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Biomedical subjects

J Drury

Publications and source records attributed to J Drury.

At least 19 recordsLinked to original sources
PubMed1995

The roots of nursing: teaching caring based on Watson.

Caring is the root of nursing. Therefore, care must be a core component of any nursing programme. Watson (1985) developed 10 carative factors that she considers central to the caring process. These carative factors, which 'form a structure for studying and understanding nursing as the science of caring' (Watson 1985), shaped a unit of study at a School of Nursing in a tertiary institution in Western Australia. This paper describes how Watson's carative factors were used as a framework for teaching caring to Semester I undergraduate students.

Curriculum↗
PubMed1995

Platelet activation induced by a murine monoclonal antibody directed against a novel tetra-span antigen.

MAb 14A2.H1 identifies a novel low-abundance platelet surface antigen, PETA-3, which is a member of the tetra-span (TM4) family. This MAb brings about platelet aggregation and mediator release, which is completely inhibitable by prostaglandin E1, and partially inhibitable by aspirin and ketanserin. Platelet activation by MAb 14A2.H1 is dependent on interaction with both the platelet Fc receptor, Fc gamma RII, and the specific antigen as it was prevented by either a blocking MAb to Fc gamma RII (IV.3) or F(ab')2 fragments of 14A2.H1. The extent of platelet activation by the antibody varied considerably between donors, and is believed to reflect the polymorphism of Fc gamma RII. Subaggregating concentrations of 14A2.H1 synergized with other platelet agonists, ADP, adrenaline, collagen and serotonin, indicating signalling via a pathway distinct from these activators. Synergy was also blocked by MAb IV.3, or F(ab')2 fragments of 14A2.H1. The similar low copy number of PETA-3 and Fc gamma RII in the platelet membrane (approximately 1000/platelet), together with the dependence on Fc gamma RII for activation by MAb 14A2.H1, suggests that PETA-3 may be a component of the Fc gamma RII signal transducing complex in platelets.

Adenosine Diphosphate↗
PubMed1993

Evaluation of the efficacy of an instructional programme in the self-management of patients with asthma.

The restrictions imposed on patients with asthma is problematic to them, in that their physical disability interferes with personal, interpersonal and/or professional goals. Twenty-three patients under the care of general practitioners were surveyed by interview in their homes, doctors' surgery or at work to determine their current control of selected variables related to their asthma: exercise, use of drugs and related factors. An instructional programme was offered to interested participants to assist in complying with their prescribed medication regimens and to tailor exercise to their tolerance levels. Findings showed that 18 patients experienced moderate to severe restrictions when troubled with asthma. Although over one-half of the patients exercised regularly for fitness, including seven with aerobic exercise, some chose sports they thought could provoke an asthmatic attack. Half took precautionary measures when exercising. All patients used bronchodilators to relieve their asthma, yet one-third did not keep their inhalers accessible. None of the most troubled 18 lived in a smoke-free environment, and one-third kept furry animals as pets. Recommendations are made for further study of the effects of instructional programme to improve compliance to a healthy lifestyle.

Absenteeism↗
PubMed1990

More rapid thrombolysis with coronary venous retroinfusion of streptokinase compared with intravenous administration. An experimental study in canines.

The efficacy of coronary venous retroinfusion vs intravenous administration of streptokinase was compared in 20 closed chest dogs with copper coil induced thrombosis of the left anterior descending coronary artery. Streptokinase was continuously infused for 60 min (100 IU kg-1 min-1) starting 60 min after coronary artery occlusion. Time to clot lysis was determined by coronary angiography performed at 5 min intervals. Complete lysis occurred in eight out of 10 dogs receiving intravenous streptokinase and in all 10 dogs in the coronary venous group. Time to thrombolysis was significantly shorter with coronary venous retroinfusion (23 +/- 8 min) than after systemic infusion (62 +/- 26 min; P less than 0.001). Recovery of ischaemic zone left ventricular systolic function, studied by two-dimensional echocardiography, was significantly better in the animals that received retrograde streptokinase than in the group that received intravenous streptokinase (17 +/- 12% vs -2 +/- 16%; P less than 0.05). Myocardial necrosis expressed as a percentage of the risk area was 8 +/- 12% after retroinfusion of streptokinase compared with 32 +/- 25% (P less than 0.005) after intravenous administration. In conclusion, coronary venous administration of streptokinase was more effective than intravenous therapy as determined by more rapid clot lysis which resulted in improved functional recovery of the ischaemic myocardium and a significant reduction in myocardial necrosis.

Animals↗
PubMed1988

Effects of autologous mesothelial cell seeding on prostacyclin production within Dacron arterial prostheses.

Canine abdominal aortas have been replaced with Dacron arterial prostheses to assess the effects of mesothelial cell seeding on graft prostacyclin and thromboxane A2 release. At both 2 weeks and 6 weeks after surgery, three seeded and two unseeded control grafts were examined for prostacyclin release. In addition, thromboxane release was assessed in one seeded and one unseeded graft. Sections of aorta and graft were removed and incubated in PBS containing either 10 microM calcium ionophore A23187 or 20 microM arachidonic acid. The incubation mixture was sub-sampled at 5 min intervals over a 20 min period to assess the progressive release of prostacyclin and thromboxane A2 using a radioimmunoassay for 6-keto-prostaglandin F1 alpha and thromboxane B2 respectively. In seeded grafts, 6-keto-prostaglandin F1 alpha release averaged 15 per cent compared with aorta at 2 weeks and 45 per cent compared with aorta at 6 weeks. By contrast, release from unseeded grafts was undetectable at 2 weeks; however, by 6 weeks there was some release amounting to 15 per cent compared with aorta. There was a statistically significant increase in the release of 6-keto-prostaglandin F1 alpha from mesothelial cell seeded grafts at 6 weeks compared with unseeded grafts (P less than 0.01). Thromboxane release from the graft sections was variable and unrelated to whether the grafts had been seeded or not. These preliminary results, showing that grafts seeded with autologous peritoneal mesothelial cells release more prostacyclin than unseeded grafts, further highlight the role of the mesothelial cell as an alternative to the endothelial cell for improving the patency of arterial Dacron prostheses in the early postoperative days.

Animals↗
PubMed1988

Promoting exercise and physical fitness in the medical school curriculum.

An elective course focusing on exercise physiology and cardiovascular fitness has been offered since 1984 to a limited number of freshman and sophomore students at Saint Louis University School of Medicine. The course consists of a series of weekly lectures. Following each lecture, the students participate in a self-designed fitness program and agree to follow the program on their own time at least two days per week. Using bicycle ergometry testing, the instructors estimated the maximum oxygen consumption for each student before and after completion of the course, and the results over the four years indicate an average increase of 15 percent. The students' evaluation of the course has been favorable. The potential benefits of such a course are discussed.

Adult↗
PubMed1987

Abnormal biochemical and cellular parameters in the blood of patients with Raynauds phenomenon.

Finger blood flow is decreased in Raynauds Phenomenon (RP). This may be due not only to vasospasm, but also to blood abnormalities. 40 patients with Raynauds Disease (RD), 28 with suspected RP (SS) and 42 with secondary Raynauds syndrome (RS) were enrolled and compared to 50 controls. Results from base-line samples show that those with RP have abnormal haemostasis and rheology whereas those with mild Raynauds, RD do not. Blood sampled after cold challenge in 15 RS patients and 15 controls show that both groups exhibit platelet activation after emersion. The degree of activation however was much more marked in the RS patients. We have shown that abnormalities of haemostasis and rheology are found in patients likely to have endothelial damage (RS). These changes are probably a consequence rather than a cause of the disease. After cold challenge the results become more abnormal and correlate with severity of disease.

Blood Flow Velocity↗
PubMed1986

Studies on haematocrit in peripheral arterial disease.

Haematocrit is often elevated in peripheral arterial disease, and is an important determinant of blood viscosity and of platelet behaviour. We have studied the relationships of haematocrit to claudication, smoking habit, calf blood flow, platelet aggregation in whole blood, and the late complications of aortic bifurcation grafts. In 31 claudicants, blood viscosity, haematocrit and fibrinogen levels were significantly higher compared to 50 controls (p less than 0.01). However this was largely explained by a higher prevalence in claudicants of cigarette-smoking, which is associated with increased blood viscosity, haematocrit and fibrinogen levels. In 8 stable claudicants with high-normal haematocrit (mean 0.50), venesection reduced haematocrit to low-normal levels (mean 0.44). Resting calf blood flow was unchanged: peak flow increased slightly (17%) but oxygen delivery (peak flow X haemoglobin concentration) was unchanged. Spontaneous platelet aggregation in whole blood was studied using a single platelet counting method: the increase in haematocrit in patients with claudication was not associated with a significant increase in aggregation, and a negative association of haematocrit and aggregation was observed. In a preliminary retrospective study of patients with late complications of aortic bifurcation grafts, significantly higher haematocrits prior to operative were found compared to controls who had not returned to the clinic. Further prospective studies are required to assess the significance of haematocrit in peripheral arterial disease, and to determine whether any adverse effects are due to associations with smoking, rheology or platelet behaviour.

Adult↗
PubMed1986

Long term glycaemic control by alternative regimens in a feasibility study of continuous subcutaneous insulin infusion.

Of 382 insulin-treated diabetic patients participating in a feasibility study of continuous subcutaneous insulin infusion (CSII) and alternative regimens in a large British clinic, 63 used CSII for a 2-yr period. Additionally 74 patients persisted with an intensified injection regimen and 85 continued on non-intensified therapy. There was no significant difference in mean glycosylated haemoglobin between the 3 groups at the study onset. At month 24 only the CSII group had significantly reduced mean glycosylated haemoglobin (11.0 +/- 1.8 (SD) at month 0; 9.8 +/- 1.9 month 24, p less than 0.001) although the intensified injection group experienced a significant reduction in mean glycosylated haemoglobin until month 18 (11.0 +/- 1.8 month 0; 10.1 +/- 1.4, p less than 0.001). Serious hypoglycaemia was not increased in the CSII-treated group compared with the intensified injection group. Thus it proved feasible to achieve sustained, improved glycaemic control in a large group of patients by the use of insulin pump therapy and the level of control was superior to that achieved by an intensified injection regimen.

Blood Glucose↗
PubMed1985

Glycosylated haemoglobin in normal pregnancy: a longitudinal study with two independent methods.

Twenty-one women completed a longitudinal study of glycosylated haemoglobin in normal pregnancy. Glycosylated haemoglobin levels were measured using two independent techniques (ion-exchange column and colorimetric). Concurrent serial oral glucose tolerance tests (75-g glucose load) and erythrocyte indices were obtained. Changes in mean glycosylated haemoglobin were similar with both techniques with a nadir at 17 weeks, a peak at delivery (p less than 0.002 versus 17 weeks) and a fall post-partum. Glycosylated haemoglobin levels in abnormal pregnancies, e.g. diabetic, should be interpreted in the knowledge of these physiological changes.

Adolescent↗
PubMed1984

Genetic and metabolic studies in diabetic neuropathy.

Forty-one diabetic patients with symptomatic diabetic neuropathy were studied together with an equal number of matched diabetic subjects without neuropathy. The acetylator status was determined and HLA-A, B, C and DR antigens were investigated. Metabolic control was assessed by measurement of glycosylated haemoglobin and by the mean of multiple random clinic blood glucose values. No significant difference was observed between the two groups in the proportion of fast and slow acetylators. The distribution of HLA frequencies was similar in subjects with and without neuropathy for both Type 1 (insulin-dependent) and Type 2 (non-insulin-dependent) diabetic patients. When compared with diabetic subjects without neuropathy, the neuropathy group had higher levels of both glycosylated haemoglobin (mean +/- SEM: 50.1 +/- 1.4 versus 57.5 +/- 1.8 mmol hydroxymethylfurfural/mol haemoglobin (10.5 +/- 0.3 versus 12.0 +/- 0.4% haemoglobin A1, p less than 0.01) mean blood glucose (9.3 +/- 0.4 versus 11.3 +/- 0.5 mmol/l, p less than 0.005). This study provides no evidence that genetic factors increase the susceptibility of diabetic patients to develop neuropathy. In contrast, the elevated glycosylated haemoglobin and blood glucose levels strengthen the association between hyperglycaemia and diabetic neuropathy.

Adult↗
PubMed1984

A feasibility study of the use of continuous subcutaneous insulin infusion in a diabetic clinic: patients' choice of treatment.

Insulin-treated diabetic patients attending a busy diabetic clinic were approached to determine their interest in using continuous subcutaneous insulin infusion (CSII) via a portable pump. Three hundred and eighty-two patients were offered the choice of CSII, intensified conventional therapy (ICT) or continuation of less intensified treatment. One hundred and sixteen patients (30.4%) chose CSII, 169 (44.2%) chose ICT, 97 (25.4%) chose the less intensive regimen. Those choosing CSII represented a broad cross section of the clinic population, though older patients with a longer duration of diabetes tended to continue with less intensified therapy. There were no differences between groups in the level of blood glucose control or the prevalence of complications at the outset of the study. Of 104 patients not previously using CSII, 86 have so far commenced the therapy. Twenty-seven (32.6%) of these discontinued within one year, 23 doing so in the first three months of treatment. Metabolic control, assessed by glycosylated haemoglobin, was significantly improved in the CSII group after three months and in the other treatment groups by six months. Glycosylated haemoglobin levels achieved with CSII were significantly lower at three and six months when compared with the other treatments.

Adolescent↗
PubMed1983

Diabetic ketoacidosis associated with outpatient treatment using continuous subcutaneous insulin infusion.

The occurrence of ketoacidosis in out-patient diabetics treated with continuous subcutaneous insulin infusion (CSII) has received little attention. We report two such cases of ketosis, each precipitated by infection and occurring in patients previously well controlled on CSII. This report illustrates that the risk of ketoacidosis is ever present in insulin-treated patients, whether the insulin is infused by pump or injected intermittently.

Diabetes Mellitus↗
PubMed1981

Coping.

Explore the source record for details and available documents.

Child, Preschool↗
PubMedDate not supplied

Elevated glycosylated hemoglobin in diabetic neuropathy.

Glycosylated hemoglobin (GHb) levels were measured in 36 patients with established symptomatic neuropathy and in an identical number of matched controls. Strict criteria were employed in the selection of subjects and all had neuropathy of at least 12 months' duration. The diagnosis of neuropathy was supported by estimation of motor conduction velocities and vibration perception threshold. A semi-automated colorimetric technique, employing the reaction between thiobarbituric acid and 5-hydroxy-methyl furfural, was used for the estimation of GHb. Those patients with neuropathy had significantly higher GHb levels (58.2 +/- 11.3 mmol HMF/mol Hb) than the controls (50.0 +/- 8.9 mmol HMF/mol Hb) (p less than 0.01). This suggests that hyperglycemia or related metabolic abnormalities are important factors in established symptomatic neuropathy.

Diabetes Mellitus↗
PubMedDate not supplied

Continuous subcutaneous insulin infusion in the management of painful diabetic neuropathy.

Nine patients with diabetic neuropathy were treated as outpatients with continuous subcutaneous insulin infusion (CSII). Painful symptoms were scored on a 10-cm horizontal graphic rating scale; motor conduction velocity (MCV) was measured in the median and peroneal nerves; and vibration perception threshold (VPT) was recorded in the great toes. All investigations were repeated after 6 wk and at the completion of 4 mo of CSII. Improved diabetic control was confirmed by significantly lower mean blood glucose levels, M-values, and glycosylated hemoglobin. Symptomatic relief was noted by all patients and was accompanied by a significant improvement in pain scores. There was also significant improvement in VPT and MCV after 6 wk of CSII, which was maintained throughout the 4-mo period. However, sensory studies in the median nerve showed no significant changes during the study. It is concluded that strict glucoregulation is indicated in all cases of symptomatic diabetic neuropathy. It remains to be seen whether strict diabetic control from diagnosis will lead to a reduction in the incidence of this complication.

Adult↗