Are you cut out for a career in research.
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Career Choice↗
Biomedical subjects
J Willis
Publications and source records attributed to J Willis.
Lecturer-practitioners: serving two masters for a common cause.
Is the theory-practice gap being bridged now that lecturer-practitioner posts exist in many parts of the country? Jenine Willis finds out how some practitioners are coping with the demands of the job.
Education, Nursing, Baccalaureate↗
High-resolution cross-sectional imaging of the gastrointestinal tract using optical coherence tomography: preliminary results.
BACKGROUND: Optical coherence tomography (OCT) is a novel technique for noninvasive cross-sectional imaging with high spatial resolution (10 to 20 microm). OCT is similar to B-mode ultrasound except that it uses infrared light rather than ultrasound. We studied OCT imaging of the gastrointestinal (GI) tract in vitro to analyze the potential of this technique for endoscopic applications. METHODS: Human gastrointestinal tissues harvested from surgical resection and autopsy specimens were used. Specimens were imaged within 5 hours of resection or snap frozen in liquid nitrogen. After imaging, OCT scan locations were carefully marked using dye microinjections, fixed, and prepared for routine histologic processing. OCT images were then compared and correlated with the histologic sections. RESULTS: OCT images demonstrated clear delineation of the mucosa and submucosa in most specimens. Furthermore, microscopic structures such as crypts, blood vessels, or esophageal glands in the submucosa and lymphatic nodules were observed. CONCLUSIONS: The resolution of OCT images of GI wall is sufficient to delineate the microscopic structure of the mucosa and submucosa. Potentially, OCT would allow in vivo imaging at endoscopy of the microstructure of the mucosa and submucosa. This would be particularly useful in the detection and staging of small lesions such as early stage cancers.
Anatomy, Cross-Sectional↗
Intrinsic hyperreactivity of mucosal T cells to interleukin-2 in pediatric Crohn's disease.
OBJECTIVES: To cells play a crucial role in many chronic inflammatory diseases. Mucosal T cells are particularly important in the pathogenesis of Crohn's disease (CD). We investigated the response of T cells in CD and other intestinal inflammatory conditions to interleukin-2 (IL-2), a cytokine essential for T-cell activation, growth, and function. STUDY DESIGN: T-cell reactivity was assessed by measuring growth induced by IL-2 in mucosal endoscopic biopsy specimens obtained from children with CD, ulcerative colitis, indeterminate colitis, and chronic nonspecific colitis and from children without gastrointestinal inflammation. RESULTS: CD mucosal T cells grew remarkably and significantly more than T cells from normal, ulcerative colitis, and chronic nonspecific colitis mucosa. T cells from indeterminate colitis mucosa grew similarly to those of CD mucosa. The enhanced growth response in CD was independent of disease location, presence or absence of intestinal inflammation, treatment, disease duration, or clinical activity. CONCLUSION: Mucosal T cells from children with CD exhibit an intrinsic hyperreactivity to IL-2. This may represent a primary pathogenic abnormality in this condition.
Adolescent↗
Type 1 diabetes in insulin-treated adult-onset diabetic subjects.
The frequency of autoimmune features was compared in adult-onset diabetic subjects either requiring insulin treatment within 12 months of diagnosis or progressing to insulin therapy after a latency of at least 5 years. Adult-onset insulin-treated diabetic subjects were sampled from the population-based Canterbury Diabetes Registry (n = 1580). There were 237 (15%) registrants who met the study criteria of age < 75 years at 1 January 1993, age at diagnosis of diabetes > or = 45 years and duration of diabetes between 5 and 15 years; 101 subjects commenced insulin 5-15 years after diagnosis (group 1) and 80 subjects commenced insulin within 1 year of diagnosis (group 2). C-peptide levels, islet cell antibodies (ICA) and antibodies against glutamic acid decarboxylase (anti-GAD) were determined in all individuals from group 1 (n = 27) and group 2 (n = 23) who agreed to be recruited to the study. The group 1 and group 2 samples did not differ significantly in their demographic characteristics, nor were they different from the two groups from which they were drawn (mean age, 64.2 years; age at diagnosis, 53.5 years; duration of diabetes, 10.7 years; body mass index, 28.6 kg/m2). Overall, 12 of the 50 (24%) study subjects tested positive for anti-GAD; 43% (10) of group 2 subjects were anti-GAD positive compared with only 7.4% (2) of group 1 subjects (P < 0.01). Postprandial C-peptide levels were significantly lower in group 2 subjects compared with group 1 subjects (627 vs 1124 pM, P < 0.05). All subjects were ICA negative. These observations suggest that autoimmune destruction of beta-cells explains early requirement for insulin in adult-onset diabetes.
Age of Onset↗
Building confidence by profiling.
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Documentation↗
Myositis ossificans-like lesion of nerve.
An unusual ossifying lesion arising within the median nerve of a young adult male is presented. While ectopic ossification has been described in a large number of sites, intraneural ossification is an uncommon event and usually occurs in association with a pre-existing intraneural neoplasm. This case, in contrast, bears striking histopathological resemblance to myositis ossificans with prominent zonation. We believe that this may represent the first example of a benign myositis ossificans-like lesion of nerve.
Adult↗
Barbiturate anticonvulsants: a neuropsychological and quantitative electroencephalographic study.
We studied 11 epileptic children aged 7 to 14 years with quantitative electroencephalographic (EEG) and neuropsychological tests, both on and off the barbiturate anticonvulsants phenobarbital and mephobarbital, comparing them to 13 controls matched for age and IQ who received testing at similar intervals. Neuropsychological tests employed were the Wechsler Intelligence Scale for Children-Revised (WISC-R), Bender-Gestalt, controlled oral word association test (COWAT), selected subtests of the Wechsler Memory Scale-Revised, Purdue Peg Board, Stroop Test, Trail Making Test, Wide Range Achievement Test-Revised, and Achenbach Behavior Rating Scale. There was no difference between on- and off-drug quantitative EEG in percentage power of any frequency band between 0.6 and 32 Hz. Neuropsychological data from all 11 subjects were analyzed with a two-factor analysis of variance with repeated measures on the time factor. The only difference from controls was on the Stroop Test. Parents reported clear behavioral changes in 6 of 11 subjects, but in 4 of these children the behavioral changes were sufficiently mild that parents chose to continue the barbiturate anticonvulsants: irritability, oppositional attitude, and overactivity were described. Mephobarbital was reported by parents to cause less severe problems than phenobarbital in subjects who had taken both barbiturate anticonvulsants. Barbiturate anticonvulsants have no effect on quantitative EEG and limited effects on neuropsychological tests in school-aged children.
Adolescent↗
Assessing for audit.
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Education, Medical, Graduate↗
Polyomavirus mimicking high grade transitional cell carcinoma.
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Adult↗
Frozen section consultation. Utilization patterns and knowledge base of surgical faculty at a university hospital.
The authors studied the knowledge base of surgical faculty concerning frozen section consultations at a university hospital to determine whether it had any relationship to the appropriateness of frozen section requests. To accomplish this, the reasons for performing frozen sections during a 3-month period were analyzed, and those request that seemed ambiguous or inappropriate were identified. Simultaneously a 15-item questionnaire was distributed to faculty and housestaff dealing with factual information concerning the technique and limitations of frozen section diagnosis (Questions 1-8), as well as appropriateness of frozen section requests in a number of clinical situations (Questions 9-15). The collective score on items of general information (Questions 1-8) was 69%, whereas scores on Questions 9-15 ranged from 39% on the gynecologic question related to evaluation of a cystic ovarian mass to 81% on the general surgery question regarding evaluation of a soft tissue mass. Of 914 frozen sections, 95% were performed for appropriate reasons, which included evaluation of margins (46%), establishing a primary diagnosis (43%), determining adequacy or viability of tissue (3%), or satisfying immediate patient/family concerns ( < 1%). Five percent of frozen sections were performed for ambiguous or seemingly inappropriate reasons. Because fewer than five faculty members were responsible for the inappropriate frozen section request, the authors did not find that the results of the questionnaire predicted or anticipated situations in which inappropriate requests occurred. Nonetheless, the results of the questionnaire indicate there is important general information concerning frozen sections that is not uniformly shared by surgical faculty, such as the types of tissue that cannot be cut on a cryostat, the reasons for deferred frozen sections, and the situations in which fresh tissue is needed for special studies. The authors suggest the inappropriate frozen section could be diminished by an educational initiative targeted at a relatively small segment of clinical faculty, whereas enhancement of general information regarding frozen section should ideally occur in the broader context of clinical conferences using illustrative case material.
Faculty↗
Monocyte monolayer assay (MMA) reactivity of alloantibodies reacting by the manual polybrene technique but not by an antiglobulin test.
The manual polybrene technique (MP) has been shown to be useful in pretransfusion testing as a rapid method capable of detecting a wide range of red cell antibodies. The clinical significance of alloantibodies reacting by the MP but not by an antiglobulin test (MP+/AGT-) has not been determined. The monocyte monolayer assay (MMA) is an established in vitro technique for assessing the likely clinical significance of red cell antibodies. This was used to examine 21 MP+/AGT- alloantibodies and 41 alloantibodies reacting by a LISS antiglobulin method (LISS-AGT). Two of the 21 MP+/AGT- antibodies (9.5%) produced positive results by the MMA compared with 26/41 (63.4%) of LISS-AGT-reactive antibodies. The incidence of positive reactivity of the latter antibodies in the MMA was similar between those that were reactive and nonreactive by the MP. These results suggest that antibodies reacting by MP and not by an antiglobulin test are less likely to be clinically significant.
Coombs Test↗
Fatal attraction: do high-technology treatments for end-stage renal disease benefit aboriginal patients in central Australia?
The health problems of Aboriginal Australians, like those of many indigenous peoples, resemble those of the developing world, yet they are dealt with using the tools, techniques, and high-technology medical solutions of first-world health. Such approaches ignore the social components of health and illness, including the need for preventive and educative programs at the primary health care level. The example of endstage renal disease provides a poignant example of the inadequacies of this approach. Central Australian Aboriginal people suffer from a high incidence of kidney disease from numerous causes including non-insulin-dependent diabetes mellitus and glomerulonephritis. The high incidence has led to numbers of people developing end-stage renal disease and moving into the Northern Territory-South Australia renal failure program for dialysis and/or transplantation. In requiring patients to leave their lands, communities and families, this program removes people from the religious and social support network that could ensure a reasonable quality of life in their final years, while offering only marginal extensions of those years. Expensive technology programs are of little benefit and of considerable cost to Aboriginal patients and draw attention away from efforts to reduce the exposure of at-risk Aboriginal people to the factors that facilitate the development of end-stage renal disease.
Adult↗
Patient-controlled analgesia devices.
PCA is a practical way of giving a measure of control to patients. A variety of pumps allows selection of an appropriate device for local needs. The cost of disposables should be considered when purchasing.
Analgesia, Patient-Controlled↗
Enteral feeding pumps.
Enteral tube feeding is a relatively safe way of meeting nutritional requirements. Pumps are a reliable and cost-effective means of feeding. Nurses should consider the range of options available when choosing a pump. The cost of disposables should always be taken into account.
Enteral Nutrition↗
Pressure-relief seating.
Many patients at risk of pressure sores spend much of their time sitting in a chair or wheelchair. These patients are increasingly buying their own seating and seeking nurses' advice. A wide range of seating systems is available, but there is a need for more comparative trials to be undertaken.
Humans↗
Infusion devices: volumetric and peristaltic pumps.
Infusion pumps are an essential part of any acute unit's equipment. But as such pumps become increasingly sophisticated, selecting the appropriate machine has become a more difficult task. Infusion pumps are expensive, and it is essential to balance the features required with the investment made.
Humans↗
Intermittent catheters.
Intermittent catheterisation can improve patients' quality of life and promote independence. Nurses need to be aware of the products available, to ensure patients receive appropriate equipment. Nurse prescribing may soon confirm the nurse's key role in selecting these products.
Adult↗