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J Ashley

Publications and source records attributed to J Ashley.

47 records · Page 3Linked to original sources
PubMedDate not supplied

Dimensions of decreased psychological well-being in advanced dementia.

Evaluation of psychological well-being among persons with an advanced dementia is primarily dependent on verbal and non-verbal cues and behaviors that are observed and interpreted by others. The purpose of the present study was to determine how many components of psychological well-being can be measured. Fifty-seven individuals who were institutionalized for advanced dementia and exhibited agitation or withdrawal were evaluated by direct observations and by interviews with nursing home staff. Engagement was measured by the Lawton Positive Affect scale, visual analog scale, and reported degree of patient's interest in the environment. Mood was measured by a global indicator of mood interpreted from facial expression and two mood items from the Multidimensional Observation Scale for Elderly Subjects. Agitation was measured by a visual analog scale and by the Short Form of the Cohen-Mansfield Agitation Inventory. Correlation analyses and multidimensional scaling provided evidence for three dimensions of psychological well-being: engagement-apathy, happy sad mood, and calm-agitation. Evaluation of these three dimensions is important for measuring quality of care in long-term care settings and for determining effectiveness of therapeutic interventions.

Affect↗
PubMedDate not supplied

Nutrition in advanced cancer: anorexia as an outcome variable and target of therapy.

The endpoints used as outcome variables in clinical cancer treatment trials, including nutrition intervention studies, should contain items that are meaningful to the patient. Variables to consider are appetite, food intake, physical performance, psychological and social functioning, response to cancer therapies, survival time, nutrition status, associated morbidity, and costs. Ideally, the design and conduct of nutrition trials should be carried out by a multidisciplinary team comprising medical oncologists, physician specialists in nutrition, dietitians, and social scientists. Anorexia has not been a focus of nutrition support trials in the past partly because of the lack of effective strategies to reverse it. Anorexia is one important cause of cancer starvation, and it also causes patient discomfort. This paper describes outcome variables that include patient derived subjective factors such as anorexia, and outlines new strategies to reverse anorexia. Pharmacologic strategies tested to reverse anorexia include corticosteroids, anabolic steroids, cyproheptadine, hydrazine sulfate, cannabinoids, and megestrol acetate. Of these, only the latter has been consistently well tolerated and effective, with significant improvements in appetite and food intake demonstrated in large-scale, randomized, controlled trials involving more than 600 cancer patients. Dose-response studies have demonstrated increasing efficacy with increasing doses of megestrol acetate from 160 to 800 mg/day. Doses in excess of 800 mg/day are not currently recommended. The mechanisms of action of megestrol acetate involve both behavioral and metabolic effects, and its impact on energy expenditure, appetite, body composition, endocrine function, and lipid metabolism is the subject of ongoing research.(ABSTRACT TRUNCATED AT 250 WORDS)

Anorexia↗
PubMedDate not supplied

The International Classification of Diseases: the structure and content of the Tenth Revision.

The Tenth Revision of the International Classification of Diseases is due to be published this year, and introduced from 1993. The aim of the classification is to facilitate comparisons between countries at the same point in time and within, and between, countries over time. The provision of comparable statistics is essential for facilitating policy decisions relating to health promotion and disease prevention, and for the collection of epidemiological data for research purposes. This article describes the major changes and important features in this revision, and compares them to the Ninth Revision of the International Classification of Diseases.

Disease↗
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Weight reduction for breast cancer prevention by restriction of dietary fat and calories: rationale, mechanisms and interventions.

A large body of epidemiologic evidence and data drawn from animal feeding studies have led to the feasibility testing of clinical breast cancer prevention trials based on the restriction of dietary fat intake. The animal data strongly suggest that restricting calories as well as fat inhibits breast cancer promotion. Body fat correlates with dietary fat intake in human populations. Obese postmenopausal women have increased levels of circulating bioavailable estrogen capable of promoting breast cancer growth. We propose that restriction of dietary fat intake will decrease total calorie intake and result in a loss of body fat in postmenopausal women. This loss of fat will decrease estrogen production from adrenal androgens and increase bioavailable estrogen, leading to decreased promotion of estrogen-dependent breast tumors. Intervention programs targeted at weight reduction via restriction of calories, reduction of dietary fat and increased physical activity are logical, practical and measurable strategies for reducing the risk of breast cancer in women at moderate to increased risk. Failure to account for variations in adherence to a restricted-fat diet in past feasibility studies has cast doubt on the hypothesis that restricting dietary fat intake can be utilized to reduce the risk of breast cancer. Current studies examining nutritional, hormonal and physiologic data in conjunction with evidence of adherence to dietary and lifestyle change will likely clarify the hormonal and physiologic effects of this potential nutritional strategy for breast cancer prevention.

Animals↗
PubMedDate not supplied

Primary care orthopedics and sports medicine in West Virginia.

Previous studies at several family practice residency programs in the U.S. have shown that many family practice graduates feel inadequately prepared to offer fracture care or casting. In order to determine if this was a problem in West Virginia, a survey was sent to all family physicians in the state which asked about their type of practice and residency training, if they provided fracture care or casting services, if they offered sports medicine coverage for teams in their communities, attitudes about their own competency in caring for fractures, as well as other personal and demographic data. Our survey confirmed that only 118 family physicians provide fracture care (42%), and that only 91 provide casting services (32%). The surveys also revealed that rural physicians feel obligated to offer this service, despite the fact that they do not perceive themselves to be very competent in this aspect of patient care, and only 43 rural physicians offer sports medicine coverage (44%). As a result of these findings, we propose that a more adequate orthopedic experience be a part of family practice training, and that there should also be increased emphasis on insuring family practice residents have a basic competency in sports medicine.

Adult↗
PubMedDate not supplied

Outpatient pulmonary rehabilitation in severe chronic obstructive pulmonary disease.

BACKGROUND: This is a study of an outpatient programme for rehabilitation of patients with severe ventilatory impairment due to chronic obstructive pulmonary disease (COPD). Its main purpose was to assess the feasibility of such a programme and so no control group was included. METHODS: The study included 44 patients (28 men) of mean age 66 years with COPD. They all had severe ventilatory impairment as defined by a forced expiratory volume in 1 second (FEV1) less than 40% of predicted. Initial assessment included a shuttle walking test, the Chronic Respiratory Disease Questionnaire (CRDQ), the Hospital Anxiety and Depression scale (HAD) and the Sickness Impact Profile (SIP). The patients then entered a 6-week outpatient programme during which they attended twice weekly for a 2 1/2 hour session. Assessment was repeated on completion of the study (the 3 1/2 month assessment) and at 6 months. RESULTS: The shuttle walking distance improved significantly and was maintained at the improved level for 6 months. The improvement in all four dimensions of the CRDQ was statistically significant and reached clinical significance for fatigue and for mastery. On entry, a notable level of depression was found in 32% of patients, and of anxiety in 40%. There was significant reduction in both of these which was maintained at 6 months. There was no improvement in the SIP at 3 months, but significant improvement was found at 6 months. CONCLUSIONS: This study shows that a successful outpatient programme can be conducted in patients with severe ventilatory impairment, and that apparent benefit in physical ability and in health-related quality of life can be achieved. The improvements were maintained at 6 months.

Aged↗
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Persons with Disabilities↗