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Biomedical subjects

L M Wallace

Publications and source records attributed to L M Wallace.

32 records · Page 2Linked to original sources
PubMed1987

Trait anxiety as a predictor of adjustment to and recovery from surgery.

Trait anxiety was found to predict elevations in state anxiety not only on the morning of surgery but six to eight weeks before hospitalization, in 118 women undergoing laparoscopic surgery. Trait anxiety was not a strong predictor of state anxiety on the evening of surgery and a very weak predictor of pain, symptoms and behavioural recovery.

Anxiety↗
PubMed1986

Informed consent to elective surgery: the 'therapeutic' value?

The prospect of surgery represents a threatening and often fear-provoking event even to adult patients. Medical practitioners are responsible for obtaining informed consent for elective surgery, which includes an explanation of the reasons for surgery and its likely and possible effects. In practice a dilemma exists between the principle of respect for autonomy of the patient, and between the wish to do the patient no harm. The extent to which patients have been shown to benefit or to be harmed by information about elective surgery is examined by reference to existing studies of surgical patients and to the author's data gathered for interviews and observations on two samples of 131 and 80 women undergoing minor gynaecological surgery. The evidence suggests that most adult patients wish to be informed in detail about their surgery. Information about the likely serious complications is upsetting to some patients, but accurate information about the likely effects of surgery is welcomed, and may even promote faster recovery after the operation. However, much information presented to patients is not understood or is rapidly forgotten. Greater involvement by patients in discussions about their medical care may redress some of these problems and shift some of the responsibility towards the patient.

Attitude to Health↗
PubMed1986

Communication variables in the design of pre-surgical preparatory information.

An experimental study of the design and implementation of a special preparatory booklet designed to reduce stress in surgical patients is reported. Patients in this study were 63 women undergoing minor gynaecological surgery. They were allocated sequentially to three groups: routine care only (control group), routine care plus a minimally informative booklet (placebo group) and routine care plus a maximally informative booklet (experimental group). Changes in cognitive variables were assessed prospectively over the course of hospitalization and surgery. As expected, the intervention had direct effects on patients' knowledge, reported information and worries about surgery. It also had indirect beneficial effects on the amount of reported information and support from staff and families. Finally, patients in the placebo group were found to have more misconceptions about surgery and to more often report anxiety in communication with staff and in association with reading materials. Partial correlation analyses showed that patients who have more knowledge about surgery have fewer worries and recover faster. The implications for cognitive theories of the process of stress reduction for surgical patients by psychological preparation are discussed.

Cognition↗
PubMed1986

Pre-operative state anxiety as a mediator of psychological adjustment to and recovery from surgery.

Psychological theories of stress suggest competing hypotheses for the predictive relationship between pre-operative anxiety and post-operative adjustment and recovery. Evidence is presented to assess whether linear or curvilinear (quadratic) relationships account for the association between pre-operative anxiety and post-operative variables. These two hypotheses are tested on two samples of patients undergoing elective minor gynaecological surgery. Multiple regression analyses provided weak support for a linear, but not a curvilinear, relationship between pre-operative anxiety and post-operative anxiety but not with post-operative outcomes other than anxiety such as pain or speed of returning to normal activities. Qualitative data are also presented which examine whether patients who show either low or high levels of pre-operative anxiety differ in the nature of their fears of surgery or their preferred methods of coping with fear and with post-operative pain. No evidence was found to suggest that patients with either high or low levels of pre-operative anxiety differed in appraisal or coping strategies. There was little evidence that the beneficial effects of a special preparatory booklet on post-operative adjustment and recovery were mediated by its influence on state anxiety.

Adaptation, Psychological↗
PubMed1985

Psychological adjustment to and recovery from laparoscopic sterilization and infertility investigation.

One hundred and thirty-one patients undergoing elective laparoscopic surgery for sterilization or infertility investigations were examined in a prospective study. Firstly, the contributions of the reason for undergoing the operation to the patients' psychological adjustment and recovery, is examined. Measures were taken of personality, mood, physical symptoms, vital signs and the patients' speed of returning to normal activities. The reason for laparoscopy does not appear to influence the amount of fear immediately before and after the operation, post-operative physical symptoms, nor the majority of mood states at follow up. There were significant differences between infertility and sterilization patients on state anxiety on the morning of surgery, vital signs, post-operative intramuscular analgesia, and the speed of returning to normal activities. In particular, sterilization patients did not report greater pain but received more analgesia, and returned to their normal activities more rapidly than infertility patients. Secondary infertility patients showed the slowest rate of return to normal activities, and reported more adverse mood states at 1 week follow up. The investigation of patients' attitudes to the operation revealed that patients undergoing sterilization and infertility investigation are concerned about the costs and benefits of the operation which include not only influencing fertility, but influencing menstruation and sexual activity. Patients misunderstood information about surgery, and the majority of patients welcomed additional psychological preparation. Suggestions concerning the management of patients undergoing laparoscopy for different fertility reasons are discussed.

Analgesia↗
PubMed1985

Surgical patients' preferences for pre-operative information.

Two studies of patients undergoing minor gynaecological surgery are presented to examine the extent to which patients welcome special preparatory communication. Their preferences for the type of information, its timing, and the format of presentation are also examined. Data is presented which shows that only 10% of patients do not welcome special preparation, and that when patients are exposed to sample materials all patients welcomed some form of written preparation. The most preferred type of information is procedural information when patients are asked to chose between procedural, sensory and temporal, coping, or generally reassuring information. However, when patients were interviewed after exposure to sample materials, the booklet containing a composite of these types of information plus general information about admission procedures, was most preferred. Most patients prefer to receive preparatory information from their surgeon. As most patients welcome preparation prior to hospitalisation the provision of preparatory booklets to back up information from the doctor, is suggested as generally the most practical solution to providing cost-effective preparation for routine adult surgery.

Demography↗
PubMed1984

Psychological preparation as a method of reducing the stress of surgery.

Studies of the preparation of adult patients for surgery are reviewed. While many show that preparation reduces stress, the studies are criticized for methodological and conceptual inadequacies. In particular, studies often fail to measure a range of stress responses, and also fail to provide measures over a sufficient time span to fully assess the effect of preparation on stress responses which are known to have differing rates of responsiveness. The experimental study was specifically designed to overcome these problems. Eighty patients undergoing a minor gynecological operation (laparoscopy for sterilization or infertility investigation) were allocated to one of three groups: routine care only (Control 1); routine care plus a minimally informative preparatory booklet (Control 2); or routine care plus a maximally informative preparatory booklet (Experimental group). Patients in the special preparation condition showed lower stress responses on measures of preoperative anxiety. At both one- and six-week follow ups they showed reduced state anxiety and elevated postdischarge vigor scores. They also showed less pain after surgery and recovered faster in hospital and in the first six days after going home. They returned to normal activities faster than patients in the two control groups. There were no differences on measures of postoperative symptoms, medication use, or reported time to return to normal health. The results are discussed in terms of previous studies of psychological preparation, and current concepts of stress. Suggestions for the design of preparatory interventions are made which match the type and timing of the intervention to the target stress response.

Adult↗
PubMedDate not supplied

Capillary gas chromatography with chemical ionization negative ion mass spectrometry in the identification of odorous steroids formed in metabolic studies of the sulphates of androsterone, DHA and 5alpha-androst-16-en-3beta-ol with human axillary bacterial isolates.

The products of metabolism of the sulphates (0.5 micromol/l) of androsterone, dehydroepiandrosterone (DHA) and 5alpha-androst-16-en-3beta-ol have been investigated after incubation with 72 h cultures of human axillary bacterial isolates for 3 days at 37 degrees C. The medium used, tryptone soya broth (TSB), contained yeast extract and Tween 80. The isolates used were Coryneform F1 (known previously to metabolize testosterone and to be involved in under-arm odour (UAO) production, i.e. UAO +ve), Coryneform F46 (inactive in both the testosterone metabolism and UAO tests, i.e. UAO -ve) and Staphylococcus hominis/epidermidis (IIR3). Control incubations of TSB alone, TSB plus each of the steroid sulphates and TSB plus each of the bacterial isolates were also set up. After termination of reactions and addition of internal standards, 5alpha-androstan-3beta-ol and 5alpha-androstan-3-one (50 ng each), extracted and purified metabolites were subjected to combined gas chromatography-mass spectrometry with specific ion monitoring. Steroidal ketones were derivatized as their O-pentafluorobenzyl oximes; steroidal alcohols (only androst-16-enols in this study) were derivatized as their tert-butyldimethylsilyl ethers. Analysis was achieved by negative ion chemical ionization mass spectrometry for the pentafluorobenzyl oximes at [M-20]- and electron impact positive ion mass spectrometry for the tert-butyldimethylsilyl ethers at [M-57]+. The incubation broth contained two compounds which had gas chromatographic and mass spectrometric properties identical to those of DHA and 4-androstenedione. It was not possible, therefore, to show unequivocally that DHA sulphate (DHAS) was converted microbially into DHA, although this is implied by the finding of small quantities of testosterone and 5alpha-dihydrotestosterone in incubations with F1. With androsterone S, no free androsterone was recorded and only very small (5 pg or less) amounts of testosterone. Two odorous steroids, androsta-4,16-dien-3-one and 5alpha-androst-2-en-17-one (Steroid I) were formed (mean quantities 40 and 45 pg, respectively). The sulphate of 5alpha-androst-16-en-3beta-ol was metabolized with F1 into large quantities of the odorous steroids, 5alpha-androst-16-en-3-one and Steroid I. In addition, much smaller quantities of androsta-4,16-dien-3-one were formed. In contrast, incubations of DHAS with F46 resulted in no metabolites except, possibly, DHA, but the sulphate moiety of androsterone S was also cleaved to yield the free steroid together with large amounts of Steroid I. In incubations of DHAS and androsterone S with F1, no 16-unsaturated steroids were formed, although 5alpha-androst-16-en-3beta-yl S was de-sulphated and the free steroid further metabolized. No evidence was obtained for androst-16-ene metabolism in incubations with F46. In incubations with S. hominis/epidermidis (IIR3), androsterone S was converted into androsterone and, in high yield, to Steroid I plus some 5alpha-androst-16-en-3-one. Both DHAS and androsterone S were converted into androst-16-enols. Sulphatase activity was also manifested when 5alpha-androst-16-en-3beta-yl S was utilized as substrate with IIR3, large quantities of Steroid I and 5alpha-androst-16-en-3-one being formed, together with further metabolism of androst-16-enes. In view of the fact that both DHAS and androsterone S occur in apocrine sweat, the metabolism of these endogenous substrates by human axillary bacteria to several odorous steroids may have important implications in the context of human odour formation.

Actinomycetales↗
PubMedDate not supplied

Urinary bladder marsupialization for treatment of obstructive urolithiasis in male goats.

OBJECTIVES: To describe a surgical procedure for urinary bladder marsupialization and to report the results obtained from its use in the treatment of obstructive urolithiasis in male goats. STUDY DESIGN: Retrospective evaluation. ANIMALS OR SAMPLE POPULATION: Male goats with obstructive urolithiasis. METHODS: Medical records of male goats that had urinary bladder marsupialization for the treatment of obstructive urolithiasis were reviewed. Data retrieved from the medical records included signalment, postoperative treatment, duration of hospitalization, and short-term and long-term complications. Median values for measured variables were calculated. RESULTS: A total of 18 of 19 goats survived. Urinary flow was re-established in all 19 goats at the conclusion of surgery. Short-term postoperative complications (bladder mucosal prolapse and death) were observed in 2 goats. Long-term postoperative complications (cystitis and fibrotic stomal closure) occurred in 2 animals. Median duration of hospitalization was 4 days. At the time of follow-up, mild urine scald was reported for all goats. Clinical signs of upper urinary tract disease or obstruction were not reported. A total of 15 of 17 owners were satisfied with the procedure. CONCLUSIONS: Urinary bladder marsupialization provided long-term resolution of urinary outflow obstruction in all goats with acceptable morbidity. CLINICAL RELEVANCE: Urinary bladder marsupialization is a procedure that provides a good prognosis for long-term resolution of obstructive urolithiasis in male goats.

Animals↗