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Biomedical subjects

J Webster

Publications and source records attributed to J Webster.

At least 307 records · Page 17Linked to original sources
PubMed1975

Successful management of caliceal fistulas following renal transplantation.

Caliceal fistulas are unusual complications of renal transplantation. Segmental renal infarction and distal ureteral obstruction may be contributing factors in their formation. Two cases are reported, the first probably a result of segmental renal infarction from failure to recognize and anastomose an accessory renal artery, the second possibly related to blunt trauma to the area of the graft in an automobile accident and ureteral obstruction resulting from blood clots. Nephrostomy drainage through a healthy area of renal parenchyma was instrumental in the salvage of both kidneys.

Accidents, Traffic↗
PubMedDate not supplied

Subgroup and per-protocol analysis of the randomized European Trial on Isolated Systolic Hypertension in the Elderly.

BACKGROUND: In 1989, the European Working Party on High Blood Pressure in the Elderly started the double-blind, placebo-controlled, Systolic Hypertension in Europe Trial to test the hypothesis that antihypertensive drug treatment would reduce the incidence of fatal and nonfatal stroke in older patients with isolated systolic hypertension. This report addresses whether the benefit of antihypertensive treatment varied according to sex, previous cardiovascular complications, age, initial blood pressure (BP), and smoking or drinking habits in an intention-to-treat analysis and explores whether the morbidity and mortality results were consistent in a per-protocol analysis. METHODS: After stratification for center, sex, and cardiovascular complications, 4695 patients 60 years of age or older with a systolic BP of 160 to 219 mm Hg and diastolic BP less than 95 mm Hg were randomized. Active treatment consisted of nitrendipine (10-40 mg/d), with the possible addition of enalapril maleate (5-20 mg/d) and/or hydrochlorothiazide (12.5-25 mg/d), titrated or combined to reduce the sitting systolic BP by at least 20 mm Hg, to below 150 mm Hg. In the control group, matching placebo tablets were employed similarly. RESULTS: In the intention-to-treat analysis, male sex, previous cardiovascular complications, older age, higher systolic BP, and smoking at randomization were positively and independently correlated with cardiovascular risk. Furthermore, for total (P = .009) and cardiovascular (P = .09) mortality, the benefit of antihypertensive drug treatment weakened with advancing age; for total mortality (P = .05), the benefit increased with higher systolic BP at entry, while for fatal and nonfatal stroke (P = .01), it was most evident in nonsmokers (92.5% of all patients). In the perprotocol analysis, active treatment reduced total mortality by 24% (P = .05), reduced all fatal and nonfatal cardiovascular end points by 32% (P<.001), reduced all strokes by 44% (P = .004), reduced nonfatal strokes by 48% (P = .005), and reduced all cardiac end points, including sudden death, by 26% (P = .05). CONCLUSIONS: In elderly patients with isolated systolic hypertension, stepwise antihypertensive drug treatment, starting with the dihydropyridine calcium channel blocker nitrendipine, improves prognosis. The per-protocol analysis suggested that treating 1000 patients for 5 years would prevent 24 deaths, 54 major cardiovascular end points, 29 strokes, or 25 cardiac end points. The effects of antihypertensive drug treatment on total and cardiovascular mortality may be attenuated in very old patients.

Aged↗
PubMedDate not supplied

Development of a computerized assessment of clinician adherence to a treatment guideline for patients with bipolar disorder.

The adoption of treatment guidelines for complex psychiatric illness is increasing. Treatment decisions in psychiatry depend on a number of variables, including severity of symptoms, past treatment history, patient preferences, medication tolerability, and clinical response. While patient outcomes may be improved by the use of treatment guidelines, there is no agreed upon standard by which to assess the degree to which clinician behavior corresponds to those recommendations. This report presents a method to assess clinician adherence to the complex multidimensional treatment guideline for bipolar disorder utilized in the Texas Medication Algorithm Project. The steps involved in the development of this system are presented, including the reliance on standardized documentation, defining core variables of interest, selecting criteria for operationalization of those variables, and computerization of the assessment of adherence. The computerized assessment represents an improvement over other assessment methods, which have relied on laborious and costly chart reviews to extract clinical information and to analyze provider behavior. However, it is limited by the specificity of decisions that guided the adherence scoring process. Preliminary findings using this system with 2035 clinical visits conducted for the bipolar disorder module of TMAP Phase 3 are presented. These data indicate that this system of guideline adherence monitoring is feasible.

Algorithms↗
PubMedDate not supplied

Maintaining study validity in a changing clinical environment.

BACKGROUND: Nurse scientists who conduct intervention research in a variety of clinical settings find themselves facing numerous challenges posed by today's changing and sometimes complex health care environment. Maintaining study validity thus becomes a major focus of interventional research, but existing literature does not fully address challenges to study validity nor offer potential solutions. OBJECTIVES: The purposes of this paper are to 1) discuss methodologic challenges to maintaining study validity of intervention research that is conducted in a changing clinical environment, and 2) share strategies for maximizing study validity. METHODS: A recently completed intervention study is used as an example to discuss two specific areas that affected study validity, provide examples of selected threats to validity, and outline strategies used to minimize these threats. RESULTS: Careful definition of goals, thoughtful decision making, and implementation of specific strategies to maintain study validity helped increased the rigor of the research. CONCLUSIONS: Investigators conducting intervention research in changing clinical settings can reduce threats to study validity and increase design rigor by considering clinical realities (e.g., clinician-researcher role conflict) when making methodologic decisions, becoming familiar with the setting, and involving clinicians in the research.

Decision Making↗
PubMedDate not supplied

Exercise and obesity.

Obesity, prevalent in industrialised societies, is most usefully categorised by means of the body mass index (BMI-weight/height2). A body mass index of greater than 25 is associated with increasingly poor prognosis. Weight reduction has been shown to be beneficial with respect to both mortality and morbidity. Excess weight results from an imbalance between energy input and expenditure in favour of the former. Weight reduction may be promoted by reducing energy input and/or stimulating expenditure. It is tempting to postulate that inactivity may be a factor in both the development and subsequent continuation of obesity via an effect on energy intake, fat-free mass or energy expenditure. Although available data are by no means conclusive, the majority of evidence suggests that obesity is not associated with either reduced activity or energy expenditure. Likewise, exercise appears not to promote a change in body composition in favour of lean body mass or have a prolonged thermogenic effect beyond the duration of the activity. Exercise alone appears largely ineffective regarding weight loss and almost certainly has to be coupled with calorie reduction. It must be remembered that the exercise tolerance in the severely obese (BMI greater than 40) is very poor. Such individuals must be closely supervised during a specifically graded programme. What is also apparent is the high drop-out rate of individuals recruited into exercise programmes. In those who voluntarily engage in physical activity, the incidence of ischaemic heart disease may be reduced, which may or may not be related to a direct exercise effect on known cardiovascular risk factors. Cigarette smoking is usually less common and general life-style may be more prudent. Whether exercise in obese subjects could have a similar effect remains unknown. Although much of the data on exercise in general and on obesity in particular are negative, it appears unwise to adopt a totally nihilistic approach. Increased physical activity should be encouraged as it is possible that the discipline involved in regularly undertaking such activity may be more conducive to weight loss, a feeling of well-being and fitness and a general change of life-style for the better. Long term it may also afford additional benefit by reducing liability to ischaemic heart disease.

Animals↗
PubMedDate not supplied

Nurse-led weaning from ventilation and extubation in the paediatric cardiothoracic intensive care unit.

An idea involving the expansion of the role of the paediatric intensive care nurse and the promotion of enhanced quality patient care is presented. A point prevalence study was conducted to investigate practices in weaning from ventilation in children after cardiac surgery. The development of a clinical protocol, audit of practice, education and training and implementation of a change in practice are discussed. Recommendations for future research are made.

Child↗
PubMedDate not supplied

The expression of sub-population markers on B cells: a re-evaluation using high-sensitivity fluorescence flow cytometry.

A number of markers which have been proposed to identify B cell subsets have been reassessed on human B cells, using an immunofluorescence technique optimized for sensitivity and an analytical mode which yields histograms showing the distribution of fluorescence on B cells. The results show that CD38, CD22, CD23, FMC6, and anti-IgM react with all blood B cells, albeit with a broad and complex distribution of fluorescence. CD5, CD9, CD10, CD43, and IgD can be regarded as subset markers since they give clearly bimodal distributions of fluorescence intensity. CD5 staining showed at least three populations, with a small number (3-5 per cent) of cells brightly stained and a population of variable size staining weakly. No clearly defined populations were seen with CD45R0, although staining was slightly above background. An antibody against the LAM-1 molecule reacted with all blood B cells. Expression of the IL-2 receptor p55 chain (CD25) was clearly bimodal, whereas the p75 chain was essentially negative on B cells. The relationship between subsets in blood and subsets in tissue, and between subsets identified by different markers in blood, is discussed.

Antigens, Differentiation, B-Lymphocyte↗