Making career paths work.
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Career Mobility↗
Biomedical subjects
J Ritchie
Publications and source records attributed to J Ritchie.
Insights from a nursing research program on social support.
This paper highlights the conceptual and practical implications of a nursing research program that focuses on social support. The diverse dimensions of the construct of social support; its relationship to stress and coping; and its impact on health, health behaviour, and use of health services are explicated in the conceptual framework underpinning the program. These associations will be elucidated by citing examples from eight assessment studies and four intervention studies. The research program yielded new insights and reinforced reported findings of other social-support research.
Adaptation, Psychological↗
Combining qualitative studies with randomised controlled trials is often useful.
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Case Management↗
Plasma and urinary 8-iso-prostane as an indicator of lipid peroxidation in pre-eclampsia and normal pregnancy.
1. This study was designed to seek evidence for excessive lipid peroxidation in pre-eclamptic women using 8-iso-prostane as a novel bioactive marker of lipid peroxidation in vivo. Plasma free, total and urinary 8-iso-prostane were measured in 20 women with proteinuric pre-eclampsia, and compared with 18 age- and gestation-matched pregnant control subjects, before delivery and at 6 weeks post-partum. 2. Plasma free 8-iso-prostane was significantly elevated in the pre-eclamptic women compared with control subjects before delivery, and fell to control levels post-partum. Conversely, levels in women with normal pregnancy rose post-partum. 3. Total plasma 8-iso-prostane levels were not significantly elevated in pre-eclamptic women compared with control subjects during pregnancy, but fell significantly in the pre-eclamptic women post-partum, suggesting that they had relatively higher levels compared with their non-pregnant state. 4. Urinary 8-iso-prostane excretion was significantly lower in the pre-eclamptic women compared with control subjects during pregnancy, suggesting that renal clearance of 8-iso-prostane is impaired in pre-eclampsia. 5. Increased levels of plasma free 8-iso-prostane in pre-eclampsia could be due to an increase in lipid peroxidation, an increase in phospholipase A2 activity or a reduction in renal clearance of 8-iso-prostane, or a combination of all three. The potent direct and indirect vasoconstrictor actions of 8-iso-prostane may contribute to the pathogenesis of pre-eclampsia.
Adult↗
The process of developing and validating national core competencies for diabetes educators.
The National Core Competencies for Diabetes Educators were developed on behalf of the Australian Diabetes Educators Association between July 1994 and November 1995. This paper traces the development of the competencies including the rationale for undertaking the project, the process involved and the measures taken to ensure their relevance and validity. The limitations of applying the competency concept to health professionals are discussed. The paper also explores issues affecting professional bodies which attempt to define and document competencies and describes some of the obstacles which may be encountered during the process.
Accreditation↗
Controlled duodenostomy for difficult duodenal stump.
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Duodenal Ulcer↗
Incidence of and risk factors for delirium among psychiatric inpatients.
OBJECTIVE: The presence and effects of delirium among psychiatric patients are not well understood. This study investigated incidence rates and risk factors for delirium among hospitalized psychiatric patients. METHODS: The charts of 199 patients admitted over a one-year period to a tertiary care teaching hospital were retrospectively reviewed. Demographic and medication variables were analyzed using multiple logistic regression. Delirium was diagnosed retrospectively using DSM-III-R criteria. RESULTS: The overall incidence of delirium in the study sample was 14.6 percent. Delirium was most common among patients with schizophrenia and bipolar disorder; patients with bipolar disorder had the highest incidence (35.5 percent). Only 48 percent of delirious patients were actually recognized as having delirium at the time it occurred. Antiparkinsonian medications were the only medications significantly associated with delirium; lithium was not an independent risk factor. Older age was the only significant demographic risk variable. The hospital stays of patients with delirium were 62.1 percent longer than those of patients without delirium. CONCLUSIONS: Patients with bipolar disorder appeared to be at higher risk for developing delirium, whether or not lithium was used in treatment. This finding may reflect an inherent predisposition to delirium among these patients. Alternatively, the combination of medications used in treating patients with bipolar disorder may be a risk factor.
Adult↗
Comparison of proliferating cell nuclear antigen versus the more standard measures of rectal mucosal proliferation rates in subjects with a history of colorectal cancer and normal age-matched controls.
Measurement of proliferation rates by the more standard in vitro uptake techniques of [3H]thymidine and 5'-bromo-2'-deoxyuridine (BrdUrd) labeling indices (LIs) were compared to proliferating cell nuclear antigen (PCNA) in rectal mucosal biopsies from 16 subjects with resected colorectal cancer and 14 normal age-matched controls. Correlation coefficients for BrdUrd versus PCNA, [3H]thymidine versus PCNA, and BrdUrd versus [3H]thymidine were 0.691, 0.876, and 0.770, respectively. No significant differences (P > 0.05) were detected in total mean LIs between the LI methods for the normal group. In contrast, total PCNA LIs were found to be significantly different in the resected cancer patients when compared to either BrdUrd (P = 0.005) or [3H]thymidine (P < 0.001). A significant difference (P = 0.010) in total PCNA LI but not in total [3H]thymidine or BrdUrd LIs was also observed between normal controls and resected colorectal cancer subjects. Compartmental analysis of the cancer group versus the normals showed a significant difference in compartments 1 and 3 for PCNA LIs only. The reproducibility of two PCNA LI counts was excellent (r = 0.9). In addition, the reliability of mean LIs were > 0.8 with the exception of [3H]thymidine in the normal group (0.7). These study results demonstrate that PCNA LIs in human rectal mucosal biopsies are correlated highly with other more commonly used cellular proliferation measurements; however, PCNA LIs were found to be significantly higher than the other two methods in the resected colorectal cancer subjects.
Adult↗
Effects of varying dietary fat, fish, and fish oils on blood lipids in a randomized controlled trial in men at risk of heart disease.
This study aimed to determine the effects of incorporating fish with 40%- or 30%-fat diets and the differences in response to fish or fish oil omega 3 fats. Men with high-normal blood pressure and elevated serum cholesterol were randomly allocated to one of seven diets for 12 wk. Fish or fish oil with a 40%-fat diet increased total cholesterol, HDL cholesterol, HDL2 cholesterol, and LDL cholesterol, and reduced triglycerides. The 30%-fat diet alone reduced cholesterol, LDL cholesterol, and HDL cholesterol, with triglycerides unchanged. Fish with the 30%-fat diet reduced cholesterol, LDL cholesterol, and triglycerides and increased HDL2 cholesterol. This study has shown that plasma lipids are affected similarly by fish or fish oil in men consuming a 40%-fat diet. Adverse effects of omega 3 fats on total and LDL cholesterol are reversed by a 30%-fat diet, whereas one daily fish meal substantially lowers triglycerides and reverses the fall in HDL cholesterol that is usual with a low-fat diet.
Adult↗
Plasma and urinary endothelin 1, prostacyclin metabolites and platelet consumption in pre-eclampsia and essential hypertensive pregnancy.
This study examined plasma and urinary endothelin 1 and urinary metabolites of prostacyclin and thromboxane, in women with pre-eclampsia and age and gestation matched controls. To determine if changes in endothelin 1 and urinary prostanoids in pre-eclampsia were due to hypertension per se, a comparison was made to a group of age and gestation matched pregnant uncomplicated essential hypertensive women. Measurements were taken prior to delivery, and at 6 weeks and 6 months post-partum, and were compared to a group of age matched non-pregnant controls. Plasma endothelin 1 was significantly elevated and the urinary metabolite of prostacyclin (2,3-dinor-6-keto-PGF1 alpha) was significantly suppressed in pre-eclamptic pregnancy, compared to normal pregnancy and essential hypertensive pregnancy. As the level of blood pressure was similar in the pre-eclamptic and essential hypertensive groups, these changes are not due to an increase in blood pressure per se. Urinary endothelin 1 was not different in the 3 pregnant groups prior to delivery but fell significantly after delivery. Urinary endothelin 1 was significantly lower in the essential hypertensive group at 6 weeks post-partum compared to pregnant controls with a similar trend at 6 months. Urinary 11-dehydro-TXB2 was elevated in pregnancy, but no further elevation was seen in women with pre-eclampsia. Platelet counts were lower, and circulating neutrophil counts higher in pre-eclampsia prior to delivery. A combination of increased plasma endothelin 1 and reduced tissue prostacyclin synthesis may contribute to hypertension, placental insufficiency, foetal growth retardation and renal dysfunction in pre-eclampsia.(ABSTRACT TRUNCATED AT 250 WORDS)
6-Ketoprostaglandin F1 alpha↗
Neutrophil platelet-activating factor in normal and hypertensive pregnancy and in pregnancy-induced hypertension.
1. Platelet-activating factor is a phospholipid with potent vasodilator and platelet-activating properties. To test the hypothesis that a generalized change in cellular platelet-activating factor metabolism may be involved in the systemic vasodilatation of normal pregnancy or pregnancy-induced hypertension, we studied platelet-activating factor and eicosanoid synthesis in isolated leucocytes obtained from pregnant women before and after delivery compared with age-matched non-pregnant control subjects. Parallel observations were carried out in age- and gestation-matched women with uncomplicated hypertension in pregnancy and in women with pregnancy-induced hypertension and a further set of normotensive pregnant control subjects. 2. Leucocyte counts were higher in all pregnant groups compared with non-pregnant control subjects. Neutrophil production of platelet-activating factor and metabolites of prostacyclin, prostaglandin E2 and thromboxane in response to calcium ionophore stimulation were all lower in pregnant women compared with non-pregnant control subjects, but returned to similar levels 6 weeks post partum. There was no significant difference between essential hypertensive and normotensive groups. When women with pregnancy-induced hypertension were a priori sub-divided into those with or without proteinuria, subjects with proteinuria showed significantly lower levels of neutrophil platelet-activating factor synthesis. 3. Plasma levels of the platelet-activating factor metabolite (lyso-platelet-activating factor) were also lower in pregnancy, suggesting alterations in the activity of enzymes controlling synthesis or degradation of this phospholipid in pregnancy. In pregnancy-induced hypertension the levels of plasma lyso-platelet-activating factor were higher than in normal pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Effects on blood pressure of omega 3 fats in subjects at increased risk of cardiovascular disease.
This study was conducted to compare the effects of omega 3 fatty acids, taken as fish or fish-oil supplements in the setting of a high- or low-fat dietary background, on blood pressure and heart rate in men with moderate cardiovascular risks. One hundred twenty men were randomly allocated to five high-fat (40% of daily energy) and two low-fat (30% of energy) groups to undertaken a 12-week dietary intervention period involving fish, fish oil, or a combination of these. Sodium intake was restricted to less than 90 mmol/d. The five high-fat groups were assigned to take either 6 or 12 fish-oil capsules daily, fish or a combination of fish oil and fish, or placebo capsules. The two low-fat groups took either fish or placebo capsules. Fish meals were devised to provide 1.3 g of eicosapentaenoic acid daily, equivalent to that contained in 6 fish-oil capsules. Subjects were instructed to eat a selection of fish that provided an average of 3.65 g/d (range, 3.2 to 4.1 g/d) of total omega 3 fatty acids. Subjects were seen at regular intervals during the baseline and dietary intervention periods for measurement of weight, blood pressure, heart rate, dietary compliance, urinary electrolyte excretion, platelet phospholipid fatty acids, blood glucose, and insulin concentration. There was a greater fall in both systolic and diastolic blood pressures in subjects allocated fish or fish oil, particularly in the low-fat groups, compared with control subjects. However, there was no significant group effect.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
The effects of omega-3 fatty acids on blood pressure and serum lipids in men at increased risk of cardiovascular disease.
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Adult↗
Managing change: introducing ancillary caregivers to the ICU.
How to introduce ancillary care personnel in a critical care setting is chronicled in this article. The goal was to try assigning three patients to one RN working with a critical care nurse technician (CCNT) in an effort to deal with a 30-35 percent vacancy rate in CCU/MICU staffing, which had resulted in closing of beds. The approach to change described by Moore and Gergen enabled this management team to move toward their goal by including both nursing staff and CCNTs in the process.
Attitude of Health Personnel↗
Association of lifestyle and personality characteristics with blood pressure and hypertension: a cross-sectional study in the elderly.
The association between certain lifestyle and personality characteristics and blood pressure in the elderly was assessed in a cross-sectional study of 843 independent living 60-87 year old volunteers. They comprised 338 women and 505 men of whom 35 and 30% respectively were being treated with antihypertensive drugs. Among untreated volunteers, 28% of women and 28% of men had systolic blood pressure greater than 160 or diastolic blood pressure greater than 95. Isolated systolic hypertension was found in 20% of untreated women and 14% of untreated men. Lifestyle factors and personality characteristics associated with blood pressure were similar to those described in younger adult populations, although there were some differences related to gender and whether subjects were being treated for hypertension. Stepwise multiple regression showed that higher blood pressure was associated with greater body mass index (BMI), alcohol intake and coffee drinking and measures of irritability. Increased physical activity, and high values for measures of suspicion and extraversion were negatively related to blood pressure. Age was positively related to systolic, but not to diastolic blood pressure. The presence of hypertension was significantly associated with self-reports of raised cholesterol, diabetes or angina, as well as past history of heart failure, heart attack or stroke. Thus, in this elderly free-living population blood pressures are still significantly associated with behavioural characteristics which could be further investigated as an alternative or adjunct to antihypertensive therapy.
Aged↗
Postural fall in blood pressure in the elderly in relation to drug treatment and other lifestyle factors.
In a study of 843 independent-living men and women aged between 60 and 87 in Perth, Western Australia, stepwise multiple regression, after correction for initial levels of systolic blood pressure, showed that postural fall in systolic blood pressure was positively related to alcohol intake of more than 20 ml/day, the use of sleeping tablets and higher levels of anxiety on the Spielberger state-trait scale, and negatively related to body mass index. Postural fall in blood pressure was not significantly related to treatment for hypertension, age, sex, patterns of usual physical activity, tea or coffee drinking, or the diagnosis of diabetes mellitus. This analysis is the first to examine the relationship between lifestyle factors and the magnitude of the fall in systolic blood pressure on standing after adjustment for the association between the change in a variable and its initial level. Our analysis suggests the need for further study of the possible role of lifestyle factors such as the use of sleeping tablets and alcohol in postural hypotension in the elderly.
Aged↗
Caring for practice: the value of nurses.
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Health Policy↗
Neuroendocrine effects of diazepam in panic and generalized anxiety disorders.
The adrenocorticotropic hormone (ACTH), cortisol, and growth hormone responses to four consecutive, logarithmically increasing doses of intravenous diazepam compared with placebo given at 15-min intervals were examined in patients with panic disorder (n = 13), generalized anxiety disorder (n = 8), and healthy controls (n = 13). Diazepam caused dose-dependent decreases in cortisol and increases in GH and dose-independent decreases in ACTH. There were no patient-control differences, possibly due to either the small sample size of the experimental paradigm, which tested subjects in an upright, sitting position in mildly arousing circumstances.
Adrenocorticotropic Hormone↗