Biomedical subjects
N Thomas
Publications and source records attributed to N Thomas.
Dimorphism in Cladosporium werneckii.
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Smoking attitudes of New Haven county physicians: a survey.
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Predicting hospital-associated mortality for Medicare patients. A method for patients with stroke, pneumonia, acute myocardial infarction, and congestive heart failure.
We created a microcomputer-based system that uses characteristics of the patient at admission to predict death within 30 days of hospital admission for Medicare patients with stroke, pneumonia, myocardial infarction, and congestive heart failure. These conditions account for 13% of discharges and 31% of 30-day mortality for Medicare patients over 64 years of age. The system was calibrated on a stratified, random sample of 5888 discharges (about 1470 for each condition) from seven states, with stratification by hospital type to make the sample nationally representative. The predictors must be specially abstracted from the medical record. The cross-validated R2 for predictions is 0.14 to 0.25, which is better than the values for other systems for which we have data. Risk-adjusted predicted group mortality rates may be useful in interpreting information on unadjusted mortality rates, and patient-specific predictions may be useful in identifying unexpected deaths for clinical review.
Antenatal ultrasound diagnosis of cerebellar vermian agenesis in a case of rhombencephalosynapsis.
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Retinal development of West Australian dhufish, Glaucosoma hebraicum.
An investigation of retinal specializations was carried out in larval and juvenile dhufish, Glaucosoma hebraicum (Glaucosomidae, Teleostei). The development of photoreceptors and formation of the retinal mosaic was followed by light and electron microscopy. At hatching the eye was undifferentiated. Cone photoreceptors were present by day 3 posthatch (dph), when exogenous feeding began. Single and multiple cones were present in a row arrangement from 3 dph to 20 dph, when the first rod nuclei were observed. Between 20 dph and approximately 3 months posthatch (mph), the row arrangement was replaced by a square mosaic of four double cones surrounding a single cone, and the cones increased in size, with the outer segments reaching up to 30 microm in length. During the period of spatial rearrangement, triple cones were often observed. From their first appearance, rod photoreceptors were added rapidly. Investigation of ganglion cell topography in 3-mph fish that had attained the adult-like square photoreceptor mosaic was carried out using retinal wholemounts. The highest densities of neurones in the ganglion cell layer were in temporal retina but no well-defined area centralis was observed. Microspectrophotometric measurements of the visual pigments within the outer segments of the photoreceptors of 3-mph fish revealed double cones with identical absorption spectra in each member of the outer segment, and the wavelength of maximum absorption (lambda(max)) located at 522 nm. Single cones were found to possess a visual pigment with lambda(max) at 460 nm and rods with a lambda(max) of 498 nm. The results imply that the larvae and juveniles are adapted for survival in coastal waters and may be active in relatively low light levels from early stages of development.
Analysis of deletions in DNA from patients with Becker and Duchenne muscular dystrophy.
Duchenne muscular dystrophy (DMD) is an X-linked recessive genetic disorder for which the biochemical defect is as yet unknown. Recently, two cloned segments of human X-chromosome DNA have been described which detect structural alterations within or near the genetic locus responsible for the disorder. Both of these cloned segments were described as tightly linked to the locus and were capable of detecting deletions in the DNA of boys affected with DMD. In an attempt to determine more precisely the occurrence of these deletions within a large population of DMD patients and the accuracy of one of the segments, DXS164 (pERT87), in determining the inheritance of the DMD X chromosome, the subclones 1, 8 and 15 were made available to many investigators throughout the world. Here we describe the combined results of more than 20 research laboratories with respect to the occurrence of deletions at the DXS164 locus in DNA samples isolated from patients with DMD and Becker muscular dystrophy (BMD). The results indicate that the DXS164 locus apparently recombines with DMD 5% of the time, but is probably located between independent sites of mutation which yield DMD. The breakpoints of some deletions are delineated within the DXS164 locus, and it is evident that the deletions at the DMD locus are frequent and extremely large.
cDNA array reveals increased expression of glucose-dependent insulinotropic polypeptide following chronic clozapine treatment: role in atypical antipsychotic drug-induced adverse metabolic effects.
Clozapine is an atypical antipsychotic drug with unique pharmacological and therapeutic properties. Unlike the typical antipsychotic drug, haloperidol, clozapine does not cause extrapyramidal side effects; however, weight gain, dyslipidemia, and type II diabetes are commonly associated with the use of this drug in subjects with schizophrenia. The aim of this study was to profile gene expression in the rat striatum following clozapine treatment. Chronic treatment with clozapine revealed upregulation of several genes including the glucose-dependent insulinotropic polypeptide (GIP) gene by over 200% in the rat striatum. The cDNA array results for the GIP gene were confirmed by real-time RT-PCR as well as by radioimmunoassay. Expression of the GIP gene in the central nervous system is consistent with the results of retinal GIP gene expression as reported by other investigators. Taken together, these findings implicate the possible role of GIP as a neuromodulator in the central nervous system. GIP is an insulinotropic agent with stimulatory effects on insulin synthesis and release from the pancreas. However, changes in brain GIP levels are most likely unrelated to the metabolic adverse effects (dyslipidemia, type II diabetes, weight gain) associated with clozapine treatment. Therefore, we also measured GIP gene expression in the K-cell-rich regions, duodenum and jejunum (small intestine), and plasma GIP levels using radioimmunoassay following chronic treatment with clozapine. GIP mRNA levels in the small intestine and the plasma GIP at the protein level were significantly elevated in clozapine-treated subjects. Furthermore, as observed in humans, chronic clozapine treatment also caused weight gain, and increased levels of insulin, triglycerides and leptin in the plasma. These results suggest that adverse metabolic effects associated with clozapine treatment may be related to its ability to increase intestinal gene expression for GIP.
Without parental consent: conducting research with homeless adolescents.
ISSUES AND PURPOSE: To identify the ethical and legal implications of conducting research with homeless adolescents and to discuss guidelines for conducting research without parental consent. CONCLUSIONS: Ethical principles of capacity, risk, postponement, and truthful disclosure within the context of the rights of minors to consent to healthcare treatment form the basis of the argument for allowing adolescents to consent to participate in research without parental consent when there is minimal risk or when such consent could place them at increased risk for harm. PRACTICE IMPLICATIONS: Adolescents who are the target population for clinical research or who are intended recipients of nursing care should be involved in setting priorities, purposes, and protocols. Parents and other adults from their communities should be included in developing strategies to protect their confidentiality and privacy while helping them achieve autonomy in making informed health-related decisions.
Unstable diabetes and peritoneal dialysis--what are the challenges?
This case study outlines the care of a young woman undergoing peritoneal dialysis (PD) who has Type 1 diabetes mellitus as the underlying cause of her renal disease. Although she is able to manage the practical aspects of her fluid exchanges and exit-site care, she has difficulty with managing her fluid balance. This necessitates the use of two 3.86% glucose bags per day, which in turn sometimes leads to high, unstable, blood glucose levels. This study will outline the nursing challenges and interventions and will evaluate the nursing management.
Using and developing your EDTNA/ERCA Professional Portfolio.
A portfolio is an instrument for continuing professional development, which can be used by all members of the multidisciplinary team. This paper describes the development of the EDTN/ERCA Professional Portfolio and discusses how health care professionals are able to complete and utilise the Portfolio in everyday practice. A discussion on reflective practice is presented and a short example of reflective writing is given. The paper concludes with an evaluation of possible Portfolio use in teaching and management and discusses plans for future development.
The European Basic Core Curriculum for Nephrology Nursing, the process of writing, publishing and disseminating.
In August 2002 the European Basic Core Curriculum (BCC) for Nephrology Nursing was published on the EDTNA/ERCA homepage. At the EDTNA/ERCA annual conference in The Hague in September 2002, it was presented to the delegates as an oral presentation and a poster presentation. Publicity flyers were translated into seven languages and distributed to delegates. This paper will describe the aims of the BCC, the process of writing and publishing, the use of the BCC in nursing schools and the measures that have already been taken in implementation and dissemination.
Accreditation of post-basic nephrology courses within the EDTNA/ERCA.
This paper will outline the development of the EDTNA/ERCA accreditation programme for post-basic courses in nephrology. It will discuss results of the pilot project and relate the experiences of one school that has successfully gone through the accreditation process. The article will conclude with a discussion on more recent developments and evaluate the project in light of the original concepts.
Care and management of diabetic nephropathy (moderate to advanced renal involvement).
This paper describes the possible risk factors in the development of renal disease in diabetes mellitus. The aim of this paper is to identify and evaluate the care and management of patients with moderate renal impairment and to make recommendations for optimal renal referral.
Can we delay the progression of chronic kidney disease (CKD) by improving collaboration between renal units and primary care teams?
This paper will discuss why nephrology teams should collaborate with primary care teams in delaying the progression of chronic kidney disease (CKD), and explain how they can collaborate to improve the outcomes for patients who eventually need dialysis. The paper will describe the staging of CKD and will discuss evidence-based guidelines for the management of CKD in the community. Practical examples of how a specialist renal nurse can improve communication with primary care and can improve the outcome of patients with early kidney disease will be described.
Measurement of quality of life for elderly people on dialysis.
Renal nurses face certain difficulties when caring for a rapidly increasing population of elderly people. This article examines quality of life and analyses the appropriateness of a self-care philosophy for this group of patients. In addition, the process of adaptation to chronic illness is discussed.
Comparing hydrocolloid dressings in management of exuding wounds.
Hydrocolloid dressings have been widely used since the late 1970s. This article compares two hydrocolloid dressings--3M Tegasorb dressing and ConvaTec's Granuflex (E)--and highlights their similarities and differences when used in the clinical situation. Both hydrocolloids were reported to perform favourably by users in most situations. 3M Tegasorb dressing becomes transparent in use and this function was rated highly by users compared to the opaque Granuflex (E). In addition, 3M Tegasorb showed better adherence. One limitation of the study was the small number of patients studied. Weekly assessments yielded 90 data sets in total.
Patient-controlled analgesia.
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