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Biomedical subjects

M A Anderson

Publications and source records attributed to M A Anderson.

At least 37 records · Page 2Linked to original sources

Identification of a novel four-domain member of the proteinase inhibitor II family from the stigmas of Nicotiana alata.

Proteinase inhibitors (PIs) of the potato type II family have been identified in a number of solanaceous species. Most family members have two PI domains which are specific for either chymotrypsin or trypsin. More recently family members have been described with three or six repeated PI domains. Here we describe a novel four-domain family member produced in the stigmas and leaves of the ornamental tobacco, Nicotiana alata, which has high sequence identity with a six-domain member from the same species. Both proteins are produced as precursors that enter the secretory pathway and are subsequently processed into a series of 6 kDa Pis. The four- and six-domain precursor proteins were isolated from immature stigmas and characterised by mass spectrometry which revealed that both proteins had been trimmed at the N-terminus, at a position corresponding to the predicted signal peptide cleavage site. Furthermore, no post-translational modifications were apparent.

Amino Acid Sequence↗

Persistent genetic abnormalities in Barrett's esophagus after photodynamic therapy.

BACKGROUND & AIMS: Photodynamic therapy (PDT) is a technique for nonsurgical treatment of patients with dysplasia in Barrett's esophagus. The primary endpoint for PDT has been resolution of dysplasia. We studied the effect of PDT at the genetic level. METHODS: Archival material from 3 patients who had initial improvement in dysplasia after PDT but occurrence of high-grade dysplasia during follow-up was used. Biopsy specimens were analyzed for increased proliferation, aneuploidy, p53 protein overexpression, p53 mutations, and p16 promoter hypermethylation. RESULTS: Patients developed high-grade dysplasia 16, 28, and 37 months after PDT. In all cases, one or more genetic markers were positive after PDT treatment, whereas histology was downstaged consistently after therapy. Increasing genetic abnormalities were noted by the end of follow-up. CONCLUSIONS: Genetic abnormalities may persist after PDT despite phenotypical improvement of dysplasia. These patients may progress to high-grade dysplasia or develop adenocarcinoma. Histologic improvement in dysplasia is an inadequate endpoint for PDT in patients with Barrett's esophagus.

Aged↗

Talking about patients: communication and continuity of care.

Continuity of patient care is a tenet of professional nursing practice regardless of setting. Communication between providers about patients is fundamental to continuity. As the role of hospitals in health care is constrained, care is now commonly delivered to patients during an episode of illness by multiple agencies. Continuity of care now assumes full communication between providers about patients' conditions and needs. Research provides evidence about the dynamics of patient care communication: more lean (background and medical) than rich (nursing care and psychosocial) data are communicated; structured, written formats transmit more information than informal channels of communication; and organizational and patient characteristics would appear to affect communication about patients. Knowledge about the communication dynamics of patient care may assist providers in designing strategies to attain the basic goals of continuity of care.

Communication↗

Integrated literature review of continuity of care: Part 1, Conceptual issues.

PURPOSE: Continuity of patient care is a fundamental tenet of professional nursing, yet comprehension of the concept and related issues remains elusive. The purpose of this study was to explore issues associated with definitions, related concepts, and research methods of continuity of care through systematic literature-based study. In Part 1 of this two-part series, definitions and related concepts, factors, and variables associated with continuity of care were explored. DESIGN: Qualitative, integrated literature review of a sample of 38 nursing research articles about continuity of care, 1990-1995. METHODS: Ganong's (1987) stages of an integrative research review guided this study. A data collection tool was developed and pilot tested, and rules for data analysis and interpretation were established. Research articles were systematically analyzed and reported using descriptive analysis. FINDINGS AND CONCLUSIONS: No consensus was found in the literature about the conceptual definition of continuity of care. Continuity of patient care is a multifactorial concept affected by environmental influences, communication, patient, professional, and system factors.

Continuity of Patient Care↗

A continuity of care integrated literature review, Part 2: Methodological issues.

PURPOSE: In Part 2 of this two-part series, research designs, methods, and measurement of continuity of care are explored. DESIGN: Qualitative, integrated literature review of a sample of 38 continuity of care nursing research article published 1990-1995. METHODS: Ganong's (1987) stages of the integrative literature research review process were followed. A data collection tool was designed and pilot tested, and rules for data analysis and interpretation were established. Research articles were systematically analyzed and reported using descriptive analysis. FINDINGS: Results showed few nursing models, primarily convenience sampling and nonexperimental cross-sectional study designs, varied data collection methods, and inadequate instrumentation. Measurement criteria were diverse and influenced by the perspectives of the measurer. CONCLUSIONS: Continuity of patient care was identified as a construct comprised of many related and tangential concepts in need of more sophisticated review. Recommendations for researchers are discussed.

Continuity of Patient Care↗

Endoscopic ultrasound is highly accurate and directs management in patients with neuroendocrine tumors of the pancreas.

UNLABELLED: Preoperative localization of pancreatic neuroendocrine tumors with traditional imaging fails in 40-60% of patients. Endoscopic ultrasound (EUS) is highly sensitive in the detection of these tumors. Previous reports included relatively few patients or required the collaboration of multiple centers. We report the results of EUS evaluation of 82 patients with pancreatic neuroendocrine tumors. METHODS: We prospectively used EUS early in the diagnostic evaluation of patients with biochemical or clinical evidence of neuroendocrine tumors. Patients had surgical confirmation of tumor localization or clinical follow-up of >1 yr. RESULTS: Eighty-two patients underwent 91 examinations (cases). Thirty patients had multiple endocrine neoplasia syndrome type 1. One hundred pancreatic tumors were visualized by EUS in 54 different patients. The remaining 28 patients had no pancreatic tumor or an extrapancreatic tumor. Surgical/pathological confirmation was obtained in 75 patients. The mean tumor diameter was 1.51 cm and 71% of the tumors were < or =2.0 cm in diameter. Of the 54 explorations with surgical confirmation of a pancreatic tumor, EUS correctly localized the tumor in 50 patients (93%). Twenty-nine insulinomas, 18 gastrinomas, as well as one glucagonoma, one carcinoid tumor, and one somatostatinoma were localized. The most common site for tumor localization was the pancreatic head (46 patients). Most tumors were hypoechoic, homogenous, and had distinct margins. EUS of the pancreas was correctly negative in 20 of 21 patients (specificity, 95%). EUS was more accurate than angiography with or without stimulation testing (secretin for gastrinoma, calcium for insulinoma), transcutaneous ultrasound, and CT in those patients undergoing further imaging procedures. EUS was not reliable in localizing extrapancreatic tumors. CONCLUSIONS: In this series, the largest single center experience reported to date, EUS had an overall sensitivity and accuracy of 93% for pancreatic neuroendocrine tumors. Our results support the use of EUS as a primary diagnostic modality in the evaluation and management of patients with neuroendocrine tumors of the pancreas.

Adenoma, Islet Cell↗

A rural perspective on home care communication about elderly patients after hospital discharge.

Little is known about home health agencies (HHA) and their integration in the continuum of care in rural areas. The aims of this study are to describe the amount and type of patient-related data transferred by discharging hospitals to rural HHAs and to explore the influence of selected organizational factors on that communication process using a previously tested model of interorganizational communication. In this study, 446 closed-case, elderly patient records at three rural HHAs were reviewed using the Referral Data Inventory. Rural HHAs receive about half of the literature-recommended referral data, characterized primarily by background data, some medical data, and almost no psychosocial or nursing-care data. Referrals transmitted by telephone and written data were superior to referrals transferred by a telephone call only. Hospital-affiliated HHAs received significantly greater amounts and richer types of referral data than did free-standing HHAs. Findings suggest that cost-saving measures in the referral process need investigation.

Aged↗

Validity of diagnostic ultrasound as a measure of delayed onset muscle soreness.

STUDY DESIGN: Repeated measures were taken to evaluate delayed onset muscle soreness (DOMS) following eccentric bicep contractions of the nondominant arm at 140% of 1 repetition maximum (RM) while the dominant arm served as control. OBJECTIVES: To explore the usefulness of a noninvasive method to assess delayed onset muscle soreness. BACKGROUND: Although many methods have been proposed to assess DOMS, most are somewhat subjective or require a blood sample. This study compared the assessment of DOMS following eccentric exercise using common assessment techniques with diagnostic ultrasound (US). METHODS AND MEASURES: Forty nonimpaired women (18-40 years) used a Cybex isotonic biceps curl machine to eccentrically lower, using their nondominant arm, 140% of their dominant arm 1 RM to induce muscle soreness. Four assessment methods, (1) goniometry assessing spontaneous muscle shortening (SMS); (2) subjective muscle soreness ratings (MSRs); (3) serum creatine kinase (CK); and (4) diagnostic US scans of muscle cross-sectional area (CSA), were conducted at 5 different assessment times: (1) pre-eccentric exercise; (2) postexercise; (3) 24 hours postexercise; (4) 48 hours postexercise; and (5) 72 hours postexercise. RESULTS: Significant differences existed across assessment times for 3 of the 4 assessment techniques, CK, SMS, and MSR. CONCLUSIONS: Previously published methodologies used to assess DOMS (CK, SMS, and MSR) were able to provide consistent and expected results relative to the onset and progression of soreness with a high degree of relatedness (r = 0.48-0.84). However, it appeared that the ability to assess muscle soreness by diagnostic US, as evidenced by intramuscular swelling, was limited. Thus, the technique was not sensitive enough to detect any statistically significant changes in muscle CSA.

Adolescent↗

Structure of a putative ancestral protein encoded by a single sequence repeat from a multidomain proteinase inhibitor gene from Nicotiana alata.

BACKGROUND: The ornamental tobacco Nicotiana alata produces a series of proteinase inhibitors (PIs) that are derived from a 43 kDa precursor protein, NaProPI. NaProPI contains six highly homologous repeats that fold to generate six separate structural domains, each corresponding to one of the native PIs. An unusual feature of NaProPI is that the structural domains lie across adjacent repeats and that the sixth PI domain is generated from fragments of the first and sixth repeats. Although the homology of the repeats suggests that they may have arisen from gene duplication, the observed folding does not appear to support this. This study of the solution structure of a single NaProPI repeat (aPI1) forms a basis for unravelling the mechanism by which this protein may have evolved. RESULTS: The three-dimensional structure of aPI1 closely resembles the triple-stranded antiparallel beta sheet observed in each of the native PIs. The five-residue sequence Glu-Glu-Lys-Lys-Asn, which forms the linker between the six structural domains in NaProPI, exists as a disordered loop in aPI1. The presence of this loop in aPI1 results in a loss of the characteristically flat and disc-like topography of the native inhibitors. CONCLUSIONS: A single repeat from NaProPI is capable of folding into a compact globular domain that displays native-like PI activity. Consequently, it is possible that a similar single-domain inhibitor represents the ancestral protein from which NaProPI evolved.

Amino Acid Sequence↗

Results of a survey of small-animal practitioners on the perceived clinical efficacy and safety of an oral nutraceutical.

A mail survey of 3080 practitioners from two sampling frames was used to determine the perceived clinical efficacy and safety of an oral nutraceutical for the treatment of degenerative joint disease (DJD) in small animals. Overall response rate was 82%, of which 64% reported that they were recommending the oral nutraceutical to their clients. There was a high variability reported between the severity of DJD and response to treatment. Sixty-eight percent of practitioners reported lame dogs older than five years to be the most responsive to treatment. Most practitioners (83%) believed response to treatment with the studied product occurred within four weeks. Practitioners using the product rated the clinical efficacy of the product to be either 'good' or 'excellent' in improving mobility, alleviating pain and improving attitude in the majority of the treated animals. No practitioner reported a worsening of pain, mobility or attitude. Self-reported adverse effects were 2% (the most common was gastrointestinal upset). The results of this survey indicated that perceived clinical efficacy of the studied nutraceutical in the treatment of DJD was regarded to be 'good' or 'excellent' by most of the practitioners who use this product and was considered to be safe with minimal side effects. This provides additional information on the product for use in planning future clinical trials.

Administration, Oral↗

Service delivery challenges of nursing research in home health care.

For nurse researchers interested in patient care and delivery systems, home health care is an area of increasing focus. Compared to institutional sites, however, there are challenges in conducting research in home health care that are a function of the organizational and operational environment. In addition to the unique environment, current regulatory and legislative changes also are having an impact on home health care nurses and agencies. Finally, home health care is an area that has not historically been involved with research of any kind. This article presents an overview of selected challenges of research in home health agencies and recommendations for nurse researchers.

Community Health Nursing↗

A novel two-chain proteinase inhibitor generated by circularization of a multidomain precursor protein.

Female reproductive tissues of the ornamental tobacco amass high levels of serine proteinase inhibitors (PIs) for protection against pests and pathogens. These PIs are produced from a precursor protein composed of six repeats each with a protease reactive site. Here we show that proteolytic processing of the precursor generates five single-chain PIs and a remarkable two-chain inhibitor formed by disulfide-bond linkage of N- and C-terminal peptide fragments. Surprisingly, PI precursors adopt this circular structure regardless of the number of inhibitor domains, suggesting this bracelet-like conformation is characteristic of the widespread potato inhibitor II (Pot II) protein family.

Amino Acid Sequence↗

Postpartum home visits: infant outcomes.

Early postpartum discharge of mothers and infants has increased as health care providers and payers attempt to control health care cost. Questions regarding patient safety have been raised. Literature supports the safety of early discharge when providers adhere to strict discharge guidelines and when clients comply with home follow-up. Previous studies calculated hospital readmission rates, but few examined other outcomes or characteristics. The purposes of this descriptive study were to examine outcome data for infant participants in a postpartum home visit program and to explore factors that may influence hospital readmissions for infants. Using an audit tool with established reliability and validity, a convenience sample of 199 infant medical records was reviewed for demographic information, characteristics, and outcomes. The hospital readmission rate for all infants within 3 weeks of discharge was comparable to other studies; however, the rate for only early discharge infants was higher than the rate reported in other studies. The study of postdelivery outcomes for infants provides additional insight into the issue of early discharge and may reflect the significance of postpartum follow-up care and education.

Adolescent↗

Capillary electrophoresis of insulin-like growth factors: enhanced ultraviolet detection using dynamically coated capillaries and on-line solid-phase extraction.

Insulin-like growth factor-I and -II (IGF-I and IGF-II) are difficult to separate and measure as a result of their homology, both structurally and immunologically. A number of binding proteins (BPs) which interact with the IGFs with high affinity complicate the ability to measure the IGFs accurately and reproducibly. Current methodology for measuring IGF is immuno-based and involves dissociation from the IGFs and removal of the binding proteins through sample acidification and removal by solid-phase adsorption. However, the net result is an assay that is time-consuming and, at best, semiquantitative. In an attempt to improve the reproducibility and accuracy of IGF-I and -II measurement, electrophoretic systems employing dynamically coated and bare silica capillaries were evaluated. Separations in bare silica capillaries in the presence or absence of the cationic additive, decamethonium bromide were ineffective for resolving IGF-I and IGF-II. However, when the capillary was coated dynamically with polybrene, IGF-I and -II could be resolved in a BSA sample matrix using a low pH buffer. Despite the fact that the IGFs could be resolved in the presence of an IGF-I analog used as an internal standard, polybrene recoating was required after as few as 12 runs and poor coating-to-coating reproducibility was observed. Use of polydiallyldimethylammonium chloride (PDMAC) as a dynamic cationic coating and a low pH buffer containing 0.5% PDMAC was found to be much more effective, providing reproducible separation of IGF-I and -II. It was found that PDMAC need not be included in the separation buffer to obtain reproducible analyses regarding IGF separation. Subsequently, functionality remained intact for as many as 35-40 consecutive analyses before recoating was required. Without the need for PDMAC in the buffer, on-line solid-phase extraction-capillary electrophoresis could be accomplished for detection of IGF-I and -II at concentrations as low 195 ng/ml.

Buffers↗

alpha-Substituted malonester amides: tools to define the relationship between ACAT inhibition and adrenal toxicity.

We prepared a series of alpha-substituted malonester amides that were evaluated for their ability to inhibit acyl-CoA:cholesterol O-acyl transferase activity in vitro and to lower plasma total cholesterol levels in a variety of cholesterol-fed animal models. Compounds of this series were also useful in examining the relationship between adrenal toxicity and ACAT inhibition. One compound from this series, 9f, was a potent inhibitor of ACAT in both the microsomal and cellular assays. It was also bioavailable as determined by both a bioassay and a HPLC-UV assay. This compound was evaluated in both guinea pig and dog models of adrenal toxicity and compared to tetrazole amide 15. In the most sensitive species, the dog, both of these compounds achieved good plasma levels; however, compound 9f caused adrenal necrosis, whereas compound 15 had no effect on the adrenal gland. This adds to the growing body of evidence that the adrenal toxicity observed with ACAT inhibitors may not be mechanism related.

Adrenal Glands↗

Extended care referral after hospital discharge.

The purpose of this study was to describe the influence of selected organizational and medical factors on communication between hospitals and extended care facilities (ECF) in the referral of elderly clients following discharge from acute care. Using a tool with previously established reliability and validity, 455 closed records of referral were purposively selected and reviewed for the amount and type of information an ECF received upon referral, as well as selected organizational and medical factors. Hospitals transferred approximately three-fourths of the patient care data recommended in the literature. Information contained in an ECF referral consisted primarily of background and medical data, with some nursing care data and limited psychosocial data. More information-rich referrals were generated by very large hospitals and by specialty care units. Similarly, proprietary ECFs received more patient care data than their not-for-profit counterparts. Research concerning patient care communication between provider organizations across the health care delivery system may assist nurses in developing better patient care information-management systems.

Aged↗