Search PubMed⌕ Search

Biomedical subjects

J McKay

Publications and source records attributed to J McKay.

At least 37 records · Page 2Linked to original sources
PubMed1998

Validating the Braden Scale for the prediction of pressure ulcer risk in blacks and Latino/Hispanic elders: a pilot study.

The purpose of this pilot study was to examine the Braden Scale for Predicting Pressure Sore Risk and determine which variables predict pressure ulcer risk in Black and Latino/Hispanic elders. A prospective clinical design was used to conduct the study. Among 36 patients, 60 years of age or older, 14 (38%) developed a pressure ulcer. A Fisher Exact test (2-tail) revealed that, at a cut-off score of 16, the Braden Scale significantly underpredicted those patients at risk for pressure ulcers (5.13 E-03). Sensitivity was 35 percent and specificity was 100 percent for a Braden Scale score of < or = 16.

Black or African American↗
PubMed1997

Audit and summative assessment: system development and testing.

Registrars in general practice have to submit an audit project as one of four parts of summative assessment. A criterion-referenced marking schedule has been developed in the West of Scotland, consisting of five independent criteria all of which have to be judged above minimum competence to pass. A system was developed to test the instrument using a marking exercise which calculated the sensitivity and specificity of the assessment process, for different combinations of assessors. One hundred and two registrar audit projects were then assessed by three independent assessors. Ninety-two (90%) passed and 10 projects (10%) were referred back to the registrar as being below minimum competence. After resubmission six projects (6%) passed, two projects (2%) were still below minimum competence, and two (2%) were not resubmitted. A referral process for assessing the audit projects of general practice registrars has been developed to maximize the opportunity of finding a project below minimum competence.

Education, Medical, Graduate↗
PubMed1997

Results of two levels of adjunctive treatment used with the nicotine patch.

The authors compared 9-, 16-, 26-, and 52-week outcomes for two randomly assigned groups of nicotine-dependent subjects: 1) nicotine patch plus four smoking cessation sessions with a nurse-practitioner giving advice and instruction (n = 36; moderate-intensity condition, MI); or 2) the foregoing treatments plus 16 weekly individual cognitive/ behavioral relapse-prevention therapy sessions (n = 33; high-intensity condition, HI). Patch completion rates were 69.7% in the HI group and 55.6% in the MI group (NS). Self-reported abstinence rates at the four follow-up points were comparable for the two treatment groups; HI: 39%, 36%, 36%, and 36%; MI: 44%, 28%, 25%, and 28%, respectively. There was some indication that MI patients with high nicotine dependence had lower abstinence rates than highly dependent HI patients.

Administration, Cutaneous↗
PubMed1996

Accelerated loss of telomeric repeats may not explain accelerated replicative decline of Werner syndrome cells.

The Werner syndrome (WS) is characterized by the premature onset and accelerated rate of development of major geriatric disorders, including atherosclerosis, diabetes mellitus, osteoporosis, ocular cataracts, and various neoplasms. Cultures of WS skin-fibroblastlike cells have been previously shown to undergo accelerated rates of decline of the replicative potentials and to exhibit variegated chromosomal translocations and deletions. Since the replicative decline of normal somatic cells is associated with a loss of telomeric repeats, we investigated the kinetics of telomeric repeat loss in WS cells. The mean length of telomere restriction fragments (TRF) from the earliest passages of WS cells studied was not shorter than those of controls, possibly reflecting selective pressure for subsets of cells with relatively high residual replicative capacity. Statistical evidence indicated an accelerated shortening of TRF length in serially passaged WS cultures, but the mean TRF lengths of WS cultures that had ceased replicating were significantly longer than those of senescent controls. Thus, while accelerated loss of telomeric repeats could potentially explain the rapid decline in proliferation of WS cells, it is possible that WS cells exit the cell cycle via mechanisms that differ from those of replicatively senescent cells from control subjects.

Adult↗
PubMed1996

Evidence that a nereistoxin metabolite, and not nereistoxin itself, reduces neuronal nicotinic receptors: studies in the whole chick ciliary ganglion, on isolated neurons and immunoprecipitated receptors.

Nereistoxin (100 microM, 2-10 min) blocks nicotinic receptors in the intact chick ciliary ganglion. This effect mimics blockade by the reducing agent dithiothreitol (2 mM, 20 min), which is not reversed until oxidation with dithiobisnitrobenzoic acid (1 mM, 5 min). After treating intact ganglia with either nereistoxin or dithiothreitol, the affinity alkylating agent bromoacetylcholine causes irreversible blockade that cannot be reversed by dithiobisnitrobenzoic acid. These data suggest that nereistoxin, or a metabolite, acts to reduce nicotinic receptors, although nereistoxin differs from dithiothreitol in that agonists only partially protect against nereistoxin reduction. In studies on chick retina, we previously proposed that a metabolite of nereistoxin (such as dihydronereistoxin) is the actual reducing agent for neuronal nicotinic receptors. Current findings in chick ciliary ganglion supporting this hypothesis include: 1) changing pH alters the minimal nereistoxin concentration needed for blockade in intact ganglia, but has little effect on the minimal concentration needed for dithiothreitol, 2) application of a quaternary analog of nereistoxin has little effect on intact ganglion, but a quaternary analog of dihydronereistoxin blocks nicotinic receptors by reduction, 3) nereistoxin weakly oxidizes rather than reduces immunoprecipitated receptors from chick brain and 4) in whole-cell patch-clamp studies, nereistoxin clearly does not reduce receptors on chick ciliary neurons, although dihydronereistoxin mimics receptor blockade by dithiothreitol, and requires oxidation by dithiobisnitrobenzoic acid for reactivation. Together, these data suggest that nereistoxin is not a direct reducing agent for neuronal nicotinic receptors.

Acetylcholine↗
PubMed1996

Evaluating the effectiveness of addiction treatments: reasonable expectations, appropriate comparisons.

Problems of alcohol and drug dependence are costly to society in terms of lost productivity, social disorder, and avoidable health care utilization. The dollar costs of alcohol and drug use run into billions of dollars, and from one-eighth to one-sixth of all deaths can be traced to this source. However, the efficacy of treatment for addiction is often questioned. A rationale for reasonable expectations of addiction treatments is offered, from which are derived three outcome criteria for judging the effectiveness of treatments: reduction in substance use; improvement in personal health and social function; and reduction in public health and safety risks. Based on these criteria, treatment was shown to be effective, especially when compared with alternatives like no treatment or incarceration. These evaluations, which were conducted in a scientific manner, support the continued value of public spending for carefully monitored treatment of addiction.

Attitude to Health↗
PubMed1996

Hydration assessment during cold-weather military field training exercises.

To quantify the magnitude of dehydration and to identify predictors of dehydration by utilizing changes in total body water (TBW), 24 male Marines were studied during an 8d moderately cold-weather (1-3 degrees C) training exercise. Training consisted of approximately 12 h/d of moderately intense activity. Variables examined included body composition, TBW, and various blood and urinary parameters indicative of hydration. Dietary food and fluid records were also maintained. Body composition changes were consistently with the high energy expenditure and insufficient energy intake. Despite a decrease in TBW, significant dehydration as assessed by blood and urinary parameters did not occur over the 8d period, therefore no relationships were found between TBW and any of the clinical indicators of dehydration. The change in TBW was reflective of a decrease in lean body mass. These data suggest that during cold-weather military field exercise, despite high activity levels and a negative energy balance, body fluid balance can be maintained when particular attention is paid to fluid intake.

Adult↗
PubMed1995

To use or to refuse cocaine--the deciding factors.

Two types of narratives were obtained from 35 cocaine-addicted patients: narratives about using cocaine and narratives about not using cocaine. The most prevalent factors in using cocaine were (a) having enough money, (b) wish to end physical/emotional pain, and (c) wish/decision to use. The factors in narratives about not using cocaine were (a) patient arranged conditions to be nonstimulating for using cocaine, (b) recognition of bad consequences, and (c) wish/decision not to use. It is clear in both the cocaine-using episodes and not-using episodes that the patient's wish/decision is important. The conditions for using cocaine tended to be more external, whereas those for not using tended to be more internal. Similar conditions were found by a questionnaire method. A major treatment implication of these findings is that the focus of therapy can be directed to planning strategies to minimize influence of the external factors and to rehearse strategies to prepare for situations involving cues that influence use of cocaine.

Adult↗
PubMed1995

Audit and summative assessment: two years' pilot experience.

An audit project has been submitted by all trainees in the West of Scotland since 1992 as part of a pilot process for summative assessment. The impact of 2 consecutive years of audit was assessed on 117 trainees in May 1994. A response rate of 89% was achieved. For 82 trainees (79%) this was their first practical experience of audit and as a result of it 85% felt more confident in introducing change to their next practice. Protected time was still a problem for the majority (53%) and one-third wanted more help from their trainer. Thirty trainees (29%) had attended four or fewer formal practice meetings in their 10 months of training, with 10% never having attended one. The previous trainee's audit project was rarely or never discussed with 70 trainees (87%) and only 12 trainees were evaluating changes recommended. An audit project as part of summative assessment may be encouraging trainees to think about change after they leave their training practices. Few, however, are evaluating change and protected time and support are still required. The marking of the summative assessment audit project may need to address this.

Education, Graduate↗
PubMed1995

General practitioner trainees' experience of undertaking audit projects: preliminary report from the west of Scotland region.

BACKGROUND: Departments of general practice increasingly provide formal teaching in audit. However, little is known about audit projects carried out by trainees in general practice. AIM: A study was undertaken to ascertain general practitioner trainees' experience of undertaking an audit project in the trainee year, with reference to their understanding of audit theory, perceived usefulness of the project in enhancing clinical knowledge, time taken to do the audit and practice team involvement in the project. METHOD: All 104 trainees in the west of Scotland region completing their trainee year on 31 July 1993 were sent a postal questionnaire that month. The replies to the questionnaire were analysed and compared with the audit project that each trainee had submitted in June 1993 as part of a pilot project for summative assessment. RESULTS: Responses were received from 103 trainees (99%). Seventy trainees (68%) felt strongly that their audit project was relevant to patient care but only 31 (30%) felt strongly that the project was a useful way of enhancing clinical knowledge of the disease process. Data collection was the most time consuming aspect of the audit project, 23% of trainees reporting taking a day or more to complete this stage. Trainees who chose their own audit project were more likely to complete two sets of data collection than those who had not chosen their own project. Seventy nine trainees (77%) indicated that trainers had been involved in their project and 51 trainees indicated that one of the other practice partners had been involved in their project. CONCLUSION: Performing an audit as a trainee is feasible in the time limit of the one year in general practice. The educational benefit appears to be limited to the knowledge of audit process, rather than to clinical knowledge. Audit projects of relevant size and complexity, involving appropriate members of the practice team, are to be encouraged, as is the development of an instrument for assessing trainee audit.

Education, Medical, Continuing↗
PubMed1995

Audit and summative assessment: a criterion-referenced marking schedule.

BACKGROUND: 1996 will see the introduction of summative assessment of general practitioner registrars (trainees). One part of this assessment is the written submission of practical work. In the west of Scotland, audit projects have been chosen as the format for practical work. A valid and reliable marking schedule for such projects is needed. AIM: A study was undertaken to develop a criterion-referenced marking schedule for assessing registrars' audit projects for summative assessment. METHOD: Medical and non-medical professionals, in a series of workshops, compiled a list of essential elements of good audit. These features were tested and refined using registrars' audit projects. All trainers in the west of Scotland were then sent a list of 14 criteria and asked to indicate whether each criterion was an essential or desirable component of a registrar's audit project for summative assessment. A final workshop was held to develop an audit marking schedule. RESULTS: Of 155 trainers in the west of Scotland, 135 replied to the list of criteria for registrar audit projects (87%). Ten criteria were deemed essential or desirable by 80% or more of the respondents. Participants in the final workshop selected five criteria which would form the audit project marking schedule for registrars undergoing summative assessment. These were: defined reason for choice of audit project, relevance of criteria chosen, appropriate preparation and planning, appropriate interpretation of relevant data and detailed proposals for change. For an audit project to pass assessment all five criteria must be present. CONCLUSION: A criterion-referenced approach to assessing registrars' audit projects, developed from their trainers' opinions of essential or desirable criteria for good audit, is described. Further evaluation of the criterion-referenced marking schedule is required.

Educational Measurement↗
PubMed1994

Reduced femoral neck bone density in the daughters of women with hip fractures: the role of low peak bone density in the pathogenesis of osteoporosis.

Low bone density in women with hip fractures ("senile" osteoporosis) may be due to excessive bone loss or low peak bone density. If excessive bone loss is responsible, then no reduction in bone density is expected in their daughters. If low peak bone density is responsible, then bone density should also be reduced in their daughters because genetic and family environmental factors influence the variability in bone density. Bone density was measured using dual-photon absorptiometry and expressed as a standardized deviation or Z score relative to 697 controls, adjusting for age, height, weight, and menopausal status. In 74 women with hip fractures, the Z score (mean +/- SEM) was -0.52 +/- 0.14 (P < 0.001) at the femoral neck, -1.04 +/- 0.17 (P < 0.001) at the femoral shaft, and -0.43 +/- 0.10 (P < 0.001) at the lumbar spine. In their 41 daughters, the Z score was -0.40 +/- 0.17 (P < 0.05) at the femoral neck, -0.41 +/- 0.19 (P < 0.001) at the femoral shaft, and 0.23 +/- 0.13 (NS) at the lumbar spine. We conclude that daughters of women with hip fractures are likely to be at increased risk for hip fractures themselves because they have reduced femoral neck bone density. Femoral neck fractures may not be entirely attributable to trauma; reduced bone density is likely to contribute and may be caused by the attainment of a lower peak femoral neck bone density.

Absorptiometry, Photon↗
PubMed1994

Managing expectations between patient and nurse.

With increasing consumer interest in the cost and quality of healthcare, it is imperative that patients' expectations of nursing care be recognized and managed. This concept is critical to the continued viability of any healthcare institution in the current competitive market. The authors describe the process that one hospital undertook in looking at patient satisfaction with nursing care, the modification of a patient satisfaction tool, and the development of a quality model of care.

Humans↗
PubMed1994

Comparison of three immunoassays for the determination of N-acetylprocainamide. Determination of false elevations by a polyclonal antibody-based method.

The performance of the ROCHE FP NAPA reagent, a newly reformulated monoclonal antibody-based fluorescence polarization immunoassay (FPIA) for N-acetylprocainamide, was compared with two commercially available polyclonal antibody-based immunoassays, the Abbott TDx and Syva EMIT. Although excellent correlation was observed between the ROCHE FP NAPA reagent and the Syva EMIT reagent, a positive bias was observed in the correlation between the ROCHE FP NAPA reagent and the Abbott TDx reagent. The bias in the TDx method was investigated further by the concurrent high-performance liquid chromatography (HPLC) analysis of patient samples. Insignificant differences (p < 0.05) were observed between the HPLC and ROCHE FP values. The TDx system, however, yielded significantly higher (p < 0.0005) results than did HPLC.

Acecainide↗
PubMed1993

Body composition following hemodialysis: studies using dual-energy X-ray absorptiometry and bioelectrical impedance analysis.

The detection, prevention and treatment of disease is greatly facilitated by the availability of accurate and non-invasive techniques for measuring the amount and regional distribution of fat mass and fat-free mass. As differing degrees of hydration may influence these measurements, we used dual-energy X-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA) to detect changes in hydration following hemodialysis, and to determine whether fat mass, fat-free mass and bone density measurements were affected by these fluid changes. Ten subjects (7 men, 3 women) mean age 46.2 years (range 25-68 years), with renal failure had bone density, fat-free mass and fat mass measured by DXA, and total body water and fat-free mass measured by BIA, before and after hemodialysis. Thirty-two subjects had fat-free mass measured by DXA and BIA in an attempt to derive new equations (using fat-free mass measured by DXA as the reference standard) to improve the predictive value of BIA. The new equations were then used to derive the changes in fat-free mass following hemodialysis measured using BIA. In absolute terms, total tissue measured by DXA (r = 0.99, p = 0.01) and total body water measured by BIA (r = 0.91, p = 0.01) correlated with gravimetric weight. Following hemodialysis, fat mass and bone density measured by DXA were unaffected by the fluid changes. The change in gravimetric weight was 1.8 +/- 0.3 kg, p = 0.01 (mean +/- SEM). This change was measured as 1.9 +/- 0.3 kg by DXA, -0.9 +/- 1.0 kg by BIA using the published equation for fat-free mass, and 3.2 +/- 0.4 kg using the new equation for fat-free mass.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗