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Biomedical subjects

J Fletcher

Publications and source records attributed to J Fletcher.

At least 91 records · Page 5Linked to original sources
PubMed1998

Cleft lip with or without cleft palate: effect of family history on reproductive planning, surgical timing, and parental stress.

OBJECTIVE: This study tested whether the presence of a family history of nonsyndromic cleft lip with or without cleft palate (NSCLP) lessens the negative impact on reproductive planning, decreases treatment anxiety, and relieves parental stress when there is a recurrent cleft. DESIGN: Sixty-one participating families, retrospectively ascertained through their children with NSCLP, were divided into two groups: those with a family history of clefting and those in which only the proband was affected. SETTING: Each family completed a questionnaire either at their home or during a clinic visit. PARTICIPANTS: Questionnaires were distributed to 117 families with an NSCLP child. Of these 117, 49 (42%) had another family member with NSCLP and 68 (58%) had no prior history of clefting. Sixty-one (52%) families returned the questionnaire and were categorized by family history. MAIN OUTCOME MEASURES: The Parenting Stress Index and the Hollingshead Index of Social Position were included with family and medical history questions in the 137-item questionnaire. RESULTS: The reproductive plans of the two groups were quite similar and were not dependent on the families' actual or perceived recurrence risks of NSCLP. The majority (85%) of the children with NSCLP underwent surgical closure at the recommended age. The two groups did not significantly differ on any score on the Parenting Stress Index, indicating a similar parental stress level between the groups. CONCLUSIONS: These findings suggest that family history does not significantly influence reproductive plans, timing of cleft repair, or stress of parents of a child with NSCLP. Further, these results indicate a need for additional psychosocial study of this population.

Adolescent↗
PubMed1998

Planning and implementing an anesthesia crisis resource management course for student nurse anesthetists.

Development of Anesthesia Crisis Resource Management (ACRM) skills is a highly desirable outcome of a nurse anesthesia educational program. Access to an ACRM course is limited by a variety of factors including cost, availability of a center, time constraints, and the lack of adequately prepared CRNA faculty. The authors describe a Nurse Anesthesia Program's planning and implementation of an ACRM course by using a high fidelity human simulator. Key supportive and logistical elements necessary to implement an ACRM course are described. The authors address administrative concerns, faculty preparation needs, and explain the process of course design. Strengths of the course and problems encountered during the implementation of the experience are described. Feedback from participating students, faculty perceptions, and lessons learned from the experience are shared.

Clinical Competence↗
PubMed1998

Use of the WWW for distributed knowledge engineering for an EMR: the KnowledgeBank concept.

Developing automated tools for clinical information management requires an appreciation of user needs and capabilities. To address the reality of practice style variation, and the varying degree of comfort with computers in clinical users, we developed the KnowledgeBank concept. The KnowledgeBank concept includes an end-user authoring tool for clinical content in the EMR, and a web-based repository of content for sharing clinical content. We describe the early experiences of end-users using the KnowledgeBank.

Artificial Intelligence↗
PubMed1997

Wound care: the healing process.

When caring for a patient with a wound, regardless of its aetiology, a thorough assessment of the patient, the wound and any other relevant factors must be undertaken before care can be planned, if a successful outcome is to be achieved and realistic time scales set. Accurate wound assessment and appropriate care planning is dependant upon an understanding of the physiology of healing and any factors that may potentially delay or prolong the healing process. To be accurate and meaningful the information recorded should be concise, objective and comprehensive.

Attitude to Health↗
PubMed1997

Molecular characterization of a gene encoding a membrane protein of Spiroplasma citri.

A 9.6-kb genomic DNA segment, previously cloned from the phytopathogen Spiroplasma citri BR3-3X [Fletcher et al. (1981) Phytopathology 71, 1073-1080], contained several open reading frames including one encoding a 58-kDa protein. In this work, the transcription initiation site of the P58 mRNA was mapped and part of the gene was expressed in Escherichia coli as a fusion protein. A synthetic peptide, whose sequence is included in the fusion protein, was produced. Antibodies against both the fusion protein and the peptide reacted with a 60-kDa protein in a S. citri total protein extract. Hydrophobicity characteristics of this protein and its fractionation into the detergent phase indicated that P58, which shares limited sequence similarity with the adhesin of Mycoplasma hominis and the attachment protein of M. genitalium, is an integral membrane protein.

Adhesins, Bacterial↗
PubMed1997

Hodgkin's disease in patients older than 70 years of age: a registry-based analysis.

Between 1973 and 1993, 529 patients aged 15 years and over with Hodgkin's disease (HD) were entered into a lymphoma registry. Twenty-eight cases (1 only diagnosed at autopsy) of histologically proven HD in patients aged 70 years or older were identified. The distribution of sex, 'B' symptoms, histology and stage was not significantly different from that of younger patients, except for the fact that there were no patients aged 70 years or older with lymphocyte predominant HD. Nineteen patients were treated radically, 5 patients palliatively and 4 patients received no radiotherapy or chemotherapy. Three of the 14 patients treated with chemotherapy achieved the planned dose intensity. The cause-specific 5-year survival was 75% for patients aged 15-69 years and 28% for patients aged 70 years and over (logrank chi(2) = 43.7, P < 0.00001). The younger and older groups treated with radical intent had complete response rates of 97% and 74%, respectively (logrank chi(2) = 17.91, P < 0.00001) and relapse rates at 5 years of 27% and 56%, respectively (logrank chi(2) = 4.86, P = 0.0275). The main reason for the poorer prognosis of patients aged 70 years and over was the increasing difficulty of chemotherapy delivery associated with advancing age.

Age Factors↗
PubMed1997

Pharmacomanipulation of HSV-1 induced chorioretinitis in mice.

In the von Szily mouse model, intracameral inoculation of herpes simplex virus type-1 (HSV-1) results in inflammation of the ipsilateral anterior segment with relative chorioretinal sparing and destructive contralateral chorioretinitis. We studied the effect of the systemic antiviral agent acyclovir (ACV) and anti-HSV-1 antibody therapy in this model. Contralateral chorioretinitis developed in none of the 18 mice receiving ACV from post-inoculation day (pid) 1 (p < 0.0001), in 6 of 10 (60%) mice when treatment was delayed until pid 7 (p = 0.40) and in 14 of 18 (77%) controls. Contralateral disease developed in 8 of 16 (50%) mice that received anti-HSV-1 antibody from pid 1 (p = 0.02), in 13 of 16 (81%) treated from pid 5 (p = 0.64), in 7 of 8 (87.5%) treated from pid 7 (p = 1.0) and in 17 of 20 (85%) controls. We conclude that early treatment with ACV or anti-HSV-1 antibody reduces the incidence of contralateral chorioretinitis in mice.

Acyclovir↗
PubMed1997

Ex vivo neutrophil function in response to three different doses of glycosylated rHuG-CSF (Lenograstim).

Granulocyte colony-stimulating factor (G-CSF) is being considered as adjuvant treatment for infections in non-neutropenic patients. Normal healthy donors were given rHuG-CSF (Lenograstim) at 2.5, 5.0 and 7.5 micrograms/kg subcutaneously daily for 5 d. Polymorphonuclear leucocyte (PMN) function tests were carried out on peripheral blood PMN before the first injection and at 24 h and 96 h. Circulating PMN levels were also measured at these time intervals and found to be significantly increased with all doses by 24 and 96 h. Investigation of cell surface antigen expression revealed no changes in beta 2 integrin (CD11b/ CD18) expression. L-selectin (CD62L) expression was reduced with all doses by 96 h, this being significant with the 7.5 micrograms/kg dose. Fc gamma RI (CD64) levels were significantly up-regulated with the 7.5 micrograms/kg dose by 96 h whereas Fc gamma RIII (CD16) expression was found to be reduced during G-CSF treatment. Superoxide anion production was significantly increased in response to N-formylmethionyl-leucylphenylalanine (FMLP) and opsonized Staphylococcus epidermidis stimulation at 24 h and 96 h with the 5.0 and 7.5 micrograms/kg doses. The initial rate of phagocytosis (0-2 min) appeared to have increased with the 7.5 and 5.0 micrograms/kg doses at 96 and 24 h compared with PMN responses pretreatment, although these increases were not statistically significant. These results show that G-CSF enhances the functional responses of PMN stimulated by physiological agnonists and may help in the treatment of infections.

Adjuvants, Immunologic↗
PubMed1997

Do nurses really care? An agenda for higher education following recent mergers.

This paper considers how the mergers of colleges of nursing into higher education may offer an opportunity to address the situation revealed in a previous paper, which suggested that nursing as practised, rather than as theorized, fails to live up to its claim to be regarded consistently as a caring profession. The economic position in which higher education currently finds itself, and which impacts on mergers, is summarized before reforms to nurse education are considered, in terms of their implications for students, staff, research, and the courses themselves. The agenda for change is substantial and urgent. The paper concludes by maintaining that the absorption of colleges of nursing into higher education is to be seen, not as a threat, but as an unprecedented opportunity for nursing to begin to realize fully its professional aspirations.

Attitude of Health Personnel↗
PubMed1997

Do nurses really care? Some unwelcome findings from recent research and inquiry.

This paper examines the position of nursing as a caring profession, in terms of an ethical code that stresses collegial relationships, a sense of obligation to a clientele that is realized in terms of expert service, and a clearly defined body of research-derived knowledge as the basis for practice. It also investigates the substance of the claim that nursing has tended to arrogate to itself another operational distinction-its exclusive capacity to blend physical and emotional support into care. A review of recent research and investigation, undertaken in a number of countries, suggests that nursing as practiced, rather than as theorized, fails to fulfil its wider professional aspirations, and to fulfil its caring rhetoric. A related paper will consider how the absorption of nursing into higher education might begin to play a part in developing and consolidating the professionalization of nursing.

Attitude of Health Personnel↗
PubMed1997

Gene expression in the pulp of ripening bananas. Two-dimensional sodium dodecyl sulfate-polyacrylamide gel electrophoresis of in vitro translation products and cDNA cloning of 25 different ripening-related mRNAs.

mRNA was extracted from the pulp and peel of preclimacteric (d 0) bananas (Musa AAA group, cv Grand Nain) and those exposed to ethylene gas for 24 h and stored in air alone for a further 1 (d 2) and 4 d (d 5). Two-dimensional sodium dodecyl sulfate-polyacrylamide gel electrophoresis of in vitro translation products from the pulp and peel of these fruits revealed significant up-regulation of numerous transcripts during ripening. The majority of the changes were initiated by d 2, with the level of these messages increasing during the remainder of the ripening period. Pulp tissue from d 2 was used for the construction of a cDNA library. This library was differentially screened for ripening-related clones using cDNA from d-0 and d-2 pulp by a novel microtiter plate method. In the primary screen 250 up- and down-regulated clones were isolated. Of these, 59 differentially expressed clones were obtained from the secondary screen. All of these cDNAs were partially sequenced and grouped into families after database searches. Twenty-five nonredundant groups of pulp clones were identified. These encoded enzymes were involved in ethylene biosynthesis, respiration, starch metabolism, cell wall degradation, and several other key metabolic events. We describe the analysis of these clones and their possible involvement in ripening.

Down-Regulation↗
PubMed1997

Helical computed tomography in the assessment of abdominal aortic pathology.

A pilot study was undertaken to evaluate the role of helical computed tomography in the assessment of abdominal aortic pathology. A total of 17 patients underwent intra-arterial digital subtraction of angiography (IADSA) and helical computed tomography, with eight patients undergoing subsequent operative intervention. A comparison of radiological findings between IADSA and helical computed tomography (CT) was made and, where applicable, a comparison was made with operative findings. Pathology included abdominal aortic aneurysm (AAA) (n = 12), thoraco-abdominal aneurysm (n = 2) and dissection (n = 1), graft distension following AAA repair (n = 1) and plaque haemorrhage in the distal aorta following percutaneous transluminal angioplasty (PTA) of the iliac artery (n = 1). Planned operative management as based on pre-operative helical CT imaging findings, in particular with reference to the type of graft used (straight or bifurcated) was not changed at operation. Our findings on helical CT in regards to AAA, thoroco-abdominal aneurysm and dissection correlated well with angiography and surgery findings.

Aged↗
PubMed1997

Phonological processing skills in speech and language impaired children.

Phonological processing has been shown by many researchers to be strongly related to the acquisition of reading and spelling skills. Children with speech and language impairment appear to be at increased risk for phonological processing problems and hence literary difficulties. However, not all children with speech and language impairment experience difficulties: the literature is not clear as to which groups of speech and language impaired children are most severely affected nor which aspects of phonological processing are most likely to be impaired. Rigorous subject selection was employed to compare the performance of four groups of 20 children, aged approximately 6 years: speech-impaired (Speech); language-impaired (Language); speech and language impaired (Mixed); and children with normally developing language (Normal), by use of a battery of phonological processing tasks. The results supported the research that has shown speech and language impaired children to have weaker phonological processing skills than the general population. All the subjects in this sample appeared to be at risk: the Mixed children demonstrated the most difficulty, followed by the Language group, with the Normal group performing the best. Whilst the Speech group as a whole performed significantly more poorly than the Normal group, it consisted of two levels of performance which, on post hoc analysis were shown to relate to the pattern of speech impairment exhibited by the child.

Child↗
PubMed1997

Interactions between periodontopathogenic bacteria and cytokines.

Cytokines produced in response to plaque bacteria clearly play a key role in the periodontal diseases. However, we know very little about the interactions between cytokines and periodontopathogenic bacteria. The aims of this study were to determine whether the key pro-inflammatory cytokines interleukin-1 beta (IL-1 beta) and IL-6 could affect the growth of Actinobacillus actinomycetemcomitans or Porphyromonas gingivalis and to determine whether these organisms could hydrolyse IL-1 beta, IL-6 or the anti-inflammatory IL-1 receptor antagonist (IL-1ra). Culture medium containing up to 100 ng/ml of IL-1 beta or IL-6 was inoculated with A. actinomycetemcomitans (serotypes a, b and c) or P. gingivalis and growth was monitored by measuring changes in electrical conductivity every 3 min for up to 48 h. IL-1 beta, IL-6 or IL-1ra were added to culture supernatants and incubated for up to 24 h. Samples were taken at various times, analysed by SDS-PAGE and the separated proteins transferred by Western blotting to PVDF membranes and probed with anti-cytokine antibodies. None of the cytokines tested had any effect on the rate of growth or yield of A. actinomycetemcomitans or P. gingivalis. Supernatants from P. gingivalis cultures, but not those from A. actinomycetemcomitans, hydrolysed IL-1 beta, IL-6 and IL-1ra. The hydrolysate from the P. gingivalis supernatant-treated IL-1 beta was unable to stimulate the release of IL-6 from human gingival fibroblasts showing that it had lost biological activity. These results suggest that P. gingivalis can perturb the cytokine network, not only by stimulating the release of cytokines from host cells, but also by removing them from its local environment.

Aggregatibacter actinomycetemcomitans↗