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Biomedical subjects

D Parker

Publications and source records attributed to D Parker.

At least 145 records · Page 8Linked to original sources
PubMed1994

Nursing: an integration of art and science within the experience of the practitioner.

In this paper it is proposed that whilst nursing knowledge is underpinned by the philosophies of art and science they are integrated in such a way that nursing is greater than their sum and is thus a unique discipline. It begins with an exploration of the philosophies underpinning art and science, and their relationship to nursing. The discussion then moves on to examine critically the nature and development of theory in nursing with reference to art and science, the nursing knowledge thus generated and how that knowledge is learned and expressed. The paper concludes with an evaluation of how far the discipline of nursing lies within the paradigms of science and of art, and whether indeed art and science may be, to some extent, false distinctions. The authors conclude that nursing may be viewed as an integration of art and science, expressed through the practitioner's unique, yet also shared experience.

Clinical Competence↗
PubMed1994

Serum albumin and CA125 are powerful predictors of survival in epithelial ovarian cancer.

OBJECTIVE: To assess the prognostic significance of presentation serum albumin, clinical stage and CA125 levels in ovarian cancer. DESIGN: Retrospective analysis of data using a Cox proportional hazards model. SETTING: A district general hospital oncology unit. SUBJECTS: One hundred and fourteen consecutive patients with epithelial ovarian cancer. INTERVENTIONS: Cytotoxic chemotherapy and surgery. MAIN OUTCOME MEASURE: Survival. RESULTS: A linear increase in risk was observed with high log CA125 (P < 0.0001) and with low albumin (P < 0.0001). In late stage patients (III and IV) albumin is the best predictor of survival (P = 0.0006). The presence of ascites, blood transfusion, type of surgery or chemotherapy did not improve the predictive model. CONCLUSIONS: CA125 and albumin can be used to identify prognostic subgroups independently of stage. Albumin alone can also be used as a predictor of survival. A simple classification of patients into three groups based on serum albumin of 41 g/l or more, 35 to 40 g/l and 34 g/l or less provides a clear separation of survival curves in the present group of patients.

Adult↗
PubMed1994

Bicycle-motor vehicle collisions. Epidemiology of related injury incidence and consequences.

This study investigated the incidence, consequences, and possible risk factors for injuries resulting from non-fatal bicycle-motor vehicle collisions during a one-year period in Minnesota. A study of 925 non-fatal collisions involving individuals 12 years of age and older in 1984 found an inverse relationship between age and collision incidence, with especially high rates identified for those between the ages of 12 and 14 (164 per 100,000) and 15 and 19 (71 per 100,000). Male bicyclists had consistently higher collision rates among all age groups. In a survey of the 925 individuals (64.3% response rate) 95% reported sustaining injuries as a consequence of the collisions. Twenty-one percent said they had not fully recovered from their injuries approximately two years post-injury, while 26% reported persistent problems. These results show a high incidence of collisions under certain conditions and suggest protective measures to make bicycling safer on our nation's roadways.

Accidents, Traffic↗
PubMed1994

Tackling wastage and inefficiency in the health sector.

Governments and the public are concerned about waste and inefficiency in the health sector. Although there are likely to be various underlying causes, wastage often results from limited information and from limited accountability for decisions about the use of resources. Corruption and fraud occur where there are conflicting interests in combination with limited accountability. Policy-makers, managers, providers and service users should feel responsible for ensuring that scare health resources are used efficiently. They should actively combat wastage by identifying the causes, and then make corresponding changes in policy, management and technical procedures.

Costs and Cost Analysis↗
PubMed1993

Cross-sectional epidemiological study of respiratory disease in turkey farmers.

This study was a cross-sectional epidemiological investigation of respiratory disease in farmers involved in the turkey growing industry. Pulmonary function tests and health history questionnaires were administered to a total of 95 turkey farmers throughout Minnesota. Respiratory symptoms were greatest during the winter months when exposure to environmental agents was highest. Prevalence of symptoms was higher for smokers, personnel who worked in hen barns, and for persons who had worked in the turkey growing industry for more than 10 years. Pulmonary function was found to decrease during the work day. Also, pulmonary function was lowest for personnel working in hen bars, and for persons who had been employed in the industry for more than 10 years. These data support the association between respiratory disease and exposure to the environment in confinement farm buildings.

Adolescent↗
PubMed1993

Competitive EIA for anti-HIV-2 detection in The Gambia: use as a screening assay and to identify possible dual infections.

The performance of a competitive EIA for the detection of HIV-2-specific antibody utilising a viral lysate antigen was assessed over a 3 year period in The Gambia, West Africa, and compared with a commercially available assay, ELAVIA-2, using three panels of sera. An immunodominant region of the transmembrane glycoprotein of an HIV-2 isolate (ANT 53) was also cloned and expressed in E. coli as a beta-galactosidase fusion protein and the resulting recombinant protein substituted in place of the existing viral lysate antigen. Competitive EIAs were found to be both a specific and sensitive means of reliably determining the HIV-2 status of an individual with a high predictive value, particularly when a strategy of concordant positive results in the two EIAs was used. When either anti-HIV-2 competitive EIAs were used in conjunction with a competitive EIA for anti-HIV-1 detection it was possible in the vast majority of cases to identify the virus-type infecting an individual and speciate HIV-1 and HIV-2 infections. A few sera which showed similar regression profiles when diluted over a serial tenfold dilution steps were identified as possible dual infections.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Hepato-biliary and renal excretion in mice of charged and neutral gadolinium complexes of cyclic tetra-aza-phosphinic and carboxylic acids.

Tissue distribution of 21 new 157/153Gd complexes was measured at 5 min and 24 hr after an intravenous injection into mice. A complex was judged to be stable in vivo when the percentage of 153Gd retained in the liver and skeleton at 24 hr was comparable with that of 153Gd(DOTA)-. Complexes varied in net charge and lipophilicity and 20 were phosphinic or carboxylic acid derivatives of tetra-aza-cyclo-dodecane. Three anionic, lipophilic complexes were cleared predominantly by the hepato-biliary pathway and were stable in vivo. The remaining 18 complexes were cleared mainly by the kidneys. Of these 18, 1 anionic, 8 neutral, and 3 cationic complexes were stable in vivo. These findings augur well for the future of hepato-biliary and general purpose Gd contrast enhancing agents for MRI.

Animals↗
PubMed1993

Systemic inflammatory responses to cardiopulmonary bypass: a pilot study of the effects of pentoxifylline.

The potential of pentoxifylline (PTX) to modify systemic inflammatory responses and lung injury following cardiopulmonary bypass (CPB) was studied in 20 patients undergoing elective coronary artery surgery. Ten control patients were compared with ten patients who received a PTX infusion of 1 mg kg-1 h-1 during surgery. Intra-vascular pulmonary leukocyte sequestration was observed in neither group following discontinuation of CPB. Plasma elastase-alpha-1-antiprotease complex rose three-fold from baseline in both groups to peak at sternal closure. No significant plasma interleukin-1 (IL-1) response was detected. Plasma interleukin-6 (IL-6) rose in both groups from baseline to peak 4 h postoperatively. There was no correlation between plasma levels of elastase complex, IL-1 or IL-6 and impairment of postoperative oxygenation. CPB was associated with significant postoperative hypoxaemia and systemic release of neutrophil elastase and IL-6 but PTX, at the given dose, did not abrogate these responses.

Cardiopulmonary Bypass↗
PubMed1993

The host inflammatory response prior to death in patients with cystic fibrosis and chronic Pseudomonas aeruginosa infection.

The intensity of the host inflammatory response to pulmonary infection with Pseudomonas aeruginosa immediately prior to death was determined in six patients with cystic fibrosis (CF). Plasma concentrations of neutrophil elastase alpha 1-antiproteinase, tumour necrosis factor-alpha (TNF alpha) and serum C-reactive protein (CRP) were increased in the 7 days prior to death (P < 0.05) when compared with a period of clinical stability during the preceding 6 months. An increased inflammatory response was sustained for many weeks prior to death and was associated with poor symptom and lung function responses to apparently appropriate antibiotic treatment.

Adolescent↗
PubMed1993

Bowel function and irritable bowel symptoms after hysterectomy and cholecystectomy--a population based study.

Because unsubstantiated beliefs link hysterectomy and cholecystectomy with bowel function, this study examined all the women who had had these operations in a defined population (79 and 37 respectively, out of 1058) with respect to bowel habits, irritable bowel syndrome symptoms, and whole gut transit time calculated from records of three defecations. Compared with unoperated controls, women after hysterectomy were more likely to consider themselves constipated; they also strained more and admitted more often to bloating and feelings of incomplete evacuation. Their stools tended to be lumpier and, in women over 50 years, transit time was longer. When women treated by cholecystectomy were compared with women having newly discovered, asymptomatic gall stones, they more often described defecation as urgent but had no other detectable differences. In conclusion symptomatic constipation is frequent in women after hysterectomy; after cholecystectomy, bowel habit is not consistently changed but the rectum seems to be more irritable.

Adult↗
PubMed1993

Correlates and determinants of bone mineral content and density in healthy adolescent girls.

The relationships between whole-body and lumbar spine bone mineral content and density, and measures of chronologic age, body composition, physical activity, cardiorespiratory and strength fitness, gynecologic attributes, sexual maturity, and endocrine status were studied in 35 healthy menarcheal girls (14-18 years of age). Body mass (0.464 < r < 0.704), growth hormone (-0.34 < r < -0.42), and one-repetition maximum double-leg press strength (0.343 < r < 0.467) were significantly (p < 0.05) correlated with each of the five bone mineral measures. Multiple regression analysis indicated that body mass accounted for the largest significant proportion of the explained variance (30.2-68.2%) in each of the five bone mineral measures. Age at first menses accounted for a smaller but still significant proportion of the variance in whole-body bone mineral content (4.05%) and lumbar spine bone mineral content (8.06%). Growth hormone entered the regression model as an important predictor of whole-body bone mineral content, accounting for 3.51% of the explained variance in this variable. Age, cardiorespiratory fitness, level of habitual activity, and strength did not contribute significantly to the explained variance in any of the bone mineral measures. Body mass appears to be the single most important determinant of bone mineral among females during this developmental period.

Adolescent↗
PubMed1993

Effect of cardiopulmonary bypass on systemic release of neutrophil elastase and tumor necrosis factor.

Leukocyte counts, plasma neutrophil elastase, tumor necrosis factor-alpha and C-reactive protein were determined serially in 19 patients undergoing elective coronary artery surgery with cardiopulmonary bypass. Neutrophil counts (mean +/- standard deviation 3.85 +/- 1.20 x 10(9)/L preoperatively) peaked 4 hours postoperatively at 10.35 +/- 4.24 x 10(9)/L (p < 0.001) and remained significantly elevated 48 hours postoperatively at 7.80 +/- 2.70 x 10(9)/L, p < 0.05. Plasma neutrophil elastase level (187 +/- 74 ng/ml preoperatively) peaked at 698 +/- 323 ng/ml at the end of surgery (p < 0.001) and remained significantly elevated at 424 +/- 146 ng/ml 48 hours postoperatively (p < 0.01). Peak elastase levels correlated significantly with duration of bypass (r = 0.47, n = 19, p < 0.05). Monocyte counts (0.29 +/- 0.19 x 10(9)/L preoperatively) peaked 4 hours postoperatively (0.87 +/- 0.41 x 10(9)/L, p < 0.001) and fell to baseline levels by 48 hours postoperatively. Plasma tumor necrosis factor-alpha, detectable in 10 of the 19 patients preoperatively (median 0.39 U/ml, range up to 10.1 U/ml), did not change significantly during or after bypass. Plasma C-reactive protein level (median 1.67 [range 0.69 to 34.33] micrograms/ml preoperatively) rose significantly to 3.99 (range 1.95 to 12.55) micrograms/ml 4 hours postoperatively (p < 0.01) and rose 48 hours postoperatively at 303 (210 to 410) micrograms/ml, p < 0.001. Oxygenation, determined by the respiratory index, was impaired at the end of operation (2.07 +/- 0.82) and remained impaired 24 hours postoperatively (2.48 +/- 0.83). Impairment of oxygenation was temporally related to elevated elastase levels, but neither peak elastase levels nor the change in elastase levels with lung reperfusion correlated significantly with the area under the respiratory index curve up to 6 hours postoperatively. This study demonstrates neutrophil elastase release during cardiopulmonary bypass but fails to show a definite role for neutrophil activation or tumor necrosis factor-alpha in the etiology of pulmonary dysfunction after cardiopulmonary bypass.

Aged↗
PubMed1992

The public and private sectors in health: economic issues.

Major changes in the public/private mix of health services are occurring in many countries. These changes may be analysed by examining the financing and provision of services and subsidization of the purchase of the factors of production. The public sector and not-for-profit and for-profit elements of the private sector must be viewed as separate entities in such analyses due to their differing objectives, motives and form of operation. The issues to be dealt with by countries in finding the public/private mix which is appropriate for their health system and achieves their objectives include efficiency, quality, regulation, equity and consumer choice and satisfaction. The recommendations for action for countries include: promoting collaboration between private and public sectors; testing different public/private mix models; identifying appropriate expansion paths for private sector services; improving information for policy and planning decisions; enhancing management capacity; and, reviewing programme and project support. International agencies also have a role in this process by supporting countries through the provision of technical assistance, financial aid, promoting policy reviews, and facilitating the sharing of information and experiences among countries concerning these public/private mix issues.

Developing Countries↗
PubMed1992

Diagnostic reagents for hepatitis C virus.

The development of diagnostic methods for hepatitis C virus is presented. Special attention is paid to the selection of antigenic markers, the type of assay selected and the interpretation of results. A few of the pitfalls and ambiguities of various assays are discussed and possible future methods are described.

Antigens, Viral↗