Search PubMed⌕ Search

Biomedical subjects

T Clarke

Publications and source records attributed to T Clarke.

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

A study of the references used in Cochrane protocols and reviews. Three bibles, three dictionaries, and nearly 25,000 other things.

OBJECTIVES: To describe the types of report that are cited by protocols and reviews included in the Cochrane Database of Systematic Reviews. METHODS: The citation for each reference included in the Cochrane protocols and reviews published in the Cochrane Database of Systematic Reviews in issue 1, 1999 of The Cochrane Library were categorized by reference type (e.g., journal article, conference proceeding, book chapter, personal communication, Cochrane review). RESULTS: Of a total of 24,913 citations, 21,694 (87.1%) were references to journal articles. There was a significant difference between the proportion of references to studies that were journal articles (12,348 of 13,472; 91.7%) and the proportion of other references in this category (9,346 of 11,441; 81.7%). CONCLUSION: The great majority of studies included in Cochrane reviews at the beginning of 1999 had been published as journal articles.

Clinical Protocols↗
PubMed2000

Healing at skin graft donor sites dressed with chitosan.

Chitosan is a derivative of chitin, extracted from the exoskeleton of lobsters, crabs and shrimps. As a semi-permeable biological dressing, it maintains a sterile wound exudate beneath a dry scab, preventing dehydration and contamination of the wound to optimise conditions for healing. In this study, evaluation of healing at split skin graft donor sites, dressed half with chitosan and half with a conventional dressing, showed that chitosan facilitated rapid wound re-epithelialisation and the regeneration of nerves within a vascular dermis. In addition, digital colour separation analysis of donor site scars demonstrated an earlier return to normal skin colour at chitosan-treated areas.

Adolescent↗
PubMed2000

A review of intensive care nurse staffing practices overseas: what lessons for Australia?

In view of market-driven health-care policies and the move to greater efficiencies within the health-care system, the cost of nursing care is being increasingly scrutinised. Different overseas practices are commonly cited as justification for changing practices within Australia. This study is based on a review of the literature on intensive care nurse staffing requirements in Australasia; specifically, New South Wales, the United States (US) and, to a lesser extent, Europe. It was found that looking to the US for cost-cutting strategies in intensive care units (ICUs) is based on a false premise: that we are comparing like with like. ICUs in the US have a different historical trajectory and culture, service wider constituencies, have technicians and unregistered personnel providing nursing care and do not provide demonstrably better outcomes or significant cost savings. Research indicates that continuous nursing care by trained professionals provides the best outcomes. If costs must be cut, technology, pharmaceuticals and laboratory tests should be targeted. Further, a greater commitment to the development of a 'progressive patient care' model in hospital planning is required, in order to establish or consolidate an intermediate level of nursing care between the ward and the ICU. Programs aiming to improve and continuously monitor patient care, such as adverse event monitoring, the prevention of unplanned extubation and facilitation of early extubation, should be instituted, as these have been shown to not only reduce ICU costs but also improve patient outcomes. (c) 2000 Harcourt Publishers Ltd.

Journal Article↗
PubMed2000

Cerebral oxygenation at high altitude and the response to carbon dioxide, hyperventilation and oxygen. The Birmingham Medical Research Expeditionary Society.

Cerebral oxygenation is likely to be of critical importance in determining function at high altitude. The present study has used the technique of near-IR spectroscopy to monitor changes in cerebral regional oxygenation in response to inhaled carbon dioxide, hyperventilation and supplementary oxygen on ascent to 4680 m over 3 days. At sea level, inhaled CO(2) resulted in a significant rise in cerebral regional oxygenation [from mean 69.6% (S.D. 2.4% to 71. 1+/-2.3%; means+/-S.D.; P<0.001). At 4680 m, CO(2) increased regional cerebral oxygenation (63.8+/-2.5% to 65.9+/-2.2%; P<0.001) and also increased peripheral oxygen saturation (75.1+/-6.1% to 83. 6+/-4.0%; P<0.001). Voluntary hyperventilation resulted in improved peripheral oxygen saturation at 2770 m, 3650 m and 4680 m, whereas cerebral regional oxygenation was reduced at sea level and at 2770 m, unchanged at 3650 m and increased at 4680 m. Supplementary oxygen (6 1itres/min) at 4680 m resulted in greater improvements in peripheral oxygen saturation (76.7+/-7.9% to 98.1+/-1.5%; P<0.001) and cerebral regional oxygenation (64.6+/-3.3% to 70.6+/-2.9%; P<0. 001) than were found with CO(2) or hyperventilation. We conclude that attempts to increase CO(2) inhalation or ventilation at high altitude are likely to be beneficial for cerebral oxygenation in the short term.

Adult↗
PubMed1999

A review of intensive care nurse staffing practices overseas: what lessons for Australia?

In view of market-driven health-care policies and the move to greater efficiencies within the health-care system, the cost of nursing care is being increasingly scrutinised. Different overseas practices are commonly cited as justification for changing practices within Australia. This study is based on a review of the literature on intensive care nurse staffing requirements in Australasia; specifically, New South Wales, the United States (US) and, to a lesser extent, Europe. It was found that looking to the US for cost-cutting strategies in intensive care units (ICUs) is based on a false premise: that we are comparing like with like. ICUs in the US have a different historical trajectory and culture, service wider constituencies, have technicians and unregistered personnel providing nursing care and do not provide demonstrably better outcomes or significant cost savings. Research indicates that continuous nursing care by trained professionals provides the best outcomes. If costs must be cut, technology, pharmaceuticals and laboratory tests should be targeted. Further, a greater commitment to the development of a 'progressive patient care' model in hospital planning is required, in order to establish or consolidate an intermediate level of nursing care between the ward and the ICU. Programs aiming to improve and continuously monitor patient care, such as adverse event monitoring, the prevention of unplanned extubation and facilitation of early extubation, should be instituted, as these have been shown to not only reduce ICU costs but also improve patient outcomes.

Cost Control↗
PubMed1998

A comparison of two methods of securing an endotracheal tube.

While a variety of methods exist for securing an endotracheal tube (ETT), there has been little research on their safety and efficacy. This study aimed to test the equivalence of two methods in three critical care settings by randomly assigning patients to receive either the knot, which requires scissors or blade to remove the ETT tape, or the bow, which can be removed manually. These methods were evaluated by comparing ETT movement, malposition, dislodgement, inadvertent extubation, reduced skin integrity, the cutting of the pilot tube and nurse satisfaction. The 5-month study was conducted in three critical care settings in a large tertiary hospital. Of the 230 patients enrolled, 222 completed the trial. Results, based on a randomised, active control equivalence design, demonstrated the two methods to be equally effective with regard to ETT movement > 2 cm (knot = 21 per cent, bow = 19 per cent; 95 per cent confidence interval for the [2 per cent] difference-8 to 12.5 per cent). The incidence of ETT-related complications was similar for both methods. No pilot tubes were cut using either method. Nurses found that patient mouth care was easier and patient comfort and skin integrity enhanced with the bow method. On the other hand, nurses perceived the knot-tying method to be more secure and easier to apply. Given the equivalence of the two methods, the bow would seem preferable for reasons of safety and comfort.

Adult↗
PubMed1998

Perinatal factors influencing survival in extremely low-birthweight infants.

The majority of deaths in normally formed infants occur in extremely low birth weight infants (< 1000 g). Survival rates for these infants have improved greatly but still vary from centre to centre and accurate local outcome figures are important for counselling parents and upholding standards of care. In the Rotunda Hospital, Dublin, over the 6 year period from 1 January 1990 to 31 December 1995, there were 34 474 deliveries over 500 g birthweight. One hundred and twenty-six of these were normally formed infants between 500 g and 999 g. Our objective was to analyse the factors influencing survival in these extremely low birthweight (ELBW) infants. Overall survival in the group was 63%. The most significant factors influencing survival to 28 days were gestation and birthweight. Survival increased from 33% at 24 weeks to 100% at 28 weeks' gestation and from 29% at 500-599 g to 87% at 900-999 g birthweight. Having controlled for gestational age, none of the following variables had a significant effect on survival: year of birth; gender; multiple pregnancy; 1-minute Apgar score; maternal age; parity; use of antenatal steroids; a history of antepartum haemorrhage, pre-eclamptic toxaemia or prolonged rupture of membranes. A 5-min Apgar score > 5 increased the chance of survival by 3.97 (95% CI: 1.46- 10). Both mode of delivery and incidence of chorioamnionitis had an influence on survival which varied according to the gestational age. A larger cohort of survivors would illustrate the effect of these variables more clearly.

Journal Article↗
PubMed1998

Near-infrared spectroscopy in the assessment of cerebral oxygenation at high altitude.

Hypoxia plays a key role in the pathogenesis of acute mountain sickness (AMS), but individual susceptibility is variable and cerebral symptoms do not always correlate with PaO2 measurements. Cerebral hypoxia may be more relevant than PaO2. We studied trends in cerebral regional oxygen saturation by the technique of near-infrared spectroscopy in 20 subjects ascending rapidly to 4680 m. Subjects were enrolled in a placebo-controlled, double-blind trial of medroxyprogesterone for the prevention of AMS. The fall in cerebral oxygen saturation was less than in the periphery. At 4680 m, cerebral oxygenation correlated with peripheral saturation but not with PaCO2 or with cerebral symptoms scores. At 4680 m, subjects on medroxyprogesterone had higher cerebral and peripheral saturation compared with those on a placebo. We conclude that cerebral oxygenation monitored with the Critikon 2020 system provided important information on the complex relationship of hypoxia to AMS and that other factors, such as changes in blood flow or capillary permeability, may be equally important.

Adult↗
PubMed1997

Characterization of Nuclear Polyhedrosis Viruses from Three Subspecies of Lambdina fiscellaria

The eastern hemlock looper (EHL), Lambdina fiscellaria fiscellaria, the western hemlock looper (WHL), L. fiscellaria lugubrosa, and the western oak looper (WOL), L. fiscellaria somniaria, are closely related insects that are pests in Canadian forests. We have used restriction endonuclease (REN) and Southern blot analyses to characterize DNA of nuclear polyhedrosis viruses (NPVs) isolated from each of the three subspecies of L. fiscellaria. REN analysis of EHL-NPV, WHL-NPV, and WOL-NPV DNAs revealed that they have nonidentical REN-banding patterns. NPV DNA extracted from WOL larvae collected from Douglas fir trees had a different REN pattern than NPV DNA extracted from WOL larvae collected from Garry oak trees. Hybridization of radiolabeled EHL-NPV genomic DNA revealed that the EHL- and WHL-NPVs share considerable DNA sequence similarity, as radiolabeled EHL-NPV DNA hybridized strongly with all WHL-NPV DNA bands. The EHL-NPV polyhedrin gene hybridized strongly with WHL-NPV DNA, but the hybridization patterns of the two NPVs were different. Very weak hybridization was detected between the EHL-NPV polyhedrin gene and DNAs of the two WOL-NPVs. Nucleotide sequence analysis revealed that the polyhedrin genes of EHL-NPV and WHL-NPV differ in sequence by only eight nucleotide substitutions (five third position and three second position changes, resulting in four amino acid substitutions). Phlyogeneitc analysis using the polyhedrin genes of EHL-NPV and WHL-NPV indicate that these two viruses cluster with the Group II NPVs as described by Zanotto, Kessing, and Maruniak (1993, J. Invertebr. Pathol. 62, 147).

Journal Article↗
PubMed1997

Evaluation of low cost in-line milk samplers for estimating individual cow somatic cell counts.

The Dairy Herd Improvement Fund of Victoria recently identified a requirement for a simple and inexpensive in-line sampler to enable dairy farmers to collect representative milk samples for counting somatic cells. We found that the currently available simple in-line milk samplers, when connected to standard 35 ml collection vessels, terminate sampling early in a milking, and thus provide samples that are unrepresentative of the whole milking. We showed that cell count during a milking varies greatly, tending to be high for the first 1-21. Analyses of resulting samples will thus tend to overestimate cell counts if samplers are used in their traditional way. We found greater sampling rates in high-line compared with low-line milking systems, and consequently developed modified samplers suitable for both situations. Our samplers utilize low sampling rates (approximately 1-3%) and large collection vessels (450 ml). Compared with currently available simple in-line samplers, our type of sampler provided milk samples considerably more representative of the entire milking for the majority of cows. In conjunction with subsampling, they provided samples of appropriate size (12.5 ml minimum to 25 ml maximum) for testing fat, protein, lactose and cell count. Cell count results indicated that errors associated with the use of currently available simple in-line samplers could frequently be > 200%. In contrast, we found that use of our samplers gave an estimate for cell count that was only slightly higher (mean 20%) than that from samples collected by an approved Tru-Test sampler.

Animals↗
PubMed1996

The myosin filament XV assembly: contributions of 195 residue segments of the myosin rod and the eight C-terminal residues.

A mixture of two peptides of approximately M(r) 13000 has been isolated from a papain digest of LC2 deficient myosin. The peptides assemble into highly ordered aggregates which in one view are made up of strands of pairs of dots with an average side to side spacing of 13.0 nm and an average axial repeat of 9.0 nm. In another view there are strands of single dots with a side-to-side spacing of 7.8 nm and an axial repeat of 9.1 nm. From N-terminal peptide sequencing, the two peptides have been shown to come from regions of the myosin rod displaced by 195 residues. We have shown that either peptide alone can assemble to form the same aggregates. The 195 residue displacement of the M(r) 13000 peptides corresponds closely to the 196 residue repeat of charges along the myosin rod. This finding permits us to designate 195 residue segments of the myosin rod and to relate assembly characteristics directly to the similar 195 residue segments and 196 residue charge repeat. The most C-terminal 195 residue segment carries information for assembly into helical strands. The contiguous 195 residue segment, in major part, carries information for the unipolar assembly, characteristic of the assembly in each half of the myosin filament. The next contiguous 195 residue segment, in major part, carries information for bipolar assembly which is characteristic of the bare zone region of the filament; and for the transition from the bipolar bare zone to unipolar assembly. The effect of the eight C-terminal residues of the myosin rod on the assembly of the contiguous 195 residues has also been studied. The entire fragment of 195 + eight C-terminal residues assembled to form helical strands with an axial repeat of 30 nm. Successive deletion of charged residues changed the axial repeat of the helical strands suggesting that the charged residues at the C-terminus are involved in determining the pitch in the helical assembly of the contiguous 195 residues.

Amino Acid Sequence↗
PubMed1996

Comparison of the effects of sertraline and its metabolite desmethylsertraline on blockade of central 5-HT reuptake in vivo.

N-demethylation of the selective serotonin reuptake inhibitor sertraline to desmethylsertraline yields a compound with 10- to 20-fold less potency at blocking serotonin (5-HT) reuptake as measured in vitro. In the present study desmethylsertraline (DMS) was examined in two in vivo models of reuptake inhibition--elevation of extracellular 5-HT in the corpus striatum as measured by microdialysis and inhibition of firing of serotonin-containing dorsal raphe neurons. Whereas sertraline (1, 3.2, and 10 mg/kg s.c.) produced a dose-dependent increase in extracellular 5-HT and a decrease in 5-HIAA in rat striatum, desmethylsertraline was without effect on either parameter. In similar fashion, desmethylsertraline had no effect on dorsal raphe cell firing at a dose (1,000 micrograms/kg i.v.) nearly 20-fold the ED50 for sertraline (52 micrograms/kg). Taken together, these data suggest that DMS does not contribute to the blockade of central 5-HT reuptake produced by sertraline in vivo and therefore would be expected to play a negligible role in its clinical activity.

1-Naphthylamine↗
PubMed1996

A quality review of high-dependency patient care.

In order to develop strategies to improve high-dependency (HD) patient care, a continuous quality improvement (CQI) study was initiated in August 1994. It sought to establish a system for the collection and evaluation of relevant information concerning medical and nursing management of HD patients. This CQI study followed a high-dependency areas needs analysis undertaken in January, 1994. Conducted over a 12-week period (August-October, 1994) the CQI study involved 92 HD patients who required cardiac and/or respiratory monitoring. The study revealed a low HD bed occupancy rate, inadequate documentation by medical staff of the need for monitoring, and insufficient numbers of nursing personnel specifically educated to care for HD patients. Recommendations include increased consultants surveillance, immediate assessment of HD patients by a medical officer on the ward, a documented plan for monitoring, avoidance of after-hours discharge from operating theatres or intensive care, and the implementation of an education program for HD area nurses.

Activities of Daily Living↗
PubMed1996

The impact of a high dependency unit continuing education program on nursing practice and patient outcomes.

Most evaluation studies of continuing education (CE) programs have concentrated on the assessment of learner knowledge and satisfaction and/or learner perceptions of change in professional competence and patient care, rather than on actual changes in nursing practice and patient outcomes. This study aimed to measure and compare frequency of nursing interventions and patient outcomes before and after a high-dependency (HD) CE program. A retrospective review of all HD patient records (n = 92) over the same 2-month periods in 1994 (n = 39) and 1995 (n = 53) was undertaken. Outcome variables were measured by assessing the incidence of cardiorespiratory complications, HD patient admission rates to critical care areas and process measures of nursing interventions with predetermined practice patterns. The before and after groups of patients were similar in age (mean 69 years), severity of illness (mean APACHE II = .12) and HD length of stay (mean 2.6 days). While the average number of critical events per patient was similar in both groups (before 2.03; after 1.96), complications resulting from critical events were 8 per cent fewer in the after group. The implementation and documentation of appropriate nursing interventions improved by 30 per cent following the introduction of the CE program (chi 2 = 25.53, df = 1, p < 0.001, 95 per cent CI 0.1804 to 0.4196, point estimate 0.3). The study revealed that there was a strong association between implementing the HD CE program and improved nursing practice. This may be related to the observed improvement in patient outcomes.

Activities of Daily Living↗
PubMed1996

Combined administration of a 5-hydroxytryptamine (5-HT)1D antagonist and a 5-HT reuptake inhibitor synergistically increases 5-HT release in guinea pig hypothalamus in vivo.

In vivo microdialysis in guinea pig hypothalamus was used to study the effect of serotonin [5-hydroxytryptamine (5-HT)] subtype 1D autoreceptor blockade on the increase in extracellular 5-HT levels produced by a selective 5-HT reuptake inhibitor (SSRI). Administration of the selective 5-HT1D antagonist GR127935 at 0.3 mg/kg had no effect, but 5 mg/kg significantly increased extracellular levels of 5-HT and 5-hydroxyindoleacetic acid to 135% of basal values. Moreover, at these doses GR127935 significantly attenuated the decrease in extracellular 5-HT levels following local perfusion with the selective 5-HT1D agonist CP-135,807. The SSRI sertraline at 2 mg/kg increased 5-HT levels to 130% of basal levels. The combination of this low dose of sertraline with either dose of GR127935 resulted in a pronounced, long-lasting increases in 5-HT levels to 230% of basal values. These results indicate that the effects of an SSRI on terminal 5-HT are significantly enhanced by coadministration of a 5-HT1D antagonist and confirm that in addition to somatodendritic 5-HT1A autoreceptors, terminal 5-HT1D autoreceptors mitigate the effect of SSRIs on terminal 5-HT. As such, antagonists of the 5-HT1D autoreceptor could be useful as rapidly acting antidepressants and may shorten the onset of antidepressant action when combined with SSRIs.

1-Naphthylamine↗
PubMed1996

Internal fixation in pelvic fractures and primary repairs of associated genitourinary disruptions: a team approach.

Associated urological and orthopedic injuries of the pelvic ring are complex with numerous potential complications. These patients are treated optimally using a team approach. The combined expertise is not only helpful initially when managing these difficult patients, but also later as problems develop. This study describes a treatment protocol and reports the early results of 23 patients with unstable pelvic fractures and associated bladder or urethral disruptions, or both, treated surgically with open reduction and internal fixation of the anterior pelvic ring injuries at the same anesthetic and using the same surgical exposure as the urethral realignments or bladder repairs or both. Early complications occurred in four patients (17%): one patient sustained a fifth lumbar nerve injury caused by the pelvic reduction procedure, and three patients had anterior pelvic internal fixation failures. Late complications occurred in eight patients (35%). There was one deep wound infection (4.3%) that presented 6 weeks after injury. Late urological complications occurred in seven patients (30%). Four of the nine male patients with urethral disruptions had urethral stricture after their primary urethral realignments (44%). Three of the 18 male patients admitted to impotence (16.7%). One of the three had a residual thoracic paraplegia caused by a burst fracture. One of the five female patients had urinary incontinence and required a bladder suspension operation to restore normal function (20%). A low infection rate can be expected despite the use of internal fixation. Early urethral "indirect" realignments avoid more difficult delayed open repairs; however, late urological complication rates are still high. Early "direct" bladder repairs are easily performed at the time of anterior pelvic open reduction and internal fixation. Suprapubic tubes are not necessary to adequately divert the urine when large diameter urethral catheters are used in these patients.

Adolescent↗
PubMed1996

Non-union of the scaphoid. Treatment with cannulated screws compared with treatment with Herbert screws.

We retrospectively reviewed the results for thirty-four patients in whom a non-union of the scaphoid had been treated with bone-grafting and internal fixation with use of one of two types of screws as well as the temporary placement of Kirschner wires parallel to the screw to prevent rotation. The patients were divided into two groups: Group 1 contained sixteen patients who had been managed with a Herbert screw from 1986 through 1989 and Group 2, eighteen patients who had been managed with a 3.5-millimeter cannulated AO/ASIF screw from 1990 through 1992. There were no clinical or radiographic differences between the two groups. The time to union, confirmed with tomography, was 7.6 +/- 3.6 months for Group 1 and 3.6 +/- 1.2 months for Group 2. This difference was significant (p < 0.01). Both screws significantly improved the alignment of the scaphoid and decreased carpal collapse (p < 0.05). Regardless of the type of screw used, the time to union was significantly shorter when the screw had been placed in the central one-third of the scaphoid (p < 0.05). Seventeen of the eighteen cannulated screws had been placed centrally, compared with seven of the sixteen Herbert screws (p < 0.01).

Adolescent↗