patient relationship.

Clinical Competence↗
PubMed1994

Serum lipids and apolipoproteins and their relationship with macrovascular disease in type 1 diabetes.

In order to examine the relationship between serum lipids and apolipoproteins and macrovascular disease in patients with Type 1 diabetes mellitus, 50 patients with Type 1 diabetes mellitus attending the diabetic clinics at St Mary's and St Charles' Hospitals, London were recruited into a cross-sectional study. B-mode ultrasound was used to measure intima-media thickness and define an arterial ultrasound score for each patient as a non-invasive indicator of atherosclerotic change. Intima-medial (i-m) thickness was significantly higher in those subjects with clinical evidence of macrovascular disease compared to those without macrovascular disease (0.865 +/- 0.191 vs 0.695 +/- 0.162 mm, p = 0.0038). In the study group there were significant correlations between i-m thickness and age (r = 0.65, p < 0.01), total serum cholesterol (r = 0.32, p < 0.01), and serum fibrinogen (r = 0.43, p < 0.01) but no other lipid or apolipoprotein variable. When i-m thickness was corrected for age there were significant correlations with total cholesterol (r = 0.43, p < 0.01) and LDL-cholesterol (r = 0.42, p < 0.01). Whereas total and LDL-cholesterol and serum fibrinogen concentrations were related to the extent of atherosclerotic disease by ultrasound techniques, there was no relationship with high density lipoprotein (HDL) or subfraction cholesterol concentrations. HDL-cholesterol may not be a useful marker for cardiovascular disease in Type 1 diabetes.

Adult↗