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J Holcombe

Publications and source records attributed to J Holcombe.

At least 19 recordsLinked to original sources
PubMed1999

Changes in free insulin-like growth factor-1 and leptin concentrations during acute metabolic decompensation in insulin withdrawn patients with type 1 diabetes.

UNLABELLED: To determine the effect of acute insulin withdrawal and its subsequent replacement on components of the insulin-like growth factor (IGF)-1 binding protein system and on circulating leptin levels in patients with type 1 diabetes. Seventeen patients (age 31 yr +/-10) with type 1 diabetes treated with continuous subcutaneous insulin infusion (HbA1c 7.6% +/-1.0) were studied. The protocol consisted of two phases: acute insulin withdrawal of up to 8 h followed by a further 2-h period of insulin replacement. For the first phase the basal insulin infusion was stopped (at 0300 h), and for the second a single dose of either regular human or insulin lispro was given subcutaneously (0.2 U/kg). Plasma insulin, glucose, growth hormone, glucagon, IGF-1, free IGF-1, IGFBP-1, -2, -3 and leptin were measured. RESULTS: After interruption of the basal insulin infusion, plasma free insulin levels fell from 60+/-12.0 pmol/L to 10.8+/-4.2 pmol/L, and plasma glucose rose from 5.6+/-0.4 mmol/L to 14.8+/-1.2 mmol/L (P< 0.01). During insulin withdrawal, IGFBP-1 increased by more than 6-fold (from 32+/-8 to 205+/-17 ng/mL, P<0.001), IGFBP-3 increased significantly (from 2631+/-118 to 3053+/-101 ng/mL, P<0.001), and total IGF-1 levels declined modestly (from 226+/-33 to 182+/-26 ng/mL, P<0.001). In contrast, free IGF-1 concentrations (0.72+/-0.22 ng/mL at baseline) were markedly suppressed during insulin withdrawal to values below the detection limit of the assay (0.08 ng/mL) in 15 of the 17 patients (P<0.001). Circulating plasma leptin declined markedly in females from 20+/-3 ng/mL to 11+/-2 ng/mL (P<0.0001) and in males from 10+/-2 ng/mL to 7+/-2 ng/mL (P<0.02). Within 2 h of insulin replacement, the changes in circulating concentrations of IGFBP-1 and IGFBP-3 were partially reversed, and free IGF-1 levels rebounded to 0.54+/-0.22 ng/mL (P<0.1 vs. insulin withdrawal). Growth hormone, glucagon, and IGFBP-2 levels did not change significantly throughout the study. Despite the rapid restoration of plasma insulin and substrate levels, circulating leptin levels continued to fall in the 2-h period after insulin replacement in both females and males. The marked reduction in circulating free IGF-1 after insulin withdrawal and its increase after insulin administration suggest that acute changes in IGFBP concentrations induced by insulin are important regulators of IGF-1 bioavailability in patients with type 1 diabetes. In both males and females, the rapid induction of severe insulin deficiency is associated with a consistent fall in plasma leptin levels.

Adolescent↗
PubMed1998

Comparison of human regular and lispro insulins after interruption of continuous subcutaneous insulin infusion and in the treatment of acutely decompensated IDDM.

OBJECTIVE: To compare the rapidity of metabolic decompensation after interruption of CSII between human regular and lispro insulin and to compare these two insulins in the correction of the hyperglycemia and ketosis of mildly decompensated IDDM. Lispro insulin may be especially useful for insulin pump therapy (continuous subcutaneous insulin infusion [CSII]). RESEARCH DESIGN AND METHODS: A total of 18 patients with well-controlled IDDM (HbA1c 7.7 +/- 1.1%, age 30 +/- 11 years) were studied. All were being treated with CSII (nine with human regular and nine with lispro insulin). The study consisted of two phases: 1) an insulin interruption phase, in which the basal insulin infusion was stopped (at 0300) and plasma insulin, glucose, and beta-O-hydroxybutyrate (beta-OHB) were measured every 15-60 min for 6 h after interruption of the insulin infusion and 2) an insulin replacement phase, which involved measuring plasma insulin, glucose, and beta-OHB for 2 h after a single injection of either human regular or lispro insulin to correct the hyperglycemia and ketosis that developed during the first phase of the study. RESULTS: After interruption of the basal insulin infusion during the insulin interruption phase, plasma insulin levels fell gradually in both groups to nadir values of 1.6 +/- 0.8 and 2.0 +/- 1.2 microU/ml in the regular insulin- and insulin lispro-treated groups, respectively. Plasma glucose concentrations rose to 13.8 +/- 1.9 and 16.0 +/- 1.7 mmol/l in the regular insulin- and insulin lispro-treated groups, respectively. No significant differences were seen between the therapy groups at any time in the insulin levels or in the concentrations of plasma glucose or beta-OHB. In the insulin replacement phase, insulin levels rose more rapidly in those treated with lispro insulin, reaching a greater peak value (e.g., at 60 min, plasma insulin 25 +/- 3.4 vs. 15.6 +/- 2.6 microU/ml, P < 0.05). In association with this, plasma glucose decreased to a lower nadir after lispro insulin (9.7 +/- 0.4 vs. 13.7 +/- 0.7 mmol/l, lispro- vs. regular-treated groups at 120 min after insulin administration, P < 0.01). beta-OHB levels decreased rapidly in both groups. CONCLUSIONS: In patients treated with CSII, interruption of the basal insulin infusion in the middle of the night does not result in more rapid metabolic decompensation in patients treated with lispro compared with those treated with regular human insulin. Lispro insulin is effective in treating mild ketosis and hyperglycemia, and its rapid action may be advantageous in the "sick day" management at home of patients with IDDM.

Acute Disease↗
PubMed1995

1994 Oncology Nursing Society Research Priorities Survey.

PURPOSE/OBJECTIVES: To determine oncology nursing research priorities as well as the type of research needed to address these priorities. DESIGN: Cross-sectional survey design. SETTING: Mail-out survey with return, postage-paid envelope provided. SAMPLE: A random sample of 10% of Oncology Nursing Society (ONS) members who identified patient care as their primary functional area, the ONS leadership group (e.g., Board of Directors, all committee chairs), all doctorally prepared ONS members, and all members of the ONS Advanced Nursing Research Special interest Group (N = 2,178). METHODS: The questionnaire was based on prior ONS Research Surveys and updated to reflect issues or topics that currently are relevant to oncology nurses. MAIN RESEARCH VARIABLES: Priority ranking of 93 research topics organized into seven major categories. FINDINGS: Seven hundred eighty-nine surveys were returned, for a 36% return rate. The top 10 priorities according to the priority index were pain; prevention; quality of life; risk reduction/screening; ethical issues; neutropenia/immunosuppression; patient education; stress, coping, and adaptation; detection; and cost containment. CONCLUSIONS: The top 10 research issues can be used to develop priorities for the direction of research in oncology nursing. IMPLICATIONS FOR NURSING PRACTICE: The findings provide a basis for identifying trends in nursing practice. The fact that prevention, risk reduction, and detection appear in the top 10 suggests that nurses are moving toward a definition of practice that is not limited to managing symptoms of disease. These findings also provide guidance for forming health policy in cancer care.

Cross-Sectional Studies↗
PubMed1995

Publication of patient-related oncology nursing research.

PURPOSE/OBJECTIVES: To identify publication rates of patient-related studies in oncology nursing research. DESIGN: Survey of publication rates of patient-related research. These results are one component of an integrative review and meta-analysis of a decade of patient-related oncology nursing research. SAMPLE: Authors of abstracts addressing patient-related oncology nursing research submitted for presentation at Oncology Nursing Society (ONS) Congresses from 1981 to 1990 (N = 237) that met the inclusion criteria for the Integrative Review of Oncology Nursing Research. METHODS: Survey letters sent to one author of each patient-related oncology nursing research abstract published in the ONS Congress proceedings. MAIN OUTCOME VARIABLE: Rate of publication. FINDINGS: Of 237 responses, 89 (38%) indicated that the study had been published by late 1991 in a peer-reviewed journal or as a book chapter; 148 abstracts (62%) were unpublished. Study abstracts accepted for podium or poster presentation at ONS Congresses were more likely to be published than those not accepted. CONCLUSIONS: The majority of patient-related oncology nursing research submitted for presentation at ONS Congresses was not published and not readily available for nurses to evaluate for use in clinical practice. Lack of nursing research publication appears to be a serious threat to knowledge development and dissemination in oncology nursing. IMPLICATIONS FOR NURSING PRACTICE: Systematic ways to organize research findings in nursing need to be developed. Experienced researchers and authors need to encourage and assist nurses in conducting research, writing, and submitting manuscripts.

Abstracting and Indexing↗
PubMed1994

Acoustic neuroma: suggestions for helping the patient adapt after translabyrinthine surgery.

An acoustic neuroma is a benign, slow growing tumor which arises from the eighth cranial nerve and produces a variety of symptoms. The translabyrinthine approach is one of the most common surgical procedures employed to remove an acoustic neuroma. Surgical removal may result in frustrating alterations to which the individual must adapt. Patient education can prepare the patient for these alterations and facilitate adaptation.

Adaptation, Psychological↗
PubMed1994

A comparison of three theories of nursing used as a guide for the nursing care of an 8-year-old child with leukemia.

This article evaluates three nursing theories that can be used to provide a framework for holistic pediatric oncology nursing practice: the Roy Adaptation Model, the Neuman Systems Model, and the Orem General Theory of Nursing. Each theory is compared in terms of its view of man, health, environment, nursing, and the nursing process. Critique of each theory is presented. The decision of which theorist to use as a basis for practice is left to the individual nurse. This article explicates the similarities and differences in the three theories.

Child↗
PubMed1994

Use of the cognitive assessment method to evaluate the adequacy of sexually transmitted disease history questions.

Cognitive assessment is an approach used to evaluate questions in survey interviews. This approach is useful in delineating measurement error due to participants' understanding of terms and interpretation of questions. The purpose of this study was to evaluate the quality of questionnaire items designed to evaluate history of sexually transmitted diseases (STDs) using a cognitive assessment approach. Participants recruited from an STD clinic were asked up to six questions to assess their history of STDs. Verbal probes were used after each question in an attempt to evaluate the participants' understanding of the questions and methods they used to recall episodes of having STDs. The findings revealed that respondents did not understand the medical terms for some STDs, that the wording of one question potentially interfered with respondents' comprehension of the question, and that respondents used an episodic recall method to determine their number of previous STD infections. Cognitive assessment is a useful method for identifying potential sources of respondent-induced measurement error.

Adolescent↗
PubMed1994

A survey of recipients of American Cancer Society master's degree scholarships.

PURPOSE/OBJECTIVES: To determine the contributions that recipients of American Cancer Society (ACS) master's degree scholarships have made to oncology nursing and care. DESIGN: Evaluation survey. SETTING: National. SAMPLE: All scholarship recipients since the program's initiation who were at least three years postfunding and who could be located (N = 103). The final sample consisted of 84 respondents. METHODS: Investigators mailed subjects surveys and conducted follow-up phone calls to increase the return rate. The 15-item survey tool contained four open-ended, nine short-response, and two Likert-type scale items. MAIN RESEARCH VARIABLES: Employment experience, ACS involvement, thesis topics, presentations/publications, integration of oncology nursing into practice, perceived ability to influence cancer prevention and detection, and professional goals. FINDINGS: A high rate of master's program completion, direct clinical involvement, ACS involvement, and prevention and detection activities. CONCLUSIONS: Recipients demonstrated a high degree of socialization into oncology nursing. They demonstrated that they are making important contributions to oncology nursing and cancer control. IMPLICATIONS FOR NURSING PRACTICE: Scholarships are an excellent way for oncology nurses to further their education and professional development. After graduation, these nurses are very likely to make strong contributions to nursing.

American Cancer Society↗
PubMed1993

Orem's theory used as a guide for the nursing care of an eight-year-old child with leukemia.

Orem's general theory of nursing provides a framework for holistic pediatric oncology nursing. In this article, an overview of Orem's theory is provided. The theory is used to assess the self-care deficits of an 8-year-old boy who has been diagnosed with leukemia, the ability of the mother to meet the son's self-care demands, and the nursing system needed to assist the mother to meet her son's self-care demands. The theory is used to plan and evaluate the nursing care of this child. A comprehensive list of nursing diagnoses and a nursing care plan for two of these diagnoses are presented.

Child↗
PubMed1993

The Roy Adaptation Model used as a guide for the nursing care of an 8-year-old child with leukemia.

Roy's Adaptation Model provides a framework for holistic oncology nursing practice. In this article, an overview of Roy's model is provided. It is used to assess the behaviors and stimuli influencing the behaviors of an 8-year-old boy with acute lymphocytic leukemia. Planning and evaluating the nursing care of this child is based on the model. A comprehensive list of nursing diagnoses is categorized according to Roy's four adaptive modes, and a nursing care plan for two of these diagnoses is presented.

Adaptation, Physiological↗
PubMed1992

Neuman systems model used as a guide for the nursing care of an 8-year-old child with leukemia.

The Neuman Systems Model (NSM) provides a framework for holistic pediatric oncology nursing practice. In this article, an overview of NSM is given. This model is applied to an 8-year-old child with leukemia for the comprehensive assessment, planning, and evaluation of nursing care. A comprehensive list of nursing diagnoses is categorized by primary and secondary prevention.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

Hope, social support and self-esteem of patients with spinal cord injuries.

A descriptive study was conducted to determine if a relationship among the variables of hope, social support and self-esteem existed in persons with spinal cord injuries. A demographic data sheet and three instruments were used: Miller Hope Scale (MHS), Personal Resource Questionnaire Part II (PRQ) and Rosenberg Self-Esteem Scale (RSES). Of the 83 inpatients and outpatients who agreed to participate, 77 sets of questionnaires were usable. Ages of subjects ranged from 18-73 (mean 34.8) years and levels of injury ranged from C4-L3. The mean scores on the tools were: MHS-153.51 (40-200 possible range), PRQ-137.42 (25-175 possible range) and RSES-29.59 (10-40 possible range). There was a statistically significant relationship between hope and social support, hope and self-esteem and social support and self-esteem. By multiple regression analysis, the best predictors of hope in the subjects were self-esteem, social support and education.

Adult↗
PubMed1990

Hope, self-esteem and social support in persons with multiple sclerosis.

A descriptive study was conducted to determine if a relationship among the variables of hope, self-esteem and social support existed in persons with multiple sclerosis. A demographic data sheet and three instruments were used: Miller Hope Scale (MHS), Rosenberg Self-Esteem Scale and Part II of the Personal Resource Questionnaire (PRQ). Of 75 individuals contacted by mail asking them to participate, 40 sets of questionnaires were returned. The subjects' ages ranged from 32 to 70 with a mean of 48.2. The mean scores on the 3 instruments were: MHS--157.9 (40-200 possible range), self-esteem--29.68 (10-40 possible range), and PRQ Part II--141.13 (25-175 possible range). A statistically significant relationship was found between hope and self-esteem, hope and social support and social support and self-esteem. Additionally, findings were reported and conclusions and nursing implications identified.

Adult↗
PubMed1989

Biosynthetic human growth hormone: current status and future questions.

Human growth hormone derived from human pituitaries resulted in excellent growth in children with growth hormone deficiency but limited supplies in many countries prevented treatment of all children, delayed the onset of therapy, and/or forced the use of doses that may have been less than optimal. Recent advances in technology allow the production of byosynthetic human growth hormone (hGH) by recombinant methods resulting in increased supplies of hormone. More than 200 previously untreated children with growth hormone deficiency have been evaluated for two years or longer while receiving biosynthetic natural sequence hGH (somatropin). The mean growth velocity of 3.6 cm/yr prior to therapy increased to 8.8 cm/yr after one year and 7.25 cm/yr in the second year. Growth response was inversely related to age when calculated as cm/yr. This response paralleled the normal decrease in growth velocity as children approach puberty. Children with hGH deficiency who had previously received replacement hGH were enrolled in a double-blind study using either 0.06 or 0.10 mg/kg thrice weekly for 12 months. Growth rate was significantly greater with the higher dose during the first six months but not during the second six month period. The use of a higher dose of hGH must be individualized as not all patients have accelerated growth with the increased dose and the mean group response is not permanent. Multiple questions remain unanswered after three decades of treating growth hormone deficiency. Are the current criteria for diagnosis of growth hormone deficiency appropriate? What dose of hGH is correct? Do children need increases in replacement therapy as their height approaches normal?(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1987

Detection of diabetic retinopathy by optometrists.

Optometrists examined 25 eyes with varying severity of diabetic retinopathy. No history or clinical information was provided to the optometrists who performed fundus examinations on dilated eyes using direct or indirect ophthalmoscopes. Color stereoscopic fundus photographs were independently graded and used as the standard. Optometrists made a correct diagnosis of whether retinopathy was present in 77% of the eyes (95% confidence interval (CI): 73%, 82%). They made a correct diagnosis of the type and degree of diabetic retinopathy in 57% of the eyes (95% CI: 39%, 75%). This diagnosis rate exceeded the rate reported for physician examiners (39%) and equaled that of general ophthalmologists (52%) in the only other similar study. Sensitivity for diagnosis of diabetic retinopathy in eyes of diabetic patients using only ophthalmoscopy was 74% (95% CI: 67%, 81%), while specificity for diagnosis of the absence of retinopathy was 84% (95% CI: 73%, 96%). 100% of these optometrists would have referred the eye with preproliferative retinopathy. 53% would have referred the eye classified as proliferative retinopathy without high risk characteristics, and 79% would have referred the eye with macular edema.

Adolescent↗
PubMed1984

Cross-cultural variations in the definition of child abuse: nurses in the United States and the United Kingdom.

As a form of social deviance, child abuse is subject to the definitions of various audiences rather than being intrinsic to the act. What is termed abuse varies between cultures, subcultures, etc. An exploratory study investigates similarities and differences in the definition of abuse among a sample of pediatric nurses in two U.S. (N = 18) and two U.K. (N = 34) hospitals. A questionnaire asked respondents to indicate whether they would define each of 14 different acts by a parent to be 'abusive'. The acts, ranging from 'yelling' to 'burning with a cigarette', were presented under two conditions: a five-year old child who, parents claim, (1) was 'yelling and getting on my nerves', and (2) 'would not stop throwing things and damaging furniture even when told to stop over and over'. Attribution of abuse was not greatly influenced by the two given conditions which provoked it. Nurses in the U.K. were slightly more likely than U.S. nurses to consider each act abusive, but the differences were significant for only one item: beating a child with a strap. Differences were reduced controlling for race. Among the U.S. nurses, whites were more likely to see each act as abusive than blacks, but differences were significant for only two items: beating a child with a strap and confinement to a room for the day. Cultural, subcultural, and professional variations in attribution of child abuse are discussed with implications for epidemiological findings. Suggestions for directions in future research on the attribution of abuse are offered.

Black or African American↗