Interferometric microscope observations of flowing blood indicate that the absolute number of red cells maintaining sliding contact with a wall is of the order 10(4) per square centi meter at low flow rates. Contacting cell oscillation and orientation results are given. The near wall local hematocrit is found to be relatively low.

Blood Viscosity↗

PubMedDate not supplied

PCDD/PCDF on land around an industrial site and identification of source.

Following the discovery of elevated levels of PCDD/PCDF in dairy products and in flue gases at a nearby industrial site, the levels and spatial distribution of these compounds on surrounding land were determined through soil monitoring. In mass terms, the levels in soil were excessive relative to the UK background but in terms of toxicity they were less significant. There were positive correlations between wind directions and deposition levels. The relative amounts of the prominent congeners/congener groups in the soil were similar to those in the flue gas but different from those in the background. An incinerator of chemical waste was identified as the likely source of the PCDD/PCDF.

Benzofurans↗

PubMedDate not supplied

Insulin-like growth factor-1 inscribes a gene expression profile for angiogenic factors and cancer progression in breast epithelial cells.

Activation of the insulin-like growth factor-1 receptor (IGF-1R) by IGF-1 is associated with the risk and progression of many types of cancer, although despite this it remains unclear how activated IGF-1R contributes to cancer progression. In this study, gene expression changes elicited by IGF-1 were profiled in breast epithelial cells. We noted that many genes are functionally linked to cancer progression and angiogenesis. To validate some of the changes observed, the RNA and/or protein was confirmed for c-fos, cytochrome P450 1A1, cytochrome P450 1B1, interleukin-1 beta, fas ligand, vascular endothelial growth factor, and urokinase plasminogen activator. Nuclear proteins were also temporally monitored to address how gene expression changes were regulated. We found that IGF-1 stimulated the nuclear translocation of phosphorylated AKT, hypoxic-inducible factor-1 alpha, and phosphorylated cAMP-responsive element-binding protein, which correlated with temporal changes in gene expression. Next, the promoter regions of IGF-1-regulated genes were searched in silico. The promoters of genes that clustered together had similar regulatory regions. In summary, IGF-1 inscribes a gene expression profile relevant to cancer progression, and this study provides insight into the mechanism(s) whereby some of these changes occur.

Blotting, Western↗

PubMedDate not supplied

Use of unopposed estrogen in women with uteri: prevalence, clinical implications, and economic consequence.

OBJECTIVE: Hormone replacement therapy with estrogen/progestin is the treatment of choice for relieving postmenopausal vasomotor symptoms and preventing urogenital atrophy and osteoporosis in women with intact uteri. However, despite the known increased incidence of endometrial hyperplasia when unopposed estrogen is used in such women, this progestin regimen has not been universally adopted. DESIGN: This study was conducted in a managed care organization to determine the extent of the use of unopposed estrogen in women with intact uteri. Pharmacy claims data for all women 55 years or older with claims for estrogen only from September 1, 1996, to December 31, 1996, were reviewed. A total of 5,209 records were identified, from which 480 were randomly selected. A survey of the members' physicians was then carried out to determine hysterectomy status and was confirmed by chart audit. RESULTS: Thirty-three (11%) of the members identified had not undergone hysterectomy. Follow-up physician contact revealed that five women did not have a uterus. Use of estrogen without opposing progestin was documented in a substantial percentage of files reviewed. It is of concern that with the documentation of the risks of endometrial hyperplasia and carcinoma in the intact uterus, unopposed therapy still occurs. In addition to the clinical costs, there are economic consequences to this practice. An economic model of unopposed estrogen use was created. A management cost of $1,504 for 3 years was estimated. CONCLUSIONS: Further educational efforts are needed to ensure the use of opposed estrogen in the woman with an intact uterus.

Algorithms↗

PubMedDate not supplied

Pre-training assessment tool (JPAT)--a pilot study.

A tool for assessing the suitability of candidates for home dialysis (Jo-Pre-training Assessment Tool--JPAT) was developed. JPAT acts as a screening instrument to identify suitable candidates for the home dialysis programme, and therefore increases a patient's chance of learning to manage the programme. JPAT is in the form of an interview questionnaire consisting of 38 assessment items in six domains: physical stability, nutritional status, communication, ability to maintain self-care, psychological suitability and social support. A pilot study was conducted (n = 20, 1996-1997) using a descriptive study design, with subjects randomly selected from an existing dialysis programme. Pearson correlation and 2-tailed tests were employed to explore the relationship between the assessment outcome (i.e. the initial JPAT scores) and the follow up data (i.e. data collected within the seven days following the initial JPAT assessment). Many of the variables attained statistical significance (p < 0.05). The inter-rater reliability was calculated at an average Kappa value of 0.909. Overall, results suggest that JPAT is sufficiently reliable to be used as a tool for assessing patients who suffer from ESRD.

Adult↗

PubMedDate not supplied

Improving the nurse-patient relationship: a multi-faceted approach.

AIM: A Corporate Education Session was held to provide concrete strategies for overcoming several specific barriers in the daily nurse-patient relationship that negatively affect the patient, nurse, or both, and to provide the latest information about best practice as it affects nurses in renal care. METHODOLOGY: The session was led by a moderator who presented three video case studies to the audience. Communication strategies for recognising and overcoming nurse-patient communication barriers were presented. The audience expressed their views about each case study using voting pads, and a panel of experts addressed the comments of the audience and discussed guidelines for best practice in renal care. The panel comprised three experienced renal nurses, a senior nephrologist, and an expert in social interaction. CONCLUSIONS: Optimal treatment of patients with renal disease should include early treatment of anaemia, adequate levels of dialysis, and a multidisciplinary approach, responding to both the medical and the social needs of the patient.

Aged↗

PubMedDate not supplied

The anaemia research nurse in effective multi-disciplinary management of patients on erythropoietin.

Following recommendations published by the Renal Association, the standard regarding optimal haemoglobin levels was questioned by members of the Oxford Renal Unit Management Team as perhaps being unrealistic in a unit responsible for nearly 400 patients on dialysis. Subsequent to the appointment of an anaemia research nurse a base-line audit revealed that only 61.3% of the dialysis population had a haemoglobin > 10 g/dl and also identified the reasons why the unit was failing to meet this pre-set target. This paper identifies how the unit addressed these problems which has subsequently led to a change in views about achieving the standard. The establishment of clear management guidelines cannot be over emphasised and all aspects of anaemia in this unit will now be addressed as part of the multi-disciplinary team function rather than being led by medical intervention.

Anemia↗

PubMedDate not supplied

Nurse practitioners: an evaluation of the extended role of nurses at the Kirketon Road Centre in Sydney, Australia.

The aim of the present study was to formally evaluate the effectiveness, professional appropriateness and acceptability of the extended role of the nurse practitioner at the Kirketon Road Centre (KRC) in Sydney, Australia. Data collection consisted of client and staff surveys and case file review by two assessors (one medical and one nursing). This paper will report on one section of this research, namely the case file review section of the study. Total study subjects were 1046 'at risk' youth, sex workers and injecting drug users attending KRC for their primary health care needs between September 1994 and April 1995. Nurse practitioners (NP) saw 613 of the clients who presented over this period. The majority of these clients were women (77.3%). The majority of NP consults were related to STD (51%), gynaecological (17%) and hepatitis (16%) issues. The results demonstrated that nurse practitioners were professionally appropriate in all aspects of expected 'best practice' in over 95% of consultations.

Adolescent↗

PubMedDate not supplied

Survey of persons with multiple sclerosis in Ottawa, 1974-75.

Explore the source record for details and available documents.

Activities of Daily Living↗

PubMedDate not supplied

Hospice care.

Hospice of Peel is a community-based hospice serving a population of between 750-800,000. Hospice care evolved to meet the needs of the terminally ill. It can, and does, take many forms, as you will see in the brief case scenarios detailed below. The individuals and situations described are real and typical of day-to-day-hospice care in a large urban environment. Both the sick and their families are in need of support and assistance to enable them to cope during this time of crisis in their lives. Increased awareness of hospice care is resulting in more and more people with a life-threatening or terminal illness and their families turning to hospice care.

Hospice Care↗