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J Daly

Publications and source records attributed to J Daly.

At least 55 records · Page 3Linked to original sources
PubMed1998

The naturalistic course of pharmacologic treatment of children with maniclike symptoms: a systematic chart review.

OBJECTIVE: To assess the effectiveness of mood stabilizers in treating maniclike symptoms in children. METHOD: Subjects were consecutively referred pediatric patients who, at initial intake, satisfied DSM-III-R criteria for mania on a structured diagnostic interview. We systematically reviewed their clinical records to assess (1) the course of maniclike symptoms and (2) all medications prescribed at each follow-up visit. Survival analysis was used to determine the effect of mood stabilizers and other medications on the course of maniclike symptoms. RESULTS: Of the 59 subjects meeting criteria for mania, 44 (75%) exhibited evidence of maniclike symptoms during follow-up. The occurrence of manic symptoms significantly predicted the subsequent prescription of mood stabilizers (rate ratio = 2.9, 95% confidence interval [CI] = 1.6 to 5.5), and use of mood stabilizers predicted decreases in manic symptoms (rate ratio = 4.9, 95% CI = 1.2 to 20.8). However, improvement was slow and associated with a substantial risk for relapse. CONCLUSION: Mood stabilizers were frequently used in children with maniclike symptoms, and their use was associated with significant improvement of maniclike symptoms, whereas use of antidepressant, antipsychotic, and stimulant medications was not.

Adolescent↗
PubMed1997

Cardiac disease construction on the borderland.

The diagnosis of possible heart disease in the well patient has undergone remarkable shifts over the past century. The traditional medical view places strong emphasis on the contribution of technological data to the diagnosis of disease. In the case of serious heart disease, cardiac diagnostic technologies can play a defining role but, more often in the clinical context, patients are assessed for heart disease which is minor. The question is whether disease is present at all. In this borderland between health and disease, the interpretation of technological data is inherently uncertain. The diagnosis then depends more heavily on the social utility of particular disease categories. Shifts in diagnostic categorisation are not therefore attributable solely to more extensive forms of cardiac imaging but are socially constructed in an interactive context which involves the technology, the medical profession and the wider social structures which exist at the time of diagnosis. Claims of technological certainty create a social space within which the medical profession generates disease categories. These shifting disease categories may serve the needs of patients but may also be influenced by those of other players.

Cardiology↗
PubMed1997

Susceptibility of beta-hemolytic streptococci to nine antimicrobial agents among four medical centers in Salt Lake City, Utah, USA.

A multicenter study was performed to evaluate the susceptibility of beta-hemolytic streptococci to nine antimicrobial agents. MICs were performed in cation-supplemented Mueller-Hinton broth with 3.5% lysed sheep red blood cells according to NCCLS guidelines. A total of 646 isolates were tested: 300 (46%) group A; 170 (26%) group B; 38 (6%) group C, 35 (5%) group F; 83 (17%) group G; and 20 (3%) nongroupable. Six percent of the total isolates were resistant to one or more of the antibiotics tested. Approximately 7% of 387 strains from the University of Utah Hospital and Clinics were resistant to erythromycin. Four isolates were resistant to clindamycin. Six strains (3%) from Primary Children's Medical Center (207 tested) were resistant to one or more of the macrolides. Resistance was rare at the LDS Hospital and the Salt Lake Veteran's Affairs Hospital. Overall, resistance among beta-hemolytic streptococci in this geographic location does not seem to be a significant problem, except at the tertiary care university hospital.

Anti-Bacterial Agents↗
PubMed1997

Cytochrome P450 genes from Helicoverpa armigera: expression in a pyrethroid-susceptible and -resistant strain.

The molecular basis of metabolic resistance to pyrethroids in Helicoverpa armigera is currently under debate. Substantial indirect evidence supports a role for both esterase- and cytochrome-P450-mediated metabolism. However, the relative roles played by these two mechanisms in field-based resistance is uncertain. Our understanding of the importance of P450-mediated metabolism is hindered by the paucity of cloned genes from this species, and the corresponding absence of data on rates of insecticide metabolism by functionally expressed P450s. To facilitate P450 gene isolation from H. armigera we used degenerate primers in the reverse transcriptase-polymerase chain reaction (RT-PCR) to clone P450 gene fragments from the RNA of a pyrethroid-resistant strain. Here we report the isolation of eight new P450 genes: seven from the CYP4 family and one CYP9. One of these genes, CYP4G8, is two-fold over-expressed in the resistant strain, whereas the other CYP4s showed either similar or undetectable levels of expression. CYP9A3 appears to be a homolog of the putatively resistance-associated CYP9A1 of Heliothis virescens. However, no difference in expression between the H. armigera strains was detected. CYP6B2, a gene previously reported to be over-expressed in a different pyrethroid-resistant strain of H. armigera, also revealed non-detectable levels of expression in both strains. These observations suggest that different P450s may be over-expressed in different resistant strains, and emphasize that recombinant expression will be necessary in order to define precisely their individual substrate specificities and ability to metabolize pyrethroids. The gene fragments described here represent an important first step in this direction.

Amino Acid Sequence↗
PubMed1997

A study of the educational and research priorities of registered nurses in rural Australia.

This study set out to identify the educational and research priorities of registered nurses practising in rural and remote areas of Australia. It included two groups of participants, one which identified as rural and another which identified as remote. The findings for the rural cohort in the study are presented in this article. Research participants represented a national sample. The Delphi method was used to obtain the most reliable consensus of the nurse participants. In the final phase of the study, 13 high priorities were identified. Study findings highlight perceived needs for clinical nursing research and continuing education for nurses practising in rural Australia.

Australia↗
PubMed1997

The research and educational priorities of rural occupational therapists.

The aim of this pilot research project was to identify the research and educational priorities of occupational therapists practising in rural New South Wales. Eight participants were recruited in the south-western region of the State. The Delphi technique was used to obtain the most reliable consensus of the research participants. Priorities emerged in four designated areas: (1) research that would be of value to clients; (2) research that would be of value in providing community care for clients; (3) research that would be of value in facilitating health promotion and disease prevention; and (4) research that would be of value to professional and educational needs. In the final phase of the study, 23 high priorities were identified. The findings of the study suggest directions for research and continuing education in occupational therapy which may benefit rural practitioners and their clients.

Attitude of Health Personnel↗
PubMed1997

Multicenter laboratory evaluation of the bioMérieux Vitek antimicrobial susceptibility testing system with 11 antimicrobial agents versus members of the family Enterobacteriaceae and Pseudomonas aeruginosa.

A four-center study in which a total of 1,082 recent clinical isolates of members of the family Enterobacteriaceae and Pseudomonas aeruginosa were examined versus 11 antimicrobial agents with the bioMérieux Vitek susceptibility test system (Hazelwood, Mo.) and the GNS-F6 card was conducted. In addition, a challenge set consisting of the same 200 organisms was examined in each of the four participating laboratories. Results obtained with the Vitek system were compared to MICs determined by a standardized broth microdilution method. For purposes of comparison, susceptibility categories (susceptible, intermediate, or resistant) were assigned on the basis of the results of both methods. The result of the broth microdilution test was considered definitive. The total category error rate with the Vitek system and the recent clinical isolates (11,902 organism-antimicrobial comparisons) was 4.5%, i.e., 1.7% very major errors, 0.9% major errors, and 1.9% minor errors. The total category error rate calculated from tests performed with the challenge set (i.e., 8,800 organism-antimicrobial comparisons) was 5.9%, i.e., 2.2% very major errors, 1.1% major errors, and 2.6% minor errors. Very major error rates higher than the totals were noted with Enterobacter cloacae versus ampicillin-sulbactam, aztreonam, ticarcillin, and ticarcillin-clavulanate and with P. aeruginosa versus mezlocillin, ticarcillin, and ticarcillin-clavulanate. Major error rates higher than the averages were observed with Proteus mirabilis versus imipenem and with Klebsiella pneumoniae versus ofloxacin. Excellent overall interlaboratory reproducibility was observed with the Vitek system. The importance of inoculum size as a primary determinant in the accuracy of susceptibility test results with the Vitek system was clearly demonstrated in this study. Specifically, when an inoculum density fourfold higher than that recommended by the manufacturer was used, high rates of false resistance results were obtained with cell wall-active antimicrobial agents versus both the Enterobacteriaceae and P. aeruginosa.

Anti-Bacterial Agents↗
PubMed1996

Opening Pandora's box: the unpredictability of reassurance by a normal test result.

OBJECTIVES: To determine the rate of failure of patient reassurance after a normal test result and study the determinants of failure. DESIGN: Replicated single case study with qualitative and quantitative data analysis. SETTING: University teaching hospital. SUBJECTS: 40 consecutive patients referred for echocardiography either because of symptoms (10 patients) or because of a heart murmur (30). 39 were shown to have a normal heart. INTERVENTIONS: Medical consultations and semistructured patient interviews were tape recorded. Structured interviews with consultant cardiologists were recorded in survey form. MAIN OUTCOME MEASURES: Patient recall of the explanation and residual understanding, doubt, and anxiety about the heart after the test and post-test consultation. RESULTS: All 10 patients presenting with symptoms were left with anxiety about the heart despite a normal test result and reassurance by the consultant. Of 28 patients referred because of a murmur but shown to have no heart abnormality, 20 became anxious after detection of the murmur; 11 had residual anxiety despite the normal test result. CONCLUSIONS: Reassurance of the "worried well"-anxious patients with symptoms or patients concerned by a health query resulting from a routine medical examination or from screening-constitutes a large part of medical practice. It seems to be widely assumed that explaining that tests have shown no abnormality is enough to reassure. The results of this study refute this and emphasise the importance of personal and social factors as obstacles to reassurance.

Adolescent↗
PubMed1996

Psychiatric complications and comorbidities in medical inpatients: the inadequacy of attestation at discharge.

The determination of an appropriate level of prospective payment for inpatient medical services requires consideration and documentation of psychiatric problems which impact on resource utilization. A major source of information for reimbursement planning is the list of secondary diagnoses referred to as "complications and comorbidities" (CCs) taken from the medical record. If psychiatry problems are omitted on the attestation sheet, they are unlikely to be included in any reimbursement formulae. This study was designed to look at actual hospital experience in terms of how often psychiatric diagnoses were attested to on the medical record. Of the 100 patients evaluated, 25 were found to have 33 psychiatric complications and CCs. Of the 33 psychiatric CCs, only 9 (24%) were recorded on the attestation sheet. Reasons for and implications of this low rate of attestation are discussed. The complete and accurate attestation of psychiatric problems may be the single most important priority for psychiatrists in general hospitals. Even when the DRG system is replaced by capitation payment, the importance of accurate diagnostic recording and recognition will remain paramount to making rate analyses and adjustments.

Bias↗
PubMed1996

Clinical nursing research priorities in Australian critical care: a pilot study.

The aims of this research project were to identify areas for research in Australian critical care nursing with potential for improvement in patient care, and to advise nursing research policy and priorities with relevance to areas of patients' needs. Research participants represented a national sample of clinical nurse specialists (CNSs) and clinical nurse consultants (CNCs). The Delphi method was used to obtain the most reliable consensus of the specialist nurses, and over 238 research priorities were identified initially. In the final phase of the research nine high priorities were identified. The findings of this study suggest directions for clinical nursing research in critical care.

Adult↗
PubMed1996

Clinical research priorities in oncology nursing: an Australian perspective.

The aims of the research project were to identify areas for research in oncology nursing that have potential for improvement in patient care and to advise about nursing-research policy and priorities that have relevance to areas of patients' needs. Research participants included 10 Clinical Nurse Consultants (CNC) representing 10 area health authorities in New South Wales, Australia. The Delphi method was used to obtain the most reliable consensus of the specialist nurses, and more than 31 high priorities were identified. Quality of life and symptom management emerged as the top two priority categories in the study. The findings of the study provide direction for clinical nursing research in oncology.

Adult↗
PubMed1996

Quality of life and the human becoming theory: exploring discipline-specific contributions.

This article explores the concept of quality of life. Current understandings of quality of life are considered in relation to the notion of discipline-specificity. The authors contend that different disciplines require distinct definitions of quality of life and that research which informs practitioners about quality of life needs to be discipline-specific and theory-based. The contribution of the human becoming theory to knowledge and understanding of quality of life in nursing science is explored, drawing on insights from theory-guided practice and research.

Human Development↗
PubMed1995

Factors associated with a positive reexcision after excisional biopsy for invasive breast cancer.

BACKGROUND: Breast-conserving therapy followed by adjuvant radiotherapy represents an alternative to mastectomy as a treatment for invasive breast cancer. When excisional biopsy has been performed outside the parent institution, reexcision is often performed, with tumor being identified in 32% to 62% of the subsequent specimens. We analyzed not only the factors associated with a positive reexcision but also those factors associated with final surgical margins that are positive for tumor. METHODS: Between 1978 and 1991, 956 female patients with American Joint Committee on Cancer clinical stage I or II breast cancer were treated with breast-conserving therapy where a total of 420 patients underwent reexcision after an initial excisional biopsy. Several factors were analyzed to determine their association with a positive reexcision, the status of the final surgical margin, and the nature of the disease present within the reexcision specimen. RESULTS: Factors that correlated with a positive reexcision in both univariate and multivariate analysis were clinical tumor size, method of detection, the pathologic status of the axillary lymph nodes, and the histologic appearance. Those factors associated with finding invasive disease at the time of reexcision were clinical tumor size, clinical presentation, and nodal status. The single factor associated with finding residual in situ disease at the time of reexcision was histologic appearance of the primary tumor. A final positive margin was associated with method of tumor detection, age of the patient, and the presence of axillary lymph node metastases. CONCLUSIONS: The most significant factors associated with a positive reexcision are clinical tumor size, method of tumor detection, pathologic nodal status, and histologic appearance. Patients with larger tumors or those that are detected by physical examination, as well as invasive lobular carcinomas, may require a more generous initial resection to achieve negative surgical margins and avoid the likelihood of reexcision.

Adult↗
PubMed1995

A mutant approach and molecular strategy to study fungal cell walls.

The current study describes recombinant plasmids which complement the hypersusceptibility to killing bleomycin of blm1-1 mutant cells of Saccharomyces cerevisiae, and a strategy developed and used to recover active clones from a stable yeast genomic library. The resistance of a spontaneous revertant isolated from the original blm1-1 mutant strain and of mutant cells transformed with each of several recombinant plasmids which complemented the recessive blm1-1 mutation was comparable to the resistance of the parental (non-mutant) strain from which the original blm1-1 mutant was derived. The strategy for cloning S. cerevisiae DNA was based on complementation and in situ hybridization. This strategy employed 32P-labelled 6.6-kb BamHI and 3.8-kb BamHI-ClaI probes from a cloned DNA fragment to recover clones which either fully or partially complemented the hypersensitivity of mutant cells to killing by bleomycin. This method considerably reduced the time and effort required to recover biologically active clones from a genomic library.

Bleomycin↗
PubMed1994

Genetic and antigenic analysis of the influenza virus responsible for the 1992 Hong Kong equine influenza epizootic.

An outbreak of influenza occurred among thoroughbred racehorses in Hong Kong in November-December 1992, with morbidity of 37%. All horses involved had been vaccinated against equine-1 and equine-2 influenza viruses but not against the virus responsible for the 1989 equine influenza outbreak in northern China (influenza A/equine/Jilin/89, subtype H3N8). Therefore the source and nature of the virus causing the Hong Kong outbreak was investigated. Virus isolated from a horse infected during the outbreak was used for genetic analysis. All the viral gene segments were similar to those of equine-2 (H3N8) influenza viruses and unrelated to those of equine/Jilin/89 virus. The nucleotide sequence of the viral hemagglutinin gene showed high homology (99.4%) to that of influenza A/equine/Suffolk/89 (H3N8) virus which has circulated extensively in Europe. However, these viruses differed in their antigenic reactivity to a panel of monoclonal antibodies. Preliminary epizootiological information plus the concordance of amino acid sequence between hemagglutinins of the Hong Kong isolate and a contemporaneous equine-2 influenza virus isolate from the United Kingdom indicated that the probable source of the Hong Kong outbreak was horses recently imported from England or Ireland.

Amino Acid Sequence↗