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Biomedical subjects

D Clark

Publications and source records attributed to D Clark.

At least 55 records · Page 3Linked to original sources
PubMed1998

Palliative care in chronic obstructive airways disease: a needs assessment.

The view that palliative care should move beyond cancer is widely endorsed, however, there remains a lack of clarity about the level at which this should occur. In order to target the palliative approach effectively, the value of more detailed and localized needs assessment becomes apparent. This paper provides evidence from a study commissioned by a department of public health, where the focus was the palliative care needs of an individual with chronic obstructive airways disease (COAD). Over a six-month period, 63 individuals in the district were interviewed about their experiences of living with COAD and the services utilized, using a combination of qualitative and quantitative research methods. The findings revealed a poor quality of life, relating to a high degree of social isolation and emotional distress, associated with low physical functioning and disability, and physical symptoms. Current service provision focused on acute exacerbations. Consequently, there is a need to manage the health and social care interface more effectively, with a shift in emphasis from reactive ad hoc provision, which is where the palliative approach to care could be best suited to meet the needs identified.

Aged↗
PubMed1998

Intrabony neurilemmoma: diagnosis and management.

The authors present a case of a mandibular neurilemmoma discovered on routine radiographic examination of an asymptomatic young woman. The lesion was surgically removed and there was no radiographic evidence of recurrence. A review of the literature is presented and the differential diagnosis, prognosis and treatment of this benign neurogenic tumor are discussed.

Adult↗
PubMed1998

Unmet health care needs. Comparison of rural and urban senior center attendees.

Rural-dwelling older adults are in poorer health and have less access to health care resources than urban older adults. However, little is known about specific unmet needs which exist for urban and rural populations. This study compared self-reported health status, use of services, and unmet health care needs of 106 elderly individuals residing in rural and urban settings to determine if these variables differed based on geographic location. Data were gathered on the three dependent measures using the Elderly Health Care Needs Assessment Questionnaire. Findings revealed rural older adults were not in poorer self-reported health (chi 2 = 1.85, p = .60). However, a t test showed rural subjects were significantly poorer in objective health as measured by the number of reported symptoms (t = 224, p = .02). Despite having a greater number of specific health complaints, these rural elderly individuals did not use significantly more services (t = 1.16, p = .24) or report more unmet needs (chi 2 = 3.67, p = .055), thereby reinforcing traditional views of rural older adults being in poorer health but also more self-reliant in matters related to health care. The results of this study provide information which will improve nursing practice in rural and urban settings and provide direction for further research.

Aged↗
PubMed1998

Assessment of a new through-the-eyelid technique for 'A' scan ultrasound ocular axial length measurement.

This study evaluated the repeatability both within one session and between two sessions of a new technique of axial length measurement using 'A' scan ultrasound through the eyelids. The validity of the technique was assessed by comparing the results to those taken through the cornea. The new technique was very reliable, the mean difference between two readings at the first visit being 0.01 mm and between the two visits being 0.01 mm with 95% of differences between two readings in both cases being less than two standard deviations. The axial length measurements through the lid were a mean of 0.05 mm longer than the corneal measurements. The standard deviation of the difference between the two forms of measurement was 0.16 mm and 95% of axial length readings through the eyelid were within two standard deviations (+/- = 0.32 mm) of the corneal measurement. Providing strict criteria are applied to the quality of the 'A' scan images we believe that satisfactory axial length values may be obtained using this technique.

Anisotropy↗
PubMed1998

Erythropoietin immunolocalization in renal cell carcinoma.

Erythropoietin (EPO) is a well-recognized hormone that induces erythrocytosis in a wide range of physiologic and pathologic situations in mammals. One of these situations is a paraneoplastic erythrocytosis, which might be seen in association with various neoplasms, including renal cell carcinoma (RCC), hepatoma, and cerebellar hemangioblastoma. Although there have been multiple studies confirming the association between this erythrocytosis and the production of EPO by tumor cells, immunohistochemical detection of EPO in formalin-fixed, paraffin-embedded tissue was not described. We report on the use of microwave antigen retrieval to detect EPO in RCCs in such routinely processed tissues. We selected 19 RCCs received as nephrectomy specimens, fixed in formalin, and routinely processed. These cases were previously diagnosed on the basis of morphologic, immunohistochemical, and clinical features. We examined the immunoreactivity of these specimens with a monoclonal anti-EPO antibody. Fetal (20 wk gestational age) liver served as a positive control. Intense positive immunoreactivity was observed as cytoplasmic, granular staining in fetal hepatocytes. Fourteen RCCs (10 clear cell and 4 tubulopapillary types) demonstrated unequivocal cytoplasmic immunoreactivity. Additionally, two clear cell tumors were only focally positive, whereas three (16%) were negative. EPO immunoreactivity might thus prove to be of value in the diagnosis or confirmation of RCC, particularly in the context of routinely processed material.

Antibodies, Monoclonal↗
PubMed1998

The road to recovery in panic disorder: response, remission, and relapse.

A standard set of definitions and criteria for the terms commonly used in panic disorder research is required to aid clinicians in their management of patients with panic disorder. Furthermore, the use of a simple, psychometrically sound assessment procedure such as the Panic Disorder Severity Scale, which considers all of the essential domains of panic disorder, will provide clinicians with an appropriate instrument for diagnosing and monitoring patients. The use of this more comprehensive scale for monitoring patients should alert clinicians to the reemergence of associated symptoms of panic disorder and allow for the rapid modification of treatment. By responding quickly to the recurrence of symptoms, a full relapse may be prevented.

Agoraphobia↗
PubMed1998

Fixed polarizer ellipsometry for simple and sensitive detection of thin films generated by specific molecular interactions: applications in immunoassays and DNA sequence detection.

Biological thin films may form on a surface by specific molecular interactions. The fixed polarizer ellipsometer (FPE) is a sensitive instrument that detects biological thin films either qualitatively or quantitatively. The design is simple and inexpensive. The assays are formatted on an optical surface, and the FPE detection is based on the phase shift of linearly polarized light after reflection through a thin film. We have constructed mathematical models of the FPE response to reflection through single-layer and two-layer films that agree closely with experimental data. Several biological assays have been measured with the FPE to demonstrate the application of this technology to clinical targets, including ultrasensitive immunoassays for hepatitis B surface antigen (0.1 ng/mL) and alpha-fetoprotein (0.01 ng/ mL) and DNA hybridization (0.5 fmol/microL target probe). A clinical study for detection of group A streptococcus from patient throat swabs demonstrated the qualitative application of the FPE to infectious disease targets. The flexibility and sensitivity of the FPE makes this technology suitable for numerous target analytes and applications.

Antigens, Bacterial↗
PubMed1997

The Family Attitude Scale: reliability and validity of a new scale for measuring the emotional climate of families.

Research on outcomes from psychiatric disorders has highlighted the importance of expressed emotion (EE), but its cost-effective measurement remains a challenge. This article describes development of the Family Attitude Scale (FAS), a 30-item instrument that can be completed by any informant. Its psychometric characteristics are reported in parents of undergraduate students and in 70 families with a schizophrenic member. The total FAS had high internal consistency in all samples, and reports of angry behaviour in FAS items showed acceptable inter-rater agreement. The FAS was associated with the reported anger, anger expression and anxiety of respondents. Substantial associations between the parents' FAS and the anger and anger expression of students was also observed. Parents of schizophrenic patients had higher FAS scores than parents of students, and the FAS was higher if disorder duration was longer or patient functioning was poorer. Hostility, high criticism and low warmth on the Camberwell Family Interview (CFI) were associated with a more negative FAS. The highest FAS in the family was a good predictor of a highly critical environment on the CFI. The FAS is a reliable and valid indicator of relationship stress and expressed anger that has wide applicability.

Adolescent↗
PubMed1997

Conjunctival impression cytology in the preterm infant and it's relation to outcome.

UNLABELLED: The preterm infant is deficient in vitamin A (retinol) and this has been implicated in the pathogenesis of chronic lung disease of prematurity. Conjunctival impression cytology (CIC) has been used in adults to assess retinol status. We aimed to assess the feasibility of performing CIC in the preterm infant and to determine the significance of abnormal CIC findings. CIC samples were collected during routine retinopathy screening, and classified as inadequate, normal, borderline normal or abnormal. Ninety preterm infants were studied. Seventy-four (82%) CIC specimens produced a positive yield, whereas 16 (18%) were inadequate. Of the 74 adequate samples, 61 (82%) were normal or borderline normal and 13 (18%) abnormal. Seventy-three CIC specimens were assessed by a second histopathologist with complete agreement on 64 (88%) samples and disagreement on 9 (12%) samples. Ten sets of conjunctival impressions, taken from both eyes, gave identical results in all adequate samples. Birth weight was significantly lower in this abnormal group. Four infants (32%) in the abnormal group required treatment for retinopathy compared to two (3%) in the normal/borderline normal group, (P < 0.01). CONCLUSION: Conjunctival impression cytology is simple and reproducible technique which maybe easily applied to the preterm infant. Abnormal CIC is associated with retinopathy of prematurity requiring treatment.

Conjunctiva↗
PubMed1997

Burst firing in midbrain dopaminergic neurons.

Midbrain dopaminergic (DA) neurons fire bursts of activity in response to sensory stimuli, including those associated with primary reward. They are therefore conditional bursters - the bursts conveying, amongst other things, motivationally relevant information to the forebrain. In the forebrain, bursts give rise to a supra-additive release of dopamine, and possibly favour the release of co-localised neuropeptides. Evidence is presented that in rat DA neurons, bursts are engendered by the activity of cortically-regulated afferents. Certain factors are identified which, in combination, lead to burst production: (1) A burst of activity in EAAergic afferents to DA neurons arising from non-cortical sources, but controlled by the medial prefrontal cortex; (2) N-methyl-D-aspartate receptor activation, producing a slow depolarising wave in the recipient neuron; (3) activation of a high threshold, dendritically located calcium conductance which produces a 'plateau potential'; (4) activation of a calcium-activated potassium conductance, which terminates the burst. These factors are argued to operate in the context of an 'optimal' level of intracellular calcium buffering for bursting. Other factors which appear to be involved in bursting in other systems, in particular a low threshold calcium conductance, are rejected as being necessary for bursting in DA neurons. The factors which do play a crucial role in burst production in DA neurons are integrated into a theory from which arises a series of hypotheses amenable to empirical investigation. Additional factors are discussed which may modulate bursting. These may either act indirectly through changes in membrane potential (or intracellular calcium concentration), or they may act directly through an interaction with certain conductances, which appear to promote or inhibit burst firing in DA neurons.

Animals↗
PubMed1997

Needs assessment and palliative care: the views of providers.

BACKGROUND: A key element within the programme of reform introduced into the UK National Health Service in the 1990s has been the concept of health needs assessment, which must be undertaken by health care purchasers as a guide to the planning process. As part of a wide-ranging study of the impact of the NHS reforms on hospices and specialist palliative care services, providers' perceptions of needs assessment for palliative care were examined, including the extent to which needs assessments had been carried out in local districts, together with the implications. METHODS: The study comprised two key elements. In spring 1995 a postal survey was conducted among all UK hospices and specialist palliative care in-patient units (n = 203) eliciting factual information concerning needs assessment and contracting, together with perceptions and evaluations of the local impact of the NHS reforms. A total of 128 (63 per cent) questionnaires was completed and returned. In addition to the survey, 12 case studies were conducted with a stratified random sample of NHS, independent and large or small hospices and specialist palliative care units. Each of the 12 case study sites was visited by a member of the research team, who conducted interviews with senior staff and analysed financial, planning and management data. Thus the survey allowed a wide analysis of the impact of the NHS reforms, which was enhanced by the more in-depth qualitative data gathered from the case studies. RESULTS: In the survey 49 per cent of those responding reported that their main purchaser had conducted a needs assessment for palliative care in the last five years. Palliative care needs assessment was seen as valuable by providers: 73 per cent considered it very important and 28 per cent of hospices had gone so far as to request a needs assessment from their health authority. In an open-ended question seeking views on the impact of health needs assessment, 66 per cent of those responding (71/107) stated that the impact had been or would be positive. The case studies, however, revealed a more mixed picture. The 12 hospices or specialist palliative care units had contracts with a total of 24 health authorities, 12 of which had conducted some type of needs assessment for palliative care. On close examination the comprehensiveness of these was questionable. Few providers had participated in the design and there were low levels of knowledge about the findings. High expectations of the value of needs assessment were often not fulfilled. There was also a tendency for providers to view needs assessment in a purely instrumental light, as a vehicle to further promote their own interests. CONCLUSIONS: Palliative care needs assessment has considerable potential to influence future purchasing and service provision, yet not all health commissions are undertaking it. There is a high level of provider enthusiasm for palliative care needs assessment, albeit coupled to low levels of technical knowledge and a lack of involvement in the process at local level. Purchaser-provider dialogue on needs assessment should focus on both raising awareness of appropriate techniques and debating 'ethical neutrality' about the outcome.

Attitude of Health Personnel↗
PubMed1997

Increasing access to health care: a study of pediatric nurse practitioner outcomes in a school-based clinic.

Pediatric nurse practitioners in school-based clinics have the potential to overcome access to care barriers for school-age children and their families by providing primary health care and linking these services with existing health and social services in the community. The article reports a study that examined health care delivered by a pediatric nurse practitioner in an elementary school setting and selected indices of access to health care (Medicaid certification; early periodic screening, diagnosis, and treatment; and linkage with existing resources). Findings suggest that greater availability of care may encourage parents to seek early preventive care for their children.

Ambulatory Care↗
PubMed1997

The initial Australian experience of technetium-99M sestamibi scintimammography: a complementary test in the management of breast cancer.

BACKGROUND: The adjunctive role of Tc-99m sestamibi scintimammography in the diagnosis and management of patients with a high probability of breast cancer was assessed. METHODS: A descriptive study of 16 patients with palpable masses who had a high probability of breast cancer as determined by investigations such as cytology and conventional imaging techniques were carried out. All patients were followed-up to surgery. RESULTS: Scintimammography true positive results were found in 14 of 18 lesions detected in 16 patients. There were two false-positives which included one lobar carcinoma in situ lesion and one complex sclerosing lesion, and one false-negative patient. Scintimammography detected abnormal radiotracer uptake in four of six patients with axillary metastases. Three patients had clinically and mammographically undetected multicentric disease detected on scintimammography which allowed appropriate modification of surgical excision. Breast cancer was detected in a patient with breast prostheses. CONCLUSIONS: Scintimammography would appear to have a useful adjunctive role to mammography in the diagnosis of breast cancer. The diagnosis of breast cancer may be enhanced in difficult cases and the detection of multicentricity on scintimammography may have an impact on subsequent surgical management.

Adult↗