Creating positive attitudes: the effects of knowledge and clinical experience of psychiatry in student nurse education.
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Adult↗
Biomedical subjects
S Chan
Publications and source records attributed to S Chan.
Antioxidant properties of carvedilol and metoprolol in heart failure: a double-blind randomized controlled trial.
Animal and human studies have shown that carvedilol has significant antioxidant properties compared with other beta-blockers. The objective of this study was to determine if these antioxidant effects are detectable in patients with heart failure and to compare carvedilol with the selective beta-blocker metoprolol. Twenty-four patients with chronic heart failure were randomly assigned to receive either carvedilol or metoprolol in a double-blind control trial for 12 weeks in a University teaching hospital clinic. Blood pressure, heart rate, exercise tolerance, left ventricular ejection fraction, plasma total antioxidant status, erythrocyte superoxide dismutase, and glutathione peroxidase activities were determined at baseline and every 4 weeks up to 12 weeks. The results showed that erythrocyte superoxide dismutase and glutathione peroxidase were significantly reduced in carvedilol treated patients after 12 weeks of therapy, whereas metoprolol had no significant effect, although the clinical improvement over the short-term was similar with both drugs. Thus carvedilol, in addition to improving symptoms in heart failure, also possesses significant antioxidant properties. Whether this additional action influences long-term outcome is at present unknown.
Adrenergic beta-Antagonists↗
Molecular regulation of the hypothalamo-pituitary-adrenal axis in streptozotocin-induced diabetes: effects of insulin treatment.
Increased hypothalamo-pituitary-adrenocortical (HPA) activity in diabetes is likely important in the development of some pathologies associated with the disorder. We hypothesized that central regulation of HPA activity differs among normal, streptozotocin (STZ)-diabetic, and insulin-treated diabetic rats. Blood glucose, ACTH, and corticosterone were elevated, 8 d after inducing diabetes. Insulin treatment normalized these parameters. Plasma norepinephrine was similar in all groups, but epinephrine was lower in STZ-diabetic and higher in insulin-treated rats vs. normals. Increased ACTH with diabetes corresponded with increased hypothalamic CRH mRNA, but no change in pituitary POMC mRNA. With insulin-treatment, CRH mRNA remained elevated, and POMC mRNA was unaltered. Hippocampal MR mRNA expression was dramatically increased with diabetes and, moreover, was not normalized by insulin. No differences in GR mRNA were detected between normal and STZ-diabetic rats. However, insulin treatment increased GR mRNA levels in the paraventricular nucleus and pituitary. We postulate that, in STZ-diabetes: 1) increased HPA activity is caused by increased central drive at and/or above the level of the paraventricular nucleus and is associated with decreased epinephrine; and 2) normalized pituitary-adrenal activity with insulin may be caused by the compensatory increase in GR mRNA allowing glucocorticoid-mediated suppression of ACTH secretion despite the residual increase in central HPA activity. Thus, insulin apparently restored HPA activity at and below the pituitary but, surprisingly, not above it.
Animals↗
Effects of oxygen and bFGF on the vulnerability of photoreceptors to light damage.
PURPOSE: To test whether tissue oxygen levels affect the vulnerability of photoreceptors to damage by bright continuous light (BCL). METHODS: Albino rats were raised in standard conditions of cyclic light (12-hour light, 12-hour darkness) with the light level at 5 to 10 lux or 40 to 65 lux. They were then exposed to BCL (1000-1400 lux), either continuously for 48 hours or for the day or night components of the 48-hour period. During BCL, some rats were kept in room air (normoxia, 21% oxygen), some in hypoxia (10%), and some in hyperoxia (70%). Their retinas were examined for cell death, for the expression of basic fibroblast growth factor (bFGF), and for response to light (electroretinogram, ERG). RESULTS: The death of retinal cells induced by BCL was confined to photoreceptors. Within the retina, the severity of death was inversely related to the level of bFGF immunolabeling in the somas of the outer nuclear layer (ONL) before exposure. The death of photoreceptors was accompanied by an upregulation of bFGF protein levels in the ONL and by a decline in the ERG. Both hypoxia and hyperoxia during BCL reduced the photoreceptor death, bFGF upregulation, and ERG decline caused by BCL. The protective effects of hyperoxia and hypoxia were evident during both the day and night halves of the daily cycle. Hypoxia or hyperoxia alone did not upregulate bFGF or ciliary neurotrophic factor (CNTF) expression in the retina. CONCLUSIONS: Photoreceptors are protected from light damage by hypoxia and hyperoxia during exposure. The protection provided by oxygen levels operates during both day and night. The protection is not mediated by an upregulation of bFGF or CNTF.
Animals↗
Case 2. Hyperlipidemia.
A 58-year-old man with typical angina since 1994 presents to his physician. His angina is relatively stable and laboratory results indicate that his lipids are elevated. Recommendations for lipid management are discussed.
Angina Pectoris↗
Frequent death-associated protein kinase promoter hypermethylation in multiple myeloma.
UNLABELLED: Death-associated protein (DAP) kinase is a novel gene regulating apoptosis induced by IFN-gamma. In B-cell malignancies, loss of DAP kinase expression is commonly associated with promoter hypermethylation. These characteristics of DAP kinase may be of particular relevance in multiple myeloma (MM), a B-lineage malignancy in which prolonged survival capacity of the malignant plasma cells may be critical in the induction and maintenance of tumor cells. PURPOSE: The involvement and potential role of DAP kinase in MM pathogenesis was examined. EXPERIMENTAL DESIGN: In this investigation, methylation-specific PCR was conducted on primary MM and MM cell lines. Methylation status findings were correlated with clinical parameters. RESULTS: We first demonstrated frequent DAP kinase hypermethylation in 24 of 36 primary MMs (20 of 26 at diagnosis and 4 of 10 with relapse/residual MM after treatment), 1 of 2 patients with monoclonal gammopathy of undetermined significance, and 1 of 3 MM cell lines studied. The high frequency of DAP kinase hypermethylation was similarly observed in MM of different stages, immunoglobulin isotypes, and histological grades, with or without plasmacytomas. Although not statistically significant, the overall survival of patients with DAP kinase methylation was notably shortened among 23 MM patients followed prospectively (P = 0.38 by Kaplan-Meier method and log-rank test). This preliminary finding suggests prognostic implications of DAP kinase in MM that may deserve further investigation. CONCLUSIONS: Our data suggest an important role for DAP kinase in MM tumorigenesis.
Adult↗
Psychiatric illness, personality traits and the irritable bowel syndrome.
INTRODUCTION: Irritable bowel syndrome is a common functional gastrointestinal disorder. Although its aetiology is still unknown, visceral hypersensitivity, disorders of motility and psychosocial factors have been proposed as possible factors that affect the "gut-brain" function. The objective of this study was to determine if psychiatric disorders exist in patients with irritable bowel syndrome. PATIENTS AND METHODS: During a 10-month period, 43 outpatients, after exclusion of organic bowel pathology and meeting Manning's criteria for the diagnosis of irritable bowel syndrome, were assessed using the Eysenck Personality Questionnaire. In addition, a psychiatric interview was conducted by two psychiatrists. Twenty patients with organic bowel disorders, who were age matched, were selected as patient control. RESULTS: Psychiatric diagnoses (62.5%) were present in significantly more female patients with irritable bowel syndrome than female patients with organic bowel disorders (16.7%, P < 0.05). On Eysenck Personality testing, female patients with irritable bowel syndrome scored significantly higher on neuroticism (15.25 versus 8.58) and lower on need for social desirability (14.04 versus 17.0) than the organic disease group. Male patients with irritable bowel syndrome were comparable with male patients with organic bowel disorders in terms of presence of minor psychiatric morbidity, psychiatric diagnoses and Eysenck Personality scores. CONCLUSION: There is a difference between male and female patients with irritable bowel syndrome in terms of psychopathology.
Adult↗
An outbreak of Salmonella enteritidis linked to baked goods from a local bakery in lower Mainland, British Columbia.
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Adolescent↗
Hippocampal pathology in schizophrenia: magnetic resonance imaging and spectroscopy studies.
The hippocampus is a site of previously reported structural and functional abnormalities in schizophrenia. We used magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (MRS) to measure gray matter volumes, the neuronal marker N-acetylaspartate (NAA), and the combination of glutamate (Glu), glutamine (Gln), and gamma-aminobutyric acid (GABA), designated Glx. Measurements were obtained of the medial temporal lobe, centered on the hippocampus, in 10 male patients with schizophrenia (3 neuroleptic-medicated and 7 medication-free), and 10 matched normal volunteers. MRI volumetric measurements and MRS data obtained with short echo time (TE=20 ms) one-dimensional STEAM chemical shift imaging (CSI) on a GE 1.5 Tesla Signa system were analyzed. A laterality index ¿(L-R)/(L+R) was generated from the ratio of Glx to choline-containing compounds (Cho) to test asymmetry changes. Reliability of the MRS measures was assessed with five test-retest studies of healthy volunteers and showed coefficients of variation (CV) in the range of 36-44% for the MRS ratios and standard deviations (S.D.) of 0.15-0.17 for the laterality indices. The Glx/Cho laterality index showed a relative right-sided excess in this region in the patients (-0.23+/-0.20) compared to the controls (+0.06+/-0.20), which was not confounded by tissue composition or placement variability of the MRS voxels. Hippocampal volume deficit and asymmetry were not significant, and other MRS measures showed no differences between patients and controls. The preliminary finding of a lateralized abnormality in Glx is consistent with postmortem findings of asymmetric neurochemical temporal lobe abnormalities in schizophrenia.
Adult↗
Frequency and clinical determinants of dementia after ischemic stroke.
OBJECTIVE: To investigate the frequency and clinical determinants of dementia after ischemic stroke. METHODS: The authors administered neurologic, neuropsychological, and functional assessments to 453 patients (age 72.0 +/- 8.3 years) 3 months after ischemic stroke. They diagnosed dementia using modified Diagnostic and Statistical Manual of Mental Disorders, 3rd ed., revised criteria requiring deficits in memory and two or more additional cognitive domains as well as functional impairment. RESULTS: The authors diagnosed dementia in 119 of the 453 patients (26.3%). Regarding dementia subtypes, 68 of the 119 patients (57.1%) were diagnosed with vascular dementia, 46 patients (38.7%) were diagnosed with AD with concomitant stroke, and 5 patients (4.2%) had dementia for other reasons. Logistic regression suggested that dementia was associated with a major hemispheral stroke syndrome (OR 3.0), left hemisphere (OR 2.1) and right hemisphere (OR 1.8) infarct locations versus brainstem/cerebellar locations, infarcts in the pooled anterior and posterior cerebral artery territories versus infarcts in other vascular territories (OR 1.7), diabetes mellitus (OR 1.8), prior stroke (OR 1.7), age 80 years or older (OR 12.7) and 70 to 79 years (OR 3.9) versus 60 to 69 years, 8 or fewer years of education (OR 4.1) and 9 to 12 years of education (OR 3.0) versus 13 or more years of education, black race (OR 2.6) and Hispanic ethnicity (OR 3.1) versus white race, and northern Manhattan residence (OR 1.6). CONCLUSIONS: Dementia is frequent after ischemic stroke, occurring in one-fourth of the elderly patients in the authors' cohort. The clinical determinants of dementia include the location and severity of the presenting stroke, vascular risk factors such as diabetes mellitus and prior stroke, and host characteristics such as older age, fewer years of education, and nonwhite race/ethnicity. The results also suggest that concomitant AD plays an etiologic role in approximately one-third of cases of dementia after stroke.
Aged↗
Temporal response of brachial artery dilation after occlusion and nitroglycerin.
This study shows that a set time after cuff deflation or after nitroglycerin administration may not be suitable to capture peak, brachial artery dilatory responses in assessing endothelial dysfunction. Automated, continuous monitoring methods are required to simplify identification of peak responses and to standardize reporting.
Administration, Sublingual↗
Observation of radiative leptonic decay of the tau lepton
Using 4.68 fb(-1) of e(+)e(-) annihilation data collected with the CLEO II detector at the Cornell Electron Storage Ring, we have studied tau radiative decays tau(-)-->nu(tau)&mgr;(-)nu;(&mgr;)gamma and tau(-)-->nu(tau)e(-)nu;(e)gamma. For a 10 MeV minimum photon energy in the tau rest frame, the branching fraction for radiative tau decay to a muon or electron is measured to be (3.61+/-0.16+/-0. 35)x10(-3) or (1.75+/-0.06+/-0.17)x10(-2), respectively. The branching fractions are in agreement with standard model theoretical predictions.
Journal Article↗
Biomechanical assessment of plantar foot tissue in diabetic patients using an ultrasound indentation system.
The biomechanical properties of plantar tissues were investigated for four older neuropathic diabetic patients and four healthy younger subjects. Indentation tests were performed at four high-pressure areas with three postures in each subject. The tissue thickness and effective Young's modulus were measured by an ultrasound (US) indentation system. The system comprised a pen-size probe having a US transducer at the tip and a load cell connected in series with it. Results showed that the plantar soft tissues of the elderly diabetic patients were significantly stiffer and thinner when compared with the healthy young subjects. For the diabetic subjects tested, the Young's modulus at the 1st metatarsal head was significantly larger than those at the other three sites. This site-dependence was not observed in the healthy young subjects. The plantar tissue became significantly stiffer in the healthy young subjects as a result of posture changes. This posture-dependence of the Young's modulus was not established for the elderly diabetic group.
Biomechanical Phenomena↗
Evaluating the effectiveness of progressive muscle relaxation in reducing the aggressive behaviors of mentally handicapped patients.
This article reports the results of a study on the evaluation of the effectiveness of muscle relaxation training in reducing aggressive behavior in mentally handicapped patients (MHPs). A pretest and posttest study design was used. Findings showed that there was a reduction of 14.7% of aggressive behavior in the subjects after the muscle relaxation training. Muscle relaxation training appeared to be effective in reducing the frequency of some aggressive behaviors. The strengths and limitations of using muscle relaxation training in reducing aggressive behaviors are discussed.
Adolescent↗
Cost-effectiveness analysis of case management versus a routine community care organization for patients with chronic schizophrenia.
This article reports the economic analysis of a study on the implementation of case management in the Community Psychiatric Nursing Service (CPNS) caring for chronic schizophrenic clients in Hong Kong. The purpose of the study was to compare the outcome of case management service with the conventional practice CPNS. Sixty-two subjects participated in the analysis. Cost-effectiveness analysis showed that case management costs more in Hong Kong $3,600 (US$450) per person and that over a 5-month period, case management was associated with improvements in psychological and functional outcomes and patient satisfaction. The results of this study will inform policy makers about resource allocation and policy development in the implementation of case management for the care of mentally ill clients.
Adult↗
An evaluation of the implementation of case management in the community psychiatric nursing service.
This paper reports the preliminary results of a study on the implementation of case management in the community psychiatric nursing service (CPNS). The purpose of the study is to compare the outcome of case management service with the conventional practice of CPNS in the care of chronic schizophrenic clients. The impact of case management service on clients' clinical status, functional level and satisfaction was measured. A matched, pre-post, case-control group design was used to compare case management and conventional care groups. A specific case management model based on the practice at Carondelet Saint Mary's Hospital and Health Centre in Tucson has been developed to care for the schizophrenic clients in the community. Subjects in the experimental group were cared for by CPNs using this case management model. Subjects in the control group were cared for by CPNs based on current practices in the CPNS. Pre- and post-measures were taken upon recruitment and at 5 months later. Findings showed that the experimental group had better outcome in terms of their mental status and functional level when compared with the control group. They were generally more satisfied with the service. When comparing case managers' role with that of conventional CPNs, case managers performed more in areas such as assessment, liaison, case discussion and life skills training. This study demonstrates that this particular model of case management can be effective in caring for clients with long-term mental health problems in Hong Kong.
Adult↗
Improving the utilisation of bilingual counsellors within a public sector mental health service.
An urban, public sector Area Mental Health Program reviewed its own bilingual counsellor program as part of an Area-wide quality improvement project, and found that the counsellors' roles needed to be better defined; that mainstream staff needed to have more access to their expertise as cultural consultants; and that their function as an Area team, rather than as service based staff, needed to be encouraged. The bilingual counsellors decided to take up this challenge, and with the support of the Area Director of Mental Health, worked together to redefine their roles.
Communication Barriers↗
Hypocaloric total parenteral nutrition: effectiveness in prevention of hyperglycemia and infectious complications--a randomized clinical trial.
OBJECTIVE: To determine whether the frequency rate of hyperglycemia and infectious complications can be reduced by an underfeeding strategy in patients requiring total parenteral nutrition (TPN), without deleterious effects on nitrogen balance. DESIGN: Prospective, randomized, controlled nonblinded trial. SETTING: A university-affiliated teaching hospital with a dedicated TPN service. PATIENTS: TPN was initiated in 40 adult patients and continued for > or =5 days. INTERVENTION: Two different TPN feeding strategies were compared: hypocaloric feeding (1 L containing 70 g protein and 1000 kcal) and standard weight-based regimen, begun in similar amounts initially, but advanced in increments toward 25 kcal and 1.5 g protein/kg dry (or adjusted ideal) weight. MEASUREMENTS AND MAIN RESULTS: We evaluated the frequency rate of hyperglycemia, average blood glucose, numbers and types of infections while receiving nutritional support and nitrogen balance after 5 days of TPN. There were significant differences between the quantities of calories, dextrose, fat, and protein provided to the two groups. However, average blood glucose, frequency rate of hyperglycemia, and infection rates (from intravenous catheter, pneumonia, and wound/abdominal collection) were similar in each group. The control group showed a trend toward a higher insulin requirement. Nitrogen balance, only available as a subset, was significantly more negative in the hypocaloric group. CONCLUSIONS: Provision of TPN to a goal of 25 kcal/kg was not associated with more hyperglycemia or infections than a deliberate underfeeding strategy. A regimen of 1.5 g/kg protein in conjunction with 25 kcal/kg did, however, provide significant nutritional benefit in terms of nitrogen balance in comparison with hypocaloric TPN.
Adult↗