Port Arthur disaster.
Explore the source record for details and available documents.
Disaster Planning↗
Biomedical subjects
S Wilkinson
Publications and source records attributed to S Wilkinson.
Schering Plough clinical lecture communication: it makes a difference.
Communication is a vital component of nursing care that can improve outcomes for patients with cancer and their families in terms of psychological distress. Research indicates that nurses' communication skills have shown little improvement over the last 20 years. Communication is a practical skill that can be learned in theory from the literature or educational programs, but putting theory to practice in the clinical setting is far more problematic. Nurses need to be aware of their own communication skills by listening to themselves and learning from their mistakes. Only with this practice will skills improve. Communication can make or mar a person's illness experience. It is time for nurses to take effective communication seriously and actively accept personal responsibility for their actions because there is clear evidence showing that good communication makes a difference for patients and their families.
Communication↗
A longitudinal evaluation of a communication skills programme.
Communication is an essential component of palliative care, but patients and their families are often dissatisfied with their interactions with health professionals. Communication difficulties are also a recognized stress factor among health professionals. Education and training, however, are said to improve communication skills. A communication skills training programme for 110 nurses has demonstrated statistically significant improvements in the nurses' skills, but no long-term effect was evaluated. This paper presents the results of the long-term follow-up study. Of the 110 nurses contacted, 20% refused to participate, 45% agreed and 35% did not respond; 33 nurses returned usable data. The mean length of time since completing the original study was 2.5 years. Since completion of the original course there was no statistically significant deterioration or improvement in eight of the nine areas of assessment skills evaluated. In the area of psychological assessment there was a statistically significant improvement, and overall the nurses maintained their skills and improved in this area. The results suggest that over time the nurses became more confident in the emotional areas of care as a result of the training. The two key elements of the training were audio-tape recordings and feedback, which raised self-awareness, and experiential workshops covering ways of handling difficult situations. Whether a similar training effect could be achieved by a short 3-5 day course on communication skills needs addressing, because the integrated training skills course evaluated here is costly. Preliminary evidence suggests that the 3-5-day course may not be as effective, so the increased costs associated with the integrated training skills course may be wisely spent if it improves the quality of nurse-patient interaction as evidence here suggests.
Adult↗
An evaluation of aromatherapy massage in palliative care.
The use of complementary therapies, such as massage and aromatherapy massage, is rising in popularity among patients and healthcare professionals. They are increasingly being used to improve the quality of life of patients, but there is little evidence of their efficacy. This study assessed the effects of massage and aromatherapy massage on cancer patients in a palliative care setting. We studied 103 patients, who were randomly allocated to receive massage using a carrier oil (massage) or massage using a carrier oil plus the Roman chamomile essential oil (aromatherapy massage). Outcome measurements included the Rotterdam Symptom Checklist (RSCL), the State-Trait Anxiety Inventory (STAI) and a semi-structured questionnaire, administered 2 weeks postmassage, to explore patients' perceptions of massage. There was a statistically significant reduction in anxiety after each massage on the STAI (P < 0.001), and improved scores on the RSCL: psychological (P < 0.001), quality of life (P < 0.01), severe physical (P < 0.05), and severe psychological (P < 0.05) subscales for the combined aromatherapy and massage group. The aromatherapy group's scores improved on all RSCL subscales at the 1% level of significance or better, except for severely restricted activities. The massage group's scores improved on four RSCL subscales but these improvements did not reach statistical significance. Massage with or without essential oils appears to reduce levels of anxiety. The addition of an essential oil seems to enhance the effect of massage and to improve physical and psychological symptoms, as well as overall quality of life.
Adult↗
Improvements in daily functioning after deep brain stimulation of the thalamus for intractable tremor.
Deep brain stimulation (DBS) of the thalamus reduces tremor in patients with essential tremor (ET). However, few studies have determined the degree of improvement in daily functioning associated with DBS. We developed a self-report Tremor Activities of Daily Living Scale (TADLS) to compare daily functioning with the stimulator turned on and off. Patients rated their performance on the 30 items of the TADLS with the stimulator turned off and then on. They also performed 10 activities under the supervision of a clinician who rated their functional ability with stimulation off and then on. There was a 58% improvement in self-rated TADLS scores in patients with DBS with the stimulator on compared with stimulation off. When activities were rated by the clinician, the average improvement in functioning with the stimulator on was 54%. There were reasonably high correlations between patient and clinician ratings of functioning. ET patients have a marked improvement in daily functioning with thalamic DBS.
Activities of Daily Living↗
The use of multidisciplinary consensus groups in the planning phase of an integrated problem-based curriculum.
In response to the General Medical Council's initiative to reform UK medical undergraduate education only a minority of medical schools have developed entirely novel curricula. Although the experiences gained by these schools in curriculum design and planning have not been recorded in the literature they are likely to be of interest to other medical schools still contemplating course revision. The medical school at the University of Liverpool recently launched an integrated problem-based course differing radically from its predecessor. The General Medical Council considered integration of contributing disciplines one of the most important aims of reform, yet courses that integrate independent component disciplines may be perceived by staff as threatening due to the loss of structure and disciplinary autonomy. Strategies for early course development must take account of these concerns as well as dealing with the identification of course content. A multidisciplinary consensus group process, designed to combat some of these problems, was employed to identify the learning objectives and core content for the new course. The purpose of this paper is to describe, first, the processes employed to identify the core palliative care component for a new PBL curriculum and secondly, how these objectives were integrated horizontally and vertically throughout all course elements.
Curriculum↗
Evidence that trypanothione reductase is an essential enzyme in Leishmania by targeted replacement of the tryA gene locus.
Trypanothione reductase (TR), a flavoprotein oxidoreductase central to the unique thiol-redox system that operates in trypanosomatid protozoa, has been proposed as a potential target for the chemotherapy of trypanosomatid infections. In this study, targeted gene replacement was used to obtain evidence that TR is an essential cellular component and that its physiological function is crucial for parasite survival. Precise replacement of the Leishmania donovani tryA gene encoding TR was only possible upon simultaneous expression of the tryA coding region from an episome; in its absence, attempted removal of the last tryA allele invariably led to the generation of an extra copy of tryA, seemingly as a result of selective chromosomal polysomy. Partial replacement mutants were drastically affected in their ability to survive inside cytokine-activated macrophages in a murine model of Leishmania infection. As no compensatory mechanism for the partial loss of TR activity was observed in these mutants and as it was not possible to obtain viable Leishmania devoid of TR catalytic activity, specific inhibitors of this enzyme are likely to be useful anti-leishmanial agents for chemotherapeutic use.
Animals↗
Pallidotomy lesion locations: significance of microelectrode refinement.
OBJECTIVE: To determine whether stereotactic pallidotomy requires refinement using microelectrode recording to ensure proper lesion placement. METHODS: The experiment approach was based on retrospective comparisons of microelectrode-refined radiofrequency lesion locations with hypothetical unrefined lesion positions. Actual and hypothetical pallidotomy lesions were classified based on their lesion center (thermocoagulative zone) locations and their total lesion areas (surrounding edematous zone) relative to the pallidal target. Assessments were made using postoperative T2-weighted magnetic resonance axial images, which showed both the lesion and globus pallidus (GP). The magnitude of microelectrode refinement from an initial preoperative starting point determined by computed tomography was calculated using stereotactic coordinates and included corrections for the lesioning tract trajectory angle. RESULTS: In all 25 patients, the center of the actual pallidotomy lesion was within the GP. Without microelectrode refinement, 13 of 25 hypothetical lesion positions would have been localized such that the lesion center would not have remained in the GP. In eight cases, microelectrode refinement resulted in no significant change in lesion location, but in one case, microelectrode refinement resulted in lesion center placement away from the GP. CONCLUSION: Kinesthetically driven microelectrode refinement in pallidotomy lesioning seems to be required to ensure proper lesion location within the GP.
Adult↗
Effects of xylem pH on transpiration from wild-type and flacca tomato leaves. A vital role for abscisic acid in preventing excessive water loss even from well-watered plants
The pH of xylem sap from tomato (Lycopersicon esculentum) plants increased from pH 5.0 to 8.0 as the soil dried. Detached wild-type but not flacca leaves exhibited reduced transpiration rates when the artificial xylem sap (AS) pH was increased. When a well-watered concentration of abscisic acid (0.03 &mgr;m) was provided in the AS, the wild-type transpirational response to pH was restored to flacca leaves. Transpiration from flacca but not from wild-type leaves actually increased in some cases when the pH of the AS was increased from 6.75 to 7.75, demonstrating an absolute requirement for abscisic acid in preventing stomatal opening and excessive water loss from plants growing in many different environments.
Journal Article↗
pH-regulated leaf cell expansion in droughted plants is abscisic acid dependent
Elongation rates of barley (Hordeum vulgare L. cv Hanna) leaves decreased with decreasing soil water content, whereas the pH of xylem sap increased from 5.9 to 6.9 over 6 d as the soil dried. The reduction in leaf-elongation rate (LER) was correlated with the increase in sap pH. Artificial sap buffered to different pH values was fed via the subcrown internode to derooted seedlings. Although leaves elongated at in planta rates when fed artificial sap at a well-watered pH of 6.0, LER declined with increasing sap pH. This effect persisted in the light and in the dark. pH had no effect on the relative water content or the bulk abscisic acid (ABA) concentration of the growing zone of these leaves. LERs of the ABA-deficient mutant Az34 were uniformly high over the pH range tested, whereas those of its isogenic wild-type cultivar Steptoe were reduced as the artificial sap pH was increased from 6.0 to 7.0. However, supplying a well-watered concentration of ABA (3 x 10(-8) M) in the artificial xylem sap restored the pH response of the Az34 mutant. The results suggest that increased xylem sap pH acts as a drought signal to reduce LER via an ABA-dependent mechanism.
Journal Article↗
Controlled trial of antituberculous chemotherapy in Crohn's disease: a five year follow up study.
BACKGROUND: It has been suggested that Mycobacterium paratuberculosis is the cause of Crohn's disease. In a previous report the immediate effect of two years treatment with antituberculous chemotherapy showed no clinical benefit. AIMS: To assess both the immediate and longer term effect of treatment on the disease. METHODS: Patients were followed for five years from their date of entry to the study. One hundred and thirty patients entered the initial study, and of these 111 (81%) were followed regularly. RESULTS: Overall, there was no evidence of consistent benefit or disadvantage from antituberculous chemotherapy in any of the assessments made, including the number of acute relapses, surgical episodes, hospital admissions, disease activity, blood tests, or medication required for Crohn's disease during the follow up period. CONCLUSION: The absence of any benefit at the end of the initial two year trial period, and during the three year subsequent follow up, fails to support the hypothesis that mycobacteria play an important part in the pathogenesis of Crohn's disease, or that antituberculous chemotherapy may be of benefit.
Antitubercular Agents↗
Comparison of actual pallidotomy lesion location with expected stereotactic location.
Accuracy of pallidotomy lesion placement was assessed by comparing actual lesion locations with expected pallidotomy lesion locations based on stereotaxy. Actual and expected lesions were compared in anteroposterior, dorsoventral and lateral axes. In 22 pallidotomies, actual lesion locations were determined using axial MR images. Expected lesion locations were calculated using a starting point derived from preoperative computerized tomography, displacements from the starting point based on microelectrode-driven electrophysiological refinement, and the trajectory angle of the lesioning tract relative to the anterior-posterior commissural plane. On average, actual lesion locations were found 2.91 +/- 2.23 mm posterior, 3.22 +/- 2.49 mm ventral, and 0.05 +/- 1.80 mm lateral compared to the expected lesion location. Discrepancies between the actual lesion and expected lesion locations may be mostly accounted for by posterior and ventral lesion spread from the exposed electrode tip, in-plane and volume averaging effects associated with MR images, and possible brain shifting during surgery. However, despite the remaining small differences between actual and expected lesion location, good clinical outcome of reduced dyskinesias and 'off' time along with UPDRS-based improvement in mentation, motor and activity of daily living measures was observed.
Aged↗
Comparative magnetic resonance image-based evaluation of thalamotomy and pallidotomy lesion volumes.
Acute thalamotomy and pallidotomy lesion volumes based on magnetic resonance (MR) images were measured in 22 patients (11 thalamotomy and 11 pallidotomy patients). Thalamotomy inner lesion volumes (0.06 +/- 0.04 ml; thermocoagulative zone) were smaller than pallidotomy inner lesion volumes (0.14 +/- 0.08 ml) as determined using T(1)-weighted 3D-MPRAGE (1.5-mm slice spacing). Similar results were found using T(1)-weighted (6-mm slice spacing) image sets (0.09 +/- 0.05 ml, thalamotomy; 0.13 +/- 0.05 ml, pallidotomy). No differences were found when comparing thalamic or pallidal inner lesion volumes when the comparison was based on T(2) weighted images. Thalamotomy total lesion volumes (thermocoagulative and surrounding edematous zones) were less than pallidotomy total lesion volumes independent of the MR protocol. The difference in thalamotomy and pallidotomy lesion volumes is most likely based on the distance between each discrete lesion placed along the lesioning tracts. In 7 of 11 thalamotomies, this distance was 1 mm with the remaining having 2 mm between each discrete lesion. All pallidotomy discrete lesions were 2 mm apart. More overlap between discrete lesioning sites for thalamotomies is likely to produce reduced lesion volumes.
Adult↗
Lesion volume and clinical outcome in stereotactic pallidotomy and thalamotomy.
Postoperative lesion volume and clinical outcome were assessed in 19 Parkinson's disease (PD) patients who received posteroventral pallidotomy, and in 14 essential tremor (ET) patients who received ventrolateral thalamotomy. Before and after surgery, PD patients were evaluated using the Unified PD Rating Scale (UPDRS), and ET patients were evaluated using the Fahn-Tolosa-Marin (FTM) tremor rating scale. Inner and total lesion volumes were determined with postoperative MR imaging and three-dimensional data segmentation. Lesion volumes were compared to percent improvement in UPDRS and FTM scores, using Spearman's rank-order correlation test. No rank-order correlations were found between lesion volume and clinical improvement in either the PD or the ET patients. In performing stereotactic surgery for movement disorders, any lesion volume within a prescribed range may be equally effective in relieving symptoms associated with PD or ET.
Aged↗
Nurse-patient communication in palliative care: an evaluation of a communication skills programme.
Good communication between nurses and patients is a central aspect of palliative care. However, evaluation of courses designed to improve nurses' communication skills has been inconclusive. Most courses have concentrated on skills training, although communication training programmes which have been integrated into clinical practice over time and have also focused on attitudes and used a range of teaching methods, have been shown to be effective. A study was set up to evaluate whether a communication skills course which would focus on knowledge, attitudes and skills would improve nurses' communication skills. One-hundred-and-ten nurses completed a 26 h training programme over six months and completed precourse and postcourse audiotape recordings of a patient assessment. An overall statistically significant improvement in assessment skills between pretest and post-test mean total scores (P < 0.001) was found, with statistically significant improvements in six of the nine key areas assessed. The nurses reported that although some elements of the programme, such as role play, had been stressful they felt more confident in handling difficult situations. The longer integrated communication skills programme which allows nurses to explore attitudes, raise self-awareness and develop knowledge and skills appears to be effective.
Adult↗
Surgical treatment options in Parkinson's disease.
Surgical treatment of Parkinson's disease has become an important mode of therapy for advanced disease. Both ablative lesions and, more recently, deep brain stimulation have been employed. Various brain areas, including the thalamus, globus pallidus, and subthalamus, have been target sites.
Decision Making↗
Texture analysis of cerebral white matter in SIV-infected macaque monkeys.
Image texture analysis is used in a wide variety of applications in medical research. Neurovirulent simian immunodeficiency virus (SIV) infection in monkeys is considered a good model for HIV-1 infection in humans and causes neuropathological changes in white matter which can include diffuse myelin pallor, subtle white matter astrocytosis, perivascular macrophage infiltrates, and microglial nodules with multinucleated giant cells. The ability of image texture analysis to quantify these changes was evaluated. Sections of thionin-stained brain tissue from eight male rhesus macaques ranging in age from 42-59 months were used. Four animals served as controls and four animals were infected with neurovirulent SIVmac239/17E-R71 by bone marrow inoculation. Images of cerebral white matter were captured and analyzed by calculating 13 textural features based on statistical analysis of spatial co-occurrence matrices. Statistical analysis of the results included multiple comparisons using the Newman-Keuls multiple range test. The effect of variation in background illumination used at image acquisition was also evaluated. Ten of the 13 textural features used in this study successfully discriminated between tissue from control and SIV-infected animals and were consistent with independent neuropathological assessment. Three textural features were highly sensitive to variation in background illumination and found not useful in this application.
Acquired Immunodeficiency Syndrome↗
Magnetic resonance image evaluation of pallidotomy lesions: a volumetric and shape analysis.
Determination of acute pallidotomy-produced lesion volumes, pre- and postpallidotomy globus pallidus (GP) volumes, and assessment of lesion shape using magnetic resonance (MR) imaging-based computerized segmentation (contouring) and three-dimensional rendering was made in 19 patients. Magnetic resonance image slice thickness (1.5 mm or 6 mm) was not found to be a significant factor influencing contour-based pallidotomy lesion volume estimates. Previously reported lesion volumes produced by pallidotomy have often been estimated using the ellipsoid volume formula. Using 1.5-mm-thick MR sections, contour-based pallidotomy-produced lesion volumes were significantly different from those volumes estimated by the ellipsoid formula. Globus pallidus volumes, estimated by contouring T2-weighted MR images, were bilaterally similar (2.4 +/- 0.37 ml [right]; 2.2 +/- 0.45 ml [left]). Postoperative GP volumes were found on the contralateral, unlesioned side to be 2 +/- 0.45 ml and on the lesioned side to be 1.25 +/- 0.45 ml. Using the contralateral, unlesioned side as a reference volume, approximately 39 +/- 14% of the GP was visibly affected on the lesioned side. Seventeen of 18 patients had a favorable outcome with reduced dyskinesias and "off" time with improvement in parkinsonian symptoms. Analysis of computerized three-dimensional rendering of pallidotomy-produced lesions based on MR images showed no relationship between lesioning technique and resulting lesion shape. Important factors in the volumetric analysis of pallidotomy lesions are identified and allow reasonable assessment of the pallidotomy lesion volume and shape and the extent of the affected GP.
Journal Article↗