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Biomedical subjects

C Gray

Publications and source records attributed to C Gray.

334 records · Page 19Linked to original sources
PubMedDate not supplied

From evidence to practice: factors affecting the specialist breast nurse's detection of psychological morbidity in women with breast cancer.

Psychological morbidity is high for women with breast cancer and is often undetected and untreated. Encouragingly, there are well-evaluated strategies to help improve psychological outcomes, but the challenge remains as to how to transfer these to routine care settings. The National Health and Medical Research Council (NHMRC) National Breast Cancer Centre used evidence-based psychosocial clinical practice guidelines and breast cancer treatment guidelines to develop a comprehensive specialist breast nurse (SBN) model of care and conducted a feasibility study to observe its implementation in diverse clinical conditions. Seven SBNs at four Australian cancer treatment centres implemented the model of care to support 196 women with a new diagnosis of early or locally advanced breast cancer. The SBN role in detecting women's psychological difficulties is reported here. Two months after diagnosis, 36% of women had a likely psychological disorder on the General Health Questionnaire 12-item (GHQ12) version. The SBNs detected as many as 85% and as few as 20% of high GHQ12 scorers, depending upon a woman's psychosocial risk factors and consultation factors. Few women were referred to psychological services, suggesting other barriers to care. More specific communication skills training, psychological symptom screening questionnaires and better access to psychological services may help the implementation of the model of care.

Adult↗
PubMedDate not supplied

High temporal and spatial resolution studies of bone cells using real-time confocal reflection microscopy.

Chick and rat bone-derived cells were mounted in sealed coverslip-covered chambers; individual osteoclasts (but also osteoblasts) were selected and studied at 37 degrees C using three different types of high-speed scanning confocal microscopes: (1) A Noran Tandem Scanning Microscope (TSM) was used with a low light level, cooled CCD camera for image transfer to a Noran TN8502 frame store-based image analysing computer to make time lapse movie sequences using 0.1 s exposure periods, thus losing some of the advantage of the high frame rate of the TSM. Rapid focus adjustment using computer controlled piezo drivers permitted two or more focus planes to be imaged sequentially: thus (with additional light-source shuttering) the reflection confocal image could be alternated with the phase contrast image at a different focus. Individual cells were followed for up to 5 days, suggesting no significant irradiation problem. (2) Exceptional temporal and spatial resolution is available in video rate laser confocal scanning microscopes (VRCSLMs). We used the Noran Odyssey unitary beam VRCSLM with an argon ion laser at 488 nm and acousto-optic deflection (AOD) on the line axis: this instrument is truly and adjustably confocal in the reflection mode. (3) We also used the Lasertec 1LM11 line scan instrument, with an He-Ne laser at 633 nm, and AOD for the frame scan. We discuss the technical problems and merits of the different approaches. The VRCSLMs documented rapid, real-time oscillatory motion: all the methods used show rapid net movement of organelles within bone cells. The interference reflection mode gives particularly strong contrasts in confocal instruments. Phase contrast and other interference methods used in the microscopy of living cells can be used simultaneously in the TSM.

Animals↗
PubMedDate not supplied

Options for change in the NHS consultant contract.

The lead negotiators for the management and consultant sides in an NHS trust in northern England responded to debate in their trust about consultant contracts by offering to research the attitudes of their peers towards a variety of contract options. The options tested included the current contract; models already examined in the trust and elsewhere, such as time sensitive and mild performance related contracts; and some more radical and speculative possibilities, including consultants franchising their services to the trust. Beyond the predictable conclusion that consultants would prefer no change while managers desired it, a time sensitive contract emerged as having potential for successful negotiation. On the other hand, neither consultants nor managers favoured a strict performance related contract or a fee for service contract. There was a strong similarity of opinion between the two groups on the relative salary values of the options, though the consultants consistently priced these higher than the managers.

Consultants↗
PubMedDate not supplied

Immunologically-mediated tumour cell apoptosis: the role of TRAIL in T cell and cytokine-mediated responses to melanoma.

Immune responses against human melanoma are common and are believed to influence the natural history of the disease. In particular, CD4 T cell infiltrates are associated with regression of primary melanoma and with responses to treatment with interferon-alpha2 (IFN-alpha2). Our studies have shown that CD4 T cells appear to kill melanoma by means of a member of the tumour necrosis factor (TNF) family expressed on their surface and called TNF related apoptosis inducing ligand (TRAIL). Moreover, sensitivity to TRAIL also predicts responsiveness of melanoma to CD4 T cells. TRAIL is not expressed on resting lymphocytes but is expressed at high levels after exposure to IFN-alpha2 and on activated T cells. Lymphocytes from melanoma patients in early stages of the disease show high levels of expression after exposure to IFN-alpha2 and IFN-gamma but expression was less on lymphocytes from stage IV patients. This may be due to factors from melanoma cells in that supernatants from some melanoma cultures suppressed IFN-alpha2 upregulation of TRAIL. Sensitivity of melanoma cells to TRAIL can be increased by inhibition of the activation of NF-kappaB and anti-apoptotic events downstream of NF-kappaB. These results suggest that TRAIL may be an important mediator of responses against melanoma induced by immunotherapy or by treatment with IFN-alpha2 and interleukin-2. Studies on surgical biopsies of melanoma however show that fresh isolates appear less sensitive to TRAIL-induced apoptosis and effective therapy may involve combinations with other agents.

Apoptosis↗
PubMedDate not supplied

Morphometric differences between cytologically benign and malignant serous effusions.

The morphometric differences between benign and malignant serous effusions, as diagnosed by standard cytologic criteria in 95 unselected cases (50 benign and 45 malignant), were studied using the IBAS semi-automated image analysis system, which calculates various parameters from tracings of cellular and nuclear outlines. Fourteen cases were also stained for cytokeratin proteins (with the CAM 5.2 antibody) by the immunoperoxidase technique and reanalyzed for positive cells. Significant differences were found for mean values between cytologically benign and malignant cases for cellular and nuclear areas, perimeters and maximum diameters, but not for two form factors. Some differences were enhanced in the CAM 5.2-stained cases. Real morphometric differences in samples of cells from benign and malignant cases are the basis of cytologic diagnosis. Fully automated diagnostic systems could operate on arbitrary threshold values, but there is considerable overlap in specimen means for all parameters between benign and malignant cases.

Adult↗
PubMedDate not supplied

A framework for planned change: achieving a funded PhD program in nursing.

This paper describes a process of planned change undertaken by a group of graduate nursing students of the University of Alberta. Their goal, a funded PhD program in Nursing, was realized fourteen months after their initial meeting. The message of their story is a simple yet significant one for all nurses who wish to influence their environment: Using a framework of planned change, a group of people who organize and commit themselves to a clear goal can become impossible to ignore. In the complexities and uncertainties of today's health care system, many nursing leaders wonder how to effectively insert themselves into the changes occurring in their environments. In this paper, the process of planned change is described through the story of one group of nurses who deliberately set out to reach a desired goal: a funded PhD Program in Nursing at the University of Alberta. Fourteen months later on December 21, 1990, a funded PhD Program in Nursing became a reality. In the early 1980's, several nurses attempted to establish doctoral education for nurses in Canada. The need was for nurse researchers and leaders with doctoral qualifications within the Canadian context. By 1986, the collaboration of nursing faculties at the University of Alberta in Edmonton and the University of Calgary was well under way. The work of Dr. Shirley Stinson, Dr. Janetta McPhail, and Dr. Margaret Scott-Wright with their colleagues resulted in academic approval for the first PhD Program in Nursing in Canada, at the University of Alberta in Edmonton. The starting date of the program, however, was subject to the availability of funding. Funding remained elusive for the next three years, and in the fall of 1989, the Nursing Graduate Student Association decided to form a committee to obtain funding for the doctoral nursing program. Nineteen graduate nursing students from the University of Alberta and the University of Calgary banded together to create the "Nursing PhD Program a Reality" group (NPPR). The group used a framework of planned change based on concepts found in the literature on power, politics, and political action.

Alberta↗