Biomedical subjects
Publications and source records attributed to D O'Brien.
The moment has arrived for you to go online! This article provides an overview of online access and Internet services. Resources are suggested and hints are offered to get the novice started on the information highway. Enjoy your journey!
Computers open the door to an ever-expanding arena of knowledge and technology. Most nurses practicing in perianesthesia setting were educated before the computer era, and many fear computers and the associated technology. Frequently, the greatest difficulty is finding the resources and knowing what questions to ask. The following is the first in a series of articles on computers and information technology. This article discusses computer hardware to get the novice started or the experienced user upgraded to access new technologies and the Internet. Future articles will discuss start up and usual software applications, getting up to speed on the information superhighway, and other technologies that will broaden our knowledge and expand our personal and professional world.
You have that new computer and you are ready to start computing, right? Not quite. There is another essential to get started--software. This article focuses on software necessary and nice for your computer, and resources that can help you in your quest for creating the best possible and easiest to use computer system. Once you have gotten everything installed and functioning, you will be ready to take the next step--going online. In the next issue of the Journal we will get you online and traveling on the information superhighway. Happy computing!
Seizures are a relatively nonspecific response of the cerebral cortex to insult and can be caused by a variety of toxic or metabolic diseases. Seizure in response to extracranial disease are called reactive seizures. Toxins cause seizures by altering the balance of excitation and inhibition in the nervous system or interfering with energy metabolism. Many therapeutic or illicit drugs will cause seizures through similar mechanisms. Metabolic diseases can cause seizures by interfering with energy metabolism, changing osmolality, or producing endogenous toxins. In addition, metabolic disease may alter the pharmacokinetics of antiepileptic drugs or drugs that have the potential to cause seizures. While seizures represent a serious sign for many of these conditions, reactive epilepsy always carries the possibility that the seizures may be eliminated if the underlying cause is detected and corrected.
Previously published PCR-based diagnostic tests for melioidosis were evaluated for clinical usefulness. A Burkholderia pseudomallei 16S rRNA-derived primer set had a sensitivity approaching 100% for clinical samples from 22 culture-confirmed cases of melioidosis and enabled diagnosis of 3 culture-negative cases. However, samples from 10 of 30 inpatients from Royal Darwin Hospital with other diagnoses were positive by PCR, giving a specificity of 67% and a positive predictive value of only 70%. Although there are a number of intriguing possible explanations for our results, concerns of inappropriate therapy resulting from a positive result by PCR have led us to forgo the advantage of rapid PCR diagnosis for melioidosis until a better system is validated.
The relationship between perceived need for further education in wound care issues and actual knowledge of pressure ulcer care was examined among 86 professional and nonprofessional nursing staff members of a community urban hospital. A weak correlation between perceived need for further education and actual wound care knowledge base was found. Participants were poorly informed in several basic aspects of pressure ulcer care while generally desiring more wound care education. These results are discussed in light of future educational needs vis-a-vis current "re-engineering" efforts in nursing personnel.
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OBJECTIVE: To document that regional anesthesia of the infraorbital and inferior alveolar nerves would abolish reflex-evoked muscle action potentials (REMP) in the digastricus muscle during noninvasive stimulation of tooth pulp in halothane-anesthetized dogs. DESIGN: Prospective study. ANIMALS: 9 healthy female dogs between 2 and 6 years old. PROCEDURE: Dogs were anesthetized using halothane. An alligator clip anodal electrode was attached to the tooth to be stimulated, and a platinum needle cathodal electrode was inserted in adjacent gingival mucosa. The cathodal and anodal electrodes were moved to the left upper and lower canine, fourth premolar, and first molar teeth for sequential stimulation. Baseline recording of REMP was made for each tooth. Catheters were inserted percutaneously in the infraorbital and mandibular canals. Saline (0.9% NaCl) solution was injected at each catheterized site in 3 control dogs, and chloroprocaine hydrochloride was injected at each catheterized site in 6 test dogs. Each tooth was stimulated every 10 minutes for 90 minutes (test dogs) or every 10 minutes for 30 minutes and at 90 minutes (control dogs), and REMP was recorded. RESULTS: REMP was abolished within 10 minutes in all test dogs, except during stimulation of the lower first molar in 1 dog. In 4 dogs, duration of blockade was less than 90 minutes. The REMP was not restored within 90 minutes for the upper teeth in 1 dog and within 2 hours for all teeth in another dog. At 24 hours, REMP was restored for all teeth except the lower left canine in 1 dog. The REMP was restored for the lower left canine in that dog at 96 hours. The REMP was not abolished at any time in control dogs. CLINICAL IMPLICATIONS: Regional anesthesia of the infraorbital and inferior alveolar nerves may effectively provide analgesia for dental procedures in dogs.
The B cell-specific cell surface molecule CD19 is expressed at all stages of B cell development, including normal plasma cells, and mediates signal transduction via interaction with cytoplasmic effector proteins. Cross-linking CD19 on early human B lineage cells induces the formation of a CD19/Vav/phosphatidylinositol-3 kinase complex, tyrosine phosphorylation of CD19 and Vav, and activation of the Ras pathway. To further explore the ramifications of CD19 signaling, the current study examined whether phosphorylation of Elk-1, activation of activator protein-1 (AP-1), or activation of nuclear factor-kappaB (NF-kappaB) transcription factors occurred following CD19 cross-linking. The cells used were the BLIN-1 pre-B cell line expressing low levels of cell surface mu heavy chain associated with surrogate light chain and the 1E8 immature B cell line expressing cell surface mu/kappa. Lysates from CD19 cross-linked 1E8 cells induced robust phosphorylation of an Elk-1 fusion protein in vitro, whereas no phosphorylation of Elk-1 fusion protein occurred using lysates from CD19 cross-linked BLIN-1 cells. An electrophoretic mobility shift assay employing AP-1 and NF-kappaB consensus oligonucleotides was used to demonstrate that AP-1 -binding activity increased, while constitutive NF-kappaB-binding activity was not enhanced, following 2 h of CD19 cross-linking in 1E8 cells. Supershift experiments revealed that JunD and c-Fos proteins mediated anti-CD19 induced AP-1-binding activity in 1E8 cells. In contrast, CD19 cross-linking in BLIN-1 cells resulted in the induction of NF-kappaB, but had no apparent effect on AP-1-binding activity. These data suggest that CD19-mediated signal transduction activates different transcription factors at juxtaposed stages of B cell development that may culminate in the activation or suppression of distinct sets of genes.
Traumatic aneurysms (TAs) are an unusual etiology for late neurological deterioration after traumatic brain injury (TBI) and represent less than 1% of all cerebral aneurysms. TAs most often are diagnosed acutely but may be delayed in presentation. To increase awareness of this serious but treatable condition when diagnosed early, we report a delayed TA after a motor vehicle accident. The patient experienced a seizure on day 46 postinjury while in rehabilitation and demonstrated persistent lethargy and hemiparesis. Neuroimaging revealed a large, ruptured left pericallosal artery TA, which was surgically clipped. The patient completed his rehabilitation course and was eventually discharged home with family. Among TBIs, TAs are associated with penetrating injuries and skull base or anterior cranial fossa fractures. Associated mortality is high, especially if rupture has occurred. Although TAs are rare, the clinician should be vigilant in the at-risk patient.
OBJECTIVE: To increase the knowledge of nurses and doctors in an emergency department about the topic of domestic violence; to change any negative practices and attitudes toward victims; to increase knowledge of the referral processes for psychosocial aspects of domestic violence; and to increase knowledge of community resources for domestic violence victims. METHODS: Identical knowledge, attitude, and practice surveys were conducted with nurses and doctors in an emergency department before and after an educational intervention program about domestic violence. A matched-pair analysis of those respondents who answered both pretest and posttest surveys was conducted to measure the impact of the program on nurses and doctors. RESULTS: Nurses and doctors had a reasonable knowledge of the topic of domestic violence before the education program (correct answers: nurses, 61.6%; doctors, 63.4%). However, the program had a positive impact on their knowledge (correct answers posttest: nurses, 71.5%; doctors, 72.4%), with more significant changes for nurses than for doctors. The program affected both nurses' and doctors' attitudes (of 10 positive attitudinal statements: pretest, 7.9; posttest, 8.6). On both the pretest and posttest, nurses and doctors did not subscribe to a number of the myths about domestic violence that have been described in the domestic violence literature. These findings should be treated with caution because of the low response rates to the surveys from doctors (28.0%, n = 20) and nurses (53.0%, n = 48). DISCUSSION: Further research is needed into the beliefs and practices of nurses and doctors about domestic violence. The impact of this education program highlights the necessity for introducing training programs for health professionals on domestic violence problems.
The practice of routinely prehydrating patients by infusing a crystalloid or colloid solution (up to 1.0 L/70 kg) for prevention of spinal anesthesia-induced hypotension has been challenged recently, after several reports of failure to demonstrate its efficacy in young women. We compared the incidence and frequency of hypotension and vasopressor therapy after spinal anesthesia and no prehydration with crystalloid and colloid prehydration in elderly patients. Eighty-five ASA grade I or II patients (aged 60-89 yr) for elective total hip replacement were randomized to receive 500 mL crystalloid solution (Hartmanns, n = 29), 500 mL colloid (Haemaccel, n = 28), or no prehydration (n = 28) over 10 min prior to spinal anesthesia. Hypotension was defined as a 30% decrease from baseline systolic blood pressure (BP) or systolic < 90 mm Hg, and was treated with ephedrine 3-mg boluses. Although absolute systolic BP readings were significantly higher in the colloid group between 6 and 30 min (P < 0.05), the incidence of hypotension was not significantly different between the groups. The incidence of ephedrine use, incidence of nausea/vomiting, and median total dose of ephedrine were similar in all groups. We conclude that, in elderly patients undergoing elective procedures, withholding prehydration is not associated with any greater degree of hypotension or need for vasopressor therapy compared with crystalloid or colloid prehydration.
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Mercuric chloride (HgCl2) induces a T cell-dependent autoimmune syndrome in Brown-Norway (BN) rats characterized by a humoral response, tissue injury with an accumulation of CD8+ and CD4+ T cells, and an increase in tissue IL-4 mRNA and serum IgE suggesting Th2 cell activation. In other models of autoimmune disease, CD8+ cells act in both anti- and pro-inflammatory capacities, suggesting that functionally distinct CD8+ populations exist in vivo. The effect of treatment with OX8, a depleting anti-CD8 MoAb, on the initiation of HgCl2-induced autoimmunity was assessed in two experiments in a total of 20 BN rats, and compared with 20 animals treated with a control MoAb or PBS. OX8 significantly depleted peripheral blood CD8+ lymphocytes, had no effect on HgCl2-induced anti-collagen or myeloperoxidase antibodies, nor on the incidence or severity of caecal vasculitis. The severity of HgCl2-induced arthritis was significantly reduced in OX8-treated animals; median peak score reduced from 7.5 to 3.0 (experiment 1) and from 7.0 to 4 (experiment 2) (P = 0.009, Mann-Whitney U-test). OX8 treatment also exacerbated the early rise in HgCl2-induced IgE and induced a significant rise in plasma interferon-gamma (IFN-gamma), suggesting that CD8+ cells may have a regulatory influence on Th cell populations. These data provide direct evidence that CD8+ cells may act in a proinflammatory capacity in both this model of autoimmunity and the pathogenesis of inflammatory arthritis.
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