Concepts of the mechanisms of the tumor metastasis.
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Animals↗
Biomedical subjects
J F Potter
Publications and source records attributed to J F Potter.
Motility characteristics of malignant cells.
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Animals↗
Comparison of nifedipine and captopril as third-line agents in hypertensive patients uncontrolled with beta-blocker and diuretic therapy.
The effect of adding either nifedipine or captopril as third-line agents was studied in a single-blind crossover fashion in 24 patients with essential hypertension uncontrolled by combination beta blocker and diuretic therapy. Nineteen patients completed both phases of the study. The mean initial sitting blood pressure before the addition of nifedipine was 164/109 mm Hg and captopril 165/108 mm Hg. Both nifedipine and captopril produced further significant reductions in both sitting and standing blood pressure, 47% of the captopril-treated patients achieving target blood pressure of less than 160/95 mm Hg compared with 67% with nifedipine. Further increase in the dosage resulted in 63% of the captopril- and 81% of the nifedipine-treated patients achieving target blood pressure. There were, however, no statistically significant differences in the mean fall in blood pressure or in the number of patients obtaining target pressure at the end of each treatment period. Captopril treatment also resulted in a small reduction of pulse rate, and, although pulse rates rose with nifedipine, these changes were not significant. Both treatments were generally well tolerated, and serious side effects were not reported. Both nifedipine and captopril were effective and well tolerated as third-line antihypertensive agents.
Adrenergic beta-Antagonists↗
Comprehensive geriatric assessment in the outpatient setting: population characteristics and factors influencing outcome.
The chronic diseases of old age reduce the "active life expectancy" of older persons and result in significant health care expenditures. Yet, among disabled persons, the degree of disability does not explain who actually accesses long-term care (LTC) services. Comprehensive geriatric assessment (CGA) has been proposed as the technology of geriatric medicine which will reduce both excess disability and health care costs. Outpatient CGA programs may be the ideal setting in which to study older disabled persons who are at risk for increasing their use of LTC services. A prospective study of our CGA population suggests that understanding the factors which influence outcome will be critical to designing interventions and improving outcome for this population. CGA patients suffer from a limited number of functionally disabling problems, each of which has a broad array of etiologies. Use of LTC services seems most closely tied to social factors, including the feelings of burden experienced by caregivers. Caregiver burden is a better predictor of service use than any measure of the older person's mental or physical health or functional abilities. Reducing health care costs including nursing facility placement will likely require interventions which reduce caregiver burden. Further definition of the problems seen in the CGA population and delineation of the factors influencing outcome will identify interventions to achieve the desired health care outcomes.
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Dynamic but not static cerebral autoregulation is impaired in acute ischaemic stroke.
It remains unclear as to whether dynamic and static cerebral autoregulation (CA) are impaired in acute ischaemic stroke, and whether these changes are related to stroke subtype. This could have important implications with regard to post-stroke prognosis and the management of blood pressure (BP) in the acute post-ictal period. Using transcranial Doppler ultrasonography and non-invasive manipulation of BP, we compared both mechanisms in 61 patients with ischaemic stroke within 96 h of ictus, and 54 age- and sex-matched controls. There was no difference in static and dynamic CA indices between the various stroke subtypes. Combining all stroke subtypes dynamic autoregulation, as measured using thigh cuff release, was significantly impaired in both the affected and non-affected stroke hemispheres compared to controls (mean autoregulation index 4.1 +/- 3.3, 4.8 +/- 3.1 and 6.2 +/- 2.3, respectively, p < 0.05). By comparison static autoregulation, assessed using isometric hand grip and thigh cuff inflation, was not significantly different. In conclusion, dynamic but not static CA appears to be globally impaired in acute ischaemic stroke. This deserves further study and may identify possibilities for therapeutic intervention.
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A case of arrhythmia-induced transient cerebral hyperaemia.
Transient cerebral hyperaemia following an arrhythmia has not been previously demonstrated in humans. We report the effects of head-up tilt on a 78-year-old man with neurocardiogenic syncope. During tilt, an asymptomatic arrhythmia caused arterial blood pressure and transcranial Doppler-recorded cerebral blood flow velocity to fall markedly. Upon spontaneous resumption of sinus rhythm, cerebral blood flow velocity increased to values greater than those prior to the arrhythmia. This occurred prior to a full recovery of arterial blood pressure, indicating spontaneous transisent hyperaemia. Pressure-flow velocity graphs support current methods of measuring critical closing pressure and demonstrate a rise in critical closing and a fall in resistance-area product after the arrhythmia.
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The effect of antihypertensive treatment on the quality of later years.
There is now a considerable body of evidence demonstrating the benefit of pharmacological therapy in reducing cardiovascular risk in elderly hypertensive patients. With the high prevalence of hypertension that exists in the elderly, the impact of the widespread use of antihypertensive treatment on the quality of life of older individuals requires consideration. Quality of life is a difficult concept to define and thus to measure scientifically. It is most commonly measured in clinical trials using questionnaire-based instruments designed to assess the subjects' perception of their own health and the degree of well-being and satisfaction in various health-related areas of their lives. Nonpharmacological methods of blood pressure reduction are generally regarded as being neutral or beneficial in their effects on quality of life, and deserve prolonged evaluation in elderly patients before introducing pharmacological therapy. The many antihypertensive drug treatments now available have varying impact on quality of life, which should be taken into account when developing a rational approach to antihypertensive intervention in the elderly patient.
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Barriers to vision care for nursing home residents.
OBJECTIVE: To describe the prevalence of periodic eye examinations by eye professionals and to examine nursing facility resident characteristics associated with lack of periodic screening. DESIGN: Retrospective chart review. SETTING: Two Midwestern nursing facilities. PARTICIPANTS: Between 1995 and 1997, 134 subjects aged 60 and older were recruited from two metropolitan nursing facilities. MEASUREMENTS: Nursing home charts were reviewed for: demographics, length of stay, date of eye examination, eye diagnosis,visual acuity. Nursing assessments were used to obtain information about cognition, function, behavior, and the presence of Do Not Resuscitate or Do Not Hospitalize orders. The chart was reviewed for visual acuity, intraocular pressures, and the presence of eye pathology. Individuals who had not had eye examinations in the previous 2 years were screened by an ophthalmologist. This examination included external examination of the eye, fundoscopic examination, tonometry,visual acuity with correction. RESULTS: Only 62 (46%) of the subjects had been seen by an eye care professional in the previous 2 years. Visual acuity information was available for 37/64 previously examined subjects. Of those with no eye examination in the previous 2 years (n = 72), visual acuity was obtained in 32 (44%) of subjects. New eye diagnoses were made in 64% (41/64). Logistic regression models with "eye examination within the past 2 years" as the dependent variable show that residents who do not desire hospital transfer are 80% less likely to have had an eye examination than those without this designation. Sex, age, length of stay, functional status, presence of severe dementia, behavior problems, or DNR orders do not change the likelihood that a resident would have been examined. Logistic regression models with "visual acuity measured" as the dependent variable show that residents with severe dementia are 12.6 times less likely to have acuity measured than those without dementia. Those with a length of stay in the facility less than 6 months are 10% less likely to have visual acuity measured. CONCLUSIONS: This study does not confirm that barriers still exist in the provision of eye care to all nursing home residents, but the prevalence of such assessments remains low. Additional screening results in a substantial increase in the identification of treatable eye diseases. Contrary to the original hypotheses that patient characteristics that make testing difficult would provide a barrier or disincentive to vision testing, this study did not show statistical differences in the rates of vision screening for those with dementia, behavior problems, or severe functional impairment. Severe dementia does seem to affect the ability of the eye care specialist to gather subjective data such as visual acuity. It also demonstrates that vision screening does take place on nursing home residents with a broad range of cognitive and functional abilities, and this screening results in the diagnosis of many treatable eye conditions. Future efforts should be made to increase vision screening and treatment in the nursing home.
Journal Article↗
The prevalence, composition, and function of ethics committees in nursing facilities: results of a random, national survey of American Health Care Association members.
OBJECTIVES: To determine the prevalence, composition, and function of ethics committees in extended care facilities in the United States. DESIGN: Descriptive survey by mail. SETTING: A 5% random sample (n = 851) of nursing facility members of the American Health Care Association (n = 17,020). Most of these facilities (75%) are intermediate care facilities; the remainder include a varying number of skilled beds. METHODS: An eight-item questionnaire was sent to the randomly selected 851 extended care facilities. The questionnaire inquired about the existence of an ethics committee, plans for formation when applicable, composition of the ethics committee, and its function. Survey data was coded and merged with information on facility characteristics that are part of the American Health Care Association's database. RESULTS: Of the responding facilities (n = 394), 34% reported the presence of a functioning ethics committee, with an additional 19% indicating definite plans for ethic committee formation. Forty-three percent expressed no interest in establishing an ethics committee, and 4% reported having had an ethics committee sometime in the past. The greatest proportion of committee time was spent in case review (39%) with lesser amounts of time expended in areas of policy formation (27%) and education (27%). Forty percent of the ethics committees performed two or fewer case reviews per year. Nearly all committees included the following disciplines in the membership: nurses (96%), physicians (95%), and social workers (89%). Facility administrators (77%) and clergy (70%) were frequently represented. Very few facilities reported representation by residents (8%) and Certified Nursing Assistants (2%). The Medical Director served as a committee member on 75% of the ethics committees, and in more than one-half of those instances, he/she was the sole physician on the committee. CONCLUSION: Ethics committees are currently active in or there are plans for their development in more than 50% of extended care facilities in the U.S. this represents a very significant increase in prevalence during the last decade. This tendency to form ethics committee's may slow considerably in the future. Ethics committees exhibit considerable variability in structure and function.
Journal Article↗