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Biomedical subjects

A Wilson

Publications and source records attributed to A Wilson.

At least 577 records · Page 32Linked to original sources
PubMedDate not supplied

Using content analysis of video-recorded consultations to identify smokers' "readiness" and "resistance" towards stopping smoking.

Although physicians' brief advice against smoking is effective in helping smokers to stop, very little is known about the process of counseling smokers. We describe the development of a coding system for describing smokers' motivation to stop smoking as judged by their behaviour when discussing smoking with their family physician. We analysed video-recordings of consultations between 47 self-reported smokers and 29 family physicians where smoking was discussed. By a process of observing recordings, reading transcripts and discussion, we developed a coding system for describing smokers' levels of motivation to stop smoking. This consists of four behaviours thought to indicate "readiness" (higher motivation to stop) and four "resistance" (lower motivation to stop). Interobserver reliability between two observers was good (Kappa = 0.71 for readiness, 0.73 for resistance behaviours). We discuss the relevance of our descriptions for clinicians and the possibility of developing this work further to enable systematic research into doctor-patient interactions where smokers are counseled to stop.

Attitude to Health↗
PubMedDate not supplied

Manipulation under anesthesia for primary frozen shoulder: effect on early recovery and return to activity.

Frozen shoulder is still an enigma of shoulder surgery. It is reported that at 2 years from onset, most patients will have recovered whether treated or not. However, the duration of morbidity has major implications for patient function and satisfaction. In view of this fact, we have focused on the early effect of manipulation under anesthesia on shoulder function. We prospectively assessed 39 shoulders in 37 patients who were given the diagnosis of primary frozen shoulder between June 1997 and June 1998 and were treated with manipulation under anesthesia of the affected shoulder. The median preoperative Constant score rose from 24 of 100 to 63 of 100 at 3 to 6 weeks and to 69 of 100 at 3 months. Improvement was maintained at a mean follow-up of 11 months after surgery (range 6 to 18 months). Overall, 94% of patients were satisfied with the procedure. At 3 months 59% (23 shoulders) were rated as having no or mild disability only, 28.2% (11 shoulders) as having a moderate degree of disability, and 12.8% (5 shoulders) as having a severe degree of disability. Of the 5 cases scoring less than 50 of 100 (mean 40) at 3-month follow-up, 1 had unmasked symptoms of a subacromial impingement syndrome that has required further treatment. There was no relationship between the initial Constant score or the initial range of movement after manipulation and the eventual result. We recommend the use of manipulation under anesthetic in primary frozen shoulder to restore early range of movement and to improve early function in this often protracted and frustrating condition.

Adult↗
PubMedDate not supplied

Chondroblastoma of the talus: a case report.

Chondroblastoma of bone is an uncommon condition that has a predilection for secondary ossification centers, particularly of the humerus, tibia, and femur. Treatment usually involves surgical curettage and autogenous bone graft. This article reports the case of a chondroblastoma affecting the talus of a young man and a minimally invasive surgical approach for the treatment of this lesion. The patient presented with an 18-month history of right ankle pain and swelling. The lesion involved most of the talar body, with 2.5-cm cortical erosion inferiorly at the posterior talocalcaneal facet. A lateral approach was made to the talus and a window was fashioned at the distal end of the sinus tarsi under fluoroscopic guidance to allow access to the lesion. This was curetted and the defect was filled with autogenous bone graft taken from the ipsilateral iliac crest. The patient underwent an uneventful recovery, and was asymptomatic at follow-up 24 months postsurgery. He had 75% movement at the subtalar joint, when compared with the contralateral foot.

Adult↗
PubMedDate not supplied

Effects of EMS transportation on time to diagnosis and treatment of acute myocardial infarction in the emergency department.

INTRODUCTION: Recent studies have documented decreased time to emergency department (ED) thrombolytic therapy with the use of prehospital electrocardiography. PURPOSE: Is the time to ED diagnosis and treatment of acute myocardial infarction (AMI) patients with thrombolytic agents decreased by emergency medical services (EMS) transport when compared with those transported by other means (non-EMS)? DESIGN: Retrospective, case-control study. POPULATION: The AMI patients treated with thrombolytic agents at a 34,000-visit, community hospital ED during 1992. METHODS: Review of records of patients who received thrombolytic therapy for AMI. Statistical analysis was performed using "Student's" t-test and Yates corrected Chi-square (chi 2). RESULTS: Eighty-seven patients received thrombolytic agents for AMI during 1992; 33 arrived by ambulance, 54 arrived by other methods. There were no differences in age, gender, or time of ED arrival among these groups. Ambulance patients received standard advanced life support (ALS) care, but not a 12-lead electrocardiogram (ECG) or thrombolytic agents. Ambulance patients experienced a significantly shorter time to first ECG (12.9 +/- 9.1 min. versus 20.8 +/- 25.3 min.; p = .028) and received thrombolytic therapy sooner than did controls (56.0 +/- 31.5 min. versus 78.0 +/- 63.4 min.; p = .018). There was no difference in time from diagnosis to treatment between these groups. CONCLUSION: Emergency medical services transport of AMI patients in this study decreased time to diagnosis and treatment and may be a confounder in studies that assess the value of field EMS interventions. Non-EMS AMI patients did not receive as rapid diagnosis and treatment, and emergency physicians should evaluate and address this issue in their departments.

Ambulances↗
PubMedDate not supplied

The reproductive health awareness (RHA) model: a qualitative perspective.

The Reproductive Health Awareness model developed by Georgetown University Institute for Reproductive Health is responsive to the elements of quality of care articulated by Judith Bruce in 1989. The model encourages self-choice regarding family planning options, informed choice and flexibility to change family planning options with changing circumstances, and inclusion of men and the family. Providers utilizing the model must know the stages of behavior change and how to program care based on the client's knowledge and readiness, and how to communicate with clients such that they are facilitating care rather than prescribing it.

Awareness↗
PubMedDate not supplied

Mouse strain differences in subset distribution and T cell antigen receptor expression among CD4-CD8- thymocytes.

'Double negative' (CD4-CD8-) thymocytes from adult mice of different inbred strains were examined for surface expression of CD3 and of various forms of the T cell antigen receptor (TcR), as well as for the levels of subpopulations defined by the surface markers HSA ('heat stable antigen', recognized by M1/69, J11d and B2A2), CD5 (Ly 1) and Thy 1. Marked variations were found in the level of the double negative subsets which were surface TcR+, or which were HSA-CD5+; these generally varied together since most CD4-CD8-HSA-CD5+ thymocytes were TCR+. The level of the CD3-TCR complex on the surface of those double negative thymocytes which were TcR+ was as high as on mature T cells in some strains (CBA/Ca), but was much lower in other strains (C57BL/6J). In most mouse strains the CD4-CD8-HSA-CD5+ thymocytes expressed predominantly the alpha beta form of the TcR, with an exceptionally high (70%) usage of V beta 8 gene products. In strains which lacked V beta 8 expressing T cells due to a deletion of the V beta 8 gene region, reduced levels of alpha beta TcR+ cells were found within the CD4-CD8- thymocytes; the HSA-CD5+ subset was then only present at low levels (as in SJL/J and C57BR mice) or was present at a high level but expressed predominantly gamma delta TcR (as in SWR mice). The results suggest that the accumulation of CD4-CD8-TcR+ HSA-CD5+ thymocytes is a selective event, and that their developmental pathway is off the mainstream of T cell maturation in the thymus.

Animals↗
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Education, Nursing↗
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A double-blind, placebo-controlled trial of magnesium sulfate in the ethanol withdrawal syndrome.

One hundred alcoholics treated for ethanol withdrawal were assigned randomly according to a double-blind protocol to receive four intramuscular injections of 2 g of magnesium sulfate at 6-hr intervals or an equivalent amount of normal saline. All patients were treated for signs of withdrawal according to a standardized protocol using orally-administered chlordiazepoxide for sedation. Three observers rated each patient for signs of withdrawal. There was no statistically significant difference between magnesium sulfate and placebo groups on any of the variables measured. The groups required equivalent amounts of chlordiazepoxide for control of withdrawal. The authors concluded that the routine administration of magnesium sulfate is not indicated for the management of alcohol withdrawal unless accompanied by cardiac arrhythmias.

Adolescent↗
PubMedDate not supplied

Double-blind trial of alprazolam and chlordiazepoxide in the management of the acute ethanol withdrawal syndrome.

A sequential sample of 101 patients hospitalized for ethanol withdrawal and requiring sedation for evolving withdrawal syndromes was assigned randomly according to a double-blind protocol to treatment with either alprazolam or chlordiazepoxide administered orally. The data from one patient were unevaluable due to acute bleeding, leaving a sample of 100 (50 in each condition). At discharge, three independent ratings of diaphoresis, tremor, hallucinations, nausea/vomiting, and overall severity of withdrawal were obtained, and the occurrence of delirium tremens and grand mal seizures was noted. Patients also completed the Beck Depression Inventory, and their disposition following discharge was recorded. There were no statistically significant differences between the two treatment groups on any of the dependent variables studied. It was concluded that the choice between alprazolam and chlordiazepoxide for managing ethanol withdrawal should be based on criteria other than efficacy of control. Potential antidepressant effects and drug kinetics were suggested as the basis for rational decision-making.

Adolescent↗
PubMedDate not supplied

Nurses in academic departments of general practice and primary care.

In 1997, the authors conducted a survey of registered nurses working in the academic departments of general practice and primary care in UK and Irish medical schools. The survey aimed to determine the number, demographic and professional profile of nurses employed in these academic departments, including their employment status and their views on their clinical work and professional development. The majority of nurses were professionally experienced, had higher degrees, worked in a research capacity, and were likely to have short-term contracts. Contrary to professional perceptions, the majority of nurses stated that clinical work is important to their current job and expressed a need for research support and recognition of their autonomy as healthcare professionals.

Adult↗
PubMedDate not supplied

A randomized clinical trial comparing behavior modification and individual counseling in the nutritional therapy of non-insulin-dependent diabetes mellitus: comparison of the effect on blood sugar, body weight, and serum lipids.

To determine whether a group behavior modification approach might be preferable to individual counseling in the nutritional therapy of non-insulin-dependent diabetes mellitus, 40 adults younger than 65 yr of age with diabetes mellitus who were not receiving insulin were randomized to either a program of individualized dietary review and recommendations or a program of group meetings aimed at controlling the signals leading to overeating and noncompliance with a diabetic dietary regimen. Statistically significant (P less than 0.05) decreases in body weight, sum skin-fold thickness, fasting serum glucose, and serum triglycerides but not LDL-C or HDL-C were observed. The individual counseling group had a greater amount of weight loss than the behavior modification group. There were no significant (P greater than 0.05) differences between the two groups with respect to the biochemical outcome variables. Patient characteristics assessed at entry--namely anxiety, internal versus external locus of control and perceived disease severity, and compliance with advice--were significantly associated with weight loss in the behavior modification group while only the latter index was of value in the individual counseling group. Thus, our use of these programs does not identify a clear advantage of either approach in the nutritional therapy of non-insulin-dependent diabetic patients.

Adult↗
PubMedDate not supplied

Using practice led design research to develop an articulated mechanical analogy of the human hand.

Contemporary prostheses have developed from small iterations on moderately successful archetypes. This has resulted in modern designs that can either be termed cosmetic or functional, with neither attribute being fully satisfied. A new strategy is needed to develop a generation of upper-limb prostheses that will integrate both cosmetic and functional requirements in a single device. It is hypothesized that design principles applicable to a new generation of prostheses will result from exploring close analogies to the human upper limb. A method of practice led design research has been adopted to explore appropriate analogies, using the production of physical models to elucidate the design problem to the design team and other interested parties. This method uses a consciously iterative approach whereby criticisms and lessons learnt in the development of early models are embodied in subsequent models. This paper describes the first iterative cycle. It includes a critical review of the devices currently available and a study of mechanical analogies to original anatomy which form two of the inputs to the development of a skeletal model hand. It details the lessons learnt from this study and concludes on the wider application of practice led design research in medical engineering.

Artificial Limbs↗