[Angioplasty of post-irradiation arterial disease].
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Aged↗
Biomedical subjects
A Long
Publications and source records attributed to A Long.
[Abdominal aortic aneurysm repair treated with endoprosthesis: technical and economic evaluation by ANAES(National Agency of Health Accreditation and Evaluation)].
OBJECTIVE: To evaluate the safety, efficacy and cost of stent-grafts for the endovascular repair of abdominal aortic aneurysms (AAA). MATERIALS AND METHODS: The ANAES report was based on a critical analysis of the published international literature and on consultation of technology assessment agencies. The report was reviewed by a group of experts and validated by the ANAES Scientific Council (Evaluation Section). RESULTS: The literature analysis indicated that the technique was feasible. However, it also revealed a shortage of methodologically sound clinical trials. The long-term outcome of the stent-grafts and the accompanying complications are not yet known. CONCLUSION: Further clinical studies are needed for a truly objective assessment. The ANAES working group has issued a series of recommendations designed to help physicians define the optimal conditions for the effective and safe use of these stent-grafts.
Aortic Aneurysm, Abdominal↗
High-risk sexual behavior in Los Angeles: who receives testing for HIV?
No recent population-based data on HIV testing in people with high-risk sexual behavior are available. We sought predictors of testing using data from the 1997 Los Angeles County Health Survey, a random-digit telephone survey of 8004 county households. An estimated 2.3 million (35.5%) adults were tested for HIV in the past 2 years and approximately 370,000 (5.6%) engaged in high-risk sexual behavior (defined as having > or =2 partners in the past 12 months and not always using condoms). Among high-risk persons, an estimated 46% of heterosexual men, 56% of heterosexual women, and 72% of men who had sex with men (MSM) were tested for HIV. In a multivariable model of high-risk people, both heterosexual men (odds ratio [OR], 0.31; 95% confidence interval [CI], 0.16-0.61) and women (OR, 0.41; 95% CI, 0.19-0.87) had significantly lower proportions of testing than MSM. Although African Americans and Hispanics had significantly higher testing proportions than whites overall among all county residents, those reporting high-risk sexual behavior did not test at higher proportions. We conclude that the proportion of adults with high-risk sexual behavior tested for HIV is higher than almost a decade ago. However, testing among this group remains suboptimal. Future public health campaigns should intensify efforts to encourage HIV testing among this population.
AIDS Serodiagnosis↗
Assessment of neonatal diaphragmatic paralysis using magnetic phrenic nerve stimulation.
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Electric Stimulation↗
Transient myocardial dysfunction associated with angiotensin-converting enzyme inhibitor-induced angioedema: recognition by serial echocardiographic studies.
We report a case of a 58-year-old woman who had angiotensin converting enzyme inhibitor-induced angioedema after she underwent a biopsy of a hypopharyngeal mass. The angioedema was associated with severe transient myocardial dysfunction documented on echocardiography. She did not have anaphylaxis or coronary artery disease. To our knowledge this is the first reported case of transient myocardial dysfunction in the setting of angiotensin converting enzyme inhibitor-induced angioedema without anaphylaxis.
Angioedema↗
Targeted hepatitis C lookback: Quebec, Canada.
BACKGROUND: Since March 1990, all blood donations in Canada are screened for antibodies to hepatitis C virus (HCV). Because HCV may cause chronic asymptomatic hepatitis, in February 1995, the Canadian Red Cross began targeted HCV lookback studies. STUDY DESIGN AND METHODS: From March 1990 to March 1997, the Quebec Center of the Canadian Red Cross collected 1,750,846 donations, and there were 561 anti-HCV-positive repeat donors, from whom 3,196 blood components had been issued to the hospitals. Hospital blood bank directors were asked to test recipients and return results to the Quebec Center. One hundred nine hospitals were surveyed to determine methods and resources involved in lookback. The transfusion medicine service at the Royal Victoria Hospital (RVH) developed a standard operating procedure for performing lookbacks and analyzed the costs and outcomes of lookbacks. RESULTS: As of April 1998, information has been received on 2329 (73%) of components; 1020 patients had died of unrelated causes, 590 were untraceable, and 353 were tested. Of those tested, 215 (61%) were anti-HCV positive; their average age was 47, and at least 53 percent were already aware of their HCV status. Few hospitals had received any additional resources to perform lookbacks. At the RVH, lookback on 182 components resulted in the identification of nine seropositive recipients, average age 70, who did not previously know their HCV status; four of these patients had abnormal alanine aminotransferase levels. The cost of lookback per newly diagnosed case of HCV was estimated at $2727 (US) for the Quebec Center and $6014 (US) for the RVH. CONCLUSION: Targeted lookback in the province of Quebec on 3196 components has resulted in the identification of 101 seropositive recipients who did not previously know their HCV status.
Blood Banks↗
Living with dementia: communicating with an older person and her family.
This article is designed to explore and examine the key components of communication that emerged during the interactional analysis of a role play that took place in the classroom. The 'actors' were nurses who perceived the interaction to reflect an everyday encounter in a hospital ward. Permission to tape the interaction was sought and given by all persons involved. The principal 'players' in the scenario were: the patient, a 70-year-old-woman who had been admitted with dementia, her son and daughter, and the nurse in charge of the ward. The fundamental dynamics of the use of power and restriction, truth telling, family stress, interpersonal conflict, ageism, sexism, empathy and humanism surfaced during the analysis. The findings show that therapeutic communication should be the foundation on which nursing should stand. The article continues with an exploration of the theoretical frameworks that guided the analysis of interaction and concludes by suggesting tentatively some meaningful implications for nursing practice. It plans to furnish provocative new insights into the sometimes covert communication dynamics occurring within the nurse-patient relationship. Finally, it aims to generate discussion on this little-charted realm of human social interaction.
Adaptation, Psychological↗
More on centralisation.
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Diagnosis, Differential↗
Inside the crawling T cell: leukocyte function-associated antigen-1 cross-linking is associated with microtubule-directed translocation of protein kinase C isoenzymes beta(I) and delta.
T cells activated via integrin receptors can polarize and start crawling locomotion with repeated cycles of cytoskeletal reassembly processes, many of which depend on phosphorylation. We demonstrate that protein kinase C (PKC) activation represents an essential event in induction of active T cell motility. We find that in crawling T cells triggered via cross-linking of integrin LFA-1 two PKC isoenzymes, beta(I) and delta, are targeted to the cytoskeleton with specific localization corresponding to the microtubule-organizing center (MTOC) and microtubules, as detected by immunocytochemistry and immunoblotting. Clustering of LFA-1 associated with its signaling function also occurs at the membrane sites adjacent to the MTOC. We further show that cells of a PKC-beta-deficient clone derived from parental PKC-beta-expressing T cell line can neither crawl nor develop a polarized microtubule array upon integrin cross-linking. However, their adhesion and formation of actin-based pseudopodia remain unaffected. Our data demonstrate the critical importance of the microtubule cytoskeleton in T cell locomotion and suggest a novel microtubule-directed intracellular signaling pathway mediated by integrins and involving two distinctive PKC isoforms.
Biological Transport↗
Getting prepared for rural practice.
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Canada↗
Neuropeptide immunoreactivity in ligature-induced neuromas of the inferior alveolar nerve in the ferret.
Injury to branches of the trigeminal nerve can sometimes result in persistent dysaesthesia. In an attempt to understand the aetiology of this condition we are currently investigating changes which occur at the injury site. In the present study we have examined the expression of seven neuropeptides, all of which have been implicated in nociceptive transmission, or have previously been shown to have altered expression following nerve injury. In 20 adult ferrets the inferior alveolar nerve was sectioned and ligated, and recovery permitted for 3 days, 8 days, 3 weeks, 6 weeks or 12 weeks. Longitudinal sections of the neuromas were processed using immunohistochemical techniques to quantify the expression of substance P, calcitonin gene-related peptide, vasoactive intestinal polypeptide, galanin, somatostatin, enkephalin and neuropeptide Y. After 3 days, all of the neuropeptides were expressed at the injury site. In the neuromas examined after longer recovery periods these levels of expression had declined and were similar to those found in the contralateral controls. This initial high level, followed by a decline, parallels the incidence of ectopic neural activity recorded electrophysiologically in the same model. It is, therefore, possible that the accumulation of neuropeptides at the injury site may play a role in the initiation or modulation of ectopic neural activity.
Animals↗
The conception of community children's nursing services in Northern Ireland.
This report is an exploration of the implications of establishing a community children's nursing service in Northern Ireland. It provides a description of the backdrop to the development of the service in the United Kingdom, and the experiences of children's nurses in attempting to upgrade the quality of care offered to sick children in this province. The frustrations that have characterized this development are explored in detail within the context of broader changes in health care on the national scene. The article ends with recommendations for implementing an effective service, following our experiences in Northern Ireland.
Adolescent↗
Are altered pharmacokinetics of non-steroidal anti-inflammatory drugs (NSAIDs) a risk factor for gastrointestinal bleeding?
AIMS: We hypothesised that pharmacokinetic factors might go some way to explaining the risk of major gastrointestinal haemorrhage with non-steroidal anti-inflammatory drugs (NSAIDs), with bleeders exhibiting a reduced clearance of NSAIDs compared with non-bleeders and set out to investigate this. METHODS: Fifty patients presenting to hospital with acute gastrointestinal bleeding while taking piroxicam, indomethacin, diclofenac or naproxen and age, sex, musculoskeletal disease and drug matched community dwelling controls, up to two for each index case, who had not bled were recruited. Clinical details including duration of therapy were recorded. Bleeders discontinued the implicated NSAID at presentation, controls at least five half-lives before the study. Bleeders were contacted by letter 1 month after discharge and invited to take part and were studied after a median delay of 5 months. Subjects received an oral dose of their respective NSAID and venous blood was sampled, over a period determined by the half-life of the NSAID. Plasma concentrations were determined by high performance liquid chromatography. RESULTS: The median length of treatment for the index patients was 1 year (range 2 weeks--28 years) and for the control patients 2 years (1 month--25 years), P<0.0005. There were no significant differences in peak plasma concentration, time to peak plasma concentration or area under the plasma concentration-time curve between bleeders or controls for any of the NSAIDs studied, apart from piroxicam Cmax being lower in bleeders at 2.07 mg l(-1) than in controls at 3.21 mg l(-1), mean difference (95% CI) -1.14 (-1.83 - -0.48), P<0.005. CONCLUSIONS: The data failed to support the hypothesis that reduced clearance of NSAIDs, which results in higher plasma concentrations, is a risk factor for acute gastrointestinal haemorrhage.
Anti-Inflammatory Agents, Non-Steroidal↗
The role of mental health nursing in the prevention of child sexual abuse and the therapeutic care of survivors.
This paper is primarily designed to stimulate discussion and debate on the role of the mental health nurse dealing with survivors of sexual abuse. The authors contend that, in reality, all nurses should be prepared through education and training to treat the sufferers of emotional and spiritual pain, regardless of from where the hurting stems. The need for nurses to open their eyes and acknowledge the agony and distress caused to children as a result of abuse by adults is highlighted. So too is the necessity for nurses to enhance their own unique and specific practice. Nurses (and particularly mental health nurses) have a role in promoting a healthy generation of children--children who are looked after and protected by caregivers and not by caretakers. As the result of nurses advocating healthy caregiving and healthy relationships children may never need to suffer from inhumane and denigrating acts against their very beings. Nurses have no excuse for being unable to imagine child sexual abuse. Therefore they have no excuse for not being prepared to deal with the resulting, excruciating pain. It is both uncaring and inhumane for nurses not to be prepared to accept the sharing of such emotionally painful and disturbing experiences. Mental health nurses have a genuine role in offering therapeutic care to victims and survivors. This paper concludes by exploring and examining the nurse's role in counselling survivors of child sexual abuse.
Adult↗
The healing process, the road to recovery and positive mental health.
This paper is designed to explore and examine the experience of loss following a hysterectomy. The painful aftermath of the ordeal and the work involved in the healing process are outlined and discussed from both a personal and professional perspective. The manuscript highlights a number of inner struggles that had to negotiated before an equilibrium in mental health and wellbeing was successfully achieved. The forces that move the dialogue forward from one theme to the other are complex in their simplicity. The enigmatic dimensions of physical pain and emotional torment are expressed and worked through in a sensitive and intimate manner. The mysteries of internalized, conflicting messages on socialization issues, such as gender roles and living in and identifying with only one culture are discussed and debated. In addition, the disharmony between spiritual ideals, the meaning and purpose of life, the process of self-actualizing and the physical realities involved in living are identified and elaborated upon. Embroidered within the tapestry of the text is the need to revisit the curriculum for the education and training of mental health nurses to enhance the quality and provision of effective, humane and therapeutic nursing care.
Adaptation, Psychological↗
Linking injection drug users to medical services: role of street outreach referrals.
Street outreach workers in HIV prevention have expanded their role to include referring injection drug users to medical services. However, little is known about whether drug users act on these referrals. The study discussed in this article examined the level of exposure to street outreach reported by injection drug users, the most common medical referrals acted on as a result of such contacts, and the predictors of acting on these referrals. Findings indicate that injection drug users with four or more contacts with street outreach workers during the preceding six months were more likely to report acting on referrals. To maximize the relevance of outreach for encouraging medical treatment, both street outreach workers and social workers in health care could benefit from cross training that focuses on strengthening the referral process.
Adult↗
New needle and syringe use, and use of needle exchange programmes by street recruited injection drug users in 1993.
BACKGROUND: Needle exchange programmes (NEP) provide injection drug users (IDU) with sterile injection equipment and receive used needles in exchange. In this paper we describe the use of new syringes and NEP by IDU and characteristics associated with using NEP in 1993. METHODS: Street-recruited IDU were interviewed in five US locations: Atlanta, Philadelphia, Chicago, New York City, and Los Angeles (LA) county. RESULTS: Most (75-95%) reported it was easy to get a new syringe and for their last injection, 45-77% used a new syringe and 2-18% used a syringe previously used by another IDU. Use of NEP ranged from 8% to 16% in Chicago, Philadelphia, and LA County. In LA County not having injected 'speedball' in the last 30 days, last injection with a new syringe, and reporting it was very easy to get a new syringe were associated with NEP use. In Philadelphia, NEP use was associated with 'speedball' injection in the last 30 days, and in Chicago, not injecting with 'speedball' and injecting with cocaine were associated with NEP use. CONCLUSIONS: In 1993, most street-recruited IDU in Chicago, Philadelphia, and LA County had not used NEP. Factors associated with NEP use were not consistent across sites. Dispersion of NEP and removal of legal barriers restricting access to sterile syringes may be more important in increasing the use of sterile syringes and NEP than client characteristics.
Adult↗
Suicide: a statement of suffering.
This article is designed to focus on the provision of nursing care in general medical wards following the admission of persons who have attempted suicide or who have a previous history of attempting suicide. The authors explore, analyse and synthesize how nurses, as key players in the health care team, may begin by recognizing the uniqueness of the individual, and by cotravelling therapeutically with the person on part of his or her journey towards recovery and healing. Efforts are made to demonstrate how nurses can influence the health gain of this group of people and their families. Professional attitudes and related ethical aspects, such as autonomy, respect for autonomy and paternalism, are also examined within the context of the nursing care of people who have attempted suicide. The need to enhance sensitive and caring communication skills for nurses who work with this group of people is tentatively considered. Some reasoning about why there may be difficulties in specific areas of communication such as empathy are contested and explored.
Attitude of Health Personnel↗