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C A Kirton

Publications and source records attributed to C A Kirton.

14 recordsLinked to original sources

Primary care and case management of persons with HIV/AIDS.

The nurse practitioner can meet the multiple needs of people living with HIV disease. Given the broad scope and integration of services required to care for clients with HIV/AIDS, the skill of a nursing case manager is also an integral part of the health care team. Together, these nursing clinicians can enhance the quality of care provided to HIV-infected individuals as each plays numerous roles with specific competencies and skills. This article discusses primary care services and the role of health care providers in working with persons with HIV/AIDS.

Case Management

Alterations in basal protein kinase C activity modulate renal afferent arteriolar myogenic reactivity.

Myogenic vasoconstriction of the renal afferent arteriole contributes to the autoregulation of renal blood flow, glomerular filtration rate, and glomerular capillary pressure (PGC). The reactivity of the afferent arteriole to pressure and the efficiency of PGC control are subject to physiological and pathophysiological alterations, but the determinants of the myogenic response of this vessel are largely unknown. We used the in vitro perfused hydronephrotic rat kidney to investigate the role of protein kinase C (PKC) in the control of this response. Inhibition of PKC by 1 microM chelerythrine attenuated myogenic reactivity but did not affect the afferent arteriole vasoconstrictor response to KCl (35 mM)-induced depolarization. Low concentrations of phorbol ester (10 nM phorbol 12-myristate 13-acetate) and low levels of ANG II or endothelin-1 (3 pM) potentiated myogenic vasoconstriction without affecting basal afferent arteriolar diameters. These actions were blocked by 1 microM chelerythrine, suggesting a PKC-dependent mechanism. Finally, although PKC inhibition attenuated basal myogenic responses, full reactivity to pressure was restored by 1 mM 4-aminopyridine, a pharmacological inhibitor of delayed rectifier K channels, which are known to be modulated by PKC. The ability of 4-aminopyridine to circumvent the effects of PKC inhibition militates against a direct role of PKC in myogenic signaling. We interpret these observations as indicating that basal PKC activity is an important determinant of myogenic reactivity in the renal afferent arteriole. However, PKC activation does not appear to play an obligate role in myogenic signaling in this vessel. We suggest that basal PKC activity directly modulates voltage-gated K channel activity, thereby indirectly affecting myogenic reactivity.

4-Aminopyridine

Assessing edema.

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Edema

Hazardous terrain and over the edge: the survival of HIV-positive heterosexual, minority men.

The purpose of this study was to describe and explore the experience and perceptions of heterosexual minority men living with and surviving HIV infection. This descriptive, exploratory qualitative study used in-depth interviews that were guided by Rosenstock's health belief model and Ajzen's theory of planned behavior. A purposive sample of 18 HIV-positive heterosexual, minority men were accrued from an outpatient HIV/AIDS clinic in upstate New York and a community-based AIDS service organization in New York City. The findings revealed that the experience of surviving HIV infection encompassed several stages. The men of this study described the choices they made in adolescence that led them down a trail of life that may be metaphorically described as "hazardous terrain," as the majority became involved in substance use or other illicit activities. With the diagnosis of HIV infection came a "Falling Off" stage, in which the participants went "over the edge" and initially were afraid to die but realized at this point that they were okay but vulnerable. The next stage was "Hanging On," in which they attempted to gain control, reevaluated priorities, and developed a new perspective on life and health. In the "Pulling Up" stage, participants realized that the rescue team included self, God, family, and friends, with self-rescue occurring on emotional, physical, and spiritual levels. As the participants reached the "Turning Around" stage, they began to accept responsibility for their health, focused on their abilities rather than their limitations, and reframed their perspectives to living with rather than dying from HIV infection. This study has implications for health-education programs, AIDS prevention, health assessment, and interventions for HIV-positive, heterosexual, minority men.

Adaptation, Psychological