Nursing goes home--again.
Explore the source record for details and available documents.
Community Health Nursing↗
Biomedical subjects
K Wright
Publications and source records attributed to K Wright.
The prevalence and costs of psychiatric disorders and learning disabilities.
BACKGROUND: The economic burden of psychiatric disorders and learning disability is assessed in order to aid decisions on priorities for research funding. METHOD: A wide variety of data sources both on prevalence and on the usage and costs of relevant services were used to measure the economic burden of each condition. RESULTS: Despite methodological problems and problems with the data, an attempt is made to estimate the relative economic burden imposed by each condition. No attempt is made to sum up the costs for each condition across the agencies and individuals involved. CONCLUSIONS: Our findings show that learning disability, schizophrenia and neurotic conditions (including depression) are major burdens on the National Health Service; senile dementia and depression in older people impact largely on local authority social services. Senile dementia, schizophrenia and learning disability are also heavy charges on the social security system. It is also notable that the large numbers with less severely disabling neurotic disorders generate a burden that, according to our figures, is comparable to schizophrenia and other psychotic disorders.
Adolescent↗
Targeting simian virus 40 T antigen to the osteoclast in transgenic mice causes osteoclast tumors and transformation and apoptosis of osteoclasts.
Osteoclasts are terminally differentiated cells that express tartrate-resistant acid phosphatase (TRAP) at a higher level than other normal cells. Therefore, in an attempt to develop immortalized osteoclasts, we produced two lines of transgenic mice in which expression of the simian virus 40 T antigen oncogene was targeted to osteoclasts using the TRAP gene promoter. Osteoclasts were increased in number in bones from both lines. More than 50% of them appeared morphologically transformed, 2-5% were mitotic, but, unexpectedly, 5% were apoptotic. Osteoclast tumors were observed occasionally in one line of mice (line 4), and sheets of TRAP-positive cells (tumorlets) developed in most mice in both lines. Although cells isolated from these tumorlets formed multinucleated TRAP-positive cells that resorbed bone in vitro, to date we have been unable to develop an immortalized osteoclast cell line from them. Osteoclasts from one line (line 5) had reduced ruffled border formation and a higher level of T-antigen expression than osteoclasts in the other line (line 4), and these features were associated with the presence of osteopetrosis. However, osteoclasts from these osteopetrotic mice and from line 4 mice resorbed bone normally when the mice were treated with interleukin-1. These findings indicate that T antigen can be targeted to osteoclasts in transgenic mice and causes osteoclast transformation, tumors, mitosis, and apoptosis. When T antigen is expressed at high levels, functional impairment of osteoclasts can be detected. Furthermore, these results suggest that T antigen is insufficient on its own to immortalize cells in the osteoclast lineage.
Acid Phosphatase↗
Selective suppression of cytochrome P-450 gene expression by interleukins 1 and 6 in rat liver.
Inflammatory stimuli suppress constitutive hepatic expression of the CYP2C11 and CYP2C12 genes in male and female rat livers, respectively. We have shown previously that injection of interleukin-1 (IL1), but not interleukin-6 (IL6), to female rats also suppresses CYP2C12. In the present study, we examined the effects of these cytokines on CYP2C12 expression in rat hepatocyte cultures, and their in vivo effects on expression of multiple cytochrome P-450 (P450) gene products in male rat livers. IL1 suppressed the expression of CYP2C12 mRNA and protein in hepatocytes cultured on Matrigel in the presence of growth hormone. No consistent effect of IL6 was observed. Maximal suppression of CYP2C12 mRNA after 24 h of IL1 treatment reached 12 and 32% of control levels in two separate experiments. The approximate ED50 for IL1 was 5 ng/ml. CYP2C12 protein was suppressed to 28% of control levels as early as 12 h after IL1 treatment. Injection of IL1, low doses of dexamethasone, or both, in male rats produced decreases in total P450, and in CYP3A2 and CYP2C11 mRNA and protein expression similar to effects previously seen for CYP2C12 expression in females. CYP2E1 mRNA and protein was significantly suppressed only by the combination of IL1 and dexamethasone. IL6 treatment of male rats down-regulated the CYP2C11 and CYP2E1 mRNAs at a dose of 4.5 micrograms/kg, which was lower than that required to induce haptoglobin mRNA, a prototype acute phase gene product. CYP2C11 protein content of the microsomes was also decreased by IL6 treatment, with a slower time-course than for suppression of its mRNA. No significant effects of IL6 treatment were seen on CYP3A2 mRNA or CYP3A2/1 proteins. These results demonstrate that IL1 and IL6 treatments in vivo differentially affect subsets of P450 gene products in rat liver.
Animals↗
Lack of association of glucocorticoid therapy and retinopathy of prematurity.
OBJECTIVE: To determine if glucocorticoid therapy alters the severity of retinopathy of prematurity (ROP). DESIGN: Retrospective survey. SETTING: Tertiary intensive care nursery. PATIENTS: One hundred forty-seven surviving infants with birth weight of 1.25 kg or less born July 1990 through January 1993. OUTCOME MEASURES: Maximum stage of retinopathy and the need for cryosurgery. RESULTS: Using logistic regression, neither corticosteroid exposure nor total corticosteroid dose was associated with either ROP greater than stage 2 or cryosurgery. The significant predictors of ROP greater than stage 2 were birth weight and the duration of supplemental oxygen therapy. The only significant risk factor for cryosurgery was gestational age. CONCLUSIONS: No association between corticosteroid therapy and the severity of ROP was found after controlling for traditional risk factors such as birth weight, gestational age, and duration of supplemental oxygen therapy.
Birth Weight↗
A pilot experience with competency-based clinical skills assessment in a surgical clerkship.
This investigation examines a competency-based clinical skills assessment program for surgical clerks using checklists and rating forms for precise measurement of physical exam (PE) skills, physician-patient interaction (PPI) skills, and patient write-up (PW) skills. Analysis of variance demonstrated improvement in PW skills across the academic year when measured by the rating instrument, but this improvement was not detected on traditional subjective rating forms (SRF). PPI skills improved between first rotations across 2 academic years with the addition of orientation to expectations (mean, 79% versus 92%, P = 0.000). Poor correlation was noted between the National Board of Medical Examiners Surgery Subtest scores and PE skills (r = .19), PW skills (r = .20), and PPI skills (r = .15). While the overall ratings given by faculty on SRF correlated with the SRF ratings of PE skills (r = .77) and PPI skills (r = .58), these same faculty ratings correlated poorly with these skills as assessed by checklist (r = .16 and r = .14, respectively). This pilot experience demonstrates that PE skills, PW skills, and PPI skills (1) improve only with orientation to expectations and feedback, (2) correlate poorly with fund of knowledge assessment, and (3) are best assessed with precise measurement (eg, checklist, direct observation), which avoids the halo effect of overall evaluation that occurs with subjective rating forms.
Clinical Clerkship↗
The clinical utility of the Safe Times Questionnaire.
PURPOSE: To evaluate a valid, reliable self-report health behavior screening instrument, the Safe Times Questionnaire (STQ), in a clinical setting. METHODS: One hundred and fifty-two patients at a primary care health center completed the STQ and were randomized into two groups; physicians in the "STQ group" (79 patients) used the STQ while physicians in the "interview group" (73 patients) were blinded to the STQ. Physicians rated each patient on their need for intervention in nine topic areas. Patients then had a psychological interview and were rated on the same topic areas. RESULTS: The total time of the patient visit was significantly longer in the interview group than in the STQ group. Physicians in the STQ group had significantly higher accuracy in identification of subjects at risk for depression and family conflict. CONCLUSIONS: The Safe Times Questionnaire is a potentially useful instrument to efficiently screen adolescents.
Adolescent↗
Turn your research wishes into action--and make it fun.
Recognizing that beginning researchers have difficulty starting a study and successfully completing it, the authors describe 10 guidelines for conducting a research study and making it fun. They describe strategies such as working with a partner, selecting an exciting topic to study, and using time effectively. They discuss ways to seek support from colleagues and friends and also provide information about writing grant proposals. The authors provide personal examples from their research on enema techniques to illustrate each guideline.
Adaptation, Psychological↗
Anti-Tn human monoclonal antibodies generated following active immunization with partially desialylated ovine submaxillary mucin.
Partially desialylated ovine submaxillary mucin plus an immunological adjuvant has been used by us to induce a humoral immune response to Tn antigen and sialylated Tn in colon cancer patients at risk of recurrence. Peripheral blood lymphocytes were purified from one of these patients with a high IgM titer reactive with Tn antigen transformed with Epstein-Barr virus and subsequently fused with a human-mouse heteromyeloma cell line, HMMA2.11TG/O. Clones were screened and subcloned using an enzyme-linked immunoassay and four stable IgM-secreting clones were tested for reactivity with a variety of natural and synthetic antigens, paraffin-embedded colon carcinomas and normal colonic mucosa to determine their specificity. Four human IgM monoclonal antibodies reactive predominantly with Tn antigen were produced and shown to react with a mucinous human colon carcinoma cell line, LS-174T, and with paraffin-embedded human colon carcinomas. We conclude that modified ovine submaxillary mucin is an effective vaccine for generating a humoral immune response directed to Tn antigen present on human colon cancer.
Animals↗
Combined doxorubicin and alpha-interferon therapy of advanced hepatocellular carcinoma.
BACKGROUND: Modest activity for doxorubicin has been detected repeatedly for the therapy of advanced hepatocellular carcinoma. Variable activity in this disease also has been documented for alpha-interferon. Preclinical data indicated the possibility that alpha-interferon could enhance or add to the cytotoxic effect of doxorubicin. METHODS: The authors evaluated the use of alpha-interferon at a dose of 12 x 10(6) units/m2/day for 5 days given by intramuscular injection plus doxorubicin 25-40 mg/m2 given intravenously on day 3 (both repeated every 4 weeks) for the treatment of advanced hepatocellular carcinoma. RESULTS: Among 31 eligible patients treated, there was only one instance of objective tumor regression. The median survival for all patients was 10 months. Both hematologic and nonhematologic toxicity were significant but tolerable to the patients. CONCLUSIONS: The 3% response rate indicated that, by the method used, the addition of alpha-interferon to doxorubicin does not improve the clinical effectiveness. This combination cannot be recommended for further study.
Adult↗
A cost function analysis of residential services for adults with a learning disability.
Successive UK governments have pursued a policy of community care for people with learning disabilities which, in the past ten years, has led to a marked change in the nature of residential provision. Research evidence on the costs and quality of alternative forms of community provision is inconclusive and contradictory. It is therefore timely to consider whether or not community residential facilities have delivered the expected quality of service at appropriate cost. The paper presents the results of a cost function analysis of a random stratified sample of staffed community facilities in England excluding London. Both costs and quality of care were found to vary greatly amongst community residential facilities. The most important factors explaining differences in cost were case-mix factors relating to client age, dependency and length of stay. Facility characteristics such as the type of building, the internal layout and the structural quality were not significant. Quality of service measures such as the extent to which care-regimes were client orientated and made use of local community services were positively and significantly associated with costs. Type of provider had no impact on costs independent of differences in case-mix and quality of care with the exception of the private for profit sector which appeared less expensive than other agencies. The shortcomings of the methods and implications of these findings for policy makers are discussed.
Activities of Daily Living↗
How do communication aid centres provide services to their clients?
A survey of the functioning of the six communication aid centres (CACs) in England and Wales was undertaken. All CACs are specialist units drawing clients from a wide area of the country which means that referrals are more likely to come from outside, rather than from within the districts in which the CACs are located. All CACs have developed individual assessment procedures, with some CACs undertaking continuous assessment of clients, and others recommending an aid after a single session. Funding of aids was often a problem because CACs were only able to recommend aid provision and did not supply them; their stocks of aids were used in assessment sessions or for interim loan to clients until a definitive aid had been acquired. CAC staff engaged in a variety of other functions including the organisation of courses, acting as an advice and information service, and undertaking research.
Communication Devices for People with Disabilities↗
Evaluation of Communication Aid Centres in England and Wales.
This paper reports the findings of an evaluation (funded by the Department of Health) of six Communication Aid Centres established in 1983. The evaluation was undertaken to assess the effectiveness of these Centres in meeting their set objectives, and to examine service costs and client satisfaction. The findings show that the work of each Centre was effective in meeting its stated objectives, but that the work of individual Centres reflected its own specialised interests. Two problems with current funding arrangements were highlighted. First, the need to replace the original funding by locally based finance, and second, the funding of communication aids for clients. The findings also show that the specialist service provided by these Centres can be managed at costs per person assessed at, or below, non-specialist services in health districts. Client satisfaction with the services provided by the Centres was high.
Communication Devices for People with Disabilities↗
Risky enemas: what's the ideal solution?
Explore the source record for details and available documents.
Aged↗
The influence of ethnicity and race on attitudes toward advance directives, life-prolonging treatments, and euthanasia.
Explore the source record for details and available documents.
Adult↗
Continuous quality improvement. Improving quality in your home care organization.
Total commitment to quality is an important factor in dealing with the competitive market and ensuring future survival. This article details the implementation of a continuous quality improvement program in one home care organization and examines initiation, implementation, and acceleration of the program over a period of just 16 months. It also illustrates how the same organization monitors clinical activities through quality assessment.
Costs and Cost Analysis↗
New postnatal growth grids for very low birth weight infants.
OBJECTIVE: To generate contemporary postnatal growth curves for hospitalized very low birth weight infants. DESIGN: Retrospective survey. SETTING: Tertiary intensive care nursery. PATIENTS: All surviving singleton, appropriate-for-gestational age infants with birth weight < or = 1500 g, born January 1, 1987, to May 31, 1991, who did not develop necrotizing enterocolitis (N = 205). MEASUREMENTS AND RESULTS: Macronutrient intakes and body weights were recorded daily, with crown-heel length and occipital-frontal head circumference recorded weekly up to 105 days of age or hospital discharge, whichever occurred first. Growth curves were generated for four birth weight ranges: 501 through 750, 751 through 1000, 1001 through 1250, and 1251 through 1500 g. Compared to previously published growth curves, the current infants regained birth weight more quickly and exhibited larger average daily weight gains. These differences were most apparent in infants of lowest birth weight. CONCLUSIONS: The "premature growth grid" constructed by Dancis et al more than 40 years ago may no longer be a useful standard of early postnatal growth for present-day very low birth weight, appropriate-for-gestational-age infants. The new weight curves are a more accurate reflection of current in-hospital growth trends, especially for infants weighing < or = 1000 g at birth.
Female↗
Control of interocular suppression as a function of differential image blur.
This experiment studied normal adults, normal children, and corrected strabismics with alternating fixation, evaluating their ability to detect information presented to one eye under viewing conditions which might affect their eye preference. An apparatus was used which allowed unconstrained, binocular viewing of a video monitor, but in which the image seen by one eye was blurred while that seen by the other eye was in sharp focus. Under these viewing conditions, subjects were asked to identify a sharply focused letter which was shown briefly to the eye which was seeing the blurred background image or to the one which was watching the well-focused image. The question was whether there would be general suppression of the eye that was shown a degraded background, causing a reduction in its ability to process other information being presented. The results indicate no performance penalty for children, a mild decrement in recognition accuracy for normal adults, and a severe deficit in the ability of corrected strabismics to attend to the eye which views a blurred image. These results suggest that the loss of binocular vision that accompanies childhood strabismus is not a result of an inherent sensitivity to blurring, insofar as such vulnerability is reflected by these acute testing conditions.
Adolescent↗