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Biomedical subjects

C Taylor

Publications and source records attributed to C Taylor.

At least 199 records · Page 11Linked to original sources
PubMed1995

Rethinking nursing's basic competencies.

An increasing tendency to focus primarily on the intellectual and technical competence of nurses is radically redefining nursing and threatening nursing's ability to respond to human need. After exploring why interpersonal skills and moral competence are essential to the practice of nursing, the article describes practical strategies to develop interpersonal competence and challenges nurses to hold themselves and one another accountable for interpersonal proficiency. The discussion redirects nursing's attention to the human outcomes of nursing and health care.

Clinical Competence↗
PubMed1995

The use of domestic steam cleaning for the control of house dust mites.

BACKGROUND: Control of dust mites using extremes of temperature is an alternative to the use of acaricides. In the past we have attempted control by freezing with liquid nitrogen. The present paper deals with the opposite extreme, the use of steam. OBJECTIVE: To assess the feasibility and effectiveness of a domestic steam cleaner for the control of dust mites, its effect on mite populations and concentrations of the allergen Der p 1. METHODS: A domestic steam cleaner was used to treat carpet squares that had been seeded in the laboratory with known numbers of dust mites (Dermatophagoides pteronyssinus). The number of live mites was monitored for a period of 4 months in eight treated carpet squares and eight controls. Dust samples were taken from 12 standardized areas of carpet in a tenement flat in Glasgow, UK, before and after steam cleaning treatment, and the concentration of allergen Der p 1 was compared with 12 adjacent, control areas. RESULTS: No live mites were found at any time in the treated carpet squares, whereas in the control squares geometric mean mite population density rose from 11 after 3 days to 39 after 1 month, 66 after 2, 122 after 3 and 185 after 4 months. There was a mean reduction of 86.7% in Der p 1 concentration (3.3-0.44 microgram/g) compared with a reduction of 4.7% (2.22-2.116 micrograms/g) in control areas, a difference that was statistically significant at the 5% level. CONCLUSION: These data indicate that steam cleaning has considerable potential as an highly effective and efficient method of killing dust mites and reducing concentrations of Der p 1 in domestic premises.

Allergens↗
PubMed1995

Medical futility and nursing.

Defining medical futility is central to the efforts of clinicians and ethicists who seek to identify the limits of patient autonomy. This article is a critique of current efforts to define and then use policies of medical futility to justify refusing requests for treatment and care that have no perceived medical benefit. After exploring the current definitions of medical futility in the bioethics and clinical literature, comparisons of the advantages and disadvantages of the following three options are provided: allowing patients to decide all but physiologic futility, allowing clinicians to decide futility, and pursuing negotiated compromise. The third option--negotiated compromise--is recommended. A role is developed for nurses in preventing and resolving conflict about futile treatment.

Decision Making↗
PubMed1995

Hemograms and hematozoa of sharp-shinned (Accipiter striatus) and Cooper's hawks (Accipiter cooperii) captured during spring migration in northern New York.

Hemograms were determined for 26 Cooper's (Accipiter cooperii) and 55 sharp-shinned hawks (Accipiter striatus) captured during spring migration (27 March to 12 May 1987) on the south shore of Lake Ontario, New York (USA). No significant differences were noted in packed cell volume and estimated total solids between the species. However, Cooper's hawks had significantly higher total white blood cells counts and higher concentrations of heterophils, monocytes, and eosinophils. Proportionally, lymphocytes made up a smaller percentage of the differential count in the Cooper's hawk. Eosinophil concentrations and percentages of the differential count were significantly higher in the females of both species. Both species had a high prevalence of Leucocytozoon toddi and Haemoproteus spp. infection. Haemoproteus nisi and H. elani were identified in both hawks. Trypanosoma avium was identified in a single Cooper's hawk and Plasmodium circumflexum was identified in a sharp-shinned hawk. Prevalence of Leucocytozoon toddi and Haemoproteus spp. infections were significantly higher in the birds caught late in the spring as compared to those caught earlier in the spring; this was evidence for a spring recrudescence of patent parasite infections.

Animals↗
PubMed1995

Hybrid intubation technique for the management of a difficult airway: a case report.

There are circumstances when induction of general anesthesia followed by direct laryngoscopy and intubation is contraindicated. This case report describes and presents a protocol for a method of endotracheal intubation that combines the benefits of light wand and fiberoptic techniques. The patient was a 73-year-old male with a history of two cervical fusions. He was reported to be "unintubatable" at the time of his last surgery. A physical examination revealed limited neck extension. Awake endotracheal intubation was accomplished by a hybrid technique, using a light wand and fiberoptic bronchoscope simultaneously. The light wand facilitated positioning of the endotracheal tube at the glottis and provided surface clues concerning the position of the tip of the endotracheal tube. The bronchoscope allowed direct visualization of the pharyngeal, laryngeal, and tracheal anatomy. Since our initial experience, the hybrid technique has been modified by replacing the light wand with a conventional stylet. Subsequent uses of the technique have been successful and free of complications.

Aged↗
PubMed1995

Influence of local treatment on the recurrence rate of ductal carcinoma in situ.

BACKGROUND: Screening mammography has resulted in a significant increase in the diagnosis of ductal carcinoma in situ (DCIS). The role of breast conservation therapy and the long-term recurrence rate are still controversial. This article compares mastectomy, wide excision alone, and wide excision with radiation as treatments for DCIS. STUDY DESIGN: One hundred twenty-four cases of DCIS were retrospectively reviewed and were found to be pure DCIS by a senior pathologist. The mean age at diagnosis was 60 years (range, 33 to 81). Originally, 101 patients (81 percent) presented with calcification on mammogram, and 23 (19 percent) presented with a palpable mass. Histologic data showed that 54 (44 percent) had noncomedo type lesions, 46 (37 percent) had comedo type, and 24 (19 percent) had unknown type DCIS. RESULTS: Four of the 124 patients had a recurrence during a mean follow-up period of 43 months. Recurrence is defined as any development of DCIS or invasive carcinoma in the ipsilateral breast. There was one (1.3 percent) recurrence in the 75 patients treated with mastectomy (an adenocarcinoma of the chest wall), which occurred at 59 months. Treatment was 5,750 cGy to the chest wall and the patient is free of disease 37 months postradiation. There were three (11 percent) recurrences at 14, 21, and 29 months, respectively, in the 28 patients treated with wide excision alone. All three recurrences were found by calcifications on mammogram and all patients had comedo type original lesions. Two recurrences were pure DCIS of the breast. Both patients were treated with mastectomy and are free of disease at 33 and five months, respectively. The third recurrence was an invasive colloid carcinoma of the breast. Treatment was a modified radical mastectomy; the patient is free of disease after 62 months. There were no recurrences in the 21 patients who were treated with wide excision and radiation. Average total dose of radiation was 5,835 cGy (range, 4,500 to 6,480). CONCLUSIONS: The results of this study indicate that both mastectomy and wide excision with radiation are associated with very low recurrence rates. Wide excision alone is associated with a higher recurrence rate. However, all recurrences were detected mammographically and all lesions were salvaged by mastectomy. Therefore, the ultimate local control and survival rates were similar for all three modalities.

Adult↗
PubMed1995

RAS and FMS mutations following cytotoxic therapy for childhood acute lymphoblastic leukaemia.

Patients who have received cytotoxic therapy for primary neoplastic disease are at an increased risk of developing secondary (therapy-related) acute myeloid leukaemia (AML) or myelodysplasia (MDS). RAS and FMS mutations have been observed in patients with AML and MDS. It has been suggested that the mutational status within these genes may be predictive of early secondary leukaemic disease. In this study we have screened 50 haematologically normal patients in complete remission from childhood acute lymphoblastic leukaemia (ALL) for activating point mutations in the RAS and FMS proto-oncogenes. Such patients may be considered at risk of therapy-related disease. Codons 12, 13 and 61 were screened in RAS and codon 969 in FMS using the polymerase chain reaction (PCR) followed by oligonucleotide hybridization (ONH). Three of the 50 patients (6%) were found to harbour N12 RAS mutations. One of these three patients (2%) had both a N12 RAS and FMS 969 mutation. Upon sequencing the RAS mutations, substitutions of serine, cysteine and aspartic acid for glycine were identified. The FMS 969 mutation was also confirmed, by sequencing, as a histidine substitution. RAS mutations were not detected in presentation samples indicating that these lesions have been somatically acquired presumably subsequent to cytotoxic therapy for the primary disease. Continued follow-up of these patients may indicate a role for these mutations in the development of secondary malignancies.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

Phase Ia trial of murine immunoglobulin A antitransferrin receptor antibody 42/6.

In preclinical in vitro and in vivo systems, mAbs to human transferrin (Tf) receptors blocked iron uptake from Tf and showed antitumor activity. However, Tf receptors are also displayed by normal tissues, and a large, soluble pool of circulating serum Tf receptors has been detected. We report results of a Phase Ia trial of IgA monoclonal anti-Tf receptor antibody 42/6. Twenty-seven patients with advanced refractory cancer received 33 treatments with 42/6 administered as a 24-h infusion at doses ranging from 2.5 to 300 mg/m2. 42/6 was generally well tolerated, although one patient receiving a second treatment experienced an allergic-type response associated with a human antimouse antibody response. Three patients with hematological cancers showed mixed tumor responses; there were no partial or complete remissions. Peak serum levels of antibody were obtained at the termination of the 24-h infusion. At doses >/=25 mg/m2, there was a linear relationship between the 42/6 dose and average peak serum 42/6 levels ranging from <1 to 36 microgram/ml. Serum Tf receptors showed a dose-dependent decrease during 42/6 infusion to 20-30% of baseline, and remained depressed for at least 48 h after terminating the infusion. Serum 42/6 levels rose in an inverse relationship to the drop in Tf receptors. 42/6 induced an increase in serum iron and Tf saturation consistent with blockade of peripheral iron uptake, and reduced Tf receptor display by bone marrow cells. Human antimouse antibody was detected in nine patients. Anti-Tf receptor antibody was well tolerated and mediated in vivo effects on iron uptake and Tf display. Antibody concentrations capable of inhibiting malignant blood cell growth were obtained without toxicity. This represents the first clinical trial of an IgA mouse mAb, and one of only a few trials in which an antibody reacting with a broad range of normal tissues has been administered. Additional clinical trials of anti-Tf receptor antibodies in blood cell cancers are indicated.

Adult↗
PubMed1994

Estimating numbers of homeless and homeless mentally ill people in north east Westminster by using capture-recapture analysis.

OBJECTIVES: To use routinely collected data to provide a reliable estimate of the size and psychiatric morbidity of the homeless population of a given geographical area by using capture-recapture analysis. DESIGN: A multiple sample, log-linear capture-recapture method was applied to a defined area of central London during 6 months. The method calculates the total homeless population from the sum of the population actually observed and an estimate of the unobserved population. Data were collected from local agencies used by homeless people. SUBJECTS: Homeless people in north east Westminster residing in bed and breakfast accommodation and hotels or sleeping rough who had contacted statutory or voluntary agencies in the area. RESULTS: 2150 contacts by 1640 homeless people were recorded. The estimated unobserved population was 3293, giving a total homeless population for the period of around 5000 (SD 1250). Mental health problems were significantly less prominent in the unobserved compared with the observed population (23% (754) v 40% (627), P < 0.0001). For both groups the prevalence varied greatly with age and sex. CONCLUSIONS: Capture-recapture techniques can overcome problems of ascertainment in estimating populations of homeless and homeless mentally ill people. Prevalences of mental illness derived from surveys that do not correct for ascertainment are likely to be falsely inflated while at the same time underestimating the total size of the homeless mentally ill population. Population estimates derived from capture-recapture techniques may usefully provide a good basis for including homeless populations in capitation calculations for allocating funds within health services.

Adult↗
PubMed1994

Right atrial electrocardiography: a technique for the placement of central venous catheters for chemotherapy or intravenous nutrition.

Central venous catheters used for chemotherapy are usually sited so that the catheter tip lies in the superior vena cava. This study evaluated right atrial electrocardiography as a method of accurately placing the catheter tip in 34 patients over a period of 22 months. An electrocardiograph adaptor was connected to the catheter and the tip advanced into a central vein until a biphasic P wave was identified. In 31 of 34 patients the characteristic P wave changes were observed and the position of the catheter tip confirmed by screening to be in the superior vena cava. Right atrial electrocardiography is an accurate, reliable and rapid method of positioning the tip of a central venous catheter, and avoids or reduces exposure to radiation.

Catheterization, Central Venous↗
PubMed1994

Blood lead levels of British competitive cyclists.

This study examined the extent to which the potentially toxic lead particulates emitted from motor vehicles are absorbed by competitive cyclists. A time trial (n = 5), a road race (n = 5), and a sedentary control group (n = 5) were examined with respect to blood lead (PbB) levels. In the two cycling groups, the PbB levels were measured before and after (1) a time trial (80 km) held on a dual carriageway; and (2) a road race (120 km) which took place in a rural area. Mean (+/- SE) resting PbB levels for the sedentary subjects, time trialists, and road racers were 0.442 +/- 0.041, 0.490 +/- 0.111 and 0.384 +/- 0.061 mumol l-1 respectively (p > 0.05). Mean post-race PbB levels of the time trialists (0.528 +/- 0.046 mumol l-1) and road racers (0.346 +/- 0.024 mumol l-1) did not differ significantly from the pre-race levels (p > 0.05). However, after their respective races, the mean PbB level of the time trialists was higher than that of the road racers (p < 0.05). Ninety minutes of cycling (70% VO2 max) in a laboratory containing approximately 1 microgram m3 of airborne lead did not affect blood lead levels. All PbB levels compiled with EC regulations regarding lead exposure. Despite a positive relationship between the amount of training and the PbB levels (r = 0.64, p < 0.05), competitive cyclists did not evidence abnormal levels of lead absorption. Time trialing on dual carriageways was associated with higher PbB levels than road racing.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Olfactory receptor gene cluster on human chromosome 17: possible duplication of an ancestral receptor repertoire.

A gene superfamily of olfactory receptors (ORs) has recently been identified in a number of species. These receptors share a seven transmembrane domain structure with many neurotransmitter and hormone receptors, and are likely to underlie the recognition and G-protein-mediated transduction of odorant signals. Previously, OR genes cloned in different species were from random locations in the respective genomes. We report here the cloning of 16 human OR genes, all from chromosome 17 (17p13.3). The intronless coding regions are physically mapped (on 35 cosmids) in one 0.35Mb long contiguous cluster, with an average intergenic separation of 15kb. The human OR genes in the cluster belong to four different gene subfamilies, displaying as much sequence variability as any randomly selected group of ORs. This suggests that the cluster identified may be one of several copies of an ancestral OR gene repertoire whose existence may predate the divergence of mammals. The latter may have duplicated in some species to form the present mammalian OR gene repertoire, with several hundred genes. The human chromosome 17 OR gene cluster may thus be a good model for understanding human olfaction, as well as the ontogeny and phylogeny of the OR gene superfamily.

Amino Acid Sequence↗
PubMed1994

What happens over the long-term?

What happens over the long-term course of alcoholism focuses our view on a number of issues found throughout the literature of alcoholism studies, placing them in a quite different perspective. When trying to encompass the effects of what may be a chronic condition, lasting for decades, the importance of short-term prognoses and treatment results falls back and gives centre stage to the overall pattern of events. Treatment episodes recur and become an accumulated treatment experience, a voluntary consumption pattern of treatment services. The spontaneous recoveries that take place in the community and the undiagnosed cases of alcoholism that do not reach for medical intervention take on a special significance in charting the general course. The backdrop of maturing and ageing processes interacts with a life course of events in determining the direction of the play.

Aging↗
PubMed1994

Mortality in men with drinking problems: a 20-year follow-up.

This study presents mortality data from a 20-year follow-up of 99 married men with drinking problems. Forty-four of the sample had died and death certificates were obtained on 43. Cause of death was classified according to the Ninth Revision of the International Classification of Diseases. Most of the mortality excess was in the 45-54 year age group. The observed/expected mortality ratio was 3.64 for the group as a whole, 2.93 for the moderately dependent group and 4.41 for the severely dependent group. The commonest causes of death were carcinoma of the bronchus and diseases of the circulatory system. Cause of death was analysed in terms of years of life lost. The number of years of life lost per death was highest for injury and poisoning. Only four of the 43 death certificates obtained mentioned "chronic alcoholism".

Adult↗
PubMed1994

Death and survival in a cohort of heroin addicts from London clinics: a 22-year follow-up study.

Data are presented on the 43 people who died over a 22-year follow-up period of a cohort of 128 heroin addicts drawn in 1969 from the newly opened London clinics. The main causes of death were drug-related, with 18 deaths specifically determined as due to overdose, of which the great majority were among people being prescribed opiates at the time. The mortality rate was a mean of 1.84% annually, and the excess mortality ratio was 11.9. This excess was highest at the beginning and varied over the period of study, appearing higher at the opening of the clinics and again in the mid-1980s. No sex differences in mortality rates were demonstrated but the excess mortality was concentrated at younger ages. No prediction of the 85 survivors could be made on the basis of length of heroin use prior to study intake, nor on age at intake.

Adolescent↗
PubMed1994

A test of the matching hypothesis: alcohol dependence, intensity of treatment, and 12-month outcome.

The "matching hypothesis"--the concept that treatment will be improved if matched to individual needs or characteristics--has, over recent years, attracted attention, and some research to test its validity has been conducted. These studies are briefly reviewed and an analysis then reported which focuses on exploration of the possible interaction between treatment intensity, patient characteristics with particular reference to degree of dependence on alcohol, and 12-month treatment outcome. The data derive from a controlled trial in which patients were randomized between "Treatment" and "Advice". No significant interactions of the kind postulated were identified and, at least for this data set, the matching hypothesis is not confirmed. Possible interpretations of these findings are discussed.

Alcoholism↗