The diuretic effect of desmethyl-pipazuroyl-guanidine (MK-870) in man.
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Acids↗
Biomedical subjects
J Conway
Publications and source records attributed to J Conway.
The antihypertensive and diuretic effects of amiloride and of its combination with hydrochlorothiazide.
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Adult↗
Comparison of a new beta adrenergic blocker (MK 950) and propranolol in man.
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Adrenergic beta-Antagonists↗
An assessment of central-peripheral ventilatory chemoreflex interaction in humans.
The independence of the central and peripheral chemoreflexes has been tested in humans. Acute metabolic acidosis generated by a prior bout of brief, hard exercise was used to stimulate primarily the peripheral chemoreceptors, and respiratory acidosis generated by inhaled CO2 was used to stimulate both central and peripheral chemoreceptors. Seven healthy young men were studied. Ventilation and arterial pH, PCO2 and PO2 were recorded. Peripheral chemoreflex sensitivity to hypoxia during acute metabolic acidosis was repeatedly determined by measuring ventilation in euoxia (PETO2 = 100 Torr) and hypoxia (PETO2 = 50 Torr) as the subject recovered from exercise-induced acidosis. Peripheral chemoreflex sensitivity to hypoxia during CO2 inhalation was repeatedly determined by measuring ventilation in euoxia and hypoxia at two levels of hypercapnia (PETCO2 = 45 Torr and PETCO2 = 50 Torr). The ventilatory sensitivity to hypoxia at matched arterial pH values was not significantly different between conditions of high (CO2 inhalation) and low (metabolic acidosis) central chemoreceptor activity. We therefore conclude that interaction between central and peripheral chemoreflexes was non-significant in all subjects.
Adolescent↗
Immunoprofile studies for patients with bronchogenic carcinoma--I: correlation of pre-therapy studies with stage of diseases.
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Adult↗
Behavior adjustments in traumatic brain injury. A case study.
A traumatic assault to the brain often leaves significant residual effects, including severe behavioral dyscontrol. The person may demonstrate unwanted behaviors, such as physical aggression or verbal abuse, and lack motivation or the skills to engage in desirable behavior. ReMed, a community-based brain injury program, specializes in using a behavior analytic approach to address unwanted behaviors while understanding and developing strategies to further recovery from the brain injury.
Activities of Daily Living↗
Terminal restlessness in the nursing facility: assessment, palliation, and symptom management.
Terminal restlessness, sometimes called agitated delirium, is a common occurrence at the end of life. This type of delirium may appear as thrashing or agitation, involuntary muscle twitching or jerks, fidgeting or tossing and turning, yelling, or moaning. Among older adults, especially those in long-term care situations, the delirium may not appear to be very different from previous episodes observed when the resident experienced an infection, exacerbation of a chronic condition, anxiety, pain, or adverse drug reactions. However, delirium at the end of life is usually multifactorial and exacerbated by the progressive shutdown of multiple body systems. Therefore, the effective management of terminal restlessness requires a different approach than the usual care of residents with delirium. For many nurses, this responsibility means adding new clinical knowledge and skills to their practice inventories. This article provides an overview of terminal restlessness, offers assessment guidelines for older adults in long-term care situations who are dying, and describes comfort and symptom management strategies for these individuals.
Geriatric Assessment↗
Clinical impact and prognostic value of metaiodobenzylguanidine imaging in children with metastatic neuroblastoma.
PURPOSE: The clinical value of metaiodobenzylguanidine (mIBG) scintigraphy in patients with disseminated neuroblastoma (NB) at the time of diagnosis and after induction chemotherapy was evaluated. PATIENTS AND METHODS: The medical records and imaging studies of 30 patients with stage 4 NB who underwent mIBG scintigraphy and 99mTc hydroxy methylene diphosphonate bone scintigraphy at the time of diagnosis were reviewed. Scores were calculated for the mIBG and bone scintigrams, and outcome according to the initial and follow-up imaging studies was determined. RESULTS: Discrepancies between bone scintigraphy and mIBG osteomedullary localization were seen in six patients. For the entire cohort, 2-year event-free survival did not significantly differ for the group of patients with initial mIBG or bone scintigraphy scores > or = 10 compared to those with scores < 10 (P = 0.23 and 0.61, respectively). However, for patients older than 1 year, a trend associating worse outcome with mIBG scores > or = 10 at diagnosis was seen (P = 0.08). A trend correlating abnormal mIBG scintigraphy after induction therapy and poor outcome was also observed (P = 0.09). Outcome did not correlate with the results of the bone scintigram studies performed after induction chemotherapy (P = 0.68). CONCLUSION: Because a discordance between mIBG and bone scintigraphy results were seen in a subset of stage 4 NB patients, both imaging studies should be performed at the time of diagnosis. mIBG imaging studies performed at the time of diagnosis and after induction chemotherapy may be of prognostic value, particularly in stage 4 patients older than 1 year.
3-Iodobenzylguanidine↗
The influence of the intrinsic sympathomimetic activity of beta-adrenoceptor antagonists on haemodynamic effects in anaesthetized dogs.
1. The effects of propranolol, atenolol (ICI 66,082), practolol and pindolol on heart rate and maximal left ventricular dp/dt, atrioventricular conduction time, mean aortic flow and diastolic blood pressure during cardiac pacing were investigated over a wide dose range (0.025-4.0 mg/kg, i.v.) in dogs anaesthetized with pentobarbitone.2. Propranolol and atenolol produced similar reductions in haemodynamic parameters. Propranolol had no further effect in dogs pretreated with atenolol. 3. Practolol tended to cause smaller reductions in the haemodynamic parameters than either propranolol or atenolol. Subsequent administration of propranolol still had some depressant activity. 4. Pindolol produced a biphasic response, with depression of cardiac function at the low doses (0.025 and 0.1 mg/kg), but a reversal of effect as the dose was increased. 5. It is therefore concluded that, in anaesthetized dogs, the intrinsic activity of practolol and pindolol limits the fall in heart rate, cardiac conduction, aortic flow and maximal dp/dt observed with beta-adrenoceptor blockade. With pindolol, however, the influence of intrinsic activity is observed only in high doses related to beta-adrenoceptor blockade.
Adrenergic beta-Antagonists↗
The role of angiotensin in the control of blood pressure during sodium depletion.
Sodium depletion was induced in dogs to raise plasma renin activity (PRA) from 1.11 to 26.48 ng/ml/hr. Little overall change in blood pressure (BP) occurred, but cardiac output (CO) and central venous pressure fell, while total peripheral resistance and heart rate (HR) increased. A nonapeptide converting enzyme inhibitor (CEI) produced a fall in BP which was linearly related to log. PRA; the intercept with PRA was at 1.05 ng/ml/hr, close to the average value for dogs on a normal diet. The fall in BP with this agent was not accompanied by an increase in HR or CO. When Sar1-Ala8 angiotensin II was used to antagonize the action of angiotensin, the fall in BP was also linearly related to log. PRA. However, for a given level of PRA this fall in BP was less than that achieved with CEI and the intercept of BP fall with PRA was 2.6 ng/ml/hr. Again with this agent there was little change in HR or CO as BP was reduced. Thus, both antagonists lowered peripheral resistance without exciting the homeostatic reflexes indicating that, as PRA rose above the normal resting level, the angiotensin generated had both a direct and indirect effect in maintaining BP.
Angiotensin II↗
Angiotensin-converting enzyme inhibitor resets baroreceptor reflexes in conscious dogs.
The present experiments investigate whether the absence of tachycardia during lowering of blood pressure (BP) with an angiotensin-converting enzyme inhibitor (CEI) in salt-depleted dogs is due to an alteration in the activity of the baroreflex. Baroreflex activity was measured after pharmacological manipulation of BP using intravenous nitroglycerin or phenylephrine, and the heart period (R-R interval) relative to the arterial pressure pulse was recorded. The slope of the relationship between BP and R-R interval is a measure of the sensitivity of the baroreceptor reflex and displacement of the line indicates a change in the setpoint of BP. On normal sodium diet, the sensitivity and setpoint of the baroreflex were unaltered by the nonapeptide CEI given both intravenously and into a lateral cerebral ventricle. During salt depletion. however, intravenously but not centrally administered CEI altered the setpoint of the baroreflex without modifying the sensitivity. The alteration in the setpoint that occurred following intravenous CEI in the salt-depleted dog could well account for the fact that the fall in BP induced by CEI does not cause reflex tachycardia. These results indicate that circulating but not brain angiotensin II is essential for the maintenance of baroreflex function during sodium depletion and provide further evidence for the important interactions between angiotensin and the autonomic nervous system.
Angiotensin-Converting Enzyme Inhibitors↗
Involvement of the baroreceptor reflexes in the changes in blood pressure with sleep and mental arousal.
We have measured baroreflex sensitivity and blood pressure in 13 subjects during sleep and three stages of progressive mental arousal after waking. Baroreflex sensitivity was measured by correlating the increase in pulse interval with the increase in systolic pressure produced by an intravenous injection of 80 micrograms of phenylephrine. Blood pressure was measured directly from the brachial artery. During sleep, blood pressure fell and baroreflex sensitivity increased; with increasing mental arousal, blood pressure rose and baroreflex sensitivity decreased. These results suggest that baroreflex activity may be involved in the medium-term regulation of blood pressure during the day and night in addition to its recognized role in buffering acute changes in blood pressure.
Arousal↗
Infraspinatus muscle-splitting incision in posterior shoulder surgery. An anatomic and electromyographic study.
Standard posterior shoulder surgical approaches include infraspinatus tendon detachment and infraspinatus-teres minor interval development. Cadaveric and clinical investigation of a new infraspinatus-splitting approach to the posterior glenohumeral joint was undertaken to assess efficacy in providing exposure, preserving tendon attachment, and avoiding neurologic compromise. Infraspinatus musculotendinous and neural anatomy was examined in 20 cadavers. Four patients with posterior shoulder instability underwent posterior capsulorrhaphy through this infraspinatus-splitting approach, followed by electrodiagnostic testing. Infraspinatus muscle was bipennate in all specimens, the tendinous interval an average 14 mm inferior to the scapular spine at the glenoid rim. The infraspinatus-splitting interval bisected the posterior glenoid rim at its midpoint, whereas the infraspinatusteres minor interval crossed the glenoid rim's lower quarter. The suprascapular nerve provided sole innervation to the infraspinatus muscle in all specimens, entering the infraspinous fossa at the notch as a single trunk 22 mm medial to the glenoid rim. Minimum branching variability was observed. Electrodiagnostic testing showed no evidence of axonal damage or muscle denervation in either infraspinatus pennate bundle. Limiting infraspinatus-splitting dissection medially to 1.5 cm from the posterior glenoid rim prevents damage to any interval-crossing suprascapular nerve branches. Posterior shoulder surgery through a horizontal, longitudinal infraspinatus tendon-splitting approach provides excellent exposure of posterior capsule, labrum, and glenoid, without requiring tendon detachment or causing neurologic compromise.
Acromion↗
Accreditation and nursing practice.
As part of a larger study (Conway, 1993) the literature relating to accreditation of prior learning (APL), accreditation of prior experiential learning (APEL), and the credit accumulation and transfer scheme (CATS) was examined. Significant influencing factors are identified and a general overview of the background to APEL is presented.
Accreditation↗
Profiling and nursing practice.
This article examines profiling, with particular reference to profiling approaches and the use of profiling in preregistration nursing. It also identifies some of the difficulties that have arisen in relation to diary keeping and the use of a competence approach to education. It is taken from and forms part of a working paper produced for West Midland Regional Health Authority on profiles and accreditation of prior experiential learning.
Accreditation↗
Quality, philosophy and Riehl's model of nursing.
It is theoretically possible to use Riehl's model of nursing as a vehicle for quality assurance. The individual's view of quality is a critical determinant. Patients should be partners in care, negotiating and instigating outcomes together with nurses whenever possible. A holistic approach and a humanistic philosophy for care in combination are important considerations in determining quality of care. Empowerment of the patient through an internal locus of control should enable care to be individualised. A patient thus empowered may then be able to assume responsibility for his/her health status.
Humans↗
Reflection, the art and science of nursing and the theory-practice gap.
In their daily practice, nurses appear to encounter difficulties in incorporating science into the art of nursing and in bridging the gap between theory (which is often developed separate from practice) and practice itself. Indeed, there is a debate within nursing itself as to whether nursing is an art, a science, or both an art and a science.
Humans↗
Microencapsulation of lobster carotenoids within poly(vinyl alcohol) and poly(D,L-lactic acid) membranes.
The use of natural pigments such as lobster carotenoids in fish feed formulations offers advantages over the use of the synthetic alternatives. Microencapsulation of the pigments, with or without the addition of antioxidants to the formulation, may be of benefit in terms of stabilizing pigment colour. In the present study, lobster carotenoids were extracted from lobster shell into petroleum ether and microencapsulated by phase separation and salt coacervation within (poly vinyl alcohol) and poly(vinyl alcohol)/poly(D,L-lactic acid) membranes. Spherical microcapsules, with smooth, thin and resilient membranes were obtained with mean diameters ranging from 50 to 150 microns, depending on the membrane material, and source of pigment. The microcapsules were pink-orange in colour, and colour stability was followed spectrophotometrically. Enhanced stability was observed in both membrane materials, in comparison to the non-encapsulated control. Rates of discoloration were determined under a variety of storage conditions, including the absence of light, reduced temperatures and under nitrogen atmosphere. The best stability of lobster carotenoids was observed under a nitrogen atmosphere within PVA/PLA membranes, representing an 11-fold enhancement of pigment stability in comparison to the controls. Under ambient conditions, the enhancement in pigment stability was approximately 6-fold. The optimum concentration of PVA during microencapsulation was 3-4%, and the microencapsulated pigments appeared most stable under acidic conditions. The rate of discoloration appeared independent of pigment concentration.
Animals↗