Introducing the third US Preventive Services Task Force.
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Advisory Committees↗
Biomedical subjects
J D Allan
Publications and source records attributed to J D Allan.
Spatial awareness in urologists: are they different?
OBJECTIVE: To compare innate spatial awareness skills, using the MIST-VR system (Ethicon Ltd, Edinburgh, a computer-based virtual reality system that objectively tests spatial awareness) among three groups of people (consultant urologists, urological trainees and controls who were not surgeons), because urological surgeons require spatial awareness for endoscopic and laparoscopic surgery, but trainees are selected by academic prowess rather than surgical aptitude. SUBJECTS AND METHODS: The MIST-VR system was used to test 122 volunteers in three groups, i.e. 39 consultant urologists, 46 urological trainees and 37 controls (not surgeons). The demographic data recorded for each group included age, sex, eyesight, handedness, and endoscopic and laparoscopic experience. Volunteers performed a repetitive series of three tasks using the system. Their performance was measured in terms of time, errors and economy of movement, as well as the duration and accuracy of diathermy in Task 3. RESULTS: The consultants were significantly older than the trainees and controls (both P<0.001) and had more endoscopic experience (P=0.005). In Task 1, the trainees made significantly fewer errors (P=0.045) and had a greater economy of movement (P=0.03) than the controls. In Task 2 the trainees performed the task more rapidly than the consultants (P=0.04) and controls (P=0.02). Trainees were more economical in movement than were consultants (P=0.031) and controls (P=0.046). In the more complex Task 3, trainees outperformed consultants in terms of errors (P=0.03), economy of movement (P=0.046), total diathermy time (P=0.005) and diathermy error (P=0.03). Controls performed similarly to the consultants. Although there was a trend towards better performance by trainees over controls, this was only significant for time (P=0.04) and total diathermy time (P=0.011). A few participants had results that were >2 SD above the mean and several people could not complete Task 3. CONCLUSIONS: Urologists do not differ from the general population in terms of innate spatial ability in this setting. There are several people who may have a defect in spatial awareness but the incidence was the same in each group. Urological trainees outperformed consultants in these tasks; the reasons for this are unclear. The MIST-VR system is of no help in aptitude testing for urological trainees, although it may have a role in teaching laparoscopic surgery. Testing other psychometric components may be more important for acquiring surgical skills than innate spatial-awareness skills. Further studies are required to investigate this possibility.
Adult↗
Virtual endoscopy in urology.
Recent years have seen notable advances in virtual reality technology and increased interest in potential medical applications. Computed tomography and magnetic resonance imaging data sets, historically viewed as axial images, may now be used to construct a virtual reality endoscopic image, and navigator software systems allow the operator to 'fly' through the urinary tract. Technological evolution has improved the quality of reconstruction, as this is dependent on the software and data set, allowing virtual reality to begin to challenge endoscopic evaluation. This review describes the evolution of virtual reality in urology and the milestones of its current clinical use. Applications may become widespread in the diagnostic evaluation of common urological symptoms, the planning of surgery and the training of future urologists.
Cystoscopy↗
Laparoscopic radical nephrectomy.
Laparoscopic radical nephrectomy has gained in popularity as an accepted treatment modality for localized renal cell carcinoma at many centers worldwide. Laparoscopic radical nephrectomy may be performed via a transperitoneal or retroperitoneal approach. Mostly, the transperitoneal approach is used. Current indications for laparoscopic radical nephrectomy include patients with T(1)-T(3a)N(0)M(0) renal tumors. Herein, transperitoneal as well as retroperitoneal laparoscopic approaches are described. Surgical outcomes and complications from published series are reviewed with comparison to open surgery. Special related concerns as oncologic principles, organ retrieval, lymphadenectomy, and concomitant adrenalectomy are addressed. In conclusion, laparoscopic radical nephrectomy is now established with considerable advantages; decreased postoperative morbidity, decreased analgesic requirements, improved cosmesis, shorter hospital stay and convalescence. Although no long-term follow-up is available, short and intermediate follow-up results confirm the effectiveness of laparoscopic radical nephrectomy.
Carcinoma, Renal Cell↗
Weight management practices among primary care providers.
This pilot study examined how primary care providers manage patients with weight problems, an important component of primary care. A convenience sample of 17 nurse practitioners and 15 physicians were surveyed about assessments and interventions used in practice for weight management along with perceived barriers to providing effective weight management. Practice patterns between gender, profession and practice setting of the nurse practitioners were compared.
Adult↗
The complexity of obesity.
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Attitude to Health↗
New directions for the study of overweight.
In this issue, three authors contribute to our knowledge of triggers or cues to weight-related behavior. Two of these authors focus on the effect of emotion on eating behavior. Popkess-Vawter, Wendel, Schmoll, and O'Connell (1998, in this issue) explicate reversal theory as a way to account for feelings and stress that trigger weight cyclers to overeat. Timmerman (1998, in this issue), in a study of nonpurge binge eaters, reports the relationship between caloric intake patterns and binge eating. Both researchers have added to our knowledge about triggers to eating behavior. Finally, Brink and Ferguson (1998), in their study of male and female successful dieters, add to the limited knowledge concerning triggers to weight loss. They describe reasons for deciding to lose weight among a population of successful underweight, normal weight, and obese dieters. Three authors contribute to the new weight research thrust of prevention. Two of the authors report the results of intervention studies. Reifsnider (1998, in this issue), in the only article on children, presents a follow-up study of a family-focused, community-based nursing intervention for growth-deficient, low-income Euro-American and Mexican American preschool children. Her work is an example of the context- and lifestyle-sensitive prevention-focused studies needed in weight research. Ciliska (1998, in this issue) reports findings from a randomized trial of a psycho-educational intervention with obese healthy women aimed at increasing self-esteem and decreasing restrained eating patterns. Her work follows some new thinking in the area of weight control that recognizes the dangers of chronic dieting and proposes a focus on self-acceptance, better nutrition, regular physical activity, and the prevention of further weight gain triggered by chronic dieting (Brownell & Cohen, 1995). Walker (1998, in this issue), the third author, in a multiethnic study of new mothers, explores the concept of weight-related distress and associations of anthropometric and psychosocial variables with feelings about weight. Her work adds to our understanding about critical periods and risks for weight gain. Allan (1998, in this issue), in a study of African American, Euro-American, and Mexican American women, reports women's explanatory models of overweight and the congruence of these models with professional models and recommendations for treatment for overweight. Her research contributes needed understandings of how high-risk populations view overweight, how participants' lifestyles and situations influence their ideas about weight, and how these perspectives influence efforts to control weight. Nursing needs to continue to refine and rethink what constitutes research on weight. This special issue offers some examples of scholars attempting to trailblaze new directions in nursing weight research. One thrust has been the significant attention on weight as a focus of investigation and not just as one of several health behaviors. A second and equally compelling area of inquiry has been the explicit attention directed to studying people of color, especially women, within the social context of their lives. Because ethnicity, social status, and gender are inextricably intertwined with health, one challenge is to try to understand weight issues through an ethnic, gender, and social status lens. Researchers who embrace this paradigm refuse to look at weight as a homogeneous condition but focus their attention instead on specific subgroups in the population without making middle-class Euro-Americans the norm. The number of researchers who are examining connections between ethnicity and social status and weight is growing. The complexity of weight-health promotion requires that we not only boldly examine weight in relationship to the individual in context but also explicate the macroenvironmental influences on weight. More needs to be done to translate findings from this body of research into better models
Adolescent↗
Explanatory models of overweight among African American, Euro-American, and Mexican American women.
Ethnographic interviewing methods were used to explore women's explanatory models (EMs) of overweight and the congruence of these models with professional models and professionally recommended treatments for overweight. Through community-based snowball and theoretical sampling, 40 African American, 40 Euro-American, and 40 Mexican American women of varying social status and weight participated in multiple ethnographic interviews, which were subsequently interpreted using domain analysis and constant comparison. Study participants' EMs of overweight ranged from simple to complex, were generally similar across the three study groups, and only partially congruent with professional EMs of obesity. Major differences in EMs between the study groups were found in the dimensions of etiologies and consequences of overweight. There was partial congruence between participants' EMs and professionally recommended treatments for overweight.
Adult↗
Striving for quality in advanced practice nursing education.
The issue of establishing and maintaining high-quality advanced practice educational programs, practice competencies, and certification criteria is currently the focus of much debate and discussion within nursing. This article focuses on the issue of accreditation for advanced practice nursing educational programs in four areas: (1) history of accreditation in nursing education; (2) accreditation of educational programs for clinical nurse specialists, nurse midwives, and nurse anesthetists; (3) accreditation of programs for nurse practitioners; and (4) current and future educational issues and challenges. To participate in shaping the changes occurring in the current health delivery system, the nursing profession and advanced practice nursing educators must present a strong, visionary, and collaborative voice concerning quality educational programs.
Accreditation↗
Weight loss methods used by African American and Euro-American women.
In this naturalistic study employing intensive interviews and anthropometric measures, an educationally and economically diverse community-based sample of 40 African American and 40 Euro-American women described their lifetime experiences with weight management. Twenty types of weight loss methods were identified and grouped into one of three categories: lifestyle work, head work, and professional services. The most frequently used weight loss methods were from the lifestyle work category, with the leading methods identified as exercise on own and reduce high calorie and/or increase low calorie foods. African Americans and Euro-Americans overwhelmingly used similar weight loss methods, with the only significant difference occurring in the more frequent use of commercial diet products among the African American group. Methods from the head work category were used significantly more often by women with higher social status, while heavier women more frequently sought professional services to lose weight than thinner women. The Euro-American women engaged in weight loss methods for significantly longer periods of time and were found to weigh significantly less than the African American women. These findings suggest that the shorter duration of weight loss attempts may be a major factor contributing to the larger body size in African American women.
Adult↗
Exploring the use of explanatory models in nursing research and practice.
PURPOSE: To address the lack of information in nursing for delivering culturally appropriate care and provide a framework for nurses to incorporate diverse beliefs and health needs into research and practice. People interpret and react to health and illness events within a cultural system. However, the nursing literature contains little about how to elicit cultural beliefs. ORGANIZING FRAMEWORK: Use of Kleinman's (1980) concept of explanatory models (EMs) is explored first, by describing the concept as it was developed by Kleinman, and second, by illustrating how it was used in three research studies conducted between 1990 and 1994. METHOD: Individual in-depth interviews were conducted with community-based convenience samples. Data were analyzed using content analysis. Explanatory models were explored with health people following illness, and with people having a condition with potential health risks, to illustrate their usefulness in nursing research and practice. CONCLUSIONS: The findings provide a beginning understanding of the complex linkages between beliefs and actions and demonstrate the versatility and usefulness of EMs for nursing research and practice. Assessing models offers one means for researchers and clinicians to explore health beliefs and the linkages between beliefs and behaviors.
Adult↗
Combination and monotherapy with zidovudine and zalcitabine in patients with advanced HIV disease. The NIAID AIDS Clinical Trials Group.
OBJECTIVE: To compare the safety and efficacy of continuing zidovudine therapy with that of zalcitabine alone or zalcitabine and zidovudine used together. DESIGN: A randomized, double-blind, controlled trial. SETTING: AIDS Clinical Trials units and National Hemophilia Foundation sites. PATIENTS: 1001 patients with symptomatic human immunodeficiency (HIV) disease and 300 or fewer CD4 cells/mm3 or asymptomatic HIV disease and 200 or fewer CD4 cells/mm3 who had tolerated zidovudine therapy for 6 months or more. INTERVENTION: Patients were randomly assigned to receive zidovudine, 600 mg/d; zalcitabine, 2.25 mg/d; or zidovudine, 600 mg/d, and zalcitabine, 2.25 mg/d. MEASUREMENTS: The primary end point was time to disease progression or death. RESULTS: The median follow-up time was 17.7 months. The estimated 12-month event-free rates were 70%, 67%, and 73%, respectively, for the zidovudine, zalcitabine, and combination groups (P = 0.26). A trend analysis showed significantly lower progression rates for combination therapy compared with zidovudine therapy as the pretreatment CD4 cell count increased (P = 0.027). For patients with 150 or more CD4 cells/mm3, those receiving combination therapy were less likely to have disease progression or to die than were those receiving zidovudine (relative risk, 0.51; 95% CI, 0.28 to 0.93; P = 0.029). We observed no difference between the zalcitabine and zidovudine groups (relative risk, 0.74; CI, 0.40 to 1.36; P = 0.33). For patients with 50 to 150 CD4 cells/mm3 or fewer than 50 CD4 cells/mm3, we found no differences among the treatment groups (P = 0.69 and P = 0.57, respectively). Severe toxic effects occurred less frequently among patients with 150 or more CD4 cells/mm3. CONCLUSIONS: We found no overall benefits of zalcitabine used alone or with zidovudine. However, a trend analysis suggested a better outcome for combination therapy compared with zidovudine as the pretreatment CD4 cell count increased.
Acquired Immunodeficiency Syndrome↗
A biomedical and feminist perspective on women's experiences with weight management.
Weight concerns and dieting have become so normative for U.S. women that weight is the lens through which experience is viewed. The obsession with weight and dieting among women is considered by feminists to be one result of the oppression by women resulting from questionable weight standards and weight control programs that foster a view of overweight as a sign of addiction and lack of control. Feminist critique is used to deconstruct both the literature related to weight standards and health and the research on weight loss/weight management. Feminist and ethnographic methods are used to describe successful and unsuccessful experiences with weight management of 20 Euro-American women who had participated in a 1985 weight study and agreed to be reinterviewed. Success at weight management was examined from a biomedical perspective using Body Mass Index (BMI) norms and from a feminist perspective using participants' subjective definitions of success. Based upon BMI, only 8 members of the study group were defined as successful, whereas based upon the women's perspectives, 11 members were successful. Participants' definitions of successful weight management were divergent from biomedical definitions and could be categorized into three perspectives: biomedical, reframed normal weight, and holistic. Women who ascribed to the biomedical definition of success embodied the cultural ideal of thinness by adhering to an underweight weight norm. Participants using the reframed normal weight definition of success rejected biomedical weight norms and created their own weight norms. The holistic perspective on success involved the use of a broader, health-focused definition of successful weight management and offers some directions for revising current health promotion care relative to weight.
Adult↗
Splenic abscess: pathogenesis, clinical features, diagnosis, and treatment.
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Abscess↗
Body size values of white and black women.
The purpose of this naturalistic study was to compare values held by 36 white and 31 black women related to body size, and to identify factors that influence these values and linkages between body size values and weight management activities. Black women of lower SES were significantly different from black women of higher SES and white women, regardless of SES, in that they were heavier, viewed themselves as heavier, and perceived attractive body size as heavier. Black lower status women had to become a great deal heavier than the other groups before they defined themselves as overweight. We suggest that black lower social status women have a wider range of "normal" and attractive body size and that this wider range is developed from comparisons of other women in their social milieu and influences the initiation of weight loss activities.
Adult↗
Longitudinal analysis of responses to oral didanosine therapy following zidovudine therapy in advanced infection with human immunodeficiency virus.
The effect on immunologic and virological parameters of up to 24 weeks of therapy with didanosine at daily oral doses of < or = 12.5 mg/(kg.d) was studied retrospectively in 69 patients with advanced disease due to human immunodeficiency virus--i.e., AIDS or advanced AIDS-related complex--who had previously been treated with zidovudine. Patients entered the study with a low CD4 cell count (median, 39/microL) and with evidence of an ongoing depression of bone marrow function. Didanosine therapy was associated with a significant increase in CD4 counts and a prolonged decrease in serum levels of p24 antigen relative to baseline. These changes were more pronounced in the population with baseline CD4 counts of > or = 100/microL. A beneficial effect of didanosine therapy on hematologic parameters was observed in these patients, with increases during therapy of hemoglobin levels as well as white blood cell, granulocyte, and platelet counts. These responses were maximal at weeks 16-20. Further investigations are needed to establish the clinical correlates of these observations.
Administration, Oral↗
Long-term follow-up of didanosine administered orally twice daily to patients with advanced human immunodeficiency virus infection and hematologic intolerance of zidovudine.
This phase 1 trial was conducted to evaluate the safety and tolerance of didanosine (ddI) in subjects with AIDS or AIDS-related complex (ARC) who previously had demonstrated hematologic intolerance of zidovudine. Thirty subjects, 21 with AIDS and nine with ARC, were enrolled. Initially, didanosine was administered orally twice daily for a total daily dose of either 750 mg or 1,500 mg. Subsequently, the dosage for those receiving 1,500 mg/d was reduced to a maximum of 750 mg/d (375 mg twice daily) when data from this and other phase 1 studies showed that the dosage of 1,500 mg/d (750 mg twice daily) was associated with an unacceptable risk of developing neuropathy. The subjects were studied for 46 weeks (mean time; range, 7-122 weeks). The dose-limiting toxic effect observed was peripheral neuropathy, which occurred in eight patients. Other significant toxic effects included pancreatitis in three patients and xerostomia in eleven. In general, didanosine was well tolerated from a hematologic standpoint by the majority of patients during prolonged administration.
Administration, Oral↗
Effects of therapy with didanosine on hematologic parameters in patients with advanced human immunodeficiency virus disease.
Myelosuppression is associated with human immunodeficiency virus (HIV) infection and may also be produced by agents used for the treatment of the disease or the treatment of its complications. Didanosine (ddl; 2',3'-dideoxyinosine) is a newer purine nucleoside that has recently become available for therapy for HIV infection. The effects of didanosine on peripheral blood counts have been retrospectively evaluated in the first 170 patients treated with this new agent in four phase I trials. Patients treated with didanosine showed statistically significant improvements in hemoglobin levels, white cell counts, and granulocyte and platelet numbers as compared with baseline values. These changes were seen with or without prior therapy with zidovudine, were somewhat more pronounced at higher doses of didanosine, and persisted for up to 1 year. Reported adverse events included peripheral neuropathy, diarrhea, and most notably, pancreatitis. It is concluded that, while some toxic side effects occur, didanosine therapy in HIV infection is associated with an amelioration of HIV-induced myelosuppression.
AIDS-Related Complex↗