Search PubMed⌕ Search

Biomedical subjects

J Bennett

Publications and source records attributed to J Bennett.

At least 37 records · Page 2Linked to original sources
PubMed1999

Medication adherence in rheumatoid arthritis patients: older is wiser.

OBJECTIVES: To create a profile of individuals nonadherent to their medications in an age-stratified sample (ages 34-84) of community-dwelling rheumatoid arthritis patients. The relative contributions of age, cognitive function, disability, emotional state, lifestyle, and beliefs about illness to nonadherence were assessed. DESIGN: A direct observation approach was used in conjunction with structural equation modeling. All participants were administered a preliminary assessment battery. Medications were then transferred to vials with microelectronic caps that recorded medication events for all medications for the next 4 weeks. PARTICIPANTS AND SETTING: A volunteer sample of 121 community-dwelling rheumatoid arthritis (RA) patients were recruited from newspaper ads, posters, and via informal physician contact from private rheumatology practices in Atlanta and Athens, Georgia. Written verification of the RA diagnosis and a disease severity rating were obtained from personal physicians before patients were enrolled in the study. Patients were tested in a private physician's office, and their medication adherence was monitored electronically for a month in their every-day work and home settings. MEASUREMENTS AND RESULTS: Structural equation modeling techniques were used to develop a model of adherence behavior. Cognitive and psychosocial measures were used to construct latent variables to predict adherence errors. The model of medication adherence explained 39% of the variance in adherence errors. The model demonstrated that older adults made the fewest adherence errors, and middle-aged adults made the most. A busy lifestyle, age, and cognitive deficits predicted nonadherence, whereas coping with arthritis-related moods predicted adherence. Illness severity, medication load, and physical function did not predict adherence errors. Omission of medication accounted for nearly all errors. CONCLUSION: Despite strong evidence for normal, age-related cognitive decline in this sample, older adults had sufficient cognitive function to manage medications. A busy lifestyle and middle age were more determinant of who was at risk of nonadherence than beliefs about medication or illness. Thus, practicing physicians should not assume that older adults have insufficient cognitive resources to manage medications and that they will be the most likely to make adherence errors. Very busy middle-aged adults seem to be at the greatest risk of managing medications improperly.

Adaptation, Psychological↗
PubMed1999

Long-term followup of the North American multicenter UroLume trial for the treatment of external detrusor-sphincter dyssynergia.

PURPOSE: We determine the long-term efficacy and safety of the UroLume stent as minimally invasive treatment for external detrusor-sphincter dyssynergia in spinal cord injured men. MATERIALS AND METHODS: A total of 160 spinal cord injured men with a mean age plus or minus standard deviation of 36.3 +/- 12.1 years (range 16 to 74) were prospectively treated with an endoprosthesis at 15 centers as part of the North American UroLume trial for external detrusor-sphincter dyssynergia. Urodynamic parameters, including voiding pressure, residual urine volume and bladder capacity, were compared before treatment and at 1, 2, 3, 4 and 5 years after treatment. RESULTS: Mean voiding pressure was 75.1 +/- 28.2 cm. water before treatment in the 160 patients, and 37.4 +/- 23.9 at year 1 in 97, 39.5 +/- 22.2 at year 2 in 84, 42.6 +/- 27.3 at year 3 in 61, 46.3 +/- 33.2 at year 4 in 57 and 44.2 +/- 28.9 cm. at year 5 in 41 after stent insertion (p <0.001). Residual urine volume decreased after stent placement and was maintained throughout the 5-year followup (p <0.001). Mean cystometric capacity remained constant from 269 +/- 155 before insertion to 337 +/- 182 ml. 5 years later (p = 0.17). Hydronephrosis and autonomic dysreflexia improved or stabilized in most patients with functioning stents. Stent explant was necessary in 24 patients (15%), of whom 4 (16.7%) had another stent implanted. CONCLUSIONS: The UroLume stent demonstrates long-term safety and efficacy for the treatment of external detrusor-sphincter dyssynergia. The outcome was similar in men with and without previous sphincterotomy.

Adolescent↗
PubMed1999

Modified continuous femoral three-in-one block for postoperative pain after total knee arthroplasty.

UNLABELLED: We prospectively studied the continuous "modified" femoral three-in-one block for postoperative pain after total knee arthroplasty. Sixty-two patients undergoing elective knee arthroplasty under spinal anesthesia with bupivacaine (B) and fentanyl were randomized to receive 0.2% B, 0.1% B, or placebo at 10 mL/h for 48 h after an initial bolus of 30 mL of the same solution via the femoral block catheter. The catheters were inserted under the fascia iliaca using a "double pop" technique and a peripheral nerve stimulator and were advanced 15-20 cm cranially. Venous plasma levels of B, desbutylbupivacaine, and 4-hydroxy B were measured daily for 3 days. All patients received patient-controlled analgesia with morphine and indomethacin suppositories for 48 h. Using computed tomography, we evaluated the catheter location for 20 patients. The catheter tips, located superior to the upper third of the sacroiliac joint in the psoas sheath, were labeled as ideally located. The group receiving 0.2% B had a larger block success rate, smaller morphine consumption in the immediate postoperative period (15 vs 22 mg) and during the first postoperative day (9 vs 18 mg), and achieved a greater range of motion in the immediate postoperative period (91 degrees +/- 10 degrees vs 80 degrees + 13 degrees ). Visual analog scores for pain during both rest and activity were low but similar between the groups. Forty percent of the catheters evaluated were ideally located. Ideal location and use of 0.2% B resulted in 100% success of blockade of all three nerves. The S1 root was blocked in up to 76% of patients. The plasma levels of B, 4-hydroxy B, and desbutylbupivacaine were below the toxic range during the infusion. We conclude that continuous fascia iliaca block with 0.2% B results in opioid-sparing and improved range of motion during the immediate postoperative period. Larger doses of bupivacaine may safely be used in the immediate postoperative period if needed. IMPLICATIONS: Continuous fascia iliaca block with 0.2% bupivacaine reduces opioid requirements and improves range of motion in the immediate postoperative period compared with a placebo and 0.1% bupivacaine. Plasma levels are below the toxic range with this dose. Only 40% of the catheters are positioned in the ideal location. With the smaller dose of bupivacaine, the success rate with this block is small.

Aged↗
PubMed1998

Surgical correction of an acquired vaginal stricture in a llama, using a carbon-dioxide laser.

An acquired vaginal stricture in a llama secondary to trauma from uterine torsion during gestation was repaired, using a carbon-dioxide laser. The procedure was accomplished by use of epidural anesthesia with the llama in a standing position. Repeated dilation of the vagina was required after surgery; however, the llama subsequently mated and conceived, and a male cria was delivered by cesarean section at the end of a full-term gestation.

Animals↗
PubMed1998

Temporal and spatial regulation of gene expression mediated by the promoter for the human tissue inhibitor of metalloproteinases-3 (TIMP-3)-encoding gene.

A complex interplay between enzymes involved in extracellular matrix formation and their inhibitors is thought to control organogenesis during mammalian development. Disturbance of this balance may result in a wide range of diseases, including macular degeneration, arthritis, and tumor metastases. In order to define elements which may be involved in regulating human tissue inhibitor of metalloproteinase 3 (TIMP3) expression, we isolated and sequenced a clone containing 1315 bp of the 5'-upstream region of the human TIMP-3-encoding gene. A 1.2 kb fragment of this clone, which contains multiple motifs which are binding sites for known transcription factors, was used to drive expression of the lacZ reporter gene in multiple lines of transgenic mice. TIMP3 promoter activity, detected through beta-galactosidase histochemical assay, was observed at high levels in selected tissues, the identity of which varied according to developmental stage. TIMP3 promoter activity was detected at embryonic and early postnatal stages in tissues undergoing extensive remodeling, such as developing somites, bones and joints, choroid plexus, webs between the digits, and the spongiotrophoblastic portion of the placenta. In adulthood, TIMP3 promoter activity was restricted to a few tissues which exhibit high metabolic activity or rapid turnover. These include the retinal pigment epithelium (RPE), cells of the kidney cortex, hair follicles, gingiva, ovarian follicles, and testis. The results suggest that TIMP3 expression plays an active role in developmental patterning and in the maintenance of specific differentiated tissues.

Animals↗
PubMed1998

Developing guidelines for community child health staff and examining the referral pathways and outcomes of care in the support of emotionally and behaviourally disturbed children.

The East Sussex Public Health Commissioners had enquired whether referral guidelines were needed to ensure that the children with the greatest concerns achieved support from the Child and Adolescent Mental Health Services (CAMHS). Community child health doctors and nurses recorded all contacts with children with emotional and behavioural difficulties (EBD) over a one month period. Data on presenting difficulties and on intervention pathways were recorded. The same children were reviewed five months later and the outcome was measured by clinical assessment and by support offered. The work showed that child health staff were managing cases both through single advisory sessions and through planned on-going support. Additionally, the use of the three tier pathways recommended by the Department of Health was demonstrated. Analysis of recorded data was used to describe referral pathways and to give guidance on the characteristics of children who needed referral to CAMHS.

Attention Deficit and Disruptive Behavior Disorder↗
PubMed1998

Adverse impact of infections on antibody responses to measles vaccination.

Antibody titres were determined in 102 Thai infants who were vaccinated at 9-months of age during the respiratory disease season. The symptom densities of illnesses at or following vaccination, including rhinorrhea and diarrhea, were significantly lower among seroconverters, although the simple presence or absence of specific symptoms was not significantly related to seroconversions. Logistic regression indicated that neutralization test antibody titres below the median titre of 1:80 following vaccination were significantly more frequent among those with rhinorrhea when vaccinated and among those with diarrhea after vaccination. Compared with a referent group without these symptoms, titres were lower in those who had rhinorrhea when vaccinated, rhinorrhea during the first week post vaccination, and diarrhea in either of the two follow-up weeks. Illnesses concurrent or subsequent to measles vaccination adversely affected antibody responses in these study objects.

Antibodies, Viral↗
PubMed1998

Incremental bolus versus a continuous infusion of propofol for deep sedation/general anesthesia during dentoalveolar surgery.

PURPOSE: This article compared the use of the traditional incremental bolus technique with the continuous infusion technique for the administration of propofol for deep sedation/general anesthesia. PATIENTS AND METHODS: Patients were sedated with midazolam and fentanyl and then had maintenance of an anesthetic state achieved with propofol administered by either of the two techniques. Data were collected to evaluate the overall surgical/anesthetic procedure, movement of the patient, and his or her hemodynamic status. RESULTS: Both groups received a mean maintenance dose of propofol exceeding 6 mg/kg/hr. However, the patients in the continuous infusion group received a statistically greater maintenance dose (continuous infusion + supplemental vs incremental bolus). All patients were maintained in a deep sedation/general anesthetic state. Respiratory and blood pressure values were comparable in both groups. However, the continuous infusion group showed improved hemodynamic stability manifested as fewer fluctuations in heart rate. Visual analog scale (VAS) questionnaires completed by the surgeon and surgical assistant reported less patient movement and improved surgical/anesthetic conditions with the continuous infusion technique. Recovery of the two groups was comparable. CONCLUSION: This study, although finding advantages in the continuous infusion technique, showed satisfactory conditions associated with both techniques.

Alveolar Process↗
PubMed1998

Subcutaneous administration of midazolam: a comparison of the Bioject jet injector with the conventional syringe and needle.

PURPOSE: The purpose of this study was to compare jet injection to a syringe and needle in terms of the difference in discomfort and pharmacokinetics after the subcutaneous administration of midazolam. PATIENTS AND METHODS: Using a prospective, randomized, double-blinded study design, 14 subjects were administered midazolam on two separate occasions (at least 2 weeks apart). The subjects were randomly distributed into two groups: syringe and needle (saline)/jet injector (midazolam) or syringe and needle (midazolam)/jet injector (saline). The subjects were randomly assigned to receive either EMLA (eutectic mixture of local anesthetics) or a placebo at the injection site for the first administration and the other topical agent on the second visit. Each subject received one subcutaneous injection in the deltoid region per arm per day. Each injection contained the same volume of solution. Subjects completed visual analog scale (VAS) questionnaires assessing the discomfort of the injection. Blood samples were taken at specified intervals over 2 hours for determination of midazolam levels. RESULTS: The discomfort associated with the injection was less with the Biojector 2000 (Bioject Inc, Portland, OR) although this was not statistically significant. However, persistent discomfort was significantly greater at the needle site. The mean peak plasma level of midazolam was achieved more rapidly with the Biojector 2000 than with the syringe and needle (P < .05). However, the peak plasma level after jet injection or injection with a syringe and needle was not statistically different. CONCLUSION: The results of the study show that the Biojector 2000 is a needle-free injection system that can be used for the administration of a premedicant before induction of anesthesia. It has several advantages, including the potential reduction of anxiety associated with the "fear of needles" and occupational injuries.

Adolescent↗
PubMed1998

Laboratory investigation and comparison of Salmonella Brandenburg cases in New Zealand.

An apparent increase in the incidence of S. Brandenburg in New Zealand, coupled with the possibility that the virulence of the organism may also be changing, prompted this study. Three typing methods: macro-restriction fragment length polymorphism (MRFLP) profiling using pulsed field gel electrophoresis (PFGE), plasmid profiling and antimicrobial susceptibility profiling were used to determine strain diversity amongst 115 recent and historical isolates of S. Brandenburg from both human cases and non-human sources. Antimicrobial resistance was noted only in three isolates. Plasmids of varying sizes were found in 31 isolates. MRFLP analysis resulted in 13 different patterns. Combining the three sets of typing data yielded 24 composite types. Comparison of composite type, isolation date and geographical location of case allowed the retrospective recognition of seven potential clusters during the 5-year study period. Composite types of 24 (80%) of the non-human isolates tested were indistinguishable from human isolates, suggesting that human infection may be via a number of vehicles. Although not cost-effective for routine use on all salmonella isolates, the methods used in this study are an important adjunct to serotyping for discrimination within an emerging serotype.

DNA, Bacterial↗
PubMed1998

Adenovirus-mediated delivery of rhodopsin-promoted bcl-2 results in a delay in photoreceptor cell death in the rd/rd mouse.

Gene transfer to retinal cells may provide a means to retard photoreceptor cell death and thus prevent blindness in diseases such as retinitis pigmentosa. We tested the possibility of interfering with apoptotic photoreceptor cell death in the rd mouse through subretinal delivery of a recombinant replication-defective adenovirus containing the human cDNA for bcl-2, Ad.2.5HRPbcl-2. Photoreceptor-specific transgene expression was accomplished through incorporation of the 2.5 kb human rhodopsin upstream fragment (HRP). Ad.2.5HRPbcl-2 was injected alone or in combination with Ad.CMVPDE beta. Ad.CMVPDE beta contains a cDNA encoding the beta subunit of cGMP phosphodiesterase (PDE beta). Recombinant viruses containing lacZ (driven either by the cytomegalovirus (CMV) promoter/enhancer or HRP) and of Ad.CMVPDE beta and vehicle alone were injected in contralateral eyes as control. Injection of Ad.2.5HRPbcl-2 in the rd mouse resulted in histologically detectable rescue lasting 6 weeks after birth. Extent of rescue was not as large as after delivery of wildtype PDE beta, the gene defective in the rd mouse. However, delivery of genes which prevent apoptotic cell death may have broad application to gene therapy of retinal degenerative diseases.

Adenoviridae↗
PubMed1998

Fear of contagion: a response to stress?

Most of the research on nurses' responses to people affected by AIDS has comprised atheoretical surveys or cross-sectional correlation studies. A decade ago, Meisenhelder and LaCharite were among the first to propose a theoretical explanation for these responses, including implications for altering them. They posited that "fear of contagion [is] an affective response of the stress-coping process ... [and] highlighted origins of the fear, behavioral manifestations, and avenues for exploration to decrease this perceived threat." This article reexamines the interpretation of the empirical data on which their proposition rested, places that data in the context of other research about the nurses' AIDS-care attitudes, including Meisenhelder's own subsequent research, and discusses the model's utility for anticipating and influencing nurses' behavioral response to HIV-affected populations.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Gastroesophageal reflux in patients fed by percutaneous endoscopic gastrostomy (PEG): detection by a simple scintigraphic method.

OBJECTIVES: Gastroesophageal scintigraphy has been described as a sensitive and accurate way to detect and quantitate gastroesophageal reflux (GER). Our objectives here were to evaluate the usefulness of a modified scintigraphic technique in the detection of GER and lung aspiration in patients fed by percutaneous endoscopic gastrostomy (PEG), and to assess the incidence of GER after insertion of PEG. Further, we sought to examine whether or not the underlying cause of dysphagia plays any significant part in the causation of GER. METHODS: Twenty-two patients, 13 with neurological dysphagia and nine with mechanical dysphagia, were studied. Each patient received 25 MBq of Tc-99m-tin colloid in orange juice followed by 300 ml of normal saline through the PEG tube. Dynamic and static images were taken immediately and at 4 h over esophagus, stomach, and lungs. RESULTS: Twelve patients (10 with neurological dysphagia) had GER and one had aspiration into the lungs. In all but one patient GER occurred in the immediate postprandial period. CONCLUSIONS: Scintigraphy is useful in assessing GER in PEG-fed patients. We also note that GER is a major problem in patients with PEG, especially in those with neurological dysphagia.

Adult↗
PubMed1998

Bone grafting and its essential role in implant dentistry.

Pressure to deliver implant-born prosthetics in most partially edentulous situations is growing. The implant team is faced with high patient expectations for optimal function and aesthetics while being challenged to restore more complex areas of the jaw. Osseous ridge deficiencies are more often the norm than the exception following tooth loss. Squeezing short or narrow implants into deficient ridges is a poor technique that often fails to properly replace ridge anatomy or provide stable restorations. Bone grafting should assume an essential role to the implant team if their objective is to create biologically sound replicas of missing natural teeth.

Alveolar Bone Loss↗