Delay in diagnosis in breast cancer.
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Breast Neoplasms↗
Biomedical subjects
S Bond
Publications and source records attributed to S Bond.
A juxtacrine mechanism for neutrophil adhesion on platelets involves platelet-activating factor and a selectin-dependent activation process.
The aim of this study was to identify the molecular mechanisms involved in neutrophil adhesion to immobilized platelets with particular focus on the possible existence of a juxtacrine system for neutrophil-platelet interactions. Platelets were immobilized onto collagen (type I)-coated coverslips that were placed in a flow chamber and neutrophils were perfused across these confluent monolayers at a shear stress of 1 to 4 dynes/cm2. Neutrophils rolled, and a significant proportion (25% to 50%) adhered to platelet monolayers. P-selectin was expressed in very large quantities on the surface of platelets and mediated all of the rolling, whereas the beta2-integrin mediated firm adhesion. An activation mechanism for adhesion was necessary inasmuch as fixed neutrophils continued to roll on immobilized platelets, but did not adhere. Platelets adherent to collagen produced significant levels of platelet-activating factor (PAF). Accordingly, the firm adhesion of neutrophils to platelets was significantly inhibited by a PAF receptor antagonist (WEB 2086). Treatment of only the platelets with acetylhydrolase, which converts membrane-associated PAF to lyso-PAF, prevented 60% of the adhesion. These data suggest that PAF, on the surface of platelets, mediated a significant portion of the adhesive interaction. Addition of some selectin-binding carbohydrates (fucoidan or soluble SLEx analogs but not dextran sulfate) to the platelets caused rolling neutrophils to immediately adhere, an event that was not observed on histamine or thrombin-treated endothelium or P-selectin transfectants. These data support the view that a juxtacrine activation process exists on immobilized platelets for neutrophils. This process can be greatly enhanced on platelets and may involve a signaling mechanism through P-selectin.
Anticoagulants↗
Dental defects of congenital syphilis.
Diagnosis of the congenital form of syphilis is an important part of the palaeopathology of this disease. In theory, there are clear clinical signs to be found in the long bones and teeth, but it has rarely been possible to recognise the latter with a confidence in archaeological material, partly because the original descriptions of the dental deformities are sometimes contradictory and partly because it is nowadays difficult to find reference specimens in museums. This article describes two such specimens which have recently been rediscovered, and discusses the form of the dental defects which they show (Hutchinson's incisors, Moon's molars, and mulberry molars) in relation to the developmental sequence of the teeth.
Child↗
A sequential randomised controlled trial comparing a dry visco-elastic polymer pad and standard operating table mattress in the prevention of post-operative pressure sores.
Four hundred and forty-six general, vascular and gynaecological surgical patients were recruited to a two centre, double triangular sequential randomised controlled trial to compare the post-operative pressure sore incidence in patients positioned on the standard operating table mattress with those positioned on the dry visco-elastic polymer pad (Action Products Inc.). Two hundred and twenty two patients were randomised to the experimental group and 224 to the standard mattress. The main endpoint failure rate (a pressure sore) was found to be 11% (22/205) for patients allocated to the dry visco-elastic polymer pad and 20% (43/211) for patients allocated to the standard operating table mattress. There was a significant reduction in the odds of developing a pressure sore on the dry visco-elastic polymer pad as compared to the standard, [symbol see text] = 0.46 with 95% confidence interval of (0.26, 0.82), P = 0.010. The adjusted point estimates of the probability of developing a pressure sore on the dry visco-elastic polymer pad and the standard operating table mattress were 0.11 and 0.21 respectively.
Aged↗
Pruritic urticarial papules and plaques of pregnancy: clinical and immunopathologic observations in 57 patients.
BACKGROUND: Pruritic urticarial papules and plaques of pregnancy (PUPPP) has been described either as a homogeneous or a polymorphic clinical process. Its cause is unknown. OBJECTIVE: We attempted to characterize the clinical and immunopathologic findings in PUPPP on the basis of long-term clinical and immunopathologic observations. METHODS: The clinical and immunopathologic features of 57 patients with PUPPP were evaluated. RESULTS: The clinical features in 57 patients with PUPPP were categorized into three types: mainly urticarial papules and plaques (type I), nonurticarial erythema, papules, or vesicles (type II), and combinations of the two forms (type III). Direct immunofluorescence studies in 48 of the 57 patients showed nonspecific immunoreactants in dermal blood vessels and/or moderate granular deposits at the dermoepidermal junction in 15 patients. CONCLUSION: Type I PUPPP differed from types II and III in clinical appearance and distribution (absence of face, palm, and sole lesions), but trimester onset, parity, and direct immunofluorescence findings were not significantly different among the three groups.
Adolescent↗
The importance of place for older people moving into care homes.
In an increasingly mobile society, the importance of place can be forgotten in the process of making decisions about where older people should receive care. There is some evidence, however, that issues of location and place are important to older people, both in the way that their sense of self is developed and maintained through identification with places and through their ability to participate in activities. This paper describes a research study which followed a group of older people through the process of moving into care homes, and discusses some of the data produced, which indicated how a sense of place shaped the process of moving.
Aged↗
Nursing organizational practice and its relationship with other features of ward organization and job satisfaction.
This paper describes a new classification of ward organizational practice in nursing. Data related to aspects of ward nursing practice were collected by postal survey from a nationally representative sample of 74 acute hospital wards, and subjected to hierarchical cluster analysis. The model which was deemed to best 'fit' the data, provided three types of ward practices, which have been named: 'devolved', 'two tier' and 'centralized' nursing. The distinguishing features of the three classifications are similar but not identical to accepted 'ideal types' of primary, team and functional systems. The relationships between wards in each of the three identified categories and other ward organizational practice processes of nursing care and job satisfaction are described.
Analysis of Variance↗
A comparative analysis of six audit systems for mental health nursing.
PURPOSE: To devise an analytical framework to help identify strengths and weaknesses in the audit process as specified by existing psychiatric nursing audit systems, in order to analyse current audit practice and identify improvements for incorporation in the Newcastle Clinical Audit Toolkit for Mental Health. DATA SOURCES: Published material relating to the following six systems: the Central Nottinghamshire Psychiatric Nursing Audit; Psychiatric Nursing Monitor; Standards of Care and Practice; Achievable Standards of Care; Quartz; and Quest. DATA EXTRACTION: Comparison of the six systems according to an analytical framework derived from detailed empirical study (structures, processes and outcomes) of one of them in use and the educational evaluation literature. Examination of the extent to which guidance is provided for operating the systems and for wider process-related aspects of audit. RESULTS OF DATA SYNTHESIS: Five of the systems failed to specify some important elements of the audit process. Conceptually, the six systems can be divided into two main types: 'instrument-like' systems designed along psychometric lines and which emphasize the distance between the subjects of audit and the operators of the systems, and 'tool-like' systems which exploit opportunities for care setting staff to engage in the audit process. A third type of system is the locally-developed system which is offered to a wider audience but which does not make the same level of claim to universal applicability. CONCLUSION: The analytical framework allows different approaches to audit to be compared and contrasted not only according to the techniques used, but also according to process issues. The analysis of six systems revealed a variety of different techniques and procedures which can facilitate, in a methodologically rigorous manner, practitioner and other stakeholder involvement in audit processes.
Humans↗
Workforce planning. The human factor.
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Administrative Personnel↗
Relationship of enamel hypoplasia to the pattern of tooth crown growth: a discussion.
The defects of enamel hypoplasia can be related to the layered structure of enamel which represents the sequence of development in tooth crowns. From such studies, it is possible to see that furrow-type enamel defects (the most common form of hypoplasia seen with the naked eye) are just the most prominent expression of a continuum which extends ever smaller, down to a microscopic disturbance to a single layer in the crown formation sequence. Furthermore, the progressive decrease in spacing between development layers which occurs down the crown sides, from occlusal to cervical, affects both the prominence and apparent width of the defects. This makes it difficult to use measurements as a means of estimating the duration of the disturbance causing a particular defect. The difficulty is even greater for the less common pitted or exposed-plane-type defects, for which the apparent width bears very little relationship with the duration of the growth disturbance. The defects of enamel hypoplasia can therefore be understood clearly only when examined under the microscope in relation to the structures which mark the development sequence of the tooth crown.
Anthropometry↗
Clinical specialty and organizational features of acute hospital wards.
Ward clinical specialty is a variable which has been largely ignored in studies of nursing organization and effectiveness. Analysis of data collected from a nationally representative sample of 83 acute medical, surgical and orthopaedic hospital wards demonstrates that while wards had similar staffing resources, differences exist in the likelihood of adopting a nursing organizational system with devolved authority, in nurses' views of prevailing hierarchical attitudes, and their perceived influence over a range of organizational features of the ward. Medical wards were more likely to have developed organizational practices associated with increasing nursing autonomy.
Analysis of Variance↗
The nursing record as a research tool to identify nursing interventions.
This paper describes a study which was designed to test the feasibility of using retrospective case note abstraction of data from nursing records to identify the nursing interventions given to two groups of patients: those who had suffered a myocardial infarction and those who had sustained a fractured neck of femur. The aim of the study was to assess whether the data obtained from the records were an accurate reflection of the nursing care given to patients. This was done by comparing what was recorded in the notes for specific areas of care with what the nursing staff said they did. The specific areas of care for patients suffering a myocardial infarction were: pain, mobility, anxiety, patient education. The specific areas of care for patients sustaining a fractured femur were: pressure areas, pain, nutrition, mobility and rehabilitation, information and teaching. Data were collected in three ways: using a retrospective data abstraction tool to examine the case notes of a particular patient; interviewing a nurse who had looked after the same patient; interviewing a senior ward nurse to obtain information about ward policies and practices to obtain a profile of the care usually given to these groups of patients. In this paper we present some of our findings and discuss the methodological and logistical problems of using this method.
Feasibility Studies↗
Changes in reported dietary habit and exercise levels after an uncomplicated first myocardial infarction in middle-aged men.
Education of patients and their partners about appropriate lifestyle changes following myocardial infarction (MI) is a key element in rehabilitation; developing relevant educational strategies requires a knowledge of patient beliefs and attitudes. This paper reports findings from a survey of diet and exercise in a group of 153 middle-aged men who had suffered a first uncomplicated MI. Just over half of those questioned expressed a desire to change their diet post-MI; those who perceived their pre-morbid diet to be 'less healthy' were more likely to want to change. Significant changes in food consumption (towards a more healthy diet) were observed at 3 months post-MI. Patients were less likely to change their behaviour with respect to exercise, and few attained recommended levels of physical activity either pre- or post-MI. Patients held a number of misconceptions regarding the role of diet and exercise in predisposing to coronary heart disease, and the need for change in behaviour. Beliefs and behaviour change were only weakly associated with receipt of information and advice. The findings have important messages for the more appropriate targeting of information-provision during the period of rehabilitation.
Diet↗
A study to determine patient satisfaction with nursing care.
In this paper, the authors describe a newly constructed measure of patient satisfaction entitled the Newcastle Satisfaction with Nursing Scales (NSNS). A study using the NSNS found that patients 'most liked' the humour that nurses tried to inject into their interactions with patients, but that they were dissatisfied in general with the amount of information given to them by nurses. The sensitivity of the tool in relation to detecting differences between wards, hospitals or groups of patients is emphasised. The authors then discuss how the NSNS package can be used by others to carry out similar comparisons.
Adult↗
Forging links between academe and practice through research.
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Education, Nursing, Continuing↗
The effect of epigastric vessel ligation on the vascular territories of the pig rectus muscle.
In a pig model, unilateral ligation of the inferior epigastric vessels caused an initial decrease in normal vascularity, followed by an increase toward normal vascularity, in the inferior portion of the rectus muscle over 42 days. Ligation appeared to dilate the choke vessels between the superior and inferior arterial territories. The results indicate that by ligation of the inferior epigastric vessels, the vascular territory, which is normally tenuous, can undergo a transposition without vascular compromise.
Animals↗
Measuring patients' satisfaction with nursing: 1990-1994.
Assessing patients' satisfaction with the care they receive is assuming greater importance in the new-style National Health Service. This paper reviews recent developments in the measurement of patients' satisfaction with nursing, including new approaches and taking into account increased interest in users' opinions. Studies published since 1990 generally demonstrate lack of clarity with regard to the purpose and intent of the study, as well as a lack of conceptual rigour and methodological investment. However, several new approaches were found upon which future nursing research could build.
Humans↗
Newcastle satisfaction with nursing scales: an instrument for quality assessments of nursing care.
OBJECTIVES: To test the validity and reliability of scales for measuring patients' experiences of and satisfaction with nursing care; to test the ability of the scales to detect differences between hospitals and wards; and to investigate whether place of completion, hospital, or home influences response. DESIGN: Sample survey. SETTING: 20 wards in five hospitals in the north east of England. PATIENTS: 2078 patients in general medical and surgical wards. MAIN MEASURES: Experiences of and satisfaction with nursing care. RESULTS: 75% of patients approached to complete the questionnaires did so. Construct validity and internal consistency were both satisfactory. Both the experience and satisfaction scales were found to detect differences between randomly selected wards and hospitals. A sample of patients (102) were sent a further questionnaire to complete at home. 73% returned this; no significant differences were found in either experience or satisfaction scores between questionnaires given in hospital or at home. CONCLUSION: Scales to measure patients' experiences of and satisfaction with nursing in acute care have been developed and found to be valid, reliable, and able to detect differences between hospitals and wards. Questionnaires can be given before patients leave hospital or at home without affecting scores, but those given at home have a lower response rate.
Data Collection↗