Dysbaric osteonecrosis of the shoulder in a sport scuba diver.
The previously unreported occurrence of dysbaric osteonecrosis in an amateur sport scuba diver who had no other identified cause of avascular bone necrosis is described.
Adult↗
Biomedical subjects
K Ross
Publications and source records attributed to K Ross.
Reduction of medical liability claim frequency: the Texas experience.
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Expert Testimony↗
Neoral: the new cyclosporine.
Neoral is an improved formulation of cyclosporine which, through microemulsion technology, provides a more consistent rate of absorption and exposure. If patients are able to take less Neoral and still maintain the same cyclosporine level, there will also be a cost savings involved. A dose reduction of 30% yields pharmacoeconomic savings. With a more consistent rate of absorption, the risks of nephrotoxicity may be reduced.
Administration, Oral↗
Project to develop an autonomous practitioner programme.
The early 1990s has seen a rapid expansion in the nature of clinical roles in health care in response to a number of changes. Throughout 1996, The Oxford Radcliffe Hospital National Health Service (NHS) Trust, in partnership with Oxford Brookes University, School of Health Care, and the Royal College of Nursing (UK) have been collaborating to develop an educational programme at degree and masters level, to support new and evolving clinical roles in acute and primary care, across most professional health registration areas and clinical specialities. To ensure the proposed programme was 'fit for purpose'the Trust commissioned a Training Needs Analysis by the University of Birmingham and a Role Analysis by The Royal College of Nursing. Nurses and Midwives with expertise in practice, management, education and research, have collaborated to develop an innovative educational programme which enables a wide range of public and private health care professionals across acute and community settings to develop their autonomous practice. The programme is fully supported by development of policies which are appropriate to service delivery, support professional practice, multi-professional relationships, risk management and patient safety. The issue of contractual and professional responsibilities related to career development have been debated and a proactive strategy agreed. To ensure there is thorough evaluation of the area of practice, research projects to evaluate outcomes for patients as well as practitioners have been designed. This will additionally promote a culture of evidence-based practice.
Education, Nursing, Graduate↗
Serotonin levels, pain threshold, and fibromyalgia symptoms in the general population.
OBJECTIVE: To investigate the association of serum serotonin with fibromyalgia (FM), and to study the relationship of serotonin to clinical variables associated with FM. METHODS: Serum samples (n = 292) were obtained on subjects without pain, with regional pain, and with widespread pain during a population survey. The tender point examination was made according to American College of Rheumatology examination criteria by an examiner blind to the subjects' complaints. Serotonin was determined by high performance liquid chromatography coupled to an electrochemical detector. RESULTS: No associations between clinical variables and serotonin levels were found in the group as a whole. Subjects with FM had lower serotonin levels unadjusted (p = 0.019) and adjusted for age and sex (p = 0.059) than those without FM. Within the FM group, associations between serotonin and tender point count (r = 0.563) and depression (r = 0.549) were noted, but the direction of association was opposite to previous reports and expectations. CONCLUSION: Serum serotonin levels are significantly lower in persons with FM compared to those without FM, but the range of values is wide. Difficult to explain correlations with reversed directions are noted for tender point count, dolorimetry, depression, and anxiety among those with FM. Serotonin is not correlated with any clinical variables in the general population, and separate pain groups cannot be distinguished.
Analysis of Variance↗
Clinical and morphologic features of lipomatous hypertrophy ("massive fatty deposits") of the interatrial septum.
Lipomatous hypertrophy of the interatrial septum ("massive fatty deposits in the atrial septum") may represent an incidental autopsy finding or may be associated with atrial arrhythmias, obstructive symptoms, or sudden death. Antemortem diagnosis is becoming much more common. In a literature review and in a review of our 12 cases, this condition was found to occur more frequently in obese middle-aged or elderly subjects, who frequently demonstrated atherosclerotic coronary artery disease. The unencapsulated mass generally occurred anterior or superior to the fossa ovalis, and histologically was characterized by mature fat with varying quantities of fetal fat, inflammation and fibrosis, and entrapment of myocardial fibers with cytologic atypia. Cases were included that had a minimum atrial septal thickness of 1.0 cm. The septum ranged up to 7.0 cm in maximum thickness (2.6 cm average). In our cases, no deaths were directly attributed to this disorder. It is important that forensic pathologists become more generally aware of this condition. To further delineate the true pathological significance, the atrial septum should be routinely examined by palpation and sectioning to determine its thickness and fat content.
Adipose Tissue↗
Follow the leader: mentoring and health care.
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Education, Nursing, Continuing↗
New glovebag regulations allow safer, cheaper asbestos removal.
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Asbestos↗
The prevalence and characteristics of fibromyalgia in the general population.
OBJECTIVE: To determine the prevalence and characteristics of fibromyalgia in the general population. METHODS: A random sample of 3,006 persons in Wichita, KS, were characterized according to the presence of no pain, non-widespread pain, and widespread pain. A subsample of 391 persons, including 193 with widespread pain, were examined and interviewed in detail. RESULTS: The prevalence of fibromyalgia was 2.0% (95% confidence interval [95% CI] 1.4, 2.7) for both sexes, 3.4% (95% CI 2.3, 4.6) for women, and 0.5% (95% CI 0.0, 1.0) for men. The prevalence of the syndrome increased with age, with highest values attained between 60 and 79 years (> 7.0% in women). Demographic, psychological, dolorimetry, and symptom factors were associated with fibromyalgia. CONCLUSION: Fibromyalgia is common in the population, and occurs often in older persons. Characteristic features of fibromyalgia--pain threshold and symptoms--are similar in community and clinic populations, but overall severity, pain, and functional disability are more severe in the clinic population.
Adult↗
REM sleep deprivation alters dopamine D2 receptor binding in the rat frontal cortex.
REM sleep deprivation (RSD) of rats results in facilitation of dopaminergic behavior and an increase in striatal D2 receptor density. To determine whether RSD results in changes in D2 receptor in other brain regions, receptor affinity (Kd) and density (Bmax) were measured in the anteromediofrontal (AM), cingulate (CN), and sulcal cortex (SL) in four groups of rats: 1), RSD96 group (RSD for 96 h; small pedestal/water tank method), 2) RSD24 group (large pedestals for 72 h then small pedestals for 24 h), 3) tank control group (TC; large pedestals for 96 h), and 4) cage control group. In separate groups, ambulation was recorded for 30 min following treatments. Group RSD96 showed an increase in activity compared to TC, and TC was increased compared to CC (p < 0.05 for all). In group RSD24, the AM showed an increase in Bmax and Kd (p < 0.05), but there were no effects by RSD96. In the CN, Bmax and Kd were decreased by RSD96 (p < 0.05) but not RSD24. In the SL, Bmax was increased by RSD96, but not RSD24, whereas Kd was increased in both RSD groups (p < 0.05).
Animals↗
Aspects of fibromyalgia in the general population: sex, pain threshold, and fibromyalgia symptoms.
OBJECTIVE: To investigate relationships between sex, pain threshold and fibromyalgia (FM) symptoms in the general population. METHODS: Data were obtained from a randomized populations survey of 3,006 persons in Wichita, KS and a subsample of 391 who completed a detailed interview and had an examination. Tender point counts, dolorimetry scores, clinical and psychological variables were measured. RESULTS: Dolorimetry scores were 2.04 kg/cm (1.42-2.66) lower in women than men, and women were almost 10 times more likely to have 11 tender points [OR 9.6 (2.00-46.3)] than men. Women are also more likely to have FM symptoms than men: "Pain all over," [OR 3.94 (1.34-11.38)], sleep disturbance [OR 3.06 (1.45-6.46)], fatigue [OR 4.52 (2.03-10.09)], and irritable bowel syndrome [OR 5.23 (1.83-14.96)]. Tender point counts are more correlated with FM symptoms than dolorimetry scores. CONCLUSION: Symptoms of FM are correlated with pain threshold in the general population, but tender point counts correlate better than dolorimetry. These 2 measures of pain threshold assay different but overlapping factors. Pain threshold is lower in women; and women have more FM symptoms. Decreased pain threshold correlates with all of the symptoms of FM, even in those who do not meet criteria for the syndrome. This suggests that decreased pain threshold, as measured by the tender point counts, is an intrinsically important aspect of patient distress, regardless of the extent and kind of concomitant disease; and that much can be learned about patients by employing this examination.
Disability Evaluation↗
Parents' and children's ratings of sleep behavior, excitement, and tiredness: a 10-week longitudinal study.
In a 10-week longitudinal study, 29 parents and their children kept daily records of the children's sleep behaviors, excitement levels, and tiredness levels. Although the hypothesized increase in sleep behaviors such as sleepwalking and restlessness during the week of Christmas did not occur, children rated as more excitable by their parents and themselves exhibited a higher frequency of sleep behaviors. Positive associations were also found between averaged tiredness ratings and sleep scores. The results support previous findings of an association between arousal characteristics of children and their sleep behavior. Moderate validity coefficients were obtained for parents' and children's ratings of excitement, tiredness, and nocturnal waking.
Arousal↗
Illuminating dissertation supervision through reflection.
This paper describes a small research study designed to explore the role of the dissertation supervisor and to examine the potential of using reflection as a tool for learning and for enhancing professional educational practice. The authors met to discuss and reflect upon the processes of supervision and the role of the supervisor throughout the period of supervising three dissertation students. Each author maintained individual reflective written accounts of supervisory meetings with students. These accounts and the transcribed tape-recordings of the group meetings provided two sets of data which were analysed using qualitative techniques. From the data analysis the authors were able to identify various phases in dissertation supervision--partnership; setting the learning contract; signposting; ownership of the dissertation; letting go; the rush at the end; maintaining the balance--and also contextual issues of humanness; time; and energy, which were needed to sustain the supervisory processes. The role of the dissertation supervisor was illuminated and the potential of using reflection as a tool for developing professional educational practice was realized. The importance of constructive support while engaged in processes of reflection cannot be underestimated.
Academic Dissertations as Topic↗
Effects of rapid eye movement sleep deprivation on the properties of striatal dopaminergic system.
Using the water tank procedure, we have examined the effects of rapid eye movement (REM) sleep deprivation and associated stress on the properties of striatal dopaminergic system. While stress decreased the number of D1 and D2 dopamine receptors, a combination of REM sleep deprivation attenuated the decrease. The ratio of D1 to D2 densities, however, increased on both the stress and REM sleep deprivation groups. In contrast, the number of dopamine uptake sites remained unchanged. The enhanced behavioral responses to dopaminergic stimulants after REM sleep deprivation are discussed.
Animals↗
The prognosis of rheumatoid arthritis and undifferentiated polyarthritis syndrome in the clinic: a study of 1141 patients.
OBJECTIVE: To determine the prognosis of undifferentiated polyarthritis syndrome in the clinic compared with rheumatoid arthritis (RA). METHODS: We identified consecutive patients seen within the first 2 years of disease (and further subset into 6-month groups) diagnosed as having either RA or undifferentiated polyarthritis syndrome at the first clinic visit. Undifferentiated polyarthritis syndrome was characterized by clinical presentation, laboratory data, and American College of Rheumatology (ACR) 1958 and 1987 RA criteria. Followup evaluations were done to determine change in diagnosis, resolution of symptoms, and clinical remission of RA. RESULTS: Undifferentiated polyarthritis syndrome was more common in the clinic than RA (638 vs 503). Of patients with RA 7.6% were symptom free an average of 6.9 years after the first clinic visit. For those with disease onset between 0-6 months and 0-2 years, complete resolution of undifferentiated polyarthritis syndrome occurred in 57.9 and 53.9% of cases, including 46.1 and 35.6% meeting ACR 1987 criteria for RA. Latex positivity was the strongest predictor of failure to resolve subsequently (25.0 and 29.2% resolution) and the best predictor of development of RA (41.7 and 43.1%). CONCLUSIONS: Nonrheumatoid undifferentiated polyarthritis syndrome is more common in the clinic than RA. Undifferentiated polyarthritis syndrome resolves in more than half the cases, while RA remits in 7.6%. Finally, resolution of RA criteria positive undifferentiated polyarthritis syndrome occurs predominantly in those who are seronegative.
Adult↗
Legislative tort reform: "making the bird want to sing".
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Humans↗
Localization of dopamine D2 receptor protein in rat brain using polyclonal antibody.
The precise distribution of the dopamine type D2 receptor has been mapped for the first time in rat brain using an antibody to D2 receptor protein. Polyclonal antisera were collected from rabbits inoculated with an undecapeptide identical to residues 24-34 of the D2 protein sequence. Rat brain slices, 40 microns in thickness, were incubated with either primary antiserum, the antiserum plus free peptide antigen, or pre-immune serum. Antibody binding was visualized by peroxidase-antiperoxidase (PAP) reaction followed by light microscopy. PAP complex bound moderately-to-densely throughout the medial forebrain bundle, and was seen in more discrete regions in the midbrain, consistent with the binding of D2 radioligands. There were some unexpected results, namely in the cerebral cortex and nucleus accumbens, there were unexpectedly steep gradients in binding density, decreasing caudally; no binding was detected in the hippocampus or the substantia nigra pars reticulata. In all positive-staining regions examined, the antibody was highly localized to neuronal cell bodies, except in the frontal cortex where antibody was also evident on basilar dendrites. These data confirm that the polyclonal antibody recognized dopamine D2 receptor protein throughout the rat brain, and suggest that the D2 receptor is distributed more abundantly on somata than on cellular processes.
Animals↗