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Biomedical subjects

J Smith

Publications and source records attributed to J Smith.

At least 145 records · Page 8Linked to original sources
PubMed2001

Patient outcomes after peripheral revascularization surgery.

Acquired peripheral vascular disease (PVD) is a significant problem in the United States, resulting in both morbidity and mortality. The purpose of the pilot study was to determine patient outcomes after peripheral revascularization surgery. The specific aims of the pilot study were to examine peripheral revascularization surgical patient outcomes (PVD-related clinical symptoms, functioning, atherosclerotic disease risk factor reduction, and patient satisfaction) and to determine the influence of selected patient demographic characteristics (gender, age) on selected patient outcomes (PVD-related clinical symptoms, functioning, atherosclerotic disease risk factor reduction, and patient satisfaction). A prospective, repeated measures design was used for the study. A total of 39 patients, 18 women and 21 men, participated in the study, with a mean age of 68.86 years (SD = 13.61). The average length of hospitalization after surgery was 4.05 days. At 1 month after discharge, the majority of patients had relief from claudication and paresthesia. In regard to outcomes related to atherosclerotic risk factor modification, patients reported that they exercised on a routine basis, an average of 5.31 +/- 1.97 times per week. Before surgery, 21 patients reported that they smoked; 6 patients reported that they continued to smoke at follow-up. There were no significant differences in mean total scores of atherosclerotic risk modification by either gender or age groups (<65 or > or =65 years) with the use of one-way analyses of variance (ANOVAs). By using a Likert scale (ie, 0 to 10), the mean level of functioning was 8.18 +/- 2.76, with women having significantly higher mean levels of functioning (F = 4.26, P <.05). Comparing baseline scores of functioning on the Medical Outcomes Study Short-Form 36 (MOS SF-36), there was a significant improvement (F = 2.11, P <.05) in general health subscale scores at 1 month after surgery. Subjects' mean overall satisfaction with the results of surgery, with a 0 to 10 scale, was 7.33 +/- 2.84. Again, by using one-way ANOVAs, females had significantly higher mean satisfaction rating than males (F = 4.52, P <.05). Although findings from this pilot study are limited in their generalizability, clinicians need to continue to evaluate opportunities to further reduce variability in clinical practice patterns for optimal patient outcomes. Study findings also indicated that additional interventions are warranted to educate and provide rehabilitation for patients regarding an exercise program and overall behavior modification strategies to reduce risk for atherosclerotic disease.

Aged↗
PubMed2001

Evidence-based health care and community nursing: issues and challenges.

This paper examines the implications of the movement towards evidence-based health care for community-based, primary health care nursing in Australia. While both aim to improve health status, we argue that they are antithetical in many respects. Community nurse practitioners draw upon primary health care principles and adopt a holistic, preventive, empowering approach to working with and in communities. By contrast, evidence-based approaches utilise systematic reviews of primarily quantitative research to inform decisions about health at three levels: public health, the health care system, and individual patients. In response to this challenge, community nurses must reiterate their philosophies and practice models. Moreover, it is imperative to produce verifiable evidence of the effectiveness of their approach while mounting a thorough critique of the evidence-based movement.

Australia↗
PubMed2001

Radioimmunoassay for N-terminal probrain natriuretic peptide in human plasma.

Measurement of plasma levels of natriuretic peptides has been used to assess left ventricular dysfunction and prognosis. Recently levels of the N-terminal peptide fragment of the precursor of brain natriuretic peptide have been reported to be present in peripheral plasma and to be increased in chronic heart failure patients. Our aim in this study was to develop a radioimmunoassay for N-terminal proBNP, to compare its plasma concentrations in control subjects and in patients with end-stage heart failure and to define its relation to brain natriuretic peptide (BNP). A polyclonal antibody was raised in rabbits against human N-terminal proBNP fragment (amino acid 1-21). The plasma N-terminal proBNP concentrations were assayed directly without extraction. No detectable cross-reactivity existed with other natriuretic peptides: BNP, ANP or N-terminal proANP. The assay had a detection limit (2 SD from zero) of 9.7 pmol/L. Plasma N-terminal proBNP was 29 (13-75) (median (range)) pmol/L in the control group. There were no gender difference, male: 28 (13-61) vs. female 33 (13-75) pmol/L, p= NS, but there was a positive correlation to age (r=0.52, p<0.0001). In patients with end-stage heart failure the median N-terminal proBNP levels were increased significantly 616 (114-2781) pmol/L (p<0.001) and in pooled data N-terminal proBNP showed a close correlation to BNP (r=0.96, p<0.0001). Size exclusion of plasma extracts indicated that proBNP (1-108) may circulate both as intact prohormone and as split products, N-terminal proBNP (1-76) and BNP (77-108). Our results support the concept that N-terminal proBNP measurement could be a valuable tool in the biochemical indication of increased cardiac wall stress.

Adult↗
PubMed2001

Adult cockatiels (Nymphicus hollandicus) metabolically adapt to high protein diets.

To determine the ability of cockatiels (Nymphicus hollandicus), a granivorous avian species, to adapt metabolically to high dietary protein levels, adult males (n = 26) were fed isocaloric diets containing 11, 20, 35 or 70% crude protein (CP) for 11 mo. Throughout the trial, body weight and breast muscle weight were maintained by 11, 20 or 70% CP. The 35% CP diet resulted in significantly greater body weight (P < 0.05) and whole-body lipid content (P < 0.05) compared with the 11% CP diet. The 20% CP diet resulted in greater breast muscle mass compared with 70% CP (P < 0.05). Activity of the amino acid catabolic enzymes alanine aminotransferase, aspartate aminotransferase and arginase as well as the gluconeogenic enzyme phosphoenolpyruvate carboxykinase were significantly increased with 70% CP (P < 0.05). Serum essential amino acids, urea and uric acid were also increased with 70% CP (P < 0.05), but the magnitude of their increase was similar to that found in omnivorous chickens fed a similar diet. There was no evidence of visceral gout, articular gout or renal pathology; however liver lesion severity, and specifically liver lipogranuloma severity, was significantly increased above 11% CP (P < 0.05). We conclude that cockatiels are able to up-regulate enzymes for amino acid catabolism as well as mechanisms for nitrogen excretion in response to high dietary protein levels, and that high dietary protein levels are not associated with kidney dysfunction in this avian species.

Adaptation, Physiological↗
PubMed2001

Psychological adjustment in caregivers of school-age children infected with HIV: stress, coping, and family factors.

OBJECTIVE: To assess for significant differences in psychological functioning between caregivers of HIV-infected children and caregivers of healthy children, and to examine the utility of applying a stress and coping model to caregivers of children with HIV disease. METHODS: Participants included caregivers of HIV-infected children (n = 36) and caregivers of a demographically matched control group of healthy children (n = 32). During their child's pediatric clinic visits, caregivers completed measures of psychological adjustment, stress, coping style, and family resources and support. They also completed a measure of their child's psychological adjustment. RESULTS: Caregiver psychological distress scores did not significantly differ between the HIV and control groups, and clinically significant rates of psychological distress were reported by more than a third of caregivers in both groups. Hierarchical multiple regression analyses revealed that independent of their child's illness status, stress and coping style were significant predictors of caregiver's psychological adjustment. In addition, caregiver psychological distress was a significant predictor of children's maladjustment. CONCLUSIONS: High rates of psychological distress were observed in caregivers of children with HIV disease; however, similarly high rates of psychological adjustment problems were found in caregivers of healthy children. Caregivers who reported high levels of daily stress and emotion-focused coping styles tended to report more psychological distress. Further, caregivers who reported more psychological distress also reported more internalizing and more externalizing behavior problems in their children, regardless of the child's illness status. These findings reflect the impact of poverty and environmental stress on caregivers' adjustment.

Adaptation, Psychological↗
PubMed2001

Predictors of psychological adjustment in school-age children infected with HIV.

OBJECTIVE: To assess for significant differences in psychological functioning between HIV-infected children and a demographically matched healthy control group and to examine the utility of applying a stress and coping model to children with HIV disease. METHODS: Participants included HIV-infected children (ages 6-16) and their caregivers (n = 36) and a control group of healthy children and their caregivers (n = 32). During routine clinic visits, children completed measures of psychological adjustment, health locus of control, and coping style, and caregivers completed measures of their own and their child's psychological adjustment. RESULTS: Caregiver-reported and child self-reported psychological adjustment scores did not significantly differ between the HIV and control groups, with the exception of significantly more internalizing behavior problems reported in the control group. Hierarchical multiple regression analyses revealed that the stress and coping model accounted for 36% of the variance in HIV-infected children's self-reported psychological adjustment. In addition, child age and coping style were significant predictors of child self-reported psychological adjustment, but not of caregiver-reported child adjustment. CONCLUSIONS: Approximately 25% of children with HIV disease exhibited clinically significant emotional or behavioral problems; however, even higher rates of psychological adjustment problems were found in healthy children. Children with HIV disease who have not been told their diagnosis and children who endorse more emotion-focused coping strategies tend to exhibit more psychological adjustment problems.

Adaptation, Psychological↗
PubMed2001

Prevention and treatment of experimental crescentic glomerulonephritis by blocking tumour necrosis factor-alpha.

BACKGROUND: The mechanisms controlling progression of glomerulonephritis are poorly understood, but there is increasing evidence that tumour necrosis factor-alpha (TNF-alpha) plays a central role in many aspects of glomerular inflammation and scarring. We investigated the role of TNF-alpha in an experimental model of crescentic glomerulonephritis in Wistar Kyoto (WKY) rats by continuously blocking endogenous TNF-alpha, using its soluble receptor sTNFr p55, both before and after establishment of nephritis. METHODS: Glomerulonephritis was induced by a single intravenous injection of 0.1 ml nephrotoxic serum. In the first experiment, rats were pre-treated with sTNFr p55 2 mg/kg intraperitoneally 1 hour before induction of nephritis and on a daily basis thereafter until day 4. In the second experiment, a similar protocol was followed, but treatment with sTNFr p55 was continued until day 10. In the third experiment, treatment with sTNFr p55 was delayed until 4 days after induction of nephritis and continued until day 10. The effects of treatment on renal function, renal histology, cellular infiltration, activation and proliferation, and IL-1beta expression were assessed by standard methods. RESULTS: In the first experiment, short-term treatment with sTNFr p55 caused a marked reduction in albuminuria and fibrinoid necrosis. It also reduced glomerular cell infiltration, activation and proliferation. In the second experiment, prolonged treatment with sTNFr p55 caused a sustained reduction in albuminuria and all histological and cellular parameters of glomerular inflammation; in particular it completely prevented the development of crescents. In the third experiment, delayed therapy of established nephritis with sTNFr p55 significantly reduced albuminuria and glomerular inflammation, including the prevalence of crescent formation. In both long-term experiments, there was less glomerular expression of IL-1beta and lower serum concentrations of IL-beta in sTNFr p55-treated rats. CONCLUSIONS: This study shows that neutralization of endogenous TNF-alpha is effective in preventing acute glomerular inflammation and crescent formation, and in treating established disease, in a rat model of crescentic nephritis. These results may have therapeutic implications for human glomerulonephritis.

Animals↗
PubMed2001

Comparing the efficacy of staff versus housestaff instruction in an intervention to improve hypertension management.

PURPOSE: To determine whether a resident physician can be as effective as a faculty opinion leader in changing physicians' compliance with a hypertension practice guideline. METHOD: At a general internal medicine clinic associated with an internal medicine residency program, sequential charts were reviewed for patients with uncontrolled or new-onset hypertension who were seen routinely during a two-week period. Subsequently, 23 providers were randomly assigned to an academic intervention to implement a hypertension practice guideline led by a single second-year resident instructor (RI), and 21 providers were assigned to the same intervention led by a single staff internist (SI) with an interest in hypertension. The intervention involved academic detailing, chart audit with feedback, and behavior reinforcement. Six weeks later, the chart audit was repeated to assess the change in practice patterns among providers taught by the RI compared with those taught by the SI. RESULTS: Overall, management consistent with the practice guideline improved from 32% (51/157) to 45% (56/123) (p < .01) after the intervention. This change was due to improvement in the care provided by providers from the SI-led intervention: 28% (17/60) to 57% (26/46) (p < .003). Providers from the RI-led intervention showed no improvement: 35% (34/97) to 39% (30/77) (p = NS). CONCLUSIONS: This intervention was effective in improving providers' compliance with a hypertension practice guideline, but only when led by a faculty opinion leader. A resident instructor using the same format was unable to change the providers' behaviors.

Guideline Adherence↗
PubMed2001

Development of a musculoskeletal examination skills course for a physical medicine and rehabilitation residency program.

This article describes the development of a musculoskeletal physical examination skills course for a physical medicine and rehabilitation residency training program. Course objectives, structure, and modification over time based on experience and resident feedback are discussed. The current course design is adaptable to meet the needs and resources of most residency programs.

Clinical Competence↗
PubMed2001

Neurophysiologic influences on hamstring flexibility: a pilot study.

OBJECTIVE: To examine the potential contribution of neurologic influences on hamstring length during passive range of motion. DESIGN: Prospective study. SETTINGS: Academic sports medicine center. PATIENTS: 15 subjects undergoing arthroscopic surgery for unilateral knee injuries without previous injury to the contralateral knee. INTERVENTIONS: Subjects received: 1) spinal anesthesia with bupivacaine, 2) epidural anesthesia with lidocaine, 3) general anesthesia, or 4) femoral nerve block of injured leg only. MAIN OUTCOME MEASURES: Noninjured leg popliteal angle preoperatively, intraoperatively under anesthesia, and postoperatively after recovery from anesthesia. RESULTS: The overall mean popliteal angle was 132.5 +/- 3.1 degrees preoperatively, 134.31 +/- 11.6 degrees intraoperatively, and 130.7 +/- 10.2 degrees postoperatively. Overall, the intraoperative angle was significantly greater than the postoperative angle (p = 0.02). The mean change in popliteal angle was 8.1 +/- 2.2 degrees (Group 1), -0.4 +/- 1.9 degrees (Group 2), 0.9 +/- 1.4 degrees (Group 3), and -2.4 +/- 3.8 degrees (Group 4). There was no significant change in pre- to postoperative popliteal angle in relation to postoperative pain. Females had a greater mean popliteal angle (139.84 degrees ) compared with males (128.84 degrees ) (p = 0.04). CLINICAL RELEVANCE: Understanding the neuromuscular influences on muscle flexibility will assist in the development of new rehabilitative and injury preventative techniques. CONCLUSION: The present pilot study implicates neural contributions to muscle flexibility. Further studies are needed to delineate the relative contributions of neural and muscular components and to facilitate new techniques in the rehabilitation and prevention of injury.

Adolescent↗
PubMed2001

Modified work: prevalence and characteristics in a sample of workers with soft-tissue injuries.

Modified-work programs are designed to facilitate the return to work for employees with a work-related injury. Although extensive published literature exists that describes and evaluates "ideal" programs, to date there is a paucity of data describing practice. To address this pertinent issue, we administered a survey to a large sample of 1833 workers with soft-tissue injuries in Ontario, Canada, and asked them detailed questions about modified work and employer contact. Our results reveal that most workers (66%) were contacted by someone from their workplace to check on how they were doing. However, only a minority (36%) were offered arrangements by their employer to help them return to work after developing a work-related soft-tissue injury. Most arrangements that were offered to injured workers consisted of such temporary modifications as reduced hours (24%), flexible work hours (25%), or a lighter job (57%) rather than more permanent changes to the way that work is conducted, such as changes to the work layout or equipment (8%). Merely being contacted by the workplace to check on how the worker was doing was not associated with reduced compensation benefit duration. Workplace offers of arrangements to help the worker return to work were associated with reduced compensation benefit duration but were not statistically associated with workers' pain grade.

Disability Evaluation↗
PubMed2001

Three-dimensional registration and fusion of ultrasound and MRI using major vessels as fiducial markers.

This paper describes fusion of three-dimensional (3-D) ultrasound (US) and magnetic resonance imaging (MRI) data sets, without the assistance of external fiducial markers or external position sensors. Fusion of these two modalities combines real-time 3-D ultrasound scans of soft tissue with the larger anatomical framework from MRI. The complementary information available from multiple imaging modalities warrants the development of robust fusion capabilities. We describe the data acquisition, specialized algorithms, and results for 3-D fused data from phantom studies and in vivo studies of the normal human vasculature and musculoskeletal systems.

Algorithms↗
PubMed2001

Improving depression outcomes in community primary care practice: a randomized trial of the quEST intervention. Quality Enhancement by Strategic Teaming.

OBJECTIVE: To determine whether redefining primary care team roles would improve outcomes for patients beginning a new treatment episode for major depression. DESIGN: Following stratification, 6 of 12 practices were randomly assigned to the intervention condition. Intervention effectiveness was evaluated by patient reports of 6-month change in 100-point depression symptom and functional status scales. SETTING: Twelve community primary care practices across the country employing no onsite mental health professional. PATIENTS: Using two-stage screening, practices enrolled 479 depressed adult patients (73.4% of those eligible); 90.2% completed six-month follow-up. INTERVENTION: Two primary care physicians, one nurse, and one administrative staff member in each intervention practice received brief training to improve the detection and management of major depression. MAIN RESULTS: In patients beginning a new treatment episode, the intervention improved depression symptoms by 8.2 points (95% confidence interval [CI], 0.2 to 16.1; P =.04). Within this group, the intervention improved depression symptoms by 16.2 points (95% CI, 4.5 to 27.9; P =.007), physical role functioning by 14.1 points (95% CI, 1.1 to 29.2; P =.07), and satisfaction with care (P =.02) for patients who reported antidepressant medication was an acceptable treatment at baseline. Patients already in treatment at enrollment did not benefit from the intervention. CONCLUSIONS: In practices without onsite mental health professionals, brief interventions training primary care teams to assume redefined roles can significantly improve depression outcomes in patients beginning a new treatment episode. Such interventions should target patients who report that antidepressant medication is an acceptable treatment for their condition. More research is needed to determine how primary care teams can best sustain these redefined roles over time.

Adult↗
PubMed2001

Individual and bivalent vaccines based on alphavirus replicons protect guinea pigs against infection with Lassa and Ebola viruses.

Lassa and Ebola viruses cause acute, often fatal, hemorrhagic fever diseases, for which no effective vaccines are currently available. Although lethal human disease outbreaks have been confined so far to sub-Saharan Africa, they also pose significant epidemiological concern worldwide as demonstrated by several instances of accidental importation of the viruses into North America and Europe. In the present study, we developed experimental individual vaccines for Lassa virus and bivalent vaccines for Lassa and Ebola viruses that are based on an RNA replicon vector derived from an attenuated strain of Venezuelan equine encephalitis virus. The Lassa and Ebola virus genes were expressed from recombinant replicon RNAs that also encoded the replicase function and were capable of efficient intracellular self-amplification. For vaccinations, the recombinant replicons were incorporated into virus-like replicon particles. Guinea pigs vaccinated with particles expressing Lassa virus nucleoprotein or glycoprotein genes were protected from lethal challenge with Lassa virus. Vaccination with particles expressing Ebola virus glycoprotein gene also protected the animals from lethal challenge with Ebola virus. In order to evaluate a single vaccine protecting against both Lassa and Ebola viruses, we developed dual-expression particles that expressed glycoprotein genes of both Ebola and Lassa viruses. Vaccination of guinea pigs with either dual-expression particles or with a mixture of particles expressing Ebola and Lassa virus glycoprotein genes protected the animals against challenges with Ebola and Lassa viruses. The results showed that immune responses can be induced against multiple vaccine antigens coexpressed from an alphavirus replicon and suggested the possibility of engineering multivalent vaccines based upon alphavirus vectors for arenaviruses, filoviruses, and possibly other emerging pathogens.

Alphavirus↗
PubMed2001

Stimulation of homologous recombination through targeted cleavage by chimeric nucleases.

Chimeric nucleases that are hybrids between a nonspecific DNA cleavage domain and a zinc finger DNA recognition domain were tested for their ability to find and cleave their target sites in living cells. Both engineered DNA substrates and the nucleases were injected into Xenopus laevis oocyte nuclei, in which DNA cleavage and subsequent homologous recombination were observed. Specific cleavage required two inverted copies of the zinc finger recognition site in close proximity, reflecting the need for dimerization of the cleavage domain. Cleaved DNA molecules were activated for homologous recombination; in optimum conditions, essentially 100% of the substrate recombined, even though the DNA was assembled into chromatin. The original nuclease has an 18-amino-acid linker between the zinc finger and cleavage domains, and this enzyme cleaved in oocytes at paired sites separated by spacers in the range of 6 to 18 bp, with a rather sharp optimum at 8 bp. By shortening the linker, we found that the range of effective site separations could be narrowed significantly. With no intentional linker between the binding and cleavage domains, only binding sites exactly 6 bp apart supported efficient cleavage in oocytes. We also showed that two chimeric enzymes with different binding specificities could collaborate to stimulate recombination when their individual sites were appropriately placed. Because the recognition specificity of zinc fingers can be altered experimentally, this approach holds great promise for inducing targeted recombination in a variety of organisms.

Animals↗