Biomedical subjects
Publications and source records attributed to D Kelly.
Examinations remain a source of worry to many people who fear what to expect and doubt their ability to succeed. Many fears surrounding examinations can be rationally dispelled if the student approaches them with enhanced confidence and a sense that the best possible preparation has been undertaken.
To determine the long-term effect of exercise training on glucose control, 13 subjects with type I diabetes and 7 control subjects performed 45 min of cycle exercise three times per wk for 12 wk. The acute blood glucose response, the long-term effect on glucose control (glycosylated hemoglobin and fasting plasma glucose), and changes in nutrient intake were assessed. Fitness as measured by VO2 MAX increased in both control (33.8 +/- 1.7 to 43.2 +/- 3.5 ml/min/kg) and diabetic (38.7 +/- 3.3 to 46.5 +/- 3.6 ml/min/kg) (P less than 0.05) subjects although body weight remained unchanged. In the diabetic subjects, an acute glucose-lowering effect occurred with each exercise session throughout the 12-wk training period (225.8 +/- 16.1 to 148.5 +/- 16.8 mg/dl, P less than 0.001). However, fasting plasma glucose and glycosylated hemoglobin remained essentially unchanged (pretraining, 193.7 +/- 27.5 mg/dl and 10.7 +/- 0.3%; 6-wk training, 192.5 +/- 27.1 mg/dl and 10.7 +/- 0.03%; 12-wk training, 202 +/- 30.1 mg/dl and 10.3 +/- 0.8%). Total caloric intake as assessed by diet history increased significantly on exercising days (2569-2849 kcal, P less than 0.05). Although plasma glucose decreases acutely with exercise, increased caloric intake on exercising days obviates a long-term effect of training on glucose control. More precise guidelines and recommendations as to exercise timing and nutrient intake, likely based on self-monitoring of blood glucose, are required to achieve a beneficial effect of exercise training on metabolic control in type I diabetes.
A 22-month-old child presented with massive cervical adenopathy accompanied by a retropharyngeal mass that caused stridor and dysphagia. Biopsy from both sides was consistent with sinus histiocytosis with massive lymphadenopathy (SHML). SHML is an unusual benign lesion that characteristically presents with painless, massive cervical adenopathy. Extranodal sites such as orbit, nose and skin are usually affected in association with cervical adenopathy. The pharyngeal involvement in this and several other recently reported cases adds to the heterogeneity of presentation of this unusual disease. The etiology remains unknown. No treatment is required, nor is any treatment known to be consistently effective. Gradual resolution of adenopathy over six months to several years is the expected outcome.
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AIM: This study explored clinical nurse managers' perceptions of the factors affecting role performance. METHOD: Interviews were carried out with 15 clinical nurse managers in four trusts. RESULTS: Results highlight the main influences on the role, the barriers to successful role fulfillment, and the stressors that cause some of the postholders to consider leaving the NHS. CONCLUSION: The findings of this exploratory study established the diversity of the clinical nurse manager role and showed that they continue to play a central role in healthcare delivery.
AIM: To explore clinical nurse managers' perceptions of factors influencing their ability to perform their clinical leadership role. METHOD: A random sample of 15 clinical nurse managers in four acute NHS trusts was interviewed in depth to identify and explore factors that they perceived to be helping or hindering their performance. The qualitative data were analysed to identify recurrent themes, which were used to develop a survey questionnaire that was distributed to the remaining clinical nurse managers in the four trusts (n = 152). RESULTS: The response rate was 65 per cent (n = 99). Many of the clinical nurse managers reported poor preparation to undertake key aspects of their role and did not favour open learning as a method of continuing professional development. CONCLUSION: The findings are of interest in the context of the new framework proposed by the English National Board (ENB) and the Department of Health for the preparation of nurse educators. Many of the findings are identical to the advisory standards set out for mentors in Preparation of Mentors and Teachers: A New Framework of Guidance (ENB and DoH 2001a). Attention to the development of clinical nurse managers, as well as new mentors, should continue to ensure that the proposed changes meet the needs of both groups.
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This paper will review the basics of neurostimulation in the perioperative period. Following a brief overview of neuromuscular physiology, the mechanism of action of depolarizing and non-depolarizing relaxants will be discussed. The principles of neurostimulation will then be applied clinically when different patterns of stimulation (single twitch, train-of-four, post-tetanic twitch count, double burst) are described. Clinical assessment of neuromuscular function will then be compared with both subjective and objective means of assessment of adequacy of intraoperative relaxation and postoperative reversal. The principles reviewed in this paper will then be applied in the clinical setting, and risks and benefits associated with perioperative use of muscle relaxants will be discussed.
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