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Biomedical subjects

J Scott

Publications and source records attributed to J Scott.

At least 91 records · Page 5Linked to original sources
PubMed2000

Pressure support and elevation following the removal of a radial artery for coronary artery bypass grafting.

The saphenous vein was once the standard coronary artery bypass graft. Alternate grafts, primarily the radial artery and the internal mammary artery are now being utilised for revascularisation of the heart. However, the radial artery graft site can be at risk of oedema and the development of haematoma during the post-operative period. Also tension on the suture line may compromise circulation and create functional problems for the patient. The aim of this study was to assess the effect of pressure support (elastic support bandage) and elevation in reducing swelling and arm discomfort in the harvest arm. The patients in the study undergoing coronary artery bypass grafts were randomly assigned to one of three groups: elastic support bandage, collar and cuff sling and elevation on two pillows. There were 30 patients in each group. The circumference at three locations on the forearm was measured pre-operatively and on post-operative days 3 and 5. Pain was measured on a visual pain scale, which went from 1-10, with 10 being the most painful. The patients were also asked whether their arm movement felt restricted. The study found that there was no statistically significant difference (at the 0.05 level) between the three groups in the amount of swelling witnessed at the different forearm locations. There was, however, a significant decrease in swelling for all groups between days 3-5, but no difference in pain scores between the groups. Moreover, the collar and cuff sling group reported movement restriction, which was not apparent in the other two groups. In view of the findings, the researchers advocate the elastic support bandage. Patient compliance has practical implications when applying treatment and this is enhanced by the non cumbersome elastic support bandage. This can be compared to the collar and cuff sling and pillow elevation groups where the patient's daily activities affects compliance with these two treatments. It is recommended that future research be conducted comparing the effects of the elastic support bandage with a control group.

Activities of Daily Living↗
PubMed2000

Cognitive vulnerability in patients with bipolar disorder.

BACKGROUND: No study has simultaneously explored key components of Beck's model of cognitive vulnerability to depression in people with bipolar disorders. METHODS: We compared 41 euthymic bipolar patients with 20 healthy control subjects. All subjects were assessed on the Hamilton Rating Scale for Depression, the Autobiographical Memory Test and the Mean Ends Problem-Solving procedure and also completed the Beck Depression Inventory, the Dysfunctional Attitude Scale, the Sociotropy Autonomy Scale and the Rosenberg Self-Esteem Questionnaire. RESULTS: In comparison to control subjects, patients with bipolar disorder demonstrated significantly higher levels of dysfunctional attitudes (particularly perfectionism and need for approval) and sociotropy, significantly greater over-general recall on an autobiographical memory test and significantly less ability to generate solutions to social problem-solving tasks. These between group differences remained significant when age, intelligence, latency to respond to autobiographical memory test cue words, and subjective mood ratings were included as co-variates in the statistical analysis. Within the patient group, cognitive dysfunction was significantly correlated with level of morbidity (as measured by number of previous illness episodes). CONCLUSIONS: This study suggests that cognitive vulnerability in patients with bipolar disorder is similar to that described in unipolar disorders. It is not clear whether this dysfunction is a cause or an effect of repeated episodes of bipolar disorder. However, the findings may have implications for clinical treatment as well as suggesting a number of important new avenues of research into psychological models of affective disorder.

Adult↗
PubMed2000

Clinical characteristics of familial and non-familial bipolar disorder.

OBJECTIVE: To explore the clinical characteristics of familial and non-familial bipolar disorder. METHOD: Twenty subjects with bipolar disorder, who also had a family history of bipolar disorder in a first degree relative, were matched for current age, age of first onset of bipolar disorder and gender with 20 subjects with bipolar disorder who had no family history of any psychiatric disorders in first or second degree relatives. RESULTS: Fourteen subjects in each group were female. The mean age at interview was 45.2 years and the mean age at first admission was 26 years. Although familial and non-familial probands had an equivalent number of illness episodes, familial probands were significantly more likely to experience mixed states as compared to non-familial probands. The latter experienced significantly more depressive episodes and had significantly higher neuroticism (N) scores on the Eysenck Personality Inventory (EPI; Eysenck H, Eysenck S. Manual of the Eysenck Personality Inventory. London: University of London Press, 1964.). CONCLUSIONS: If the results are replicated, they have important implications. For example, such data may aid decisions about the targeting of additional psychosocial interventions in high N score cases. Researchers will wish to investigate whether mixed states show a stronger association with early age of onset or family history of BD.

Adult↗
PubMed2000

Predicting medication adherence in severe mental disorders.

OBJECTIVE: This study explored the utility of the health belief model (HBM) in explaining medication adherence in subjects with severe and disabling mental disorders. METHOD: Six well-established measuring instruments, with confirmed reliability and validity, were used to assess each component of the HBM and medication adherence in 39 hospital-treated subjects with affective disorders (n = 27) or schizophrenia (n = 12). RESULTS: Highly adherent and partially adherent subjects differed significantly in their perception of illness severity, their beliefs about themselves and their control over the disorder, and their concerns about further hospitalization. Two components of the HBM (perceived severity of illness and perceived benefits of treatment) explained 43% of the variance in adherence behaviour. CONCLUSION: Although the study has a number of methodological limitations, the results suggest that clinical assessment of components of the HBM may improve the detection of patients at risk of medication non-adherence.

Adolescent↗
PubMed2000

The effects of age and gender on parathyroid hormone dynamics.

BACKGROUND AND AIMS: Hyperparathyroidism is a risk factor for bone loss. An age-related increase in parathyroid hormone (PTH) level has been demonstrated in several studies. It has been suggested that the type II osteoporotic syndrome, a condition of increased prevalence among elderly women, may be at least partially caused by elevations in intact parathyroid hormone (iPTH) levels. To date, however, the effects of age and gender per se on PTH dynamics in healthy subjects independent of other risk factors such as vitamin D deficiency and/or impaired renal function that can impact on parathyroid function, remain unknown. In this study, we used citrate and calcium (Ca) infusions to characterize the impact of age and gender on PTH dynamics in normal subjects. SUBJECTS AND METHODS: Twelve young women with mean age +/- SD of 26.4 +/- 1.6 years, 12 young men with mean age of 26.6 +/- 1.3 years, 12 older women with mean age of 68.6 +/- 1.3 years and 12 older men with mean age of 67.2 +/- 1.6 years were studied. The sigmoidal curves relating serum iPTH to serum levels of ionized Ca (Cai) were characterized by maximal and minimal iPTH levels, the set-points (levels of Cai causing half-maximal suppression of iPTH), and the slopes of the curves at the set-points. RESULTS: Baseline serum Ca, Cai, 25 hydroxyvitamin D [25(OH)D] and 1,25 dihydroxyvitamin D [1,25(OH)2D3] levels, as well as the set-points, slopes and minimal values of the sigmoidal curves relating Cai to iPTH, did not differ among the four groups. iPTH levels at baseline were slightly but not significantly higher in the older age groups (P = 0.18). The maximal iPTH level was 25% higher in the older women than in the younger women, although this difference was not significant (P = 0.29). However, the integrated iPTH responses calculated from the areas under the curves (AUC) of iPTH levels vs. time during the calcium and citrate infusions were significantly higher in postmenopausal women than in young women during both infusions and in older men than in young men during the calcium infusion. There was no effect of gender on serum iPTH levels. CONCLUSIONS: In both women and men, ageing per se, independent of changes in vitamin D economy or renal function, is associated with an increase in integrated PTH secretory response to changes in serum calcium. No alterations in the Cai/iPTH set-point were present. The biological relevance of these modest increments in integrated iPTH levels during dynamic testing in older healthy men and women remain uncertain.

Adult↗
PubMed2000

Practices and attitudes towards quality assurance, inspection and accreditation in blood collection establishments in the European community.

In the framework of a European Community (EC)-supported project, a survey of practices and attitudes towards quality assurance, inspection and accreditation in Blood Collection Establishments (BCEs) in the EC member states was carried out. Analysis of 352 responses to a structured questionnaire revealed a preference for national standards over international, and an introspective and reactive view to quality management. Four broad categories of operational performance in relation to safety were formed: initial, repeatable, managed and optimising, with the majority of responses (209) being characterized as initial. Although a direct relationship between the size of the BCE and the range and level of quality management practices is apparent in the data, further analysis shows that small BCEs have much higher ratio of personnel per blood unit collected/processed than large BCEs and thus seem to have an inherent potential for improvement. Overall, a clear preference for inspection and accreditation by professional peers at the national level was indicated.

Accreditation↗
PubMed2000

Mucinous cystic neoplasms of the pancreas: imaging features and diagnostic difficulties.

AIMS: To review the imaging features of mucinous cystic neoplasms (MCNs) of the pancreas and to highlight difficulties in differentiating these lesions from pancreatic pseudocysts. MATERIALS AND METHODS: The imaging investigations, case notes and histopathology of 13 patients who underwent surgery for an MCN of the pancreas, were reviewed. RESULTS: An erroneous diagnosis of a pancreatic pseudocyst had been made in five of the 13 cases and in two patients cystenterostomy had been performed. Only one patient had a documented history of acute pancreatitis although mildly elevated serum amylase levels were identified in a further five cases. CT and US correctly diagnosed a cystic pancreatic mass in all 13 patients, however cross-sectional imaging features of neoplasia, such as septae, cyst wall calcification, focal thickening of the cyst wall and papillary projections, were absent in five (38%) cases. Coexistent imaging features of chronic pancreatitis were present in five of the 13 patients and in six resected specimens. Cyst wall calcification occurred only in malignant lesions and there was no relationship between cyst size and the degree of malignancy. While ERCP, angiography, and percutaneous needle aspiration may provide additional information, the majority of these examinations were either unhelpful or even misleading. CONCLUSION: MCNs of the pancreas are frequently diagnosed and mismanaged as pancreatic pseudocysts with an associated increase in patient morbidity and mortality. Diagnostic imaging can help to distinguish MCNs from pseudocysts when there are features of neoplasia present, however, no imaging investigation can reliably differentiate the two conditions in all cases. If clinical doubt remains, it is preferable to err on the side of safety and either employ a 'wait and watch' strategy or to resect a cystic pancreatic lesion rather than drain a potentially malignant MCN.

Adult↗
PubMed2000

Building a framework for getting evidence into critical care education and practice.

One challenge for nurse educators is how best to enhance the integration of theory and practice elements in relation to critical care nursing. Practice should be evidence-based, i.e. the best available empirical evidence, including recent research findings, should be applied in practice in order to aid clinical decision-making. Barriers to the implementation of research exist at many levels including the individual practitioner, the clinical team, the practice setting and wider organizational factors. The authors propose that clinical guidelines can provide a vital link between theory and practice. At varying levels the use of care protocols, clinical pathways and algorithmic guidelines (provided they are rigorously reviewed and evidence-based) can help infuse research into practice, thereby promoting quality and standardization of care. The purpose of this paper is to discuss the value and use of these frameworks in promoting and raising awareness of the need for and use of evidence-based approaches to critical care education and practice. In this paper, we present outline information relating to an assessment method, adopted for continuing education courses in critical care within our department. This approach is designed to combine the best available evidence with reflective practice through the assessment process.

Algorithms↗
PubMed2000

Computational models of blood flow in the circle of Willis.

A two-dimensional, steady state model of the circle of Willis has been developed. To simulate the peripheral resistance of the cerebrovascular tree, blocks of porous media were used. Their effective resistance was kept constant, disregarding the effects of arterial auto-regulation. The model was then used to simulate different common abnormalities of the circle of Willis while a range of varying boundary conditions was imposed to the right internal carotid artery (ICA). The total flux was tabulated and compared favourably with both clinical measurements and other models of the circle of Willis. Relevant fluid dynamics effects were also observed and analysed. The present model demonstrates that the use of CFD can produce physiological results if the appropriate boundary conditions are used. We can provide clinicians with a priority list of the severity of the flux reduction for the considered abnormalities for different degrees of stenosis of the right ICA. From this study it is apparent that the redistribution of blood via the circle of Willis is mainly driven by changes in the vascular resistance of the brain rather than in the local arterial geometry. The use of valid peripheral resistances allows for a more realistic model of the circle of Willis but also highlights the need for more accurate means to estimate the vascular resistance of a patient.

Animals↗
PubMed2000

Mechanism of the antimicrobial drug trimethoprim revisited.

We tested the hypothesis that the mechanism of action of the antifolate drug trimethoprim is through accumulation of bacterial dihydrofolate resulting in depletion of tetrahydrofolate coenzymes required for purine and pyrimidine biosynthesis. The folate pool of a strain of Escherichia coli (NCIMB 8879) was prelabeled with the folate biosynthetic precursor [(3)H]-p-aminobenzoic acid before treatment with trimethoprim. Folates in untreated E. coli were present as tetrahydrofolate coenzymes. In trimethoprim-treated cells, however, a rapid transient accumulation of dihydrofolate occurred, followed by complete conversion of all forms of folate to cleaved catabolites (pteridines and para-aminobenzoylglutamate) and the stable nonreduced form of the vitamin, folic acid. Both para-aminobenzoylglutamate and folic acid were present in the cell in the form of polyglutamates. Removal of trimethoprim resulted in the reconversion of the accumulated folic acid to tetrahydrofolate cofactors for subsequent participation in the one-carbon cycle. Whereas irreversible catabolism is probably bactericidal, conversion to folic acid may constitute a bacteriostatic mechanism since, as we show, folic acid can be used by the bacteria and proliferation is resumed once trimethoprim is removed. Thus, the clinical effectiveness of this important drug may depend on the extent to which the processes of either catabolism or folic acid production occur in different bacteria or during different therapeutic regimes.

4-Aminobenzoic Acid↗
PubMed2000

A nursing leadership challenge: managing the chronically ill in rural settings.

The management of chronic illness presents unique challenges within and among rural regions. Rural persons with chronic illness have unique health care access challenges related to available health care personnel to provide services, distance to services, and fiscal resources to obtain services. Unique attributes of rural persons with chronic illness require continued study to enhance health care providers' understanding of how to support their relative health, well-being, and effective utilization of health care resources. Nursing leaders in rural settings are in a critical position to provide guidance and leadership to the challenge of managing this vulnerable population.

Chronic Disease↗
PubMed2000

Murine colonic mucosa hyperproliferation. I. Elevated CFTR expression and enhanced cAMP-dependent Cl(-) secretion.

Fluid transport in the large intestine is mediated by the cystic fibrosis gene product and cAMP-dependent anion channel cystic fibrosis transmembrane conductance regulator (CFTR). cAMP-mediated Cl(-) secretion by gastrointestinal cell lines in vitro has been positively correlated with the insertion of CFTR into the apical membrane of differentiated senescent colonocytes and negatively correlated with the failure of CFTR to insert into the plasma membrane of their undifferentiated proliferating counterparts. In native tissues, this relationship remains unresolved. We demonstrate, in a transmissible murine colonic hyperplasia (TMCH) model, that (8-fold) colonocyte proliferation was accompanied by increased cellular CFTR mRNA and protein expression (8.3- and 2.4-fold, respectively) and enhanced mucosal cAMP-dependent Cl(-) secretion (2. 3-fold). By immunofluorescence microscopy, cellular CFTR expression was restricted to the apical pole of cells at the base of the epithelial crypt. In contrast, increased cellular proliferation in vivo led to increases in both the cellular level and the total number of cells expressing this anion channel, with cellular CFTR staining extending into the crypt neck region. Hyperproliferating colonocytes accumulated large amounts of CFTR in apically oriented subcellular perinuclear compartments. This novel mode of CFTR regulation may explain why high endogenous levels of cellular CFTR mRNA and protein within the TMCH epithelium were not matched with larger increases in transmucosal CFTR Cl(-) current.

Animals↗
PubMed2000

Effects of cognitive therapy on psychological symptoms and social functioning in residual depression.

BACKGROUND: About 30% of psychiatric out-patients with major depression demonstrate partial remission. AIMS: To explore whether the addition of cognitive therapy (CT) had any differential effect on residual symptoms or social adjustment. METHOD: Patients with residual symptoms of major depression (n=158) were randomised to receive clinical management (CM) alone, or CM plus 18 sessions of CT. Subjects' depressive symptoms and social functioning were assessed regularly over 16 months. RESULTS: The addition of CT produced statistically significant differential effects on: two out of four measures of overall severity of depression; specific psychological symptoms (guilt, self-esteem and hopelessness); and social functioning (including dependency, interpersonal behaviour and friction). CONCLUSIONS: In patients showing only partial response to antidepressants, the addition of CT produced modest improvements in social and psychological functioning. The implications for research on the mechanisms of action of CT are discussed.

Adult↗
PubMed2000

A pilot study of the relationship between problem-solving skills and outcome in major depressive disorder.

Three methods of assessing problem-solving skills are described in the literature: questionnaires, self-report inventories and verbal assessment of the resolution of problem scenarios. These three approaches were used to assess problem-solving ability in a sample of 20 patients with unipolar major depressive disorder, who were treated with antidepressant medication alone at a hospital out-patient clinic. It was found that baseline deficits in problem-solving skills were significantly associated with prognosis at 3- and 6-month follow-up. Self-ratings of perceived self-control and confidence rather than subjective problem-solving effectiveness were important predictors of final outcome. Differences in perceived and actual problem-solving ability emerged over time. The reasons for these differences in subjective and observer assessments are unclear. The data appear to demonstrate that problem-solving deficits in depression represent both state and trait phenomena.

Adolescent↗