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Biomedical subjects

S Maxwell

Publications and source records attributed to S Maxwell.

At least 37 records · Page 2Linked to original sources
PubMed2000

A cross-national study of differences in the identities of nursing in England and Australia and how this has affected nurses' capacity to respond to hospital reform.

This paper examines similarities and differences in the identity of nursing in England and Australia. In doing this we examine how in each country nursing has developed different ideologies and strategies. Our analysis draws on data derived from a cross-national study of hospital staff in England and Australia. We demonstrate how differences in the occupational identity of nursing in each country are registered in their values, attitudes and beliefs. We suggest that these differences reflect the interplay of factors such as the strategic stances of nursing professional and industrial organisations and how nurses in each country have positioned themselves in responding to recent changes in health policy.

Adaptation, Psychological↗
PubMed2000

Methadone dose and retention during treatment of heroin addicts with Axis I psychiatric comorbidity.

We studied 90 opioid-dependent subjects, 38 with one or more additional Axis I diagnosis and 52 with no psychiatric comorbidity. There were significant differences between these two groups regarding the methadone dose required for clinical stabilization, but not in the rate of retention in treatment. Dual Diagnosis patients, those with psychiatric comorbidity, required an average stabilization dose of 154 +/- 84 of methadone compared to 99 +/- 49 mg/day for patients whose only Axis I diagnosis was Opioid Dependence. In the 990-day period considered there were no differences between the two groups of patients in terms of retention in treatment.

Adult↗
PubMed2000

Use of naltrexone in the treatment of alcohol use disorders in patients with concomitant major mental illness.

We report the use of naltrexone for treatment of alcohol use disorder in patients with major psychiatric illness. We reviewed the records of 72 mentally ill outpatients treated with naltrexone for alcohol use disorders at a community mental health center. The psychiatric diagnoses included major depression (n = 37), schizophrenia (n = 17), bipolar illness (n = 11), schizoaffective disorder (n = 7), and gender identity disorder (n = 4). Sixty-one patients (85%) had histories of psychiatric hospitalization. Total retention in naltrexone treatment for at least eight weeks was 81.9%: 5 (6.9%) were lost to follow-up, and 8 (11.1%) discontinued the medication because of side effects, primarily nausea. Patients showed good clinical response to naltrexone, with 82% reducing their drinking by at least 75%, and only 17% relapsing at eight weeks. We conclude that naltrexone is useful in the treatment of dually-disordered patients. The hypothesis that clinical response to naltrexone is facilitated by active alcohol drinking during treatment is discussed.

Adult↗
PubMed2000

Development of a business plan for women's health services, using Malcolm Baldrige Performance Excellence Criteria.

A new process for business planning at Hartford Hospital was needed to achieve critical business results. This article describes the Hospital's use of the Malcolm Baldrige Performance Excellence Criteria as a way to standardize and improve business planning. Women's Health Services is one of Hartford Hospital's "centers for excellence" and one of the first to use these criteria to improve its service. Staff learned how to build their business plan upon a set of core values and concepts such as customer-driven quality, leadership that sets high expectations, continuous improvement and learning, valuing employees, faster response to market demands, management by fact, and a long-range view of the future.

Commerce↗
PubMed1999

Community networking as a means for identifying people with diabetes in a rural, predominantly bicultural community in New Zealand.

AIMS: To assess the use of community networking to estimate the prevalence of diabetes in a predominantly New Zealand Maori and European community. METHODS: A cross-sectional survey of people with known diabetes identified either through general practice or community networks (others with diabetes, public notices or public meetings) was undertaken. Ascertainment was compared using capture-recapture methods for two independent samples. RESULTS: Overall ascertainment by community networking was greater for Maori than Europeans (40 +/- 3% vs 15 +/- 2%, p < 0.001). Ascertainment using general practice registers was comparable in the two ethnic groups (48 +/- 4% vs 55 +/- 5%, respectively). Women were more likely than men to be contacted through community networking (odds ratio 1.47, 1.05-2.06). CONCLUSION: In closely knit communities, community networking provides an independent source for estimating the prevalence of diabetes.

Community Health Planning↗
PubMed1999

Is routine synovial fluid analysis necessary? Lessons and recommendations from an audit.

This audit of 408 synovial fluid samples, analysed for cell counts and crystals, revealed that crystals were present in only 25 samples (6.1%). Of these, in only three patients was the diagnosis uncertain and therefore the analysis helpful. Cell counts and types generally reflected known underlying diagnoses of inflammatory arthritis or osteoarthritis. Routine synovial fluid analysis does not contribute to diagnosis or management in established rheumatic disorders and should be performed only when the underlying cause is uncertain or in newly presenting patients. Major savings can be made by abandoning routine synovial fluid analysis.

Diagnostic Tests, Routine↗
PubMed1999

Food coping strategies: a century on from Rowntree.

The objectives of this study were to update Rowntree's food estimates to bring them into line with contemporary food habits and changing lifestyles; to determine whether food budgeting/ coping strategies of low income households observed by Rowntree at the turn of the century were still prevalent in low income groups today: and to evaluate whether expenditure by low income households on food was sufficient to meet minimum dietary recommendations. Two hundred questionnaires were completed face to face with the interviewer within the Merseyside boundary and included only those households who were in the Post code area. Many low income households are unable to access a healthier diet due to income limitations. Many used a variety of coping strategies to stretch their incomes and were also found to rely on help from outside the immediate family such as extended family and friends and voluntary agencies. Households with children were found to be spending slightly more on food than the reconstructed Rowntree minimum dietary. There are thus two issues; firstly that there are households spending slightly more than the minimum yet that are unable to achieve a healthy diet. Secondly all the low income households are spending much less per person than the average person in the United Kingdom. It is concluded that whilst sterling work is being achieved within health promotion departments and within community health settings there is still a great deal to be undertaken. The value of Home Economics teaching in schools should be better recognised, and Home Economics should be reinstated in the National Curriculum. Secondly it is recommended that a standard approach be adopted to inform both welfare benefit payments and in-work top up payments, thus allowing households on low incomes to make informed choices within a budget that will accommodate healthier eating strategies.

Adult↗
PubMed1998

Sorting mechanisms regulating membrane protein traffic in the apical transcytotic pathway of polarized MDCK cells.

The transcytotic pathway followed by the polymeric IgA receptor (pIgR) carrying its bound ligand (dIgA) from the basolateral to the apical surface of polarized MDCK cells has been mapped using morphological tracers. At 20 degreesC dIgA-pIgR internalize to interconnected groups of vacuoles and tubules that comprise the endosomal compartment and in which they codistribute with internalized transferrin receptors (TR) and epidermal growth factor receptors (EGFR). Upon transfer to 37 degreesC the endosome vacuoles develop long tubules that give rise to a distinctive population of 100-nm-diam cup-shaped vesicles containing pIgR. At the same time, the endosome gives rise to multivesicular endosomes (MVB) enriched in EGFR and to 60-nm-diam basolateral vesicles. The cup-shaped vesicles carry the dIgA/pIgR complexes to the apical surface where they exocytose. Using video microscopy and correlative electron microscopy to study cells grown thin and flat we show that endosome vacuoles tubulate in response to dIgA/pIgR but that the tubules contain TR as well as pIgR. However, we show that TR are removed from these dIgA-induced tubules via clathrin-coated buds and, as a result, the cup-shaped vesicles to which the tubules give rise become enriched in dIgA/pIgR. Taken together with the published information available on pIgR trafficking signals, our observations suggest that the steady-state concentrations of TR and unoccupied pIgR on the basolateral surface of polarized MDCK cells are maintained by a signal-dependent, clathrin-based sorting mechanism that operates along the length of the transcytotic pathway. We propose that the differential sorting of occupied receptors within the MDCK endosome is achieved by this clathrin-based mechanism continuously retrieving receptors like TR from the pathways that deliver pIgR to the apical surface and EGFR to the lysosome.

Animals↗
PubMed1998

In polarized MDCK cells basolateral vesicles arise from clathrin-gamma-adaptin-coated domains on endosomal tubules.

Human transferrin receptors (TR) and receptors for polymeric immunoglobulins (pIgR) expressed in polarized MDCK cells maintain steady-state, asymmetric distributions on the separate basolateral and apical surfaces even though they are trafficking continuously into and across these cells. The intracellular mechanisms required to maintain these asymmetric distributions have not been located. Here we show that TR and pIgR internalize from both surfaces to a common interconnected endosome compartment that includes tubules with buds coated with clathrin lattices. These buds generate vesicles that carry TR to the basolateral border. The lattices contain gamma-adaptin and are dispersed by treatment with brefeldin A (BFA). Since BFA treatment abrogates the vectorial trafficking of TR in polarized MDCK cells, we propose that the clathrin-coated domains of the endosome tubules contain the polarized sorting mechanism responsible for their preferential basolateral distribution.

Adaptor Protein Complex gamma Subunits↗
PubMed1997

Comparison of antioxidant activity in lipoprotein fractions from insulin-dependent diabetics and healthy controls.

The insulin-dependent diabetic patient is at greatly increased risk of premature atherosclerosis. Oxidative damage to lipoproteins has been implicated as an important factor in the atherogenic process. Diabetic patients are exposed to excessive oxidative stress because of non-enzymatic glycation of proteins and a variety of defects in antioxidant systems. We have previously described an enhanced chemiluminescent method for measuring protective 'chain-breaking' antioxidant activity in plasma lipoprotein fractions. In this study we compare the lipid content and antioxidant activity of plasma lipoproteins in 22 young insulin-dependent diabetics without vascular complications and 20 age- and sex-matched controls. Mean levels of haemoglobin A 1c in the diabetic group were 8.8 +/- 0.2%. There were no significant differences in serum total cholesterol, apolipoprotein A, apolipoprotein B or lipoprotein(a) levels between the study groups. Serum total triglyceride levels (1.32 +/- 0.11 versus 1.01 +/- 0.08 mmol/l; P < 0.05) and LDL-associated triglyceride (0.28 +/- 0.04 versus 0.15 +/- 0.02 mmol/l; P < 0.05) were significantly elevated in the diabetic group. Total plasma antioxidant activity was significantly reduced in the diabetic group (272.0 +/- 15.4 versus 338.3 +/- 20.7 micromol/l; P < 0.05). Antioxidant activity measured in five lipoprotein fractions isolated by density gradient ultracentrifugation (VLDL1. VLDL2, LDL1, LDL2 and HDL) showed no significant differences between groups when corrected for protein, total lipid or cholesterol content. When corrected for triglyceride content significantly lower antioxidant values were found in the diabetic HDL fraction only. The results of this study imply that the susceptibility of the insulin-dependent diabetic to the development of premature atherosclerosis cannot be attributed to reduced antioxidant activity in circulating plasma lipoproteins.

Adult↗
PubMed1997

Routine synovial fluid culture: is it necessary? Lessons from an audit.

An estimated third of rheumatologists send aspirated synovial fluid samples for culture routinely during the course of management of their patients irrespective of the underlying diagnosis. This is done apparently even when sepsis is not suspected. This audit of 507 synovial fluid culture requests revealed that positive bacterial growth was rare even when sepsis was queried on the request forms but none was positive in any of the routine samples. Our findings throw doubt on the value of routine synovial fluid culture. We recommend that such cultures are undertaken when infection is a possibility and in immuno-compromised patients. An average health district would save pounds 3000 per annum if such a policy was adopted, but across the National Health Service as a whole the total expenditure saved on this unnecessary investigation would be considerable.

Adolescent↗