Biomedical subjects
Publications and source records attributed to P Kennedy.
It is shown that a Dirac particle of mass m and arbitrarily small momentum will tunnel without reflection through a potential barrier V = U(c)(x) of finite range provided that the potential well V = -U(c)(x) supports a bound state of energy E = -m. This is called a supercritical potential well.
STUDY DESIGN: A repeated measures design was employed with measures taken on two observational periods during the first 6 months post-discharge from hospital. OBJECTIVES: To investigate the perceived importance of specific needs implicated in the development of quality of life (QOL), and the extent to which these aspects have been achieved, in a group of people with spinal cord injury (SCI) living in the community. SETTING: The National Spinal Injuries Centre, Stoke Mandeville Hospital and the general community. METHODS: The study sample comprised 24 spinal cord injured patients discharged from a national rehabilitation centre following a rehabilitation programme. The Quality of Life and Needs Assessment Questionnaire was completed by participants at 1 and 6 months post discharge. RESULTS: No significant differences were found between the importance that participants attributed to specific needs at months 1 and 6 post discharge. Moreover, no significant differences were found between the extent to which these needs were met at 1 and 6 months post discharge. CONCLUSION: The reported quality of life of people who have a spinal cord injury remains stable during the first year following discharge.
OBJECTIVE: To examine the prevalence of anxiety and depression longitudinally in a sample of patients with a spinal cord injury (SCI). DESIGN: A prospective, longitudinal, multiple wave panel design with measures taken on 14 observational periods ranging from initial contact in the acute stages of hospitalization to 2 years' postdischarge to the community. SETTING: The National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK, and the general community. PARTICIPANTS: The cohort consisted of 104 patients with traumatic SCI (19 women, 85 men), although the numbers assessed at each interval ranged from 5 to 85. MAIN OUTCOME MEASURES: Measures included the Beck Depression Inventory, the Beck Hopelessness scale, the State Anxiety Inventory, the functional independence measure, and the Social Support Questionnaire. RESULTS: When examined longitudinally, the data illustrate a consistent pattern of results across measures, with scores highest in the acute phase of the injury and during the months leading up to discharge. CONCLUSION: The numbers of persons scoring above clinical cut-off scores for anxiety and depression highlight the need to continue to ensure that appropriate psychological care is available within SCI rehabilitation settings. Moreover, the nature of the longitudinal results provides an indicator of subtle changes in anxiety and depression over time.
OBJECTIVE: To evaluate the outcome of the Needs Assessment and Goal Planning Programme used in the rehabilitation of people with spinal cord injuries. The Needs Assessment Programme incorporates a behavioural indicator rating scale to detail the individual's progress and rehabilitation needs. This can also be used to evaluate the outcome of the rehabilitation programme in general. The Needs Assessment Checklist (NAC) forms part of the programme and is a tool which is used to evaluate rehabilitation outcome. SETTING: A purpose built, national spinal injuries centre in the United Kingdom. SUBJECTS: 82 patients who had completed the Needs Assessment Checklist, both at the beginning and towards the end of the rehabilitative process. RESULTS: Independence, as measured by the Checklist, was significantly greater in all domains at the time of the second Needs Assessment. CONCLUSIONS: The Needs Assessment and Goal Planning Programme is successful in establishing greater client independence, whether assessed at a verbal or physical level. Team members have used the Needs Assessment Checklist as a behavioural indicator of rehabilitation outcome based on available standards of rehabilitative care. Further development of the Needs Assessment Checklist now needs to focus on establishing concurrent validity and test/retest reliability. The measure developed proved to be a useful, clinically relevant and patient friendly assessment of rehabilitation outcome.
STUDY DESIGN: Longitudinal. OBJECTIVES: To characterize long-injured SCI persons with high reported stress; to assess the relationship between severity of disability and perceived stress; to identify correlates of future stress and outcomes of previous stress. SETTING: Two SCI centres in England: Stoke Mandeville Hospital in Aylesbury, and the District General Hospital in Southport. METHODS: In 1990, 1993 and 1996 187 persons who sustained spinal cord injuries prior to 1971 underwent comprehensive physical evaluations and health status interviews and completed a battery of tests to measure psychosocial functioning. Using mean scores on the Perceived Stress Scale (PSS) as the reference, a range of outcomes were analyzed to identify concurrent, previous, and future variables that were significantly correlated with perceived stress. RESULTS: No associations were found between stress and any of the proxy variables that represented injury severity. Such common SCI-related medical conditions as pressure sores and upper extremity pain were not related to stress; not even fatigue was significantly associated with stress in both time periods studied. However, depressive symptoms, poorer life satisfaction, and poorer perceived well being were associated with future stress and were outcomes that appeared to be related to earlier stress. CONCLUSION: Perceived stress in long-term SCI is not closely related to the severity of the disability or physical independence. It is, however, related to scores on several measures of adjustment and coping. Though mean stress scores in this sample did not appear to differ substantially from scores in the general nondisabled population, further controlled study is needed to definitively answer the question: Do SCI survivors report more stress than their nondisabled counterparts?
STUDY DESIGN: A retrospective review examining the cases of 137 individuals with spinal cord injury (SCI) as a result of a suicide attempt between 1951 - 1992. OBJECTIVE: To ascertain demographic details of this participant sample, explore and identify the type of psychiatric condition evident around the time of injury, and to review outcome information of this sample with specific focus on mortality, especially further evidence of deliberate self harm. SUMMARY OF BACKGROUND DATA: Research examining suicide rates in SCI populations has found such numbers to be significantly higher than in the general population. However, these studies have typically relied on small samples of individuals and have often failed to distinguish between those individuals who sustained SCI as a result of attempted suicide, and those who first attempted suicide following SCI. METHODS: An established database comprising details of 137 people with SCI as a result of attempted suicide was reviewed and updated using patient admission records. The subsequent database comprised: cause, level and completeness of injury; height fallen; psychiatric history; psychiatric diagnosis; date of last contact; further suicide attempts; religious affiliation; previous and present employment; date and cause of death; date and place of discharge; and any other relevant details. From this database the three primary objectives of the study were ascertained: demographic detail; psychiatric condition; and outcome information. RESULTS: The ratio of males to females was 1 : 1 with a mean age of 32. Almost half (48.9%) were single, around a third (32.8%) had children and 42. 3% were employed. Schizophrenia and depression were evident in 32.8% and 27% of cases respectively. Previous suicide attempts had been made by 23% (n=32). The cause of injury in 85% of cases was 'falls'. Thirty-three people are known to have died, of whom eight (24%) committed suicide. During the period between the first and last spinal cord injury examined within this study (1951 - 1992) 1.6% (n=137) of the total sample of patients treated at the rehabilitation centre (n=8347) sustained a spinal cord injury as a result of a suicide attempt. CONCLUSION: Significant findings include; a high proportion of patients with schizophrenia; similar findings concerning age profile and level of injuries with previous research, but different sex ratio; and information on longer-term outcomes. Recommendations for further research include an adaptation of the psychological autopsy approach which would provide information beyond that normally available in actual suicides.
OBJECTIVE: We aimed to assess whether GP input into discharge planning for high-risk aged in-patients admitted under the care of a geriatrician results in improved patient outcomes. METHODS: We conducted a prospective randomized controlled trial in Sydney, Australia. The subjects were 364 patients aged 60 years and over. The main outcome measures included community service referral, accommodation changes, length of stay, readmission rate, length of time to first readmission and patient satisfaction with discharge arrangements. RESULTS: No significant differences were found with regard to length of stay, readmission rates or time to first readmission. Test-group subjects were significantly more likely to be recommended for community services at discharge and to report that hospital personnel had discussed their discharge plan with them. Significantly more of the test group reported that their return home was well prepared. CONCLUSIONS: Although GP pre-discharge visits did not alter the likelihood of 'hard outcomes such as risk of readmission', the results suggest that quality of care is enhanced amongst patients receiving a pre-discharge visit and that GPs can perform a key role in planning post-discharge care with other services.
OBJECTIVES: To develop and evaluate a brief group-based psychological intervention for improving psychological adjustment and enhancing adaptive coping following spinal cord injury. The Coping Effectiveness Training (CET) programme is grounded on the cognitive theory of stress and coping of Lazarus & Folkman (1984), and represents an original adaptation of the theory to the needs of this client group. DESIGN: A controlled trial comparing patients receiving the CET intervention to matched controls in measures of psychological adjustment and coping was used. METHODS: Nineteen intervention group participants and 19 matched controls were selected from in-patients at a hospital-based spinal injury rehabilitation centre. Outcome measures of depression, anxiety and coping were collected before, immediately after and six weeks after the intervention. RESULTS: Intervention group participants showed significantly greater reductions in levels of depression (p < .01) and anxiety (p < .05) compared to matched controls immediately after the intervention and at six weeks follow-up. There was no evidence of a significantly greater change in the coping strategies used by the intervention group. Participants highlighted their interactions with other group members as the most helpful aspect of the intervention. CONCLUSIONS: This evidence suggests that the CET intervention facilitated a significant improvement, in psychological adjustment to spinal cord injury. It is proposed this may be understood in terms of changes in participants' appraisal of the implications of spinal cord injury and of the coping skills needed to continue living meaningful and satisfying lives.
Most research into psychological aspects of spinal cord injury (SCI) has focused on adult onset. This is a retrospective study of self-perceptions following a childhood onset of SCI. Self-esteem, depression and self-perception were examined in 86 people who had a traumatic SCI before the age of 16. Depression was measured using the Beck Depression Inventory, and self-esteem using the Culture-Free Self-Esteem Inventory Self-perception was measured using a scale developed for this study, consisting of 20 adjectives, with participants themselves on dimensions of 'As I am', 'As I would be without the injury', and 'as I would be ideally'. The participants' self perceptions of the injured self and the uninjured self were found to be significantly different on only nine of the 20 adjectives. Low self-perception was found to be associated with low self-esteem and high depression levels, but independent of age at injury, level of injury and gender. The change noted by the participants between how they see themselves now and how they would have been without the injury is not as great as might have been expected.
The objective of this study was to assess the quality of communications between hospitals and general practitioners (GPs). The proportion of medical records in which the patient's general practitioner (GP) was identified, the accuracy of medications recorded in the discharge summary, the proportion of GPs who received discharge summaries, and the timeliness of receipt of discharge summaries were all evaluated. Discussions were held with all stakeholders, the literature was reviewed and GPs were surveyed to identify potential measures of quality. These were then trialled to assess their utility and practicability. Timeliness, issues that required follow-up and treatment provided in hospital were of greatest importance to general practitioners. The GP's name was recorded in 88% of audited records. Few inaccuracies were detected in the medications recorded in the discharge summaries, and GPs received 77% of discharge summaries. Methods similar to those used in this study might be broadly applied to improve the quality of discharge communication throughout Australia.
Statistical analyses of DNA sequences have revealed patterns of nonneutral evolution in mitochondrial DNA of mice, humans, and Drosophila. Here we report patterns of mitochondrial sequence evolution in South American marsh rats (genus Holochilus). We sequenced the complete mitochondrial ND3 gene in 82 Holochilus brasiliensis and 21 H. vulpinus to test the neutral prediction that the ratio of nonsynonymous to synonymous nucleotide changes is the same within and between species. Within H. brasiliensis we observed a greater number of amino acid polymorphisms than expected based on interspecific comparisons. This contingency table analysis suggests that many amino acid polymorphisms are mildly deleterious. Several tests of the frequency distribution also revealed departures from a neutral, equilibrium model, and these departures were observed for both nonsynonymous and synonymous sites. In general, an excess of rare sites was observed, consistent with either a recent selective sweep or with populations not at mutation-drift equilibrium.
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The temporal fractionation of long-term retention remains a relatively uncharted area in human memory research, and in particular there is little in the way of neuropsychological data that address this issue. We describe a patient with temporal lobe epilepsy who complained of amnesia for important events that had occurred in the previous 3-24 months, but who reported that her short-term and medium-term memory were normal. She displayed normal performance on traditional tests of short-term and long-term retention, performing at a very similar level to that of age- and sex-matched healthy control subjects on immediate and half-hour delayed recall measures. Forty days later, however, she showed a dense amnesia for recall of such information, whereas control subjects could readily recall much of the original stimuli. She also showed evidence of memory loss for news events that had occurred over the previous few years. MRI scanning and EEG brain mapping indicated left temporal lobe pathology, with a possible epileptogenic focus in the left anterior hippocampus. These data provide empirical evidence for the existence of a distinct very long-term consolidation process in human episodic memory and point to its neural correlates in the temporal lobe. Transfer of information into a permanent long-term memory store may entail multiple-stage consolidation processes rather than a single-stage, unitary consolidation process.
PURPOSE: To analyze the effect of several standard artificial tear preparations on computerized videokeratographic measurements. SETTING: Cullen Eye Insitute, Baylor College of Medicine, Department of Ophthalmology, Houston, Texas, USA. METHODS: We evaluated one eye each in 18 normal volunteers. Using the EyeSys Corneal Analysis System (EyeSys Technologies), we obtained corneal topographic measurements at baseline and 0.5, 1, 2, 3, 4, 5, 6, 8, and 10 minutes after instillation of the following preparations: balanced salt solution, Tears Naturale II, Tears Naturale Free, Cellufresh, Celluvisc, HypoTears, and HypoTears PF. We analyzed changes in curvature of the keratographic rings at radii 1 to 5 mm and changes in keratometric-equivalent astigmatic power and meridian. RESULTS: All preparations except HypoTears and Tears Naturale II induced statistically significant, time-dependent changes in mean corneal power in the central 5 mm corneal zone compared with baseline measurements (P < .05). The relationship between change in dioptric power over time varied with preparation type and was nonlinear in nature. In all cases, the mean induced change was < or = 0.5 diopter. Except for Celluvisc, tear administration produced minimal changes in the values of corneal astigmatic power or meridian. CONCLUSION: When performing serial measurements of mean corneal power, the greatest consistency was achieved with no tears or with instillation of HypoTears or Tears Naturale II.
BACKGROUND: Management of MRSA infection includes immediate isolation of the patient. Long periods of isolation are considered to be psychologically detrimental, though little information is available about the impact of isolation as an infection control procedure. The purpose of this study is to examine the psychological well-being of spinal cord injured patients who are isolated as a result of being MRSA positive. METHODS: A cross-sectional matched-control study of MRSA positive patients with MRSA negative patients was carried out at the National Spinal Injuries Centre, Stoke Mandeville Hospital, Bucks, England. Sixteen MRSA positive patients, aged 18 to 65, and their matched controls completed a series of questionnaires to measure aspects of psychological impact. The measures used were functional independence, depression, anxiety, and the affective states of anger, vigour, fatigue and confusion. FINDINGS: The MRSA positive spinal cord injured patients were only significantly more angry than the control group, although these isolated patients scored higher in all measures. INTERPRETATIONS: In this spinal cord injured group the difference between the psychological well-being of isolated MRSA positive patients and non-isolated MRSA negative patients is not as great as might have been expected. Patients feel that rehabilitation is affected, but the situation may be improved by providing more space and a better view onto the ward.
Previous studies have estimated that between 25% and 45% of people with spinal cord injury report severe levels of chronic pain. Few studies have examined this longitudinally. This study examines the primary pain sites, intensity and variability of perceived pain in 76 patients, 6 weeks post injury and 45 patients from the same cohort, 8 year post discharge. Demographic information reveals a close similarity with the database (40,000) from Stover and Fine's cohort (1986). Data was assessed using visual analogue scales, measures were also taken of functional independence (FIM), emotional status and coping. At 6 weeks post injury, most pain is sited in the thoracic spine area, and in the upper and lower limbs. At 1 year post discharge, most pain is reported to be in the thoracic spine area, the lumbar region and the chest. Twenty-three per cent of the 6 week group reported that the intensity of their pain was severe, whilst at 1 year, 41% of the sample complained of severe pain. Factors associated with the pain at both time points were explored using correlational analyses. The emotional, functional and psychological factors that predict pain severity were explored using multiple regression analysis. Twenty-four per cent of those reporting moderate to severe pain at 6 weeks post injury were still reporting pain at 1 year post discharge. This study examines the relative contribution of psychological factors in reported pain.
This research attempts to close the gap in the literature on clergy views of sexuality by surveying pastors of a large conservative evangelical denomination in a metropolitan southern California county (n = 31) on moral attitudes, understandings of God's view of sexuality, and the role of the church regarding issues of sexuality. These pastors held quite conservative moral principles while also affirming sensuality within the context of a marital relationship. Pastors saw the role of the church as mainly to serve and influence the sexual practices of the people within the church but also affirmed the church's involvement in the influence of the local community. Religion and sexuality were entirely compatible concepts for these pastors. Therapeutic implications and suggestions are offered.
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