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Biomedical subjects

A Parker

Publications and source records attributed to A Parker.

At least 127 records · Page 7Linked to original sources
PubMed1993

Supervision as a focal point in nurse education: an exploratory study of its effects on the needs of student nurses.

This study reports the results of a 2 year follow up of the effects of experience of supervision on the personal needs of nursing students. Supervision was given during this period on a continual basis as a focal point of nursing education. Students were encouraged to relate critical incidents as starting points for the supervisory process. Students rated the quality of supervision in terms of its perceived effect on their sense of professional identity and on their self-confidence with respect to clinical work. A Swedish version of a standard personality questionnaire, the Edwards Personal Preference Schedule (EPPS), was given at the initiation of supervision and repeated 2 years later on its completion. The results of 48 students are presented. Two hypotheses relating to the global effects of supervision were not confirmed but the hypothesis concerning the effects of supervision to depend on its perceived quality was confirmed. As measured, the effectiveness of supervision was seen in statistically significant correlations between ratings of supervisory quality and changes reflecting an increased need for leadership and a diminished need for subordinance.

Clinical Competence↗
PubMed1993

Esophageal dilation with polyvinyl bougies, using a marked guidewire without the aid of fluoroscopy: an update.

One hundred thirty-eight patients with esophageal stricture underwent polyvinyl bougie dilations whereby American Endoscopy dilators were passed over a marked guidewire that had been placed endoscopically. Fluoroscopy was not utilized during the dilations. The dilations were performed only after the guidewire was properly placed, with 60-cm markings at the incisors, which ensured that the tip of the guidewire was in the antrum. One hundred fourteen patients had benign strictures and 24 had malignant strictures. There were 197 sessions of dilations for a total of 748 individual dilations. In 97 of 138 patients, the guidewire was placed in the antrum under direct vision. The remaining 41 patients had significant esophageal stenosis which prevented passage of the endoscope into the stomach; therefore, the guidewire was placed by advancing it blindly through the stenosis. There were no procedure-related complications. During this period, eight patients were dilated without complications, using fluoroscopic placement of guidewire because endoscopic placement of the guidewire was not considered safe. We conclude that esophageal strictures can be safely dilated in most patients by means of the American Endoscopy dilator system and the marked guidewire without the aid of fluoroscopy.

Adult↗
PubMed1992

Foley feeding catheter migration into the small bowel.

Percutaneous endoscopic gastrostomy provides a non-surgical alternative to enteral feeding. The tube may deteriorate or be expelled accidentally from the stomach and require replacement. We report a patient in whom the replacement Foley catheter migrated into the jejunum, resulting in impaction of the hub into the abdominal wall with resultant localized infection and impaction at the stoma site. We review this problem and suggest a simple technique to prevent the complication.

Catheterization↗
PubMed1992

Nutritional assessment using a pulmonary artery catheter.

To determine if oxygen consumption (VO2) derived from the Fick equation (FE) can be used to determine energy expenditure (EE), 29 paired indirect calorimetry (IC) and FE VO2 determinations were obtained. The Weir equation was used to calculate EE from the FE VO2 value. There was a strong correlation between the methods (r = 0.82, p less than 0.001). Mean EE by IC and FE was 2460 +/- 539 and 2372 +/- 787 kcal/day, respectively, a difference of 88 +/- 467 kcal/day. A single IC determination is often used to guide nutrition for several days. To evaluate this practice, FE and IC determinations were repeated in 8 patients. There was a 19% difference in EE between initial and follow-up IC, which was identical to the mean difference between paired FE and IC measurements. FE can be used to estimate EE, and is as accurate as using a single IC reading to predict EE on subsequent days.

Adult↗
PubMed1992

A comparison of Syntocinon infusion with prostaglandin vaginal pessaries when spontaneous rupture of the membranes occurs without labour after 34 weeks gestation.

In a prospective randomized trial of 106 patients who had spontaneously ruptured their membranes greater than or equal to 4 hours in the absence of labour, vaginal prostaglandin E2 pessaries and intravenous Syntocinon were compared. There was no significant difference in the treatment to delivery times between the 2 groups. The number of operative deliveries in each group were comparable. No untoward side-effects were noted. The use of vaginal prostaglandin E2 tablets appears to be a safe alternative to Syntocinon for induction of labour when spontaneous rupture of membranes has occurred in the absence of uterine contractions.

Dinoprostone↗
PubMed1992

Metastatic tumors to the upper gastrointestinal tract: endoscopic experience.

Metastatic tumors to the upper gastrointestinal tract were identified by esophagogastroduodenoscopy in 14 patients. Malignant melanoma, breast cancer, and lung cancer were the most common primary cancers in four, three, and three patients, respectively. Osteogenic sarcoma, renal cell carcinoma, Meckel cell carcinoma of the skin, and germ-cell tumor were the primary cancer in the remaining four. The esophagus was involved in three patients, the stomach in 13, duodenum in four, and papilla of Vater in one. Upper gastrointestinal bleeding and anemia were the most common presenting features. There was correlation between symptoms and endoscopic findings in all patients. Involvement of gastrointestinal tract at endoscopy was the initial and only evidence of metastases in all patients without evidence of metastases elsewhere, as evidenced by other diagnostic tests in any of these patients. Endoscopic biopsies and/or brush cytology provided histologic diagnosis in all 14 patients. The endoscopic and nonendoscopic literature regarding metastases to the upper gastrointestinal tract is reviewed.

Adenocarcinoma↗
PubMed1992

Upper gastrointestinal bleeding from Merkel cell carcinoma.

Merkel cell carcinoma is a rare small cell carcinoma of the dermis with aggressive clinical features and frequent local recurrence. Intra-abdominal spread of the cancer has previously been noted primarily in the liver and retroperitoneal nodes. We report a patient with previously diagnosed Merkel cell carcinoma of the right buttock with metastases to the stomach and duodenum presenting with acute upper gastrointestinal bleeding.

Aged↗
PubMed1990

Plasmid transformation of Bacteroides spp. by electroporation.

Transformation of Bacteroides spp. with a variety of plasmid DNAs was accomplished using electroporation. The standard transformation assay system used to deduce the optimal electroporation parameters employed a 50-to 100-fold concentrated cell suspension of mid-logarithmic phase Bacteroides fragilis strain 638 and the 5.4-kb clindamycin resistance (Ccr) vector, pBI191. A variety of electroporation buffers were used successfully in transformation experiments but of these, 1 mM MgCl2 in 10% glycerol was superior. The incorporation of MgCl2 was essential for optimum viability prior to electroporation and for optimum transformation. Transformants were routinely obtained using 5-ms pulses over a range of field strengths from 5 to 12.5 kV/cm, with a maximum of greater than 10(6) micrograms-1 DNA at 12.5 kV/cm. The number of transformants increased linearly with respect to DNA concentration over the range 0.01-2 micrograms tested. Recovery of transformants required an expression period of up to 2.5 h following exposure to the electric field. This period, however, was dependent on the antibiotic resistance marker used for selection of transformants, with a significantly shorter incubation required when chloramphenicol rather than clindamycin was used in the selective medium. The effect of the DNA source on transformation was tested using the shuttle vector pFD288. Plasmid DNA isolated from Bacteroides uniformis, Bacteroides ovatus, or Bacteroides thetaiotaomicron transformed B. fragilis 638 at frequencies 7.5- to 12.5-fold less than those observed for controls with homologous DNA. Further reductions were seen with Escherichia coli purified pFD288, which transformed at 1000-fold lower frequencies. Finally, using homologous pFD288 or pBI191 isolated from strain 638, several strains of B. fragilis, B. uniformis, and B. ovatus were transformed successfully without modification of the standard assay system. Two strains each of B. thetaiotaomicron and Bacteroides ruminicola were not transformed using the methods described here.

Bacteroides↗
PubMed1989

Rare submandibular swelling (capillary haemangioma).

The diagnosis of submandibular lumps is usually straightforward, using a combination of history, examination and simple investigation. Most will turn out to be submandibular salivary gland enlargement or lymph node swellings. We present a case in which conventional investigation failed to help in the diagnosis, and was eventually found to be what we believe is the first capillary haemangioma described in the anterior belly of the digastric muscle.

Adolescent↗