Biomedical subjects

S Summers

Publications and source records attributed to S Summers.

At least 19 recordsLinked to original sources

PubMed2004

Always look beyond the stones: hyperoxaluria overlooked.

We report a case which demonstrates the disastrous consequences of late diagnosis of hyperoxaluria in a 24-year-old woman with nephrocalcinosis, a staghorn calculus and recurrent urinary tract infections. Her initial management at another hospital included multiple percutaneous nephrostomies and lithropsies. Metabolic screening was not undertaken. Hyperoxaluria was finally diagnosed by elevated urine oxalate (1.235 mmol/24 h) and renal biopsy, by which time there was already significant reduction of renal function. A diagnosis of hyperoxaluria type I was confirmed by liver biopsy. Despite starting pyridoxine and crystallization inhibitors, her renal function deteriorated, requiring hemodialysis and she was referred for combined liver-renal transplantation. Clinical clues of primary hyperoxaluria type I are a positive family history or presentation with severe renal stones at an unusually early age. Irrespective of the above, all patients with first presentation of renal calculi should undergo metabolic screening, including urine oxalate.

Adult↗

PubMed2001

CD40 expression and function on human dermal microvascular endothelial cells: role in cutaneous inflammation.

CD40 is a member of the tumour necrosis factor (TNF) cell surface receptor family. It plays an important role in T-cell dependent B-cell functions and in dendritic cell development. It has also been identified as a cell surface receptor on endothelial cells. In this manuscript, we report that human dermal microvascular endothelial cells (HDMEC) express cell surface CD40 and that the expression of CD40 is increased by the proinflammatory cytokines TNF-alpha and interferon (IFN)-gamma. Additionally, we demonstrate that engagement of HDMEC CD40 with its recombinant CD40 ligand augments the induction of E-selectin, but not of intercellular or vascular cell adhesion molecules on the surface of HDMEC. Furthermore, we show that IFN gamma stimulation of HDMEC results in increased binding of Jurkat leucocytes to HDMEC by a CD40--CD154 dependent pathway. This study thus provides evidence that CD40 expression in HDMEC is regulated by proinflammatory cytokines, and that CD40 functions as an important mediator of cutaneous inflammation.

CD40 Antigens↗

PubMed2001

Evidence-based practice part 2: reliability and validity of selected acute pain instruments.

Pain management is an important aspect of perianesthesia patient care. PACU nurses need to be familiar with pain measurement to judge effectiveness of pain management. In fact, the 1999-2000 Joint Commission on Accreditation of Healthcare Organizations' (JCAHO) guidelines have included the measurement of pain before and after pain treatment in their standards of practice. This article reviews selected pain instruments that could be used to measure pain in perianesthesia patients and the available reliability and validity of the instruments.

Acute Disease↗

PubMed2001

Evidence-based practice part 3: acute pain management of the perianesthesia patient.

Evidence exists that pain is inadequately controlled in most patients. This is caused, in part, by the fact that doctors and nurses have based clinical practice on myths and misconceptions about pain medications, rather than by using evidence-based research. Evidence also exists that when pain is adequately controlled, there is greater patient satisfaction with care. The purpose of Part 3 in this series on pain is to review the literature on inadequate pain management, to review Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) guidelines for correcting the inadequacy of pain control, and to review evidence-based medications used for pain management.

Acute Disease↗

PubMed2001

Injuries from falls in the pediatric population: an analysis of 729 cases.

BACKGROUND/PURPOSE: Falls are classified as low or high level for triage purposes. Because triage criteria dictate less urgency for low-level falls, this classification scheme has important implications for pediatric emergency care. METHODS: Retrospective analysis was conducted of 729 (393 low-level and 336 high-level) pediatric patients treated for fall-related trauma (1992 through 1998). Falls were classified as low (<15 feet) or high-level (> or =15 feet). All falls were reported as accidental or unintentional. RESULTS: The overall mortality rate was 1.6% (2.4% for high-level falls compared with 1.0% for low-level falls). All 4 patients who died of a low-level fall had an abnormal head computed tomography (CT) scan and intracranial hypertension. Half of deaths from high-level falls were attributable to intracranial injuries, and half were caused by severe extracranial injuries. Common extracranial injuries were upper extremity fracture (6.2%), lower extremity fracture (5.6%), pulmonary contusion (1.8%), pneumothorax (1.1%), liver laceration (1.1%), bowel injury (1.0%), and splenic injury (2.1%). Orthopedic and thoracic injuries resulted more commonly from high-level falls, whereas abdominal injuries were as likely to occur after a low-level fall. CONCLUSIONS: Intracranial injury accounts for the majority of deaths from falls. Children suffering low-level falls were at similar risk for intracranial and abdominal injuries compared with those who fell from greater heights. Pediatric trauma triage criteria should account for these findings.

Abdominal Injuries↗

PubMed2000

Analysis of pediatric head injury from falls.

The authors conducted a study to describe the incidence and types of fall-related head injury observed at a pediatric trauma center. We performed a retrospective analysis of all patients under 15 years of age treated for fall-related trauma between 1992 and 1998. Falls were classified as low (< 15 feet) and high level (> or = 15 feet). Seven hundred twenty-nine cases were identified with a mortality rate of 1.7%. A fall of greater than 15 feet (high-level fall) was associated with a higher mortality rate than low-level falls (2.4% compared with 1.0%, respectively). Ninety-eight patients had sustained a calvarial fracture and 93 experienced a basal skull fracture. Twenty-six patients had suffered a cerebral contusion, 25 a subarachnoid hemorrhage, 22 a subdural hematoma, and 12 had an epidural hematoma. Forty-nine patients required surgery for traumatic injuries; of these, 10 underwent craniotomy for evacuation of a blood clot. Height was not predictive of the Glasgow Coma Scale (GCS) score. In all four deaths resulting from a low-level fall there was an admission GCS score of 3, and abnormal findings were demonstrated on computerized tomography scanning. Death from high-level falls was attributable to either intracranial injuries (50%) or severe extracranial injuries (50%). Intracranial injury is the major source of fall-related death in children and, unlike extracranial insults, brain injuries are sustained with equal frequency from low- and high-level falls in this population. The only cause of mortality from low-level falls was intracranial injury. Trauma triage criteria must account for these differences in the pediatric population.

Accidental Falls↗

PubMed2000

Evidence-based practice part 1: pain definitions, pathophysiologic mechanisms, and theories.

Evidence-based practice consists of using research evidence to validate patient care. A body of evidence exists on pain mechanisms and pain management; however, patients continue to experience unrelieved pain. This 3-part series on pain will explore evidence in pain theories, pathophysiological mechanisms, instruments to measure pain, and how to manage pain in PACU patients.

Evidence-Based Medicine↗

PubMed2000

Perianesthesia applied research.

Research is important for perianesthesia nursing to validate and to advance patient care. Evidence-based nursing practice is discussed as one method of advancing PACU nursing practice. PACU nurses are encouraged to submit pain study reviews as a beginning to evidence-based nursing practice. Resources are given for research method techniques.

Clinical Nursing Research↗

PubMed2000

Setting standards using integrated care pathways.

An integrated care pathway is a tool that can help to deliver clinical governance objectives if implemented well. Key factors of successful implementation are: effective project management; communication and training; and top-down and bottom-up support for the process.

Critical Pathways↗

PubMed1998

Synergistic induction of ornithine decarboxylase by asparagine and gut peptides in intestinal crypt cells.

The objective of this study was to determine whether the amino acid asparagine stimulated the activity of ornithine decarboxylase (ODC) synergistically with epidermal growth factor (EGF) or gastrin in IEC-6 cells, a line of normal rat small intestinal crypt cells. Cells were grown in DMEM containing 5% dialyzed fetal bovine serum, and serum was deprived for 24 h before experiments. Exposure to EGF or gastrin alone increased ODC activity 4.5- to 6-fold. Asparagine alone increased the enzyme activity 10- to 13-fold in IEC-6 cells. Simultaneous addition of asparagine and EGF or gastrin, however, increased ODC activity more than 40-fold. In contrast, there was no synergistic induction of ODC activity when gastrin and EGF were added together. Increased ODC activity in cells treated with asparagine and EGF or gastrin was associated with an increase in ODC mRNA and protein levels. The rate of transcription of the ODC gene was significantly increased by exposure to EGF or gastrin. Asparagine alone had little or no effect on the rate of transcription of the ODC gene. When given together with EGF or gastrin, asparagine also had no additional effect on the transcription rate of the ODC gene. The half-life of mRNA for ODC in unstimulated IEC-6 cells was approximately 30 min and increased to more than 2 h in cells exposed to asparagine, although neither gastrin nor EGF prolonged the stability of ODC mRNA. The half-life of mRNA for ODC after combined addition of asparagine and EGF or gastrin was extended to approximately 2 h, similar to asparagine alone. Combined addition of asparagine and EGF or gastrin also significantly increased DNA synthesis compared with cells exposed to each of the three agents alone. In conclusion, 1) simultaneous addition of asparagine and EGF or gastrin increases ODC activity in a synergistic manner and 2) asparagine increases ODC mRNA levels through completely distinct mechanisms from EGF or gastrin. EGF or gastrin specifically stimulates transcription of the ODC gene, whereas asparagine affects a posttranscriptional process.

Animals↗

PubMed1997

Waiting times. Bones of contention.

A slot system allocating a set number of outpatient orthopaedic appointments to general practices in North West Anglia HA means all patients referred are seen in eight weeks. The system has provoked criticism from GPs on the grounds that the burden of waiting lists has shifted onto them, and it limits access to services. The scheme has improved communication between GPs and orthopaedic consultants.

Appointments and Schedules↗

PubMed1995

Mutational analysis of the peptide segment linking phosphorylation and Ca(2+)-binding domains in the sarcoplasmic reticulum Ca(2+)-ATPase.

The sarcoplasmic reticulum ATPase segment extending from the phosphorylation site (Asp-351) to the preceding transmembrane helix M4 (which is involved in Ca2+ binding in conjunction with transmembrane helices M5, M6, and M8) retains a marked sequence homology to the corresponding segments of other cation ATPases. We made 26 point mutations in this segment and found that nonconservative mutations of residues that are homologous in various cation ATPases result in strong inhibition of catalytic and transport function. Mutations of nonhomologous residues to match the corresponding residues of other cation ATPases are not inhibitory and, in some cases, produce higher activity. The inhibitory mutations affect the phosphorylated intermediate turnover, which is associated with the vectorial translocation of bound Ca2+. The same mutations do not affect the kinetics of ATPase activation by Ca2+ following enzyme preincubation with EGTA. This suggests that activation of the phosphoryl transfer reaction by Ca2+ binding and vectorial displacement of bound Ca2+ by enzyme phosphorylation do not occur simply as the forward and reverse directions of the same process, but are linked to distinct structural features of the enzyme. The peptide segment extending from the phosphorylation site in the enzyme extramembranous headpiece through the M4 helix in the membrane-bound region sustains a prominent role in transmission of the phosphorylation signal for displacement of bound Ca2+. A critical structural role of this segment is also demonstrated by the interference of specific mutations with membrane assembly of the expressed protein.

Animals↗

PubMed1994

Research preceptors: assisting the postanesthesia nurse to advance from novice to expert researcher.

Benner proposed "novice to expert" to describe and explain the development of clinical skill acquisition in nursing students and practicing nurses. Frequently, nursing students' clinical skill acquisition is facilitated by a clinical instructor or preceptor; however, it is uncommon to facilitate research skills by this method. This article describes the novice-to-expert framework, its applications to practice competency development in students and nurses, and research skill expectations. Developing research skill in PACU nurses through the use of research preceptors is proposed.

Clinical Competence↗

PubMed1994

Research priorities for all phases of postanesthesia nursing: a survey by ASPAN.

This ASPAN survey was conducted by Research Committee members regarding the future of research for postanesthesia nursing and asked this question: What do postanesthesia nurses view as priorities for postanesthesia nursing research in various phases of practice? The design for the study was the Delphi technique, which uses a multiple, sequential survey to reach consensus among a group of experts. Four rounds of questionnaires were used to survey volunteer participants (N = 54). The group of experts remained stable (N = 41) for rounds 2 through 4. Findings from the survey indicated several areas of priorities for postanesthesia nursing. Of the top 10 ranked statements, 4 related to discharge criteria. Another high-priority area identified was pain management, with 5 statements pertaining to this subject being ranked in the top 10. Based on this small sample of postanesthesia nurses, this study provides a beginning step for prioritizing areas of research necessary to expand the body of knowledge for postanesthesia nursing.

Adult↗

PubMed1994

A review of postanesthesia research from 1990 to 1993.

Postanesthesia nurses are actively involved in research. Just as it is important to conduct research, it is equally important for studies to adhere to established research methodologies. This study reviewed 29 published PACU studies to determine adherence to established research methodologies. All studies were published in the Journal of Post Anesthesia Nursing from 1990 to 1993.

Humans↗

PubMed1994

Decision trees: helping the postanesthesia nurse to plan data analysis.

An important step in the research process is statistical analysis of the data. Data analysis should be planned as variables are identified, as level of measurement is determined, and as research questions or hypotheses are generated. The use of decision trees can assist the PACU nurse in determining which statistical tests are appropriate for the level of variable measurement in the study. The use of decision trees also can assist the PACU nurse when consulting with experts regarding appropriate statistical analysis.

Decision Trees↗

PubMed1993

Triangulation: a method to enhance the validity of postanesthesia nursing studies.

Triangulation is a research method that strengthens the validity of research results by using a variety of research approaches. Five approaches are discussed in this article and consist of multiple investigators, theories, data sources, methods, research designs, and data analysis. For increased understanding, these approaches are applied to the concept of pain. Suggestions are given for postanesthesia patient and nursing research topics that could be studied using the triangulation process.

Data Collection↗

PubMed1993

The research process: informed consent.

Informed consent is a vital part of the research proposal and study. Informed consent is based on principles of autonomy ie, individuals have a right to full disclosure of information in order to make an informed decision and to assume responsibility for the consequences of their decision. Informed consent also contains a legal element whereby failure to obtain it is considered negligence and/or battery. Conducting studies when patients are medicated, ill, or very young or very old require special steps to verify that subjects are fully informed. It is important that PACU nurses pay particular attention to the informed consent process when planning and conducting research studies.

Consent Forms↗