Access to palliative care in the USA: why emphasize vulnerable populations?
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Ethnicity↗
Biomedical subjects
J O'Neill
Publications and source records attributed to J O'Neill.
Palliative care in the age of HIV / AIDS. Conclusions from the meeting.
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Financial Support↗
Superoxide dismutase and catalase do not affect the pulmonary hypertensive response to group B streptococcus in the lamb.
The purpose of this study was to determine whether treatment with conjugated antioxidant enzymes could attenuate or abolish pulmonary hypertension induced by group B streptococcus (GBS). Lambs, 3-7 d old, were anesthetized and ventilated. Intravascular catheters were placed in the left ventricle, descending aorta, right atrium, and pulmonary artery for continuous monitoring of intravascular pressures. Cardiac output was measured with radiolabeled microspheres. Measurements were obtained at baseline and 15 and 60 min into a 60-min GBS infusion, and 60 min after GBS was stopped. Blood gas values were held constant and PaO(2) was maintained >100 mm Hg. The control group received saline vehicle only (n = 6), the GBS group received GBS infusion only (n = 9), the enzymes (ENZ) group received polyethylene glycol-superoxide dismutase (PEG-SOD) and polyethylene glycol-catalase (PEG-CAT) treatment only (n = 6), and the ENZ+GBS group received PEG-SOD and PEG-CAT then GBS (n = 9). Plasma samples were obtained to confirm increased superoxide dismutase and catalase activities in the groups receiving enzymes. Compared with baseline, pulmonary vascular resistance increased by 119% and 101% at 15 min and 87% and 81% at 60 min in the GBS and ENZ+GBS groups, respectively. Sixty minutes after the termination of the GBS infusion, PVR returned to baseline in the GBS group but did not in the ENZ+GBS group. Enzyme infusions resulted in at least a ninefold increase in plasma enzyme activities. As opposed to previously published data from endotoxin models, PEG-CAT and PEG-SOD were ineffective in altering the GBS-induced pulmonary hypertensive response in this model. This suggests that acute administration of antioxidant enzymes may not be effective in ameliorating GBS-induced pulmonary hypertension.
Animals↗
Health motivation: a determinant of older adults' attendance at health promotion programs.
The primary purpose of conducting this study was to determine if there is a significant relation between health motivation and participation in health promotion programs in a sample of community-dwelling older adults (n = 106). Health motivation was measured using Cox's (1985) Health Self-Determinism Index, and participation in health promotion programs was measured by tallying the self-reported number of programs attended within the past year by each individual. The effects of selected demographic variables on these two variables were also examined. The conceptual framework guiding the study was the Health-Promoting Self-Care System Model (Simmons, 1990). Intrinsically motivated older persons attended fewer programs (p < .01) than those who were more extrinsically motivated. Higher educational level (p < .001) and fewer health problems (p < .01) emerged as significant predictor variables for intrinsic health motivation, and those with less formal education attended more health promotion programs (p < .05).
Aged↗
Hypergraphia in a patient with multiple medical problems.
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Agraphia↗
Project management.
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Cooperative Behavior↗
Effects of abstinence on the brain: quantitative magnetic resonance imaging and magnetic resonance spectroscopic imaging in chronic alcohol abuse.
BACKGROUND: Structural brain damage, especially to white matter, is well documented in chronic alcohol abuse. There is also evidence for brain metabolic abnormalities in this condition. It is unknown, however, to what extent these structural and metabolic changes are present in treated alcohol abusers who achieve long-term abstinence versus treatment-naïve, heavily drinking individuals. METHODS: This study compared 12 recovering alcoholics with 8 actively heavily drinking subjects. Participants underwent magnetic resonance (MR) imaging and proton MR spectroscopic imaging of the brain. Semiautomated image segmentation techniques yielded volumes for gray matter, white matter, white matter lesions, and cerebral spinal fluid in multiple brain regions defined by Talairach stereotaxic coordinates. Automated spectral processing methods yielded gray and white matter concentrations of the metabolites N-acetylaspartate, creatine, and choline for the same regions. RESULTS: Recovering alcoholics had greater volumes of frontal white matter, but the opposite was true for white matter in a "remainder" region encompassing the basal frontal and temporal lobes, the cerebellum, and the brainstem. Recovering alcoholics also had smaller volumes of white matter lesions in whole brain, in occipital and mesial parietal regions, and in the remainder region. Recovering alcoholics had greater gray matter volumes in the orbital frontal pole and postcentral gyrus, but smaller gray matter volumes in the anterior cingulate. Whole-brain and regional metabolite concentrations did not differ significantly between the two groups. CONCLUSIONS: White and gray matter volumes in different regions of the brain were greater or smaller in recovering, treated alcoholics. The findings suggest region-specific structural recovery from chronic alcohol-induced brain injury, but also region-specific long-term structural damage in abstinent alcoholics. White matter lesions were widespread in active drinkers and may partly resolve during long-term abstinence. Proton MR spectroscopic measures, as applied in this cross-sectional study, were largely ineffective in revealing metabolic effects of abstinence on the alcohol-damaged brain.
Adult↗
Effects of guanfacine on three forms of distraction in the aging macaque.
alpha-2 adrenoceptor agonists, such as clonidine and guanfacine, enhance attention in aged animals. According to one theory, alpha-2 receptor agonists improve attention by decreasing distractibility to task-irrelevant stimuli. In two healthy aging bonnet macaques, we investigated the effects of low-(0.001 mg/kg) and high-dose (0.05 mg/kg) acute intramuscular guanfacine versus saline control on accuracy (number of trials correct) in three tasks requiring attention: delayed matching-to-sample, one-target visual tracking (test of focused attention) and two-target visual tracking (test of divided attention). Each task employed distracting stimuli in a different paradigmatic context. One monkey responded to guanfacine at both doses with significant rises in accuracy on all three tasks. The second monkey showed significant accuracy improvement for high-dose guanfacine only. No sedation was observed. These results suggest that guanfacine improves attention and reduces distractibility in multiple task contexts in healthy aging primates.
Adrenergic alpha-Agonists↗
Method to correlate 1H MRSI and 18FDG-PET.
The in vivo neuronal contribution to human cerebral metabolic rate of glucose (CMRglc), measured by 18FDG-PET, is unknown. Examining the effect of 1H MRSI-derived N-acetyl aspartate (NAA) concentration on positron emission tomography (PET) measures of metabolic activity might indicate the relationship of CMRglc to neuron density. In a population of 19 demented, cognitively impaired, and control subjects, the Miller-Gartner algorithm was applied to whole-brain PET data to isolate the PET signal originating in cortical gray matter alone (GMPET). An analogous procedure applied to multislice proton MRSI data yielded the N-acetyl aspartate concentration in cortical gray matter (GMNAA). In 18 of 19 subjects, a significant linear regression (P < 0.05) resulted when GMPET was plotted against GMNAA, whereby GMPET was higher for higher GMNAA. This suggests that CMRglc rises linearly with increasing neuron density in gray matter. This method may be used to investigate the relationship of CMRglc to neurons in various conditions.
Aged↗
A clinical evaluation of a locking orthodontic facebow.
Standard orthodontic facebows may accidentally detach from the appliance buccal tubes at night; this could reduce the effectiveness of extra oral traction and occasionally cause an injury. To try and prevent facebow detachment at night a facebow with a locking mechanism was introduced. This study assessed the ability of 706 consecutively treated patients to learn to wear and use this facebow. The facebows were fitted in 9 different practices supervised by 12 orthodontists. Data from the patients and orthodontists were collected over a 2-year period and covered approximately 166,550 nights. All the orthodontists were able to fit and adjust the facebow; a total of 697 patients successfully used the facebow. Accidental detachment of the facebow at night was reported to be less than 1%. This indicates a significant improvement in the safety of the facebow and should help to improve compliance by increasing the number of hours of wear achieved by the patients.
Accident Prevention↗
The unveiling of traumatic brain injury in an HIV/AIDS population.
This study examines the frequency of traumatic brain injury (TBI) in an HIV/AIDS population and its associated symptomatology. A panel of 173 individuals with HIV were split into two groups--those who have experienced a blow to the head within their lifetime (n = 128) and those who have not (n = 45). Self-reported symptoms from the TIRR Symptom Checklist were compared across both HIV panels, individuals who identified as traumatically brain injured (n = 416), and individuals with no disability (n = 282). Six clusters of symptoms (total, cognitive, physical, affective/behavioural, five symptoms sensitive and specific to TBI in general and 25 symptoms sensitive and specific to mild TBI) were analysed in a MANOVA, controlling for the demographic variables that were correlated with total symptoms, including panel membership, education, annual household income and substance use history. Significant main effects were found for panel membership. Individuals with HIV and a history of blow to the head reported a higher number of total symptoms and the 25 symptoms specific to mild TBI. The significance of these findings acknowledges the need to recognize the frequency of TBI in an HIV population and the subsequent need to provide the appropriate interventions that will lead to an enhanced overall quality of life.
Acquired Immunodeficiency Syndrome↗
Environmental covariates: effects on the power of sib-pair linkage methods.
The effect of inclusion of environmental risk factors on the power of sib-pair linkage methods was tested for a qualitative trait. It was found that inclusion of an environmental variable did not increase the power of the Haseman-Elston (H-E) sib-pair nonparametric linkage analysis test. However, a significant increase in power was observed for both the H-E and affected-sib-pair tests, even in small samples, when persons unexposed to the environmental risk factor were coded as unknown.
Environment↗
Possible linkage of alcoholism, monoamine oxidase activity and P300 amplitude to markers on chromosome 12q24.
Multipoint linkage analysis was used to screen for evidence of linkage between alcoholism and five alcoholism-related quantitative traits. The results suggest that a susceptibility locus that influences monoamine oxidase activity and P300 amplitude at the Pz lead, and increases the risk of alcohol dependence may be linked to markers in the 12q24 region. Furthermore, the susceptibility for alcoholism may be associated with allele 3 (allele size 144) of D12S392.
Alcoholism↗
Divided attention-enhancing effects of AF102B and THA in aging monkeys.
The effects of cholinergic drugs proposed for treatment of cognitive impairment in normal aging and dementia on divided attention have been little studied in non-human primates. We tested the hypothesis that cholinergic drugs improve spatial divided attention in primates via a computer task requiring simultaneous tracking of two visual targets in three young and two aged healthy bonnet macaques. Task accuracy (number of correct responses) and reaction time (RT) were measured 2 h after administration of either the m1 agonist +/- -cis-2-methyl-spiro(1,3-oxathiolane-5,3')quinuclidine (AF102B; 0.1-2.1 mg/kg IM) or the cholinesterase inhibitor 9-amino-1,2,3,4-tetrahydroamino-acridine (THA; 0.5-2.0 mg/kg orally). Accuracy increased for four of five monkeys at appropriate doses of one or both cholinomimetics, accompanied in two monkeys by a drop in RT. Responses were less uniform to THA than to AF102B. For the five-monkey group at Best dose, accuracy increased 34% (THA) or 43% (AF102B) above baseline (P<0.05 for both drugs), respectively, with no significant change in RT and with minimal untoward effects. Cholinotherapy may improve divided attention in young and aged healthy primates.
Aging↗
Teaching a research-based approach to the management of breathlessness in patients with lung cancer.
Breathlessness is a common but complex symptom experienced by patients with lung cancer. Corner and colleagues have developed a therapeutic nursing intervention for the management of breathlessness. The Macmillan Practice Development Unit (MPDU) have recently undertaken a multi-centre evaluation of the intervention. The authors were involved in this multi-centre study as clinical practitioners offering the intervention in a randomised control trial. There is strong evidence to suggest that much research fails to influence clinical practice. A commitment to practice development led us to explore the reasons for this research-practice gap. This paper considers the factors that facilitate implementation of research and, in particular, how this applies to the breathlessness intervention. Practitioners need to feel competent in the skills described in the intervention to implement the research findings into their practice. Therefore, we developed a course to teach the breathlessness intervention. A description of the course is presented, together with the theoretical basis for the course design and the tools used to evaluate it.
Clinical Competence↗
Reduction of motoric agitation and restlessness by AF102B and tacrine in the macaque.
The cholinesterase inhibitor tacrine (THA) and the M1 muscarinic agonist AF102B (cevimeline), both reported to enhance cognition in animals and humans, were tested in 5 macaques for reduction of spontaneous, random movements. Monkeys were videotaped 1 hour after administration of normal saline vehicle, after low- and high-dose intramuscular AF102B, and after low- and high-dose oral THA. Two independent blind judges counted numbers of spontaneous movements made by each monkey over 12 consecutive 15-second segments for each drug condition. Both THA and AF102B reduced movement significantly at high doses without overt side effects, warranting further research on the agitation-reducing potential of cognition-enhancing cholinomimetic drugs.
Alzheimer Disease↗
Levomepromazine (methotrimeprazine) and the last 48 hours.
Levomepromazine (previously known as methotrimeprazine) has a broad range of beneficial effects in the terminal phase of many illnesses, resulting from its combined antipsychotic, anxiolytic and sedative actions. Levomepromazine can safely be administered in a continuous subcutaneous infusion with most other commonly used drugs in palliative care.
Antipsychotic Agents↗