Biomedical subjects
Publications and source records attributed to B Jennings.
This conceptual model of Army nursing incorporates all of the components of nursing practice to include research, education and administration. The pyramid of clinical practice emphasizes that Army nursing maximizes the clinical expertise and graduate education of advanced practice nurses while depending on the foundation of traditional nursing.
The aim of this study was to compare the efficacy, compliance and side-effects of budesonide administered twice daily (b.d.) and four times a day (q.d.) with a Turbuhaler device in asthmatic subjects requiring < or = 1200 micrograms daily. The randomized, parallel group study design included a 2-week baseline period followed by a 6-12-month treatment period. Subjects were assessed at regular intervals in hospital through FEV1, PC20 methacholine, adrenal function and throat swabs. They were asked to record their symptoms and PEF values morning and evening at home. An asthmatic flare-up, which was the main outcome resulting in a patient's termination of the study, was defined beforehand as (a) 25% or greater diurnal variability in PEF for 2 consecutive days, and/or (b) nocturnal awakenings due to asthma symptoms 2 days or more in the same week and/or (c) an increase (doubling or more) in the need for inhaled bronchodilator 2 days in the same week. Fifty-eight adult asthmatic subjects (20 males and 38 females) entered the study, one-half being randomly assigned to the b.d. regimen and one half to the q.d. regimen. Fourteen subjects were on 400 micrograms, 15 subjects on 800 micrograms and 29 subjects on 1200 micrograms of budesonide daily. Seventeen flare-ups were recorded in the b.d. regimen group as opposed to 11 in the q.d. regimen (P = 0.05), significant differences being found in the 800 and 1200 micrograms groups (a total of 13 flare-ups in the b.d. group and eight flare-ups in the q.d. group for the two doses, P = 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
To determine whether high-dose or prolonged inhaled steroid therapy for asthma increases a patient's risk of osteoporosis and fracture, we measured bone density in 26 men and 43 women (41 postmenopausal, all of whom had received supplemental estrogen therapy) after treatment with an inhaled steroid for 10.1 +/- 5.5 years and oral prednisone for 10.7 +/- 9.7 years (mean +/- SD). Most had stopped receiving prednisone since commencing the inhaled steroid therapy. We found that bone densities (adjusted for age and sex to yield a z score) were lower in association with higher daily doses of inhaled steroid (p = 0.013 ANCOVA) and with the duration of past prednisone therapy (p = 0.032). Larger cumulative inhaled steroid doses were associated with higher bone densities (p = 0.002) and a reduction in the numbers of patients at risk of fracture. Bone density also increased with the amount of supplemental estrogen therapy (p = 0.058) and, at equivalent levels of inhaled and oral steroid use, women showed higher bone density z scores than did men. Women with a lifetime dose of inhaled steroid greater than 3 gm had normal bone density regardless of the amount of past or current prednisone use or the current dose of inhaled steroid. These data indicate that the daily dose, but not the duration, of inhaled steroid therapy may adversely affect bone density, and that estrogen therapy may offset this bone-depleting effect in postmenopausal women.
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An unusual cytogenetic translocation, t(8;13) (p11;q12), is described in a patient presenting with a CML-like myeloproliferative disorder associated with a high-grade T-cell lymphoma. Evidence is presented suggesting that the breakpoint region in the translocation involves a site implicated in both the T cell malignancy and the abnormal granulocyte proliferation.
The Enhancer of split locus is required during many cell-fate decisions in Drosophila, including the segregation of neural precursors in the embryo. We have generated monoclonal antibodies that recognise some of the basic helix-loop-helix proteins encoded by the Enhancer of split locus and have used them to examine expression of Enhancer of split proteins during neurogenesis. The proteins are expressed in a dynamic pattern in the ventral neurogenic region and are confined to those ectodermal cells that surround a neuroblast in the process of delaminating. There is no staining in the neuroblasts themselves. We have also examined the relationship between Enhancer of split protein accumulation and the Notch signalling pathway. Protein expression is abolished in a number of neurogenic mutant backgrounds, including Notch, but is increased as a result of expressing a constitutively active Notch product. We conclude that Notch signalling activity is directly responsible for the accumulation of basic helix-loop-helix proteins encoded by the Enhancer of split locus.
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Paraffin-wax-embedded samples of normal cervical tissue and of primary cervical carcinomata and nodal metastases were obtained from each of 15 patients. They were analyzed for the presence of ras point mutations and human papillomavirus (HPV) types 16 and 18 using the polymerase chain reaction (PCR) and hybridization to oligomer probes. Only 1 patient was found to have a ras mutation: a codon 13 mutation of Ki-ras which was present in only two lymph node metastases, but not in the primary tumor or in a third metastasis. These results suggest that ras point mutation is not a common factor in the development of primary or metastatic cervical cancer. HPV 16 was detected in 7 of the 15 patients and was present in both primary and metastatic tumors in 6 of these 7 cases. HPV 18 was not detected in any of the 15 patients. These results do not suggest a role for HPVs 16 and 18 in producing metastatic behavior.
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Health policy in the United States is entering an era in which explicitly value-based allocation decisions require direct attention. Policies concerning access to care, financing, and utilization management will necessarily have redistributive effects. For these policies to command social legitimacy and political support, some consensus will have to emerge around the values and ideals justifying these policies. This article addresses the problems of conceptual clarification and democratic process raised by the prospect of an explicitly value-based allocation policy. It offers a conceptual matrix distinguishing the scope of the issue of allocation in health care. Drawing on the activities of community health decisions projects in several states, it also offers suggestions about building a participatory and educational process at the grassroots level that might lead to a democratic consensus suitable for guiding policy choice.
OBJECTIVES: How do health care professionals assess the care of hospital patients near the end of life? Are physicians and nurses aware of and in agreement with national recommendations regarding patients' rights to forgo life-sustaining medical treatments and to receive adequate pain control? METHODS: We surveyed 687 physicians and 759 nurses in 5 hospitals. RESULTS: Almost half (47%) of all respondents and fully 70% of the house officers reported that they had acted against their conscience in providing care to the terminally ill. Four times as many respondents were concerned about the provision of overly burdensome treatment than about undertreatment. CONCLUSIONS: In summary, many physicians and nurses were disturbed by the degree to which technological solutions influence care during the final days of a terminal illness and by the undertreatment of pain. However, changes in the care of dying patients may not have kept pace with national recommendations, in part because many physicians and nurses disagreed with and may have been unaware of some key guidelines, such as the permissibility of withdrawing treatments.
Ethical issues in rehabilitation include both clinical dilemmas and broader philosophic issues about the goals of rehabilitation and the nature of the provider-patient relationship. Two philosophic issues are explored in this paper. One involves the social conceptions of the human good that necessarily underlie rehabilitative care and provide its ethical context. The second is the way in which the clinical reality of rehabilitation challenges the ideals of autonomy and individualism central to mainstream bioethics. This paper argues that only with a moral vocabulary of relationships and transformative healing, rather than with a vocabulary of individualistic autonomy, can rehabilitation convincingly express its social goals and professional mission in an era of scarce resources.
A definition of asthma includes symptoms due to reversible airflow limitation and airway hyperresponsiveness. Characteristically, there is also airway inflammation. In children with methacholine airway hyperresponsiveness but no asthma symptoms, we examined whether there were features of asthmatic airway inflammation. Forty one children, aged 11-16 yrs, were studied. Thirteen asymptomatic children with methacholine airway hyperresponsiveness (provocative concentration producing a 20% fall in forced expiratory volume in one second (PC20) geometric mean of 3.35 (range 1.08-7.81) mg.ml-1) were compared with 13 currently symptomatic asthmatics with a similar PC20 of 1.91 (0.42-6.5) mg.ml-1 and 13 normal children with a normal PC20 of 52.4 (17.6 to > 64) mg.ml-1. Breathlessness experienced during a methacholine test was recognized to have occurred previously in 7 out of 13 asymptomatic children and all symptomatic children. Asymptomatic children had significantly more airway responses to hyperventilation with cold dry air (4 out of 13) than normal children (0 out of 13) but less than symptomatic children (11 out of 15). Sputum induced with hypertonic saline contained lower eosinophil counts in the asymptomatic children (median (interquartile range) 0.20 (0.59)%) than in the symptomatic children (1.70 (9.45)%), and not different from the normal children (0.15 (0.61)%). Budesonide, 400 micrograms b.i.d. improved respiratory symptoms, forced expiratory volume in one second (FEV1) and methacholine PC20 in symptomatic children, but this effect did not reach statistical significance in asymptomatic children. We conclude that symptomatic children are more likely to have evidence of asthmatic inflammation than asymptomatic children and this probably explains the symptom difference.(ABSTRACT TRUNCATED AT 250 WORDS)
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To assess whether the use of larger than usual doses of inhaled steroid to treat severe asthma may adversely affect bone turnover and whether such an effect may be mitigated by altering the dose schedule, we investigated the effects of budesonide (BUD) on serum osteocalcin and the urinary output of hydroxyproline and calcium. Healthy adults were administered 1.2 or 2.4 mg of BUD per day (N = 40) or placebo (N = 8) in a crossover, double-blind comparison of morning versus diurnal dosing schedules for 1 month each. Both BUD doses reduced the 24-hour urinary free-cortisol output (p less than 0.001) and serum osteocalcin (p less than 0.001). The larger dose reduced the morning serum cortisol levels (p = 0.002). Neither dose increased the 8 AM urinary calcium or hydroxyproline output. Osteocalcin and plasma cortisol levels were higher on morning than on diurnal dosing (p = 0.01). The 24-hour urinary free-cortisol output was the same with either schedule (p = 0.96). Additional study is required to assess the clinical importance of the inhibitory effect of BUD on bone formation, as evidenced by the reduction in osteocalcin levels. Of concern is the possibility of serious bone complications resulting from the long-term use of inhaled steroid, particularly in growing children or patients in whom other risk factors for osteoporosis are present. The clinical advantage, if any, of morning dosing remains questionable.