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Biomedical subjects

J D Ward

Publications and source records attributed to J D Ward.

At least 109 records · Page 6Linked to original sources
PubMed1990

Health belief scales developed specifically for people with tablet-treated type 2 diabetes.

The design and development of scales to measure diabetes-specific health beliefs of patients treated with oral hypoglycaemic agents and diet are described. The scales, which were developed from the responses of 187 tablet-treated patients, measure perceived Benefits of, and Barriers to Treatment, and perceived Severity of, and Vulnerability to Complications of diabetes and other disorders unrelated to diabetes. Cronbach's alpha indicated that each scale was internally reliable (alpha = 0.67 to 0.89) and construct validity was indicated by expected correlations between the scales and other variables including measures of blood glucose control, body weight, and psychological well-being. Thus, patients who were overweight and/or had higher glycosylated haemoglobin (HbA1) levels perceived their treatment to be less 'Cost-effective' (Benefits less Barriers), rated Complications as being more severe, and reported greater Vulnerability for themselves and the 'average person' with diabetes to these Complications (p less than 0.05 to p less than 0.01). Furthermore, respondents with higher Depression and Anxiety scores and lower Positive Well-being and Treatment Satisfaction scores reported greater Vulnerability to Complications for themselves and the 'average person', and also felt that their treatment was less 'Cost-effective' (p less than 0.01 to p less than 0.001). The measures are likely to be particularly useful in studies which assess the efficacy of interventions in modifying health beliefs with a view to achieving desired behaviours. They may also be useful as an instrument of audit if indicators about the suitability of possible interventions are sought.

Adult↗
PubMed1989

Novel role for specialist nurses in managing diabetes in the community.

To develop care of diabetes further a specialist nurse established contact with general practices in Sheffield Health District and identified difficulties in providing a service for diabetics. One hundred and thirty practices were visited, and full data were collected from 104. Each practice agreed to establish a register of diabetics, and information and support were subsequently provided to help in developing services. In collecting information from each practice the nurse covered specific points on staff, facilities, and organisation. Over two years the service offered in 60 practices considerably improved, allowing a minimum standard of diabetic care to be achieved. This allowed coordinated and effective referral of certain patients from hospital diabetic clinics and improved services to those not attending any clinics.

Community Health Nursing↗
PubMed1989

Microangiopathy in human diabetic neuropathy: relationship between capillary abnormalities and the severity of neuropathy.

Clinical, electrophysiological and ultrastructural morphometric observations were made in 5 diabetic non-neuropathic patients, 5 diabetic patients with mild neuropathy and 11 diabetic patients with severe neuropathy. Capillary abnormalities were assessed in simultaneous nerve, muscle and skin biopsies and compared with results from 6 age-matched, non-diabetic control subjects. Nerve capillaries demonstrated markedly greater pathology than skin and muscle capillaries. Endoneurial capillary density was significantly reduced in severely neuropathic diabetic patients (p less than 0.01) when compared with control subjects. Capillary basement membrane (p less than 0.002), endothelial cell (p less than 0.003) and total diffusion barrier (endothelial cell, pericyte, basement membrane) (p less than 0.001) thickness were significantly increased, and oxygen diffusing capacity was significantly reduced (p less than 0.001) in the nerves of patients with severe diabetic neuropathy when compared to control subjects. Endothelial cell profile number and luminal perimeter were significantly increased in asymptomatic (p less than 0.01), (p less than 0.05) and severely neuropathic (p less than 0.001), (p less than 0.05) diabetic patients respectively. However, endothelial cell outer perimeter, a measure of capillary size, showed no significant increase in diabetic patients when compared with control subjects. An association was observed between neurophysiological and neuropathological measures of neuropathic severity. There was no significant correlation between the duration of diabetes and HbA1 levels with capillary pathology or with neuropathic severity. Very few abnormalities of muscle and skin correlated with neuropathic severity. However, all measures of nerve capillary pathology correlated significantly with neurophysiological and neuropathological measures of neuropathic severity.

Adult↗
PubMed1989

Diabetic neuropathy.

Many factors contribute to the nerve damage of diabetes--metabolic (myo-inositol), microvascular, glycosylation and ageing. The variety of clinical syndromes indicates the complexity of the disease. Measurement of peripheral and autonomic nerve function is improving allowing the establishment of prospective natural history and therapeutic studies. There is a need for standardization of clinical definition and staging.

Aldehyde Reductase↗
PubMed1989

Islet cell antibodies and insulin autoantibodies in patients treated with oral hypoglycaemic agents.

Clinical and immunological features suggesting Type 1 diabetes were assessed in 202 patients treated with oral hypoglycaemic agents for presumed Type 2 diabetes. Islet cell antibodies (ICA) were detected at a level exceeding 5 JDF units in 5.9% of patients, and complement-fixing ICA were detected in 3.4%. IgG insulin autoantibodies were detected in 8.8% of insulin-naive patients, none of whom were ICA positive. ICA were detected more frequently in patients with shorter duration of diabetes (p = 0.02). Age and relative body weight were similar in ICA positive and negative groups. ICA positive patients were more likely to have lost weight (p less than 0.02) than ICA negative patients, although this may have been attributable to the differing duration of diabetes in the two groups. Other individual clinical features suggesting Type 1 diabetes were not significantly more frequent in ICA positive patients. However, a higher proportion of ICA positive than ICA negative patients had one or more features suggestive of Type 1 diabetes irrespective of the duration of diabetes. Clinical features suggesting Type 2 diabetes were present in a similar proportion of ICA positive and ICA negative patients. Fasting and glucagon stimulated C-peptide levels were similar in ICA positive and matched ICA negative patients.

Adult↗
PubMed1989

Symptomatic hypoglycemia in NIDDM patients treated with oral hypoglycemic agents.

We assessed the prevalence of hypoglycemic symptoms in patients (aged 40-65 yr) treated with oral hypoglycemic agents (OHAs) attending routine diabetes clinics at our hospital. Symptoms were experienced during the previous 6 mo in 41 of 203 (20.2%) patients treated with sulfonylureas but in none of the 16 patients treated with metformin alone. Hypoglycemic symptoms were experienced at least monthly in 5.9% and less frequently in 14.3% of patients. The prevalence of symptoms decreased with increasing duration of sulfonylurea administration (P less than .01). Mean glycosylated hemoglobin and postprandial plasma glucose were significantly lower in patients reporting hypoglycemic symptoms than in those without symptoms (P less than .001). The prevalence of hypoglycemic symptoms was significantly higher in patients treated with glyburide than in patients treated with gliclazide (P less than .01) or chlorpropamide (P less than .05). The prevalence of symptoms was higher in patients taking medications in addition to OHAs (P less than .01). Ten (24%) of the patients who experienced hypoglycemic symptoms were taking drugs that may potentiate sulfonylureas.

Adult↗
PubMed1989

Cerebral blood flow and metabolism in severely head-injured children. Part 1: Relationship with GCS score, outcome, ICP, and PVI.

The literature suggests that in children with severe head injury, cerebral hyperemia is common and related to high intracranial pressure (ICP). However, there are very few data on cerebral blood flow (CBF) after severe head injury in children. This paper presents 72 measurements of cerebral blood flow ("CBF15"), using the 133Xe inhalation method, with multiple detectors over both hemispheres in 32 children aged 3 to 18 years (mean 13.6 years) with severe closed head injury (average Glasgow Coma Scale (GCS) score 5.4). In 25 of the children, these were combined with measurements of arteriojugular venous oxygen difference (AVDO2) and of cerebral metabolic rate of oxygen (CMRO2). In 30 patients, the first measurement was taken approximately 12 hours postinjury. In 18 patients, an indication of brain stiffness was obtained by withdrawal and injection of ventricular cerebrospinal fluid and calculation of the pressure-volume index (PVI) of Marmarou. The CBF and CMRO2 data were correlated with the GCS score, outcome, ICP, and PVI. Early after injury, CBF tended to be lower with lower GCS scores, but this was not statistically significant. This trend was reversed 24 hours postinjury, as significantly more hyperemic values were recorded the lower the GCS score, with the exception of the most severely injured patients (GCS score 3). In contrast, mean CMRO2 correlated positively with the GCS score and outcome throughout the course, but large standard deviations preclude making predictions based on CMRO2 measurements in individual patients. Early after injury, there was mild uncoupling between CBF and CMRO2 (CBF above metabolic demands, low AVDO2) and, after 24 hours, flow and metabolism were completely uncoupled with an extremely low AVDO2. Consistently reduced flow as found in only four patients; 28 patients (88%) showed hyperemia at some point in their course. This very high percentage of patients with hyperemia, combined with the lowest values of AVDO2 found in the literature, indicates that hyperemia or luxury perfusion is more prevalent in this group of patients. The three patients with consistently the highest CBF had consistently the lowest PVI: thus, the patients with the most severe hyperemia also had the stiffest brains. Nevertheless, and in contrast to previous reports, no correlation could be established between the course of ICP or PVI and the occurrence of hyperemia, nor was there a correlation between the levels of CBF and ICP at the time of the measurements. The authors argue that this lack of correlation is due to: 1) a definition of hyperemia that is too generous, and 2) the lack of a systematic relationship between CBF and cerebral blood volume

Adolescent↗
PubMed1989

Cerebral blood flow and metabolism in severely head-injured children. Part 2: Autoregulation.

Autoregulation of cerebral blood flow ("CBF15") was tested in a series of 26 pediatric patients (mean age 13.2 years) with severe head injury (average Glasgow Coma Scale (GCS) score 5.5) in the acute stage. A baseline 133Xe CBF measurement was performed and then repeated, after blood pressure was increased by 29% with intravenous phenylephrine or decreased by 26% with intravenous trimethaphan camsylate. Correlations were made between CBF and clinical condition, outcome, time after injury, intracranial pressure (ICP), and pressure-volume index (PVI) changes, and the site of injury (hemispheres, diencephalon, or brain stem). The site of injury was determined with multimodality evoked potential measurements. Autoregulation was intact in 22 (59%) of 37 measurements. There was no correlation with GCS score, outcome, time after injury, site of injury, or way of testing (decreasing or increasing blood pressure). Autoregulation was statistically significantly more often impaired when CBF was either below normal -2 standard deviations (SD) (reduced flow) or above normal +2 SD (absolute hyperemia). In cases with intact autoregulation, mean ICP decreased from 17.5 to 15.0 mm Hg with higher blood pressure and increased from 19.0 to 21.3 mm Hg with lower blood pressure. When PVI was measured during the blood pressure manipulations, it was found to change in a direction opposite to the ICP change. The consequences of these findings in the management of ICP problems with blood pressure control are discussed.

Adolescent↗
PubMed1988

Does adding fibre to a low energy, high carbohydrate, low fat diet confer any benefit to the management of newly diagnosed overweight type II diabetics?

The effect of supplementing a low energy (roughly 5.0 MJ), high carbohydrate (180 g), low fat (roughly 25 g) diet with 10-15 g of either cereal fibre or guar gum was investigated in 24 newly diagnosed overweight non-insulin-dependent (type II) diabetics. The patients were divided into three treatment groups: one received a low fibre control diet throughout the study period of 20 weeks and the other received two supplements of cereal fibre and guar gum in a crossover manner. The nutrient content of the diets was kept constant throughout. Though patients taking the low fibre diet showed a smaller reduction in fasting plasma glucose concentrations over the first eight weeks than patients taking a high fibre diet, this difference was not evident at the end of 20 weeks; reductions in weight and glycated haemoglobin values were similar for each dietary regimen throughout the trial. There was little evidence that supplementing a low energy, high carbohydrate diet with fibre confers any therapeutic benefit to type II diabetics and no evidence that taking fibre as viscous polysaccharides is any more beneficial to overweight diabetics than taking a similar fibre supplement as cereal. On the contrary, guar gum caused more abdominal discomfort and flatulence than the other diets.

Blood Glucose↗
PubMed1988

The association between symptomatic sensory neuropathy and body stature in diabetic patients.

In the diabetic patient the clinical manifestations of peripheral neuropathy occur more commonly in the distributions of longer neurons. Utilizing height as a proxy variable, we have examined whether neuron length is also a determinant for the occurrence of peripheral neuropathy among diabetic patients. In studies performed at two sites (Sheffield and Miami) the heights of diabetic patients with symptomatic peripheral neuropathy were compared with those of non-neuropathic diabetic patients. At each site the neuropathic patients were significantly taller (P = 0.02 for Sheffield and P = 0.01 for Miami). These data were not biased by age or race. Body stature (as a proxy for neuron length) appears to be a constitutional risk factor for diabetic peripheral neuropathy.

Adult↗
PubMed1988

How adolescents describe pain.

This study assesses how adolescents describe the experience of pain. We queried a convenience sample of 156 adolescents, 13-17 years of age, in two schools and four hospitals. Adolescents answered questions on a questionnaire developed by the investigators. Findings suggest that adolescents can clearly describe pain, their feelings when in pain, and the strategies that help when they experience pain. Pain appears to be associated with mental anguish as well as trauma and pathology.

Adaptation, Psychological↗
PubMed1988

Spectral analysis of the EEG in craniocerebral trauma.

The objectives of the present study were to evaluate the relationship between the fractional amplitudes of the EEG derived from power spectral analysis (PSA) of the electroencephalogram (EEG) and depth of coma measured clinically with the Glasgow Coma Score, and to assess the accuracy of PSA in predicting long-term outcome. Thirty-two patients rendered unconscious by blunt head injury (mean (GCS = 7) had intermittent EEG recordings daily from 1-10 days post injury. There was a significant correlation between fractional amplitude of the EEG and the GCS. The rate and magnitude of change in the EEG and GCS were also correlated. There were significant differences in PSA parameters between improved and deteriorated patient groups at the termination of monitoring (p = .02) and in the change of PSA parameters over time (p = .02). Using linear discriminant analysis of PSA parameters, the accuracy of outcome prognostication based on the six month outcome was approximately 75%. Accurate classification of outcome was possible in a number of patients in whom there was little or no change in the GCS during the period of monitoring.

Adolescent↗
PubMed1988

Comparison of nurse and computer recording of ICP in head injured patients.

The importance of intracranial pressure monitoring in management and study of the head-injured patient is clearly recognized by the clinician responsible for intensive care. However, in many institutions studies requiring quantitative measures of ICP in head-injured patients are limited by lack of sophisticated computer monitoring equipment. In this study we tested the ability of the nurse to describe ICP course by manual record and compared these results with an on-line computerized ICP monitoring system. The nurse recorded a single "end-hour" value of ICP from the bedside monitor while the computer averaged 720 data samples of ICP during the hour. Our results obtained from five head-injured patients undergoing ICP monitoring showed 55% of the 347 data points had a difference in ICP of 0.01 to 3.0 mm Hg and 38% differed between 3.01 and 6 mm Hg. In comparison, 84% of nurse observations were within 6 mm Hg. Comparison of the temporal course of nurse and computer ICP values combined with the frequency distribution of error data indicates the nurse "end-hour" value is a reasonable estimate of the patient's mean ICP for the entire hour as measured by the computer. Nurses can now ask questions regarding various aspects of a patient's ICP course and compare data with other groups as long as the method of data collection is defined in the same manner.

Computers↗
PubMed1988

A measure of treatment satisfaction designed specifically for people with insulin-dependent diabetes.

The psychometric properties of a diabetes-specific treatment satisfaction scale were examined with responses from 128 adults with insulin-dependent diabetes who had used one of three treatment options for a period of 12 months. The reliability of the seven-item measured was found to be satisfactory (Cronbach's Alpha = 0.76) and factor analyses indicated three useful sub-scales (Perceived General Management; Perceived Compatibility with Lifestyle; Perceived Frequency of Hypo/hyperglycaemia). Use of the treatment satisfaction measure in a feasibility study of continuous subcutaneous insulin infusion (CSII) demonstrated the measure's ability to distinguish between three treatment groups (CSII, intensified conventional therapy and conventional therapy). People choosing to use CSII reported significantly greater improvements in satisfaction than those choosing either from of conventional therapy (F = 36.6; df 2, 125; p less than 0.001). If used in conjunction with measures of blood glucose control, the Treatment Satisfaction measure offers the opportunity for a more holistic appraisal of outcomes in studies evaluating and comparing treatments for insulin-dependent diabetes.

Adolescent↗
PubMed1988

Reduced hyperaemic response under the diabetic neuropathic foot.

Diabetic neuropathic ulcers typically occur at high pressure sites. Microvascular blood flow has been assessed on the plantar surface of the foot in three matched groups each of 12 subjects free from macrovascular disease: (a) patients with diabetic neuropathy with abnormal foot pressures and previous neuropathic ulceration; (b) non-neuropathic diabetic patients; (c) non-diabetic control subjects. Resting flow was measured at the highest pressure point under the metatarsal heads (defined by pedobarograph) using laser doppler flowmetry, and the hyperaemic response was assessed at the same site following 3 min standing. Peak flow was significantly reduced in neuropathic patients (2.3 +/- 1.4 (SD) volts) compared with control subjects (4.0 +/- 2.0 volts; p less than 0.03). The time for blood flow return to baseline was significantly prolonged in neuropaths (159 +/- 72 s) compared with normal subjects (93 +/- 18 s; p less than 0.01), with a significant delay also seen in non-neuropaths (151 +/- 38 s; p less than 0.0001 compared with normal).

Adult↗
PubMed1988

Immunological abnormalities 17 years after accidental exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin.

Eighteen workers were reviewed 17 years after accidental exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (dioxin). Clinical assessment showed that they were in good health. A study of several biochemical and immunological parameters in these subjects and in 15 carefully matched controls showed no difference in serum concentrations of hepatic enzymes between exposed workers and controls. Although mean serum concentrations of cholesterol and triglyceride were higher in exposed subjects than in controls, the results did not reach statistical significance. Antinuclear antibodies and immune complexes were detected significantly more frequently in the peripheral blood of workers exposed to dioxin. There was no significant difference between exposed workers and controls in the number of T lymphocytes, B lymphocytes, and helper and suppressor T cell counts in peripheral blood, but the number of natural killer cells identified by the monoclonal antibody Leu-7 was significantly higher in workers exposed to dioxin.

Accidents, Occupational↗
PubMed1988

Profound pulmonary shunting without edema following stereotaxic biopsy of hypothalamic germinoma. Case report.

Hypoxemia is a nearly constant accompaniment of head injury. Diverse theories have been proposed to explain this relationship. The authors report the case of a patient who suffered an episode of severe, transient, arterial oxygen desaturation during "controlled" brain trauma: an otherwise uneventful stereotaxic biopsy of a small germinoma of the hypothalamus. Evidence is provided that pure ventilation-perfusion mismatching, without pulmonary edema, underlay the hypoxemia. The hypothalamus is intimately involved in matching pulmonary ventilation to perfusion; the hypoxemia of various brain injuries may be mediated by perturbation of this structure.

Adolescent↗