Radiological case of the month. Childhood intervertebral disk calcification.
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Calcinosis↗
Biomedical subjects
A Richardson
Publications and source records attributed to A Richardson.
Self-care behaviours initiated by chemotherapy patients in response to fatigue.
Patients receiving chemotherapy for the treatment of cancer frequently experience severe fatigue which is highly disruptive and distressing. Few studies have investigated the strategies which patients personally initiate to enable them to cope with this symptom. This paper reports the results derived from a study designed to monitor and describe patients' fatigue during chemotherapy and the self-care measures taken by them to ameliorate it. Data were collected from 109 subjects receiving different chemotherapy protocols using structured diaries. A variety of self-care behaviours were practised and these frequently included modifying or altering activity and rest patterns and employing strategies of a psychological nature. However, the self-care strategies initiated proved largely ineffective. This study indicates that common-sense measures often prove insufficient. Intervention studies are required to evaluate the best ways for health professionals to assist these patients to live with and adapt to fatigue.
Adaptation, Psychological↗
Fatigue in patients with cancer and chronic obstructive airways disease: a phenomenological enquiry.
Fatigue is frequently experienced by patients with chronic illnesses, and especially by patients with cancer and chronic obstructive airways disease. However, there is a paucity of qualitative research into the experiences of fatigued individuals and, consequently, definitions of fatigue have, to date, been based solely on observation and conjecture. The purpose of this study was to capture a detailed description of the fatigue experienced by individuals with cancer and chronic obstructive airways disease. A phenomenological research design was adopted. The findings presented in this paper depict fatigue as a complex phenomenon. The paper describes the physical and mental sensations embodied in fatigue, the impact of fatigue on everyday functioning, the emotional feelings evoked by fatigue and the impact of fatigue on perceived control. These findings have relevance for clinical nursing and future research.
Activities of Daily Living↗
Analysis and modulation of DNA repair in aging.
Nearly 40 years ago it was proposed that accumulation of mutations or increased levels of DNA damage might contribute to aging processes. Despite several correlative studies in this area, the answer as to whether genomic integrity contributes to aging has remained illusive. More recently it has been hypothesized that decreased mitochondrial DNA integrity plays a role in aging. To begin to test these hypotheses more directly, we are developing transgenic mouse and cell culture model systems. For example, transgenic mice overexpressing the DNA repair protein O6-methylguanine-DNA methyltransferase (MGMT) have been made and have a reduced spontaneous frequency of hepatocellular carcinoma. A lifespan study using the MGMT transgenic mice is in progress in an effort to determine whether cancer impacts on the median or maximal lifespan of a species. Second, a quantitative PCR technique is being used to measure mitochondrial DNA damage in mitotic and post-mitotic cells to determine if the level of damage and/or repair is different based on mitotic status. Finally, mice deficient in metallothionein-I and -II are being used in an effort to determine if the subcellular distribution of metals impact on oxidative damage with increased age.
Aging↗
Is breast cancer caused by late exposure to a common virus?
Although there are recognized risk factors for breast cancer, its cause is still unknown. It is hypothesized here that breast cancer results from late exposure to a common virus. This hypothesis is investigated by relating the epidemiology of breast cancer to the seroepidemiology of cytomegalovirus, as a surrogate for a breast cancer virus. The hypothesis is consistent with the geographical distribution of breast cancer; a correlation between breast cancer incidence and the percentage of adults who are cytomegalovirus seropositive in various countries was found (Pearson correlation coefficient -0.79). The hypothesis is also consistent with other risk factors for breast cancer, such as age at onset, family history, hormonal factors and migration.
Adult↗
Normal eruption of the maxillary canine quantified in three dimensions.
The normal eruption path of maxillary canine teeth was quantified on annual lateral and depressed postero-anterior cephalometric radiographs of 15 females and 15 males aged 5-15 years. The lateral view was rotated so that the horizontal coincided with the Frankfort plane on the depressed views, thus orientating the two views in space. Successive positions of canine cusps were marked on tracings of both views superimposed on the anterior outline of the zygomatic process. All positions of the canine cusps were digitized and the horizontal, vertical and lateral annual differences found by subtraction, taking the first position of the canine as the origin. The chronological data were corrected for enlargement and adjusted to increments of 12 months. Adjustments were also made to take into account varying ages of eruption. Posterior movement occurred between 7 and 13 years (all three years before eruption, the year of eruption and the following year). Vertical movement occurred between 5 and 13 years (all of the six years before eruption, the year of eruption and the following year). Lateral movement tended to be in a palatal direction up to 2 years before eruption followed by significant buccal movement in the year before eruption, the year of eruption and the following year. Data are given for eruption in three planes.
Adolescent↗
Applicability of interceptive orthodontics in the community.
The term interceptive orthodontics used in this paper is defined as the prompt treatment of unfavourable features of a developing occlusion categorized as local factors, crowding and displacements of the mandible in closing from the rest position. The aims of the study were to determine the best age or ages for interceptive orthodontics, to establish diagnostic cut-off points for self-correcting features of the developing occlusion which can be quantified, to investigate the reproducibility of treatment decisions and to make an initial estimate of the percentage of children suitable for interception. Based on material in the Belfast Growth Study, maximum or minimum measurements associated with spontaneous correction of quantifiable features were determined and incorporated into a disposable plastic gauge. Using the gauge, the available records of 278 Growth Study subjects at age 9 years and 272 at age 11 years were assessed for suitability for interception. Most of the conditions for interceptive treatments were present at age 9 years, but others were not present until 11 years. The majority of treatment decisions were highly reproducible. Approximately 50 per cent of the children in the Growth Study would have benefitted from interceptive orthodontics. A follow-up community study seems justified.
Age Factors↗
Determining priorities for purchasers. The public response to rationing within the NHS.
There is currently great interest in how best to consult the public on purchasing priorities, but little information about the results of such activity. Based on health panels set up by Somerset Health Authority, intends to rectify this gap. The public were found to strongly favour universality of treatment, regardless of the cause of a condition, the age of the patient or the cost, although people should take some responsibility for their own health. There is a reluctance to purchase treatment for people who are not ill, although resources are well spent on health promotion and advice services. Argues that ordinary members of the public are capable of exploring complex funding priorities. A qualitative approach is essential to provide time for reflection, as the process of deliberation affects the decisions reached.
Attitude to Health↗
Undergraduate orthodontics in Belfast: 12 years on.
The British and European Community recommendations for teaching orthodontics in the undergraduate curriculum from 1963 up to the present day are reviewed. 12 years experience of the course introduced in Belfast in 1984 is reviewed and some of the difficulties are identified. Modifications in the course to meet these difficulties are described.
Curriculum↗
Inhibition of cell spreading by expression of the C-terminal domain of focal adhesion kinase (FAK) is rescued by coexpression of Src or catalytically inactive FAK: a role for paxillin tyrosine phosphorylation.
pp125FAK is a tyrosine kinase that appears to regulate the assembly of focal adhesions and thereby promotes cell spreading on the extracellular matrix. In some cells, the C terminus of pp125FAK is expressed as a separate protein, pp41/43FRNK. We have previously shown that overexpression of pp41/43FRNK inhibits tyrosine phosphorylation of pp125FAK and paxillin and, in addition, delays cell spreading and focal adhesion assembly. Thus, pp41/43FRNK functions as a negative inhibitor of adhesion signaling and provides a tool to dissect the mechanism by which pp125FAK promotes cell spreading. We report here that the inhibitory effects of pp41/43FRNK expression can be rescued by the co-overexpression of wild-type pp125FAK and partially rescued by catalytically inactive variants of pp125FAK. However, coexpression of an autophosphorylation site mutant of pp125FAK, which fails to bind the SH2 domain of pp60c-Src, or a mutant that fails to bind paxillin did not promote cell spreading. In contrast, expression of pp41/43FRNK and pp60c-Src reconstituted cell spreading and tyrosine phosphorylation of paxillin but did so without inducing tyrosine phosphorylation of pp125FAK. These data provide additional support for a model whereby pp125FAK acts as a "switchable adaptor" that recruits pp60c-Src to phosphorylate paxillin, promoting cell spreading. In addition, these data point to tyrosine phosphorylation of paxillin as being a critical step in focal adhesion assembly.
Animals↗
Breast cancer screening: the effect of self selection for screening on comparisons of randomised controlled trials.
In randomised controlled trials of breast cancer screening women are randomly allocated to an intervention group that is offered screening, or a control group that receives the usual medical care. Not all women in the intervention group accept screening; the women who do so may differ from other women in their underlying risk of breast cancer. This self selection for screening can result in either women at high risk or at low risk being overrepresented in the screened group. When comparisons between trials are made it is important to take self selection for screening into account, as a trial with self selection of women at high risk has the potential to have greater efficacy than a trial with self selection of women at low risk. A method of adjusting for self selection when comparing randomised controlled trials of breast cancer screening is described.
Breast Neoplasms↗
The cost of health care for HIV-positive patients.
Utilizing a prospective study of health service activity for HIV/AIDS, 2 estimates of hospital costs of care analysed with reference to gender, risk activity, immunological and clinical staging (1987 definition of AIDS) were undertaken. Utilizing combined costs per life year (based on hospital and hospice activity but not primary and community care) the ratio of costs for CD4 < 200 and CD4 > 200 was for most risk groups between 2-5:1 whilst for AIDS: pre-AIDS it was between 3.6-8.3:1 except for homosexuals where it was 12.6:1. A comparison of the standard hospital costs for infectious diseases with the published accounts for clinical AIDS care in Lothian suggests a 3-4-fold underestimate in the costs of providing a comprehensive health care service.
Acquired Immunodeficiency Syndrome↗
Attitudes towards HIV testing of patients attending hospital.
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AIDS Serodiagnosis↗
Hospital and hospice resource use of HIV-positive patients in Edinburgh.
A prospective study of health service and hospice resource utilization (average length of stay or ALOS, discharge rate, bed day use, outpatient consultation) analysed with reference to gender, risk activity, immunological and clinical staging (1987 definition of AIDS) for the financial year 1992-93 was undertaken at the Regional Infectious Disease Unit (RIDU), City Hospital, Edinburgh, Scotland where 72% of 513 patients were infected via injection drug use. Not surprising therefore overall, drug users were the heaviest users of the inpatient facilities (74% of the discharges and 65% of the bed days) although homosexuals had the highest discharge rate (114 per 100 person years) and rate of bed day use (1654 days per 100 person years). Immunodeficiency (CD4 count < 200 cells/ul) and a clinical diagnosis of AIDS were both associated with greater inpatient and outpatient resource use compared to those without immunodeficiency (CD4 count > or = 200 CD4 cells/ul) or AIDS. Gender effects were complex; the ALOS for women was increased for all risk groups whatever the CD4 count whilst there was no consistent trend of more resource use for women by risk group. Drug users were the heaviest overall users of the local hospice (84% of all admissions, 83% of the bed days and a discharge rate of 76.4 per 100 person years), more than double the rates experienced by the other risk groups. Thus both clinical and immunological staging (AIDS or a CD4 count < 200 cells/ul) were associated with increased resource use in HIV infection and estimates of resource use for AIDS need to be increased by around one-third to take into account hospice use. Despite the preponderance of drug users in Edinburgh, comparisons with other centres did not reveal increased resource use.
Acquired Immunodeficiency Syndrome↗
Information for trained nurses in remote areas: do electronically networked resources provide an answer?
This paper reports on a research project which examined the potential of the Internet, and other networked information resources, to improve access to information for trained nurses working in remote areas. This paper provides a review of current literature in the field. It describes the research carried out, presents a summary of the research findings and discusses the implications of these findings. The paper concludes that the Internet and networked resources do have considerable potential to improve access to information for nurses working in remote and rural areas. However, information skills, along with professional guidance, are also required.
Community Health Services↗
Outcome prediction of the anterior open bite. Comparison of computer and clinician analysis of cephalograms.
Anterior open bite (AOB) may be expected to close spontaneously in approximately 50% of Caucasian patients. Computer-derived discriminant analysis of a single cephalometric radiograph has been shown to predict closure or non-closure in 88% of patients at the pre-puberal stage, in 74% at the puberal stage, and in 94% at the post-puberal stage. In this study, the predictive capacity of the computer analysis was tested against predictions made by groups of clinicians in Belfast and Toronto. The computer analysis was carried out on the first cephalometric radiographs of a new sample of 34 open bite cases collected serially and recorded over a minimum of 2 years. Thus, the spontaneous outcome was known to the authors. The first radiographs were shown to 20 clinicians in Belfast and 22 in Toronto who were asked to predict the spontaneous outcome. The computerised discriminant analysis made correct predictions in 85% and the clinicians in 64% of the sample. There were no significant differences between the predictions of clinicians in Belfast and Toronto, but computer prediction was more accurate than all grades of clinician. The predictions of qualified orthodontists were generally more accurate than prequalified orthodontists which were more accurate than those of undergraduate dental students but the differences did not rise to the level of statistical significance. For patients at the puberal stage the predictive capacity of qualified orthodontists was less than orthodontists in training. Computer prediction of the spontaneous outcome in open bite improves clinical diagnosis.
Adolescent↗
Learning disability. A fitting response.
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Community Health Services↗