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Biomedical subjects

M Richardson

Publications and source records attributed to M Richardson.

At least 181 records · Page 10Linked to original sources
PubMed1994

The management of individual performance planning and review: some limitations on rationality.

Individual performance planning and review has a long and turbulent history. Colleges of nursing and higher education are incorporating performance review schemes as a part of their quality management systems, BS 5750 and the like. This in the rational belief that chances of success will be enhanced. The reliability and validity of performance review schemes is explored, in particular the belief that rational planning underpins success. The value of results oriented performance review with its emphasis upon dialogue is seen to be of value for organisational learning and the de-reification of nurse education institutes as somewhat rigid systems. The incorporation of qualitative action research methods within a results oriented frame may herald a significant leap forward in the quality assurance of nurse teaching.

Education, Nursing↗
PubMed1994

Evidence for recent genetic variation in monkeypox viruses.

DNA from isolates of monkeypox virus, when digested with the endonuclease PstI, gave fragment-size profiles which correlated with the geographic area from which the isolate originated. Although some of the differences were located subterminally in the genome, others mapped to the central conserved region. Further differentiation of the viral genomes was sought by analysis of a short region within the central conserved part of the genome that appeared to be a partially deleted counterpart of an intact 1024 bp open reading frame (ORF) present in variola and vaccinia virus genomes. We reasoned that this region would not be conserved by functional selection and would therefore be likely to show more variation between isolates of monkeypox virus. The deletions found in monkeypox virus isolates from Liberia and from Benin were almost the same as that which we had previously found in the Denmark strain. A much shortened ORF, potentially coding for a product of 133 amino acids, was retained in all three West African isolates, but three Zairean isolates each showed an identical series of small insertions and deletions which effectively abolish the ORF. Three deletions, present in all isolates, must pre-date the geographical separation of monkeypox virus lineages; other, presumably more recent, changes differ between the Zairean and West African isolates. In contrast, the base similarity was found to be more than 99% when all the monkeypox virus sequences were appropriately aligned. This, in a disrupted and presumably nonfunctional gene also indicates that the changes described are recent. It is suggested that insertions and deletions occur regularly during poxvirus DNA replication, but are preserved only in sequences that are not required for continued transmission in the natural host.

Africa, Western↗
PubMed1994

Short and long-term results of coronary angioplasty in patients over 75 years.

AIMS: This report reviews the outcome of percutaneous transluminal coronary angioplasty (PTCA) on patients aged 75 years or over at this institution, in order to provide statistics that may be useful in managing elderly patients. METHODS: All elderly patients undergoing PTCA between January 1984 and December 1990 were included. Data concerning the PTCA procedure and short term (hospital stay) outcome were compared to those of all patients less than 75 years who underwent PTCA during the same period. Long term outcome was obtained for all surviving elderly patients. RESULTS: One hundred and eleven procedures were performed on patients over 75 years, compared to 3183 procedures on patients under 75. The incidence of PTCA in the elderly increased to 6.7% of all procedures in 1990. Elderly patients were more symptomatic (97% vs 79% in patients under 75 years had Canadian Cardiovascular Society grade 3 or 4 angina), more frequently had the procedure performed urgently (39% vs 14%) and often (67%) had risk factors for PTCA (3 vessel disease, significant left ventricular dysfunction, or a complicating medical illness). Primary success rates (86% vs 90% in patients under 75 years), urgent coronary artery bypass grafting (1.8% vs 1.9%) and Q wave infarction (1.8% vs 1.0%) were similar in the two age groups. In the elderly, procedural difficulties requiring non standard equipment were common (61%), and in-hospital mortality was increased (4.5% vs 0.7%). Additionally, three patients died after discharge resulting in a 30 day mortality of 7.2%. A favourable long term outcome was obtained in 50% of patients at a mean follow up of 20 months. Unfavourable or neutral outcome was due to one or more of the following; death (16%), coronary artery bypass grafting (19%), acute myocardial infarction (7.5%) or significant residual angina (17%). CONCLUSIONS: Highly symptomatic patients over 75 years constitute a high risk group for PTCA, with approximately half obtaining a favourable long term outcome.

Age Factors↗
PubMed1994

Combination diuretic treatment in severe heart failure: a randomised controlled trial.

OBJECTIVES: (a) To test the hypothesis that a fixed 3 day course of the combination of a thiazide and loop diuretic is as effective as more prolonged treatment in the management of severe resistant cardiac failure. (b) To compare two thiazide diuretics (bendrofluazide and metolazone) in combination with loop diuretics in the treatment of severe resistant cardiac failure. DESIGN: Randomised study with a 2 x 2 factorial design. SETTING: Provincial teaching hospital. PATIENTS: 33 consecutive patients (40 episodes) admitted with severe congestive cardiac failure (New York Heart Association class III or IV) unresponsive to intravenous loop diuretics for 48 hours. MAIN OUTCOME MEASURES: Change in daily weight and serum electrolytes and clinical improvement in heart failure. RESULTS: Diuresis was established during 37 of 40 episodes; of the rest two patients died in hospital. On 36 occasions improvement was sufficient to allow discharge from hospital. Median (range) maximal weight loss was -5.05 (-11.3 to 1.6) kg after the addition of bendrofluazide and -5.6 (-12.2 to 4.8) kg after the addition of metolazone (NS). Area under the body weight loss against time curves showed no significant difference between the two thiazide diuretics. Median (range) maximal weight loss after three days of treatment was -5.4 (-12.2 to 4.8) kg and -5.5 (-10.3 to 1) kg after a more prolonged course of median (range) 5.6 (1 to 13) days (NS). Area under the body weight loss time curves showed no significant difference between the two durations of treatment. Bendrofluazide was associated with fewer electrolyte disturbances. CONCLUSIONS: Bendrofluazide and metolazone were equally effective in establishing a diuresis in patients with severe congestive cardiac failure resistant to loop diuretics. A fixed three day course of the combination was as effective as a longer course.

Adolescent↗
PubMed1994

The impact of the Americans with Disabilities Act on employment opportunity for people with disabilities.

The impact of the American with Disabilities Act (ADA) on employers and the workplace extends well beyond the provisions of the Act. Besides demanding an end to discrimination in the workplace against persons with disabilities, both the ADA and the Rehabilitation Act articulate the goals of equal opportunity, full participation, independent living, and economic self-sufficiency. They state clearly the right of each person to a full and meaningful life regardless of disability. Promoting those goals through employment requires thinking more broadly about the interaction between the individual with the disability, the workplace, and society. The employer is not the only participant. The individual with the disability plays an important role, as do the health care providers. An opportunity to align the goals of SSI and SSDI more closely with the ADA may lie in efforts to expand health care approaches to disability, based on the IOM Model of Disability, and link such practice with disability management efforts in the workplace.

Activities of Daily Living↗
PubMed1994

Increased expression in vivo of VCAM-1 and E-selectin by the aortic endothelium of normolipemic and hyperlipemic diabetic rabbits.

Atherosclerosis is enhanced in humans with diabetes mellitus, but the mechanism(s) involved remains unclear. Increased leukocyte-endothelium interaction may be involved, since mononuclear leukocyte adherence to the endothelium is an early event in both experimental atherosclerosis and alloxan-induced diabetes in rabbits. In situ immunohistochemistry was used in en face Häutchen endothelial preparations to identify endothelial cells that stained with antibodies to endothelial leukocyte adhesion molecules (vascular cell adhesion molecule-1 [VCAM-1] and E-selectin), and the number of stained cells per 10,000 cells was determined. Preparations from aortas of diabetic normolipemic and egg yolk diet-induced hyperlipemic diabetic rabbits were compared with those from normoglycemic animals on similar diets. Cross sections of the vessel wall were stained with oil red O and antibodies to VCAM-1, E-selectin, and RAM-11-positive macrophages. After 4 weeks of hyperlipemia the frequency of cells expressing VCAM-1 or E-selectin was significantly increased compared with normolipemic controls; this frequency was further increased in the aortas of hyperlipemic diabetic rabbits. VCAM-1 and E-selectin expression was more frequent in normolipemic diabetic rabbit aortas than in hyperlipemic, normoglycemic vessels. The potentiation of expression of these adhesion molecules in diabetic animals may provide part of the explanation for the enhanced atherosclerosis associated with diabetes mellitus.

Animals↗
PubMed1994

Morphological alterations in endothelial cells associated with the release of von Willebrand factor after thrombin generation in vivo.

von Willebrand factor (vWF) is synthesized by endothelial cells and stored in endothelium-specific granules, the Weibel-Palade (WP) bodies. The release of vWF from endothelial cells in vitro in response to secretagogues such as thrombin is considered to result in the loss of WP bodies through the fusion of the WP bodies with the plasma membrane. Biochemical and morphological techniques, including transmission (TEM) and scanning (SEM) electron microscopy, were used to examine the plasma profile of vWF in parallel with morphological alterations in endothelial cells associated with the generation of thrombin in vivo. There was a rapid loss of high-molecular-weight multimers of the circulating vWF, with full recovery within 1 hour. Simultaneously, TEM demonstrated that the endothelial cells lost WP bodies and became severely vacuolated; this was associated with the appearance of craters in the endothelial surface on SEM. Release of stored vWF in WP bodies seemed to follow the fusion of multiple rather than individual WP bodies, with the resulting vacuole fusing and rupturing through the plasmatic membrane. Within 1 hour there was increased morphological evidence of metabolic organelle activity associated with replacement of WP bodies, presumably due to de novo synthesis of the basic protomer and its packaging in high-molecular-weight multimeric form in the storage organelles.

Analysis of Variance↗
PubMed1994

The Health Security Act of 1993 and health care for persons with disabilities.

Persons with disabilities are an important and potentially vulnerable subgroup of the American public. This article discusses both the progress and the promise of health care reform in terms of benefits and impact on persons with physical and/or mental impairments. The author investigates the possibilities implied in the Clinton reform proposals for opportunities to include health promotion, prevention, and early intervention strategies, designed specifically for persons with disabilities. The author also examines the extent to which the reform plan may change the traditional, medically oriented approach to disability.

Community Participation↗
PubMed1994

Nursing implementation of smoking bans on psychiatric wards.

Although the prevalence of tobacco dependence among psychiatric inpatients far exceeds that of the general population, psychiatric inpatients are concerned about the health risks and financial impact of their addiction. Financial resources heretofore invested in supporting psychiatric patients' smoking and treatment of cigarette related illnesses can be reallocated to underwrite patient education. Comprehensive nursing care of tobacco dependent patients addresses knowledge deficits through individual and group treatment modalities.

Hospital Units↗