Search PubMed⌕ Search

Biomedical subjects

J Devine

Publications and source records attributed to J Devine.

At least 19 recordsLinked to original sources
PubMed2001

Is methicillin-resistant Staphylococcus aureus (MRSA) contamination of ward-based computer terminals a surrogate marker for nosocomial MRSA transmission and handwashing compliance?

A survey of two acute district general hospitals (A and B) was undertaken to investigate the extent of methicillin-resistant Staphylococcus aureus (MRSA) contamination of ward-based computer terminals. Of 25 terminals examined, MRSA was identified in six (24%). Environmental contamination was of a low level. Five of the MRSA positive terminals were from hospital A which had a significantly higher rate of MRSA transmission compared to hospital B (1.02 vs. 0.49 new inpatient MRSA cases per 100 hospital admissions for 1999). MRSA containment and handwashing policies were similar at both hospitals, though only hospital B actively audited handwashing compliance and had a 44% higher rate of paper towel usage per hospital bed. Ward-based computer terminals pose a low risk of MRSA cross-infection. This risk can be further reduced if all staff wash their hands before and after patient contact.

Computer Terminals↗
PubMed2001

The natural history of intermediate and critical vein graft stenosis: recommendations for continued surveillance or repair.

OBJECTIVE: Duplex ultrasound surveillance (DUS) after autogenous lower extremity bypass grafting is controversial. Specific criteria mandating graft revision are not uniform. It has been suggested that grafts harboring critical stenoses undergo revision, whereas those with intermediate stenoses undergo arteriography with selective repair. We sought to define the natural history and determine the risk of graft occlusion associated with unrepaired vein graft stenoses. METHODS: We analyzed serial vascular laboratory and clinical data of 156 autogenous infrainguinal vein grafts in 142 patients. Grafts were categorized into three groups according to the first DUS-detected (index) lesion: (1) normal (peak systolic velocity [PSV] < 200 cm/s, velocity ratio [V(r)] < 2); (2) intermediate stenosis (200 cm/s < PSV < 300 cm/s, 2 < V(r) < 4); and (3) critical (PSV > 300 cm/s, V(r) > 4). Our policy was to repair grafts with critical lesions and monitor all others. The risks of stenosis progression, graft revision, and graft thrombosis for each group were compared. RESULTS: Serial DUS was normal in 100 (64%) grafts. The incidence of graft thrombosis in the normal group was 3% per year (mean follow-up, 27.5 months). Intermediate lesions developed in 32 grafts (20%) and were followed. Among these 32 grafts with intermediate stenoses, 63% progressed to critical and were revised, and 32% resolved or stabilized (mean follow-up, 26 months). Only one graft occlusion occurred in grafts with intermediate lesions subjected to serial DUS monitoring (incidence 1.5% per year, P = not significant). In the third group, 16 of 25 grafts with critical lesions were successfully revised and remain patent. In nine cases, critical lesions were not repaired, resulting in seven (78%) occlusions, all within 4 months of DUS detection. CONCLUSIONS: Serial surveillance is safe and effective for grafts with intermediate stenoses. The graft occlusion rate for such grafts with careful monitoring is no different from grafts without stenosis, and therefore, arteriography is not indicated in the absence of progression to critical stenosis. The short-term risk of graft occlusion in the presence of an unrevised critical stenosis is nearly 80%. These data have important clinical implications concerning the natural history of vein graft lesions.

Aged↗
PubMed2000

Uteroglobin gene transcription: what's the RUSH?

Prolactin enhances progesterone-dependent transcription of the rabbit uteroglobin gene. RUSH transcription factors are implicated in the signal transduction pathway. The RUSH acronym identifies key features of these nuclear phosphoproteins, that is, RING-finger motif, binds the uteroglobin promoter, structurally related to the SWI/SNF family of transcription factors, and helicase-like. Cloned by recognition site screening, RUSH proteins bind to an 85-bp region (-170/-85) of the uteroglobin promoter that was subsequently identified as a novel prolactin-responsive region by promoter deletion analysis. Gel shift and linker-scanning assays further reduced the RUSH target site to -160/-110. A hexameric core of MCWTDK was identified as the RUSH-specific DNA-binding site (-126/-121) by CASTing. This site overlaps authentic HNF3 beta and OCT-1 binding sites. A unique Type IV P-type ATPase that is embedded in the inner nuclear membrane binds the RING domain of RUSH. The conformationally flexible loop portion of this RING-finger binding protein (RFBP) extends into the nucleoplasm to contact euchromatin. The physical association of RFBP with transcriptionally active chromatin supports the speculation that RFBP targets RUSH transcription factors to the active uteroglobin promoter.

Animals↗
PubMed1999

Mutations in the voltage-dependent anion channel of the mitochondrial outer membrane cause a dominant nonlethal growth impairment.

Point mutations at K234 and K236 in the yeast voltage-dependent anion channel 1 (VDAC1) of the mitochondrial outer membrane have been shown to markedly impair the membrane insertion of this protein (Smith et al., 1995; Angeles et al., 1998). Mutants of this type were expressed in vivo in a strain of yeast with a disruption in the VDAC1 gene. Expression of the various VDAC1 forms was under the control of a Gall promoter. Wild-type VDAC1 expression fully complemented the slow growth phenotype caused by the disruption. VDAC1 mutants in which K234 and K236 were replaced by arginine, glutamate, or glutamine caused a more severe negative effect on growth. This effect appeared to be dominant since the mutant VDAC1 forms suppressed growth in a yeast strain that retained its VDAC1 gene. This apparent dominant negative effect on growth did not seem to be specific for any stage of the cell cycle. However, the growth defect was not lethal as the affected cells still could accumulate the vital stain, FUN1. Expression of a mutant in which K234 had been replaced by glutamate had more serious negative growth effects than did a similar mutation at K236. Expression of delta71-116 VDAC1 complemented the VDAC1 disruption; however, expression of the same deletion mutant in which the lysines corresponding to K234 and K236 were mutated to glutamate severely impaired growth. These results have shown that a deficiency of lysine at positions 234 and 236 in VDAC I causes a nonlethal growth defect that is more severe than deletion of 45 amino acids from VDACI or disruption of the VDAC1 gene. They also indicate that there is a hierarchy in the importance of these lysines with mutations at K234 being the more serious.

Gene Expression Regulation, Fungal↗
PubMed1999

Mutation of K234 and K236 in the voltage-dependent anion channel 1 impairs its insertion into the mitochondrial outer membrane.

Previous in vitro studies indicated that mutation of both K234 and K236 to arginine, glutamine, or glutamic acid impaired the ability of the voltage-dependent anion channel (VDAC1) to insert into the outer membrane of the mitochondria (Smith et al. 1995). These same mutants were expressed in a strain of Saccharomyces cerevisiae with a disruption in the VDAC1 gene. The mutant VDAC1 forms were found in the mitochondria suggesting that they were correctly sorted to the outer membrane. However, only very small amounts of the mutants were inserted into the mitochondrial membranes. Mitochondria isolated from the strains expressing the mutants were capable of catalyzing the translocation of both wild-type VDAC1 and pre-alcohol dehydrogenase III indicating that the translocation apparatus was functional. These results confirm the previously drawn conclusion that K234 and K236 are part of a membrane insertion motif. The failure of the mutant VDAC1 forms to insert did not cause VDAC1 precursors to accumulate in the soluble cell cytoplasm or in the microsomal fraction. The apparent lack of a "precursor pool" suggested that a post-transcriptional control mechanism might limit the amounts of VDAC1 precursors in the cell. Such a control mechanism is consistent with the observation that the amount of VDAC1 was very similar after epichromosomal (gene in a 2u plasmid controlled by a Gal1 promoter) and chromosomal expression (endogenous gene controlled by the endogenous promoter).

Amino Acid Substitution↗
PubMed1999

Scrofuloderma of the lower extremity treated with wide resection: a case report and review of the literature.

Scrofuloderma is tuberculosis of subcutaneous tissue that ulcerates and drains through the overlying skin. It most commonly occurs in the neck from a cervical lymph node source. Although such lymphatic spread is the usual clinical picture, there are sporadic reports in the literature of direct hematogenous seeding of subcutaneous tissue forming a tuberculoma, or "cold abscess." Definitive diagnosis requires the identification of Mycobacterium tuberculosis within the suspect lesion. Surgical intervention is necessary in any draining lesion and should be accompanied by appropriate antituberculous chemotherapy. Accounts of bone and joint involvement are numerous, but the orthopedic surgeon must also be aware of the soft-tissue manifestations of tuberculosis and the indications for surgery. We report on an immunocompromised patient who presented with a rare case of scrofuloderma of the lower extremity, which was treated with wide resection.

Adult↗
PubMed1998

Anger management style and the prediction of treatment outcome among male and female chronic pain patients.

Anger is a prominent emotion experienced by chronic pain patients. Anecdotes suggest that anger predicts poor outcome following multidisciplinary pain programs, but no empirical evidence documents this link. We expected that patient anger expression or suppression would predict poor outcome following a pain program and that gender differences would emerge. Pre- to posttreatment measures of lifting capacity, walking endurance, depression, pain severity and activity level were collected from 101 chronic pain patients. An 'anger expression x gender' interaction was found such that anger expression among males was correlated negatively with lifting capacity improvements. 'Anger suppression x gender' interactions emerged such that anger suppression among males was correlated negatively with improvements in depression and general activities. These effects remained significant after controlling for trait anger. Thus, how anger is managed may exert unique influence on outcomes apart from the effects of mere anger proneness, at least among male pain patients.

Adult↗
PubMed1998

Current trends in the detection and management of carotid body tumors.

PURPOSE: Because the natural history of carotid body tumors is believed to be unpredictable, immediate surgical removal has been recommended. The present study reviews our experience in the diagnosis and treatment of these uncommon lesions. METHODS: The medical records of patients who appeared for treatment with carotid body tumors between 1981 and 1997 were reviewed. Patients demographics, mode of presentation, imaging and treatment modalities, Shamblin classification, and neurologic complications (stroke, cranial nerve injuries) were analyzed. RESULTS: Over the past 16 years, 31 patients with 32 carotid body tumors have been evaluated, with an average follow-up of 3.2 years. The patients were arbitrarily classified into two groups on the basis of the mode of detection. Seventy percent (23 of 32) of the tumors discovered on clinical or self-examination were classified as Group 1; 28% (9 of 32) of the tumors detected during duplex scanning for carotid artery disease (8) or MRI (1) were classified as Group 2. The mean size of chemodectomas found on palpation (4.3 +/- 1.7 cm) was larger than that of those detected by duplex ultrasound (2.7 +/- 1.0 cm; p < 0.05, by paired t test). Preoperative embolization was successfully performed in 5 of 6 instances of large tumors; the remaining patient suffered a procedure-related stroke. Thirty-one carotid body tumors were resected. In one case, the tumor was felt by the primary surgeon to be too small (0.9 x 0.7 cm on duplex scan) to warrant immediate excision; this patient is being followed by periodic duplex scanning. Five neurologic complications were noted in Group 1, one after preoperative embolization and four after surgery. One cranial nerve injury occurred in Group 2. One patient had a large recurrent chemodectoma with clinical evidence of metastatic disease. CONCLUSION: The increasing use of sophisticated imaging modalities may allow earlier discovery of carotid body tumors before they can be clinically detected. Resection of carotid body tumors of all sizes in appropriate surgical candidates remains the standard of care. Unfortunately, resection of even small tumors is associated with a low but constant incidence of neurologic complications.

Adult↗
PubMed1998

Cognitive and physical capacity process variables predict long-term outcome after treatment of chronic pain.

Cognitive-behavioral and physical therapies are incorporated into multidisciplinary chronic pain programs because changes in pain cognitions and physical capacity may represent therapeutic processes that facilitate favorable outcome. Decreases in depression, however, may explain treatment responses more parsimoniously. Measures of pain helplessness, lifting capacity, walking endurance, depression, pain severity, and activity level were collected from 94 chronic pain patients at pre- and posttreatment and at 3- to 6-month follow-up evaluations. Decreases in pain helplessness were linked to pain severity reduction, whereas walking endurance increases were related to improvements in activity levels and downtime even after controlling for effects of depression decreases. Thus, cognitive and physical capacity changes that occur through pain treatment may make unique contributions to long-term outcome.

Adult↗
PubMed1997

Is mechanical bowel preparation really necessary for elective left sided colon and rectal surgery?

The value of mechanical bowel preparation for elective left sided colorectal surgery is debatable. This retrospective study evaluates the incidence of wound infection, wound dehiscence, abdominal/pelvic collections and anastomotic dehiscence between patients who received mechanical bowel preparation [MBP] (n = 61) and those who did not (n = 75). The case notes of 136 consecutive patients undergoing elective left sided colorectal surgery over a three year period in a district general hospital were reviewed. The incidence of infective and anastomotic complications between the two groups was not significantly different. There were two post-operative deaths, both in patients receiving MBP. We therefore conclude that the role of MBP in the era of systemic antibiotics must be questioned. A prospective randomised multicenter trial recruiting an adequate number of patients undergoing elective left sided colorectal procedures would clarify this long standing debate. Note: Presented at the Spring Meeting of the Minnesota Surgical Society in Rochester, Minnesota, USA, May, 1996 and to the American Society of Colon and Rectal Surgeons (ASCRS), Seattle, Washington, June 1996, and published in abstract form in Diseases of the Colon and Rectum (1996) 39:A47.

Adult↗
PubMed1995

Sweet taste: effect on cephalic phase insulin release in men.

To determine whether sweet-tasting solutions are effective elicitors of cephalic phase insulin release (CPIR) in humans, two studies were conducted using nutritive and nonnutritive sweeteners as stimuli. Normal weight men sipped and spit four different solutions: water, aspartame, saccharin, and sucrose. A fifth condition involved a modified sham-feed with apple pie. The five stimuli were administered in counterbalanced order, each on a separate day. In study 1, subjects tasted the stimuli for 1 min (n = 15) and in study 2 (n = 16), they tasted the stimuli for 3 min. Arterialized venous blood was drawn to establish a baseline and then at 1 min poststimulus, followed by every 2 min for 15 min and then every 5 min for 15 min. In both study 1 and study 2, no significant increases in plasma insulin were observed after subjects tasted the sweetened solutions. In contrast, significant increases in plasma insulin occurred after the modified sham-feed with both the 1 min and 3 min exposure. These results suggest that nutritive and nonnutritive sweeteners in solution are not adequate stimuli for the elicitation of CPIR.

Adolescent↗
PubMed1995

Association between workers' compensation and outcome following multidisciplinary treatment for chronic pain: roles of mediators and moderators.

OBJECTIVE: To determine whether the tendency for chronic pain patients who receive Workers' Compensation to show a poorer response than non-compensated patients to pain treatment can be accounted for by mediating factors; to assess whether moderating factors can distinguish subgroups of Workers' Compensation recipients who react very poorly to treatment from compensated patients who respond well. DESIGN: Outcome study based on archives. SETTING: Multidisciplinary pain treatment center. PATIENTS: Of 214 patients, 158 had complete data. OUTCOME MEASURE: Blind ratings of narrative discharge summaries written by the Pain Treatment Center staff. RESULTS: A significant negative relationship between receiving Workers' Compensation and outcome was mediated by a pessimistic belief in the ability to return to former occupation. Moderator effects showed that Workers' Compensation recipients with high initial pain and a history of pain-related surgery fared worse than any other group. Moreover, Workers' Compensation recipients not characterized by high pain and a history of surgery responded as well as noncompensated patients. CONCLUSIONS: The inadequate response to pain programs shown by Workers' Compensation recipients may be partly understood in terms of well-defined mediating factors, which may admit to amelioration via clinical intervention. Moreover, Workers' Compensation patients should not be considered high risks for failure by sole virtue of their compensation status. Multifactor assessment methods may be needed to identify that portion of compensation recipients who are actually at appreciable risk for treatment failure so that appropriate adjustments in treatment regimen may be made.

Adult↗
PubMed1995

PPAR gamma 2 regulates adipose expression of the phosphoenolpyruvate carboxykinase gene.

Phosphoenolpyruvate carboxykinase (PEPCK) is expressed at high levels in liver, kidney, and adipose tissue. This enzyme catalyzes the rate-limiting step in hepatic and renal gluconeogenesis and adipose glyceroneogenesis. The regulatory factors important for adipose expression of the PEPCK gene are not well defined. Previous studies with transgenic mice established that the region between bp -2086 and -888 is required for expression in adipose tissue but not for expression in liver or kidney tissue. We show here that a DNA fragment containing this region can function as an enhancer and direct differentiation-dependent expression of a chloramphenicol acetyltransferase gene from a heterologous promoter in cultured 3T3-F442A preadipocytes and adipocytes. We further demonstrate that the adipocyte-specific transcription factor PPAR gamma 2, previously identified as a regulator of the adipocyte P2 enhancer, binds in a heterodimeric complex with RXR alpha to the PEPCK 5'-flanking region at two sites, termed PCK1 (bp -451 to -439) and PCK2 (bp -999 to -987). Forced expression of PPAR gamma 2 and RXR alpha activates the PEPCK enhancer in non-adipose cells. This activation is potentiated by peroxisome proliferators and fatty acids but not by 9-cis retinoic acid. Mutation of the PPAR gamma 2 binding site (PCK2) abolishes both the activity of the enhancer in adipocytes and its ability to be activated by PPAR gamma 2 and RXR alpha. These results establish a role for PPAR gamma 2 in the adipose expression of the PEPCK gene and suggest that this factor functions as a coordinate regulator of multiple adipocyte-specific genes.

3T3 Cells↗
PubMed1995

Constant observation: implications for nursing practice.

1. Constant observation is an increased level of observation and supervision in which continuous one-to-one monitoring techniques are utilized to assure the safety and well-being of an individual patient or others in the patient care environment. 2. Individuals who provide constant observation vary widely among health care facilities; but ultimately are the responsibility of the registered nurse. There are many areas that must be addressed by institutions when considering the use or implementation of constant observation. These include: measuring the associated costs, risk management, role development, orientation of employees, and performance evaluation. 3. The changing health care environment and public concern over the quality of health care and risk management require nursing administrators to consider risk-benefit and cost-benefit analyses related to constant observation. There is continued need for protocol and policy development, as well as for guidelines and orientation of staff regarding constant observation.

Cost-Benefit Analysis↗