Biomedical subjects
B Taylor
Publications and source records attributed to B Taylor.
Big battles for small gains: a cautionary note for teaching reflective processes in nursing and midwifery practice.
Since 1988, Australian university nursing courses have adopted the processes of educationalists in embracing reflective practitioner concepts and strategies. The assumption underlying reflective practice appears uniformly to be that if practitioners reflect on and in their practice worlds they can develop ways of changing them. This paper will outline some cautionary points in teaching reflective processes for use in nursing practice, given that they have been processes intent on mobilizing change in densely impacted hegemonic structures in healthcare organizations. To demonstrate that the limits of reflective practice may constitute big battles for small gains, a research project undertaken with practising midwives will be used as a case in point.
Will longer hospital stays really help?
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Adolescents' attitudes to general practice in north London.
A questionnaire-based survey, undertaken in North London state secondary schools, illustrated some stumbling blocks and a lack of knowledge that is likely to inhibit an effective use of general practice among 12-18 year olds. A review of the current arrangements and some adjustment of current services might increase the likelihood of achieving Health of the Nation targets for teenage pregnancies, and may also improve health care for this important and vulnerable section of the population.
Chronic hepatitis C with normal aminotransferase levels: a clinical histologic study.
OBJECTIVE: To define chronic hepatitis C virus (HCV) infection among patients with persistently normal aminotransferase levels (PNAL). DESIGN: Retrospective chart review of all patients encountered during 1-yr with positive hepatitis C antibody (anti-C100-3 ELISA), no alternative cause for their liver disease and PNAL for 6 or more consecutive months prebiopsy. Blinded review of liver histology. SETTING: Outpatient hepatology clinics of two academic centers. PATIENTS: Fifty patients with PNAL among 303 with hepatitis C. MEASUREMENTS: Epidemiologic profiles, reasons for seroscreening and confirmatory analyses were tabulated. Histology was reviewed and grading of inflammatory activity and stage of fibrosis was determined by protocol. RESULTS: Among 50 patients with PNAL, 35 (70%) were female, 34 (68%) had parenterally acquired HCV, 44 (88%) abstained (> 2 yr) from ethanol, all were HIV-negative and none pharmacologically immunosuppressed. HCV infection was uniformly confirmed by RIBA II or HCV-RNA assay. The mean level of HCV-RNA by quantitative PCR was 3.79 x 10(5) copies/ml (range, 500 to 1.8 x 10(6) copies/ ml) and by B-DNA, 53 x 10(5) copies/ml (range, 3.5-230 x 10(5) copies/ml). Traditional histoevaluation yielded chronic hepatitis ("active", n = 15; "persistent", n = 25), cirrhosis (n = 7), and normal histology (n = 3). Blinded protocol review of histology (inflammatory grade/fibrotic stage) revealed 0/0 (n = 4), 1/0 (n = 6), 2/0 (n = 17), 2/1 (n = 3), 2/4 (n = 1), 3/0 (n = 2), 3/1 (n = 6), 3/2 (n = 2), and 3/3 (n = 9). CONCLUSIONS: In chronic HCV infection, active inflammation, fibrosis, and variable circulating HCV-RNA levels may coexist with PNAL, particularly among female nondrinkers. Asymptomatic carriers with normal histology comprise 6 to 8% of chronic hepatitis C with PNAL. Management guidelines for this group of patients need to be developed.
Teenagers' views on the general practice consultation and provision of contraception. The Adolescent Working Group.
BACKGROUND: The rate of unwanted pregnancies in adolescents in the United Kingdom (UK) is one of the highest in Europe and is a major reason for the RCGP's concern at the under-use of general practitioners' (GPs') contraceptive services by young people. AIM: To discover the attitudes of 15- to 16-year-olds to the GP consultation and contraceptive services. METHOD: Questionnaires were completed as part of an evaluation of a novel sex education programme in 30 schools in 1994, and provided the data for this study. A total of 4481 teenagers (51.6% male and 48.4% female completed the questionnaires in their classrooms under conditions of complete confidentiality. RESULTS: The median consulting rate per year was two for males and three for females. Over 60% of adolescents attended the consultation with a parent. Of the males, 27.5% 'felt that the discussion with their GP could be relayed to their parents against their wishes', as did 25.1% of the females. Other difficulties with GP appointments were identified as embarrassment (63% of females and 46% of males), difficulty getting a quick appointment (44% of both males and females), and an unsympathetic GP (32% of females and 20.5% of males). CONCLUSIONS: Adolescents identify significant factors blocking them from easy access to consultation with their GP. These included lack of trust in confidentiality, lack of staff friendliness, and delay in appointment. Consideration of how these blocks can be removed will assist in providing improved contraceptive services in primary care. General practices need to consider the above factors when providing contraceptive and other services to their teenage patients.
Induction of programmed cell death and immunosuppression by exogenous sphingolipids are separate processes.
Gangliosides are highly immunosuppressive molecules but the mechanism(s) by which they act upon cells remains to be fully defined. Several metabolic products of exogenous gangliosides, including ceramide, have recently been suggested as second messengers in programmed cell death (PCD). Therefore, we have probed the role of gangliosides and ceramides in the induction of PCD and in the inhibition of in vitro lymphoproliferation. PCD was caused only by exogenous ceramides with short fatty acyl groups-d18:1-C2:0 (C2-ceramide, where d18:1 is sphingosine and C2:O is an acetyl group) and d18:1-C6:0 (C6-ceramide, where C6:O is a hexanoyl group). None of the gangliosides studied induced PCD, including naturally occurring GM3, synthetic d18:1-C18:0 GM3 (C18-Cer GM3, where C18:0 is a stearoyl group), or even d18:1-C2:0 GM3 (C2-Cer GM3), which itself contains a PCD-causing ceramide. However, these gangliosides were highly immunosuppressive, inhibiting antigen-induced lymphoproliferation at micromolar concentrations. We conclude that exogenous sphingolipids cause inhibition of lymphoproliferation and PCD by two separate and distinct mechanisms of action.
Quantitative morphology of physiologically identified and intracellularly labeled neurons from the guinea-pig laterodorsal tegmental nucleus in vitro.
Mesopontine cholinergic neurons have been implicated in the initiation and maintenance of rapid eye movement sleep via their efferent connections to the thalamus and the medial pontine reticular formation. As a first step toward understanding how these modulatory neurons integrate synaptic input, we have investigated the dendritic architecture of laterodorsal tegmental nucleus neurons. The principal cells of the guinea-pig laterodorsal tegmental nucleus were identified electrophysiologically in a brain slice preparation, then were intracellularly injected with biocytin and reconstructed using a computer-aided tracing system. The somata were large (27 +/- 3 microns; n = 11) and gave rise to an average of 4.8 primary dendrites which, in most cases, emerged from the soma in a pattern that was radially symmetric in the plane of the slice. Primary dendrites had an average of 3.7 endings. A single axon arose from either the soma or a proximal dendrite and exited the nucleus with a medial and/or lateral trajectory. Some axons also gave rise to a local terminal plexus composed of fine fibers bearing numerous punctate swellings that ramified profusely within the neuron's dendritic field. Total dendritic area averaged about 10(5) microns2, and therefore the average contribution of the soma to the total surface area (20%) was significantly larger than the values reported for many other cell types. Dendritic diameters were non-uniform in three respects. Some processes were sparsely spiny. Most processes were varicose, with the degree of varicosity increasing substantially in secondary and tertiary dendritic segments. There was also a large degree of taper in dendritic processes; those processes with a non-negative taper had an average diameter decrease of 40 +/- 25%. Dendritic processes deviated from the criteria necessary for a Rall equivalent cylinder approximation due to non-uniformity in morphotonic path length, failure to conform to the Rall 3/2 branching rule and non-uniformity of dendritic diameter. An analysis was done to assess the impact of dendritic varicosities on the extraction of cable parameters for these cells. Voltage traces were simulated by solving the cable equation for a varicose dendrite and then membrane parameters were recovered using an equivalent cylinder model. Errors in the extracted values of specific membrane conductance and specific membrane capacitance were quite small (< or = 5%), while larger errors were seen for electrotonic length (< or = 21%) and intracellular resistivity (< or = 5%). These data indicate that the principal cells of the laterodorsal tegmental nucleus, while possessing a relatively simple dendritic structure in terms of number and branchiness of dendrites, display a heterogeneity of dendritic process types. Processes range from smooth to markedly varicose, and can be aspiny or sparsely spiny. The possibility that the dendritic varicosities function as sites of either electrical or chemical compartmentalization is discussed. The degree of error resulting from a Rall equivalent cylinder approximation in light of these varicosities indicated that a generalized cable model approach may prove more effective in estimating their cable parameters.
Can we measure the effectiveness of our organizations?
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Enhancement of proxy appointment for older persons: physician counselling in the ambulatory setting.
OBJECTIVE: To determine the effectiveness of physician-initiated counselling on the rate of health care proxy appointment. DESIGN: Observational study of an intervention in a convenience sample. SETTING: A geriatric outpatient clinic in a tertiary care teaching hospital, New York, New York. PARTICIPANTS: A total of 687 patients enrolled in the geriatric clinic during the study period March 1991 through June 1993. INTERVENTION: Physician counselling about the New York State Health Care Proxy Law, distribution of educational materials and healthcare proxy forms, and reminders in 331 of 466 eligible patients. MEASUREMENTS: Rate of healthcare proxy appointment in eligible and counselled groups; predictors of appointment and non-appointment; time elapsed from counselling to appointment; reasons for non-appointment; characteristics of the proxy appointment process. RESULTS: A healthcare proxy was appointed for 31.5% of patients eligible for counselling and for 44% of patients who actually received the intervention, compared with a 2.3% proxy appointment rate at baseline. Eighty-one percent of the patients completing the proxy appointment process did so at or before their third clinic return visit after the counselling intervention. Of the counselled patients who did not appoint a proxy, 25% explicitly declined, and 75% had not come to a decision by the end of the study period. Proxy completion was associated with ethnicity, education, and more frequent clinic visits. Of those who appointed a proxy, 97% had good or fair comprehension of the procedure, 92% discussed the appointment with their designees, 63% appointed a daughter or son, and 80% discussed their wishes for care at the end of life with their proxy. CONCLUSIONS: Physician counselling of older outpatients is an effective means of increasing healthcare proxy appointments.
Social work with transport disabled persons: a wayfinding perspective in health care.
Transport disabled persons confront extensive architectural and psychosocial barriers during their travel to community based health care services by mass transit. The current health care reform movement affords social work an opportunity to consolidate its expertise with this population. The Certificate of Need program is a method with which social work can provide service to people with transportation disabilities. Social work can also continue its use of the Americans with Disabilities Act and the Urban Mass Transportation Act to assist people with transport disabilities to access community based health care services.
Gender and nursing in colonial Victoria, 1840-1870.
The role of the nurse in health care has been the subject of a debate over time which engages with the ambiguity about the role of the nurse, the boundaries of nursing work, and the question of the status of women and men within the profession. In this paper we report on a historical analysis of the nature of nursing work in colonial Victoria, Australia, which was undertaken in order to understand how the nursing role evolved and was socially constructed in early Australia. A significant absence of accounts of nurses between 1840 and 1870, and a lack of comparative analysis of male and female roles in nursing care in this period, suggested a need to reveal some of the social, political and economic influences on the delineation of nursing work and the relevance of these factors to the relationships between hospital staff. The study adopted three strategies or methods. First, the scattered and diffuse references to the origin and development of the role and function of the nurse in this were collated, particularly identifying nursing duties and the existing division of labour. Following this, hospital administrative structures were analysed. Finally, an interpretive methodology of textual analysis was employed and the portrayal of nursing in a number of texts, including hospital histories, annual reports and contemporary literature were examined. This provided us with a socio-cultural and historical perspective on the nature of nursing work in early Victoria.
1995 Roussel Lecture. Management of adenocarcinoma of the head of the pancreas: 10 questions for the 1990s.
Carcinoma of the head of the pancreas is a lethal condition because it presents clinically late in the disease and because of its unfavourable biologic course. Surgical approaches have become progressively more aggressive in recent years, without a significant increase in long-term survival. Controversy persists as to the appropriate surgical procedure for this disease, nonoperative or operative palliation, and and future prospects for management. This review considers questions often posed by clinicians and offers answers based on a literature reivew and the experience of the hepatobiliary service at the Toronto Hospital, Toronto General Division.
Adjusting to criminal victimization: the correlates of postcrime distress.
This article explores the correlates of immediate and short-term psychological distress among victims of burglary, robbery, and nonsexual assault. A panel design was employed. Crime victims were interviewed within 1 month following the incident and again 3 months later. Four sets of predictors were examined: demographics, previctimization adjustment and stress, features of the crime incident, and victims' perceptions. Measures of distress included a range of standard indices of adjustment and symptomatology. Demographic characteristics and victim perceptions accounted for the greatest proportions of variance in the outcome measures at Time 1 and Time 2. The strongest predictors of psychological adjustment at the end of 3 months included adjustment after 1 month, education, victim injury, victims' beliefs that their lives had been endangered during the crime episode, and victims' appraisals of the world as meaningful. Implications for treatment and directions for future studies are discussed.
Laparoscopic versus open appendectomy: a prospective randomized trial of 81 patients.
OBJECTIVE: To compare the efficacy of laparoscopic appendectomy (LA) and open appendectomy (OA) in the treatment of acute appendicitis. DESIGN: A prospective randomized trial. SETTING: A university teaching hospital. PATIENTS: Eighty-one patients with a diagnosis of acute appendicitis were prospectively randomized to undergo either LA or OA. The two groups were matched for age and sex. INTERVENTIONS: LA or OA. MAIN OUTCOME MEASURES: Number of days in hospital and time to full recovery. RESULTS: The mean hospital stay for LA was 3.23 days compared with 3.03 days for OA (p < 0.001). The mean number of narcotic injections required for patients in the LA group was 4.05 compared with 5.58 for patients in the OA group (p < 0.001). The mean time to complete recovery for patients in the LA group was 9.0 days compared with 16.2 days for patients in the OA group (p < 0.001). The mean operative time for LA was 73.8 minutes compared with 45.0 minutes for OA (p < 0.001). Three patients in the LA group had intra-abdominal abscesses (p > 0.25). No significant difference in wound infection rates was demonstrated (p > 0.05). Similarly, pain scores at 7 and 28 days showed no significant difference (p > 0.05). CONCLUSIONS: With LA significantly fewer narcotic injections are required and there is a more rapid return to normal activities. LA takes longer to perform and was associated with three intra-abdominal abscesses. In cases of simple acute appendicitis the hospital stay for LA is significantly shorter.
Interdigitation of nitric oxide synthase-, tyrosine hydroxylase-, and serotonin-containing neurons in and around the laterodorsal and pedunculopontine tegmental nuclei of the guinea pig.
The topography of neurons containing nitric oxide synthase (NOS) and monoamines was investigated in the guinea pig mesopontine tegmentum. NOS-containing neurons were identified with NADPH-diaphorase (NADPH-d) histochemistry, and monoamine-containing neurons were identified with tyrosine hydroxylase (TH) and serotonin (5-HT) immunocytochemistry. The distribution of NADPH-d positive cells was centered on the laterodorsal tegmental (LDT) and pedunculopontine tegmental (PPT) nuclei. Diaphorase-containing cells had a mean soma diameter of 23.0 +/- 4.1 microns (n = 160) and were distributed inhomogeneously, with numerous cells found within densely packed clusters. A nearest-neighbor analysis revealed that these cells were closely spaced, with up to 20% within one cell diameter and more than 50% within two cell diameters of a neighboring NADPH-d cell. Within the LDT and PPT, NADPH-d positive cells were mixed with smaller, diaphorase-negative cells (diam: 12.8 +/- 3.3 microns; n = 182; P << 0.01). TH-containing cells were not organized into a compact LC as in rat and their distribution more closely resembled that observed in cat. On average, TH-containing cells (diam: 21.2 +/- 4.8 microns; n = 160) were smaller than NADPH-d cells (P < 0.01). 5-HT-containing cells were mainly located in the raphe nuclei, as in other species. 5-HT-containing cells (diam: 18.2 +/- 4.4 microns; n = 161) were smaller on average than both the NADPH-d (P < 0.01) and TH-containing cells (P < 0.01). An analysis of the overlap in soma distributions revealed that TH-containing cells were largely interdigitated with NADPH-d containing cells. As much as 78% of the area occupied by the NADPH-d cells of LDT was contained within the area occupied by TH cells. Substantial numbers of TH and 5-HT immunoreactive processes were seen in both LDT and PPT. Varicose 5-HT and TH-containing fibers, as well as thicker, possibly dendritic processes containing TH were often seen in close apposition to NADPH-d containing somata and proximal dendrites. These results support the hypothesis that NADPH-d cells of both the PPT and LDT receive input from TH and 5-HT cells. Moreover, the clustered substructure of LDT and PPT and the extensive overlap of NADPH-d and TH-containing somata raise the possibility that the membrane permeable messenger nitric oxide plays a role in modulating TH-containing somata and their processes as well as 5-HT-containing processes in the LDT and PPT.