Acute ascending aortic dissection during pregnancy.
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Acute Disease↗
Biomedical subjects
C Appleton
Publications and source records attributed to C Appleton.
Temperature-suitability maps for schistosomiasis in South Africa.
The results of parasitological surveys have shown that both urinary and intestinal schistosomiasis occur widely among the human residents of South Africa. The national data on both diseases have now been incorporated into a geographical information system, to develop new maps based on defined temperature constraints. The disease data, obtained from a 'hard-copy' atlas of schistosomiasis, were used as a template to select temperature regimes that were (1) suitable and (2) unsuitable for the transmission of schistosomes to humans in South Africa. The regimes were derived from the published results of investigations in which the biology of larval schistosomes (i.e. schistosome transmission) was related to temperature in South Africa. Those regimes that were based on the estimated temperature minima for transmission corresponded more closely to the disease-distribution data than those based on the corresponding maxima. An estimate of the number of children living in the climate-suitable areas was made but, within the context of the spatial methodology used and the limitations of the available disease data, it was not possible to predict the prevalences of schistosomiasis.
Adolescent↗
Concept, development, administration, and analysis of a certifying examination in echocardiography for physicians.
In 1993, the American Society of Echocardiography appointed a committee to develop an objective examination in echocardiography. In 1995, a pilot of this examination was administered, with operational examinations offered each year from 1996 to 1999. This report describes the development of the examination, including its underlying philosophy, the test itself, and the scoring process, and includes results from the first 4 examinations. To date, 1266 physicians have taken the examination, and roughly 60% of those have passed. The number of echocardiograms performed or interpreted each week had the largest effect on examination scores; the effects of both the amount of training and the practice discipline were small but significant. The evolution of the original committee and new directions for the testing organization are also discussed.
Certification↗
The prevalence of stress incontinence during pregnancy and following delivery.
OBJECTIVES: To examine the variation in findings from epidemiological studies which describe the prevalence of stress incontinence during and after pregnancy, and to undertake a prospective survey of the prevalence of stress incontinence during pregnancy and following childbirth in order to provide clarification of the findings presented in the literature. DESIGN: A review of the literature was undertaken using the Medline and Popline CD Rom. A postal questionnaire was sent to a sample of women when they reached 34 weeks' gestation and repeated at 8 weeks postpartum. PARTICIPANTS: 1008 women were recruited to the study when they attended the antenatal clinic at two hospitals in the north west of England. Seven hundred and seventeen (71%) women responded to the first questionnaire and 572 (57%) completed the second questionnaire. FINDINGS: The prevalence of stress incontinence during pregnancy reported in the literature ranges from 20 to 67%. Following delivery the reported prevalence is between 6 and 29%. In the present study 59% of women reported stress incontinence during pregnancy, and 31% following delivery. Ten per cent of the women had daily episodes of incontinence during their pregnancy, 2% of all women reported daily incontinence following delivery. An association was found between parity and stress incontinence, with women of higher parity being more likely to experience the condition. No difference in the prevalence of stress incontinence was found between women who had a normal delivery and those having an instrumental delivery. A caesarean section was found to be associated with a lower incidence of stress incontinence compared with a normal spontaneous delivery. KEY CONCLUSION: A high proportion of women experienced stress incontinence during pregnancy and/or following delivery. Some women reported severe symptoms, with leakage on a daily basis. Women of higher parity were more likely to suffer from the condition. Whilst women who had a normal spontaneous delivery or an instrumental delivery reported a similar level of stress incontinence, women who had a caesarean section were less likely to have the condition.
Adult↗
The experience of stress incontinence after childbirth.
BACKGROUND: Epidemiological studies have reported prevalence of stress incontinence ranging from 23 to 67 percent during pregnancy and 6 to 29 percent after childbirth, but little is known about how the condition affects women at this time. The purpose of this study was to examine the effects of stress incontinence on women in their childbearing years. METHODS: Interviews were conducted with 42 women who experienced stress incontinence at 8 weeks postpartum and 15 women who reported symptoms one year after delivery. Analysis of the qualitative data involved exploring themes and patterns, relationships and connections, contradictions and contrasts, and the language used within individual accounts and across the spectrum of narratives. RESULTS: The results are presented within a framework that the women themselves adopted: day-to-day activities, putting the condition in some form of perspective, and feelings and emotions. For some women, stress incontinence had a great impact on their lives in terms of both their daily routine and psychologically, but others described it as a minor inconvenience that rarely disturbed their routine. Major concerns comprised the restrictions placed on the women, the worry or continual awareness stemming from the condition, and feelings of embarrassment associated with it. Twelve months after childbirth the effects appeared to have lessened, but a few women were still significantly affected, both physically and psychologically. CONCLUSIONS: Although many women experience physical and psychological symptoms of stress incontinence after delivery, this study demonstrated that few sought professional care or advice for their symptoms. Health professionals should be aware of the prevalence, and women's responses to, stress incontinence so that they can initiate appropriate support and care. Further research on stress incontinence on childbearing women is necessary.
Activities of Daily Living↗
Biological and psychological processes in recovery from depression during cognitive therapy.
This study investigated the relationship between biological and psychological processes in the recovery phase of depression during treatment with cognitive therapy. In particular, we tested the hypothesis that biological and psychological processes are independent; the hypothesis that they are related in a linear or sequential process; and the hypothesis that there is a circular relationship between them. 35 depressed patients completed a 12 week program of cognitive therapy. Changes in measures of negative thinking and amine dysfunction over the course of therapy were compared for those who improved and those who did not. There was a significant relationship between improvement in symptoms and change for ATQ scores, DAS scores, and epinephrine levels. There was significant change in metanephrine levels during therapy which was not related to improvement. The changes were not consistent across indices. Although the results did not provide definite support for any of the four models of the relationship between biological and psychological variables during recovery from depression, the finding that there was some change in some of the indices of amine dysfunction during cognitive therapy indicates that the interface between biological and psychological processes in depression should continue to be studied.
Adaptation, Psychological↗
Nursing research. Moving into the clinical setting.
In nursing, inquiry is the road to research. It refines clinical practice and personal and professional development and lays the groundwork for incorporating research programs in hospital organizations. Strategies to formalize nursing inquiry into research programs are discussed.
Clinical Nursing Research↗
Arbutamine vs. exercise stress testing in patients with coronary artery disease: evaluation by echocardiography and electrocardiography.
Arbutamine is a new beta-adrenergic agonist with potent chronotropic and inotropic properties developed to pharmacologically induce stress. A prospective trial was conducted in five centers with a total enrolment of 45 patients with angiographically documented coronary artery disease. The primary purpose of the trial was to compare the efficacy of arbutamine with symptom-limited exercise in provoking clinical (angina), electrocardiographic (> or = 0.1 mV ST depression) and echocardiographic (induced wall motion abnormality) evidence of transient stress-induced ischemia. The secondary purpose was to assess the safety of arbutamine in patients with coronary artery disease. Ischemia was induced at a lower heart rate, systolic blood pressure and pressure-rate product during arbutamine infusion than during exercise. Using angina and/or electrocardiographic evidence of ischemia, arbutamine was more sensitive than exercise in detecting myocardial ischemia (77 vs. 58%, P = 0.021). Using echocardiography, the sensitivity for inducing wall motion abnormalities was 88% with arbutamine and 79% with exercise (P = not significant). Echocardiography in combination with angina and/or electrocardiographic evidence increased the sensitivity to 94% using arbutamine and to 88% with exercise. For the patients with multivessel disease, the sensitivity was 97% and 91%, respectively. No serious adverse events, either cardiac or noncardiac, were associated with arbutamine, and no patient had prolonged ischemia. Although exercise is the preferred method of stress for patients who are able to exercise adequately, arbutamine is at least as sensitive as exercise for the diagnosis of myocardial ischemia, and appears to be a safe and effective alternative to exercise testing in patients unable to exercise adequately.
Adrenergic beta-Agonists↗
Nursing as the promotion of well-being: the client's experience.
An essential question of the discipline of nursing is: What do nurses do to promote the client's well-being? Using a phenomenological-hermeneutic approach to inquiry, this study explored the client's experience of nursing as the promotion of well-being, explicating in three distinct metathemes the meaning of well-being as transforming and nursing as caring. Based on this critical view of nursing, prospective directions for education, research and practice are suggested.
Adaptation, Psychological↗
Environmental messages: experiencing the wisdom of the natural world.
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Congresses as Topic↗
The gift of self: a paradigm for originating nursing as art.
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Art↗
Caring: in women's experience.
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Caregivers↗
The art of nursing: the experience of patients and nurses.
Historical and contemporary conceptualizations of nursing have not addressed the art of nursing from an experiential research approach. This study explores patients' and nurses' experiences of the art of nursing using a phenomenological-hermeneutic approach to enquiry that allows for exploration of the empirical experience. Explicating a paradigm of the art of nursing, five distinct metathemes express nursing as art and describe the complex artistic processes that are lived through the nurse and patient.
Caregivers↗
The meaning of human care and the experience of caring in a university school of nursing.
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Cultural Characteristics↗
Control of cardiac function and venous return in thyrotoxic calves.
The mechanisms responsible for maintenance of the high-output state associated with thyrotoxicosis have been investigated by measurement of cardiac-function curves and venous compliance during ganglionic blockade with trimethaphan. Thirteen calves were injected daily with L-thyroxine (200 micrograms/kg) for 12-14 days. Thyroxine treatment increased heart rate (70%), left ventricular systolic pressure (22%), cardiac output (120%), left ventricular maximum rate of pressure development (dP/dt) (56%), and total blood volume (18%) and decreased systemic vascular resistance (39%). These hemodynamic changes persisted during ganglionic blockade or autonomic blockade with atropine and propranolol. Cardiac-function curves in conscious thyrotoxic calves were displaced upward and to the left. Mean circulatory filling pressure (MCFP), measured during anesthesia, was increased from 8 +/- 1 to 12 +/- 1 mmHg. During autonomic and ganglionic blockade MCFP remained elevated after treatment with thyroxine. Venous compliance decreased from 2.1 +/- 0.2 to 1.3 +/- 0.1 ml X mmHg-1 X kg-1 after thyroxine. Unstressed vascular volume was increased from 52.3 +/- 1.1 to 67.1 +/- 0.9 ml/kg. Thus the elevated cardiac output and new cardiac-function curve in thyrotoxicosis are associated with a combination of increased inotropic state, increased blood volume, and decreased venous compliance. These effects are not the result of autonomic influences and may represent direct actions of thyroid hormone on the heart and peripheral venous circulation.
Animals↗
Ethmozine for ventricular premature complexes.
Twenty patients with an average of more than 30 ventricular premature complexes (VPCs) per hour were treated with ethmozine. Eighteen had either not responded or had adverse reactions to at least 1 other antiarrhythmic drug. Patients were treated with 200 to 300 mg 3 times daily (8.25 to 11.7 mg/kg) and were followed for up to 6 months. Three patients were withdrawn from ethmozine therapy because of unwanted effects before evaluation of efficacy. One of these patients had sustained ventricular tachycardia (VT) after a loading dose of ethmozine. Eleven of the remaining 17 patients (65%) experienced more than a 75% reduction in ventricular ectopic activity. Six patients had a smaller or no decrease in VPC frequency. Eleven of 16 patients (68%) with paired VPCs had a more than 90% reduction in paired VPC frequency. Eleven of 13 patients (84%) with VT events of 3 beats or more had more than a 90% reduction in VT events. Of the 11 patients in whom a more than 75% reduction in VPC frequency occurred, 1 patient died suddenly after 133 days of effective drug therapy. Three patients discontinued ethmozine therapy for reasons not related to the drug. Of the 6 patients in whom there was less than a 75% reduction in VPC frequency, 2 patients discontinued treatment, 1 patient because of hyperanxiety and 1 because of drug-related left anterior hemiblock. Ethmozine lengthened PR and QRS intervals but not the JT interval. Thus, ethmozine is effective and clinically useful for suppression of frequency VPCs in 50% (10 of 20 patients) of a selected population.
Aged↗
Alpha-1 adrenergic control of the venous circulation in intact dogs.
To study alpha adrenergic control of the venous circulation, 17 dogs were lightly sedated and instrumented with thermodilution pulmonary flow and aortic catheters. Hemodynamics, cardiac output and central blood volume were measured at rest. Mean circulatory filling pressure, pressure gradient for venous return and resistance to venous return were calculated from pressures obtained during transient acetylcholine-induced circulatory arrest. Phenylephrine was then infused at two steady-state levels to increase mean aortic pressure by 50 and 100% above control values. Heart rate was controlled with atropine. Phenylephrine increased (P less than .025) mean aortic pressure from 80.7 +/- 2.9 to 121.3 +/- 7.6 to 164.7 +/- 6.1 mm Hg and systemic vascular resistance from 23.3 +/- 2.0 to 32.2 +/- 3.5 to 43.5 +/- 4.1 mm Hg/min/ml and did not change cardiac output (161.9 +/- 12.6-175.6 +/- 13.8-169.6 +/- 11.9 ml/min/kg). Mean circulatory filling pressure increased from 7.1 +/- 0.5 to 9.7 +/- 0.6 to 13.2 +/- 1.3 mm Hg (P less than .025). Pressure gradient for venous return increased from 6.4 +/- 0.4 to 7.7 +/- 0.4 to 8.9 +/- 0.4 mm Hg (P less than .025). Central blood volume increased from 16.2 +/- 0.9 to 19.4 +/- 1.4 to 22.0 +/- 1.9 ml/kg (P less than .025). To eliminate reflex changes in vascular tone, eight dogs received ganglionic blockade with trimethaphan. After ganglionic blockade phenylephrine increased cardiac output, systemic vascular resistance, mean circulatory filling pressure, pressure gradient for venous return and central blood volume (P less than .025). Thus, in conscious dogs, phenylephrine reduces peripheral vascular capacitance and shifts blood from the venous circulation to the central and arterial vascular compartments.
Animals↗