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Biomedical subjects

T Jones

Publications and source records attributed to T Jones.

At least 577 records · Page 32Linked to original sources
PubMedDate not supplied

Nurses' knowledge of pain management: implications for staff education.

Among the 217 nurses responding (one third of those queried), average scores on the NKAS were slightly higher (68%) than that reported in the literature but still inadequate. Nurses' greatest knowledge deficits were related to pharmacotherapeutics. Knowledge scores were uncorrelated with self-assessed level of knowledge about pain. Strategies for re-dressing these nurses' knowledge through Department of Nursing Education interventions are explored.

Adult↗
PubMedDate not supplied

Treatment of childhood encopresis--a review.

Children with encopresis may present to a number of different professionals. The literature on different treatment methods is reviewed. The roles of verbal psychotherapy, physical treatment, behaviour therapy and mixed treatment programmes are discussed.

Administration, Rectal↗
PubMedDate not supplied

Laparoscopic environmental changes during surgery enhance the invasive potential of tumours.

OBJECTIVE: The use of laparoscopic techniques in resection of malignant tumours has been proposed to offer potential benefit to the patient in the form of earlier recovery and less immune paresis; however, reported tumour seeding, both peritoneal and at port site, has put this approach into question. The biological effects of the introduction of carbon dioxide or helium to form a pneumoperitoneum on tumour invasion and dissemination are unknown. METHODS: A human colonic adenocarcinoma cell line (SW1222) was exposed to in vitro laparoscopic environment of either carbon dioxide or helium for 4 h, mimicking the duration of a laparoscopic colorectal resection. Alteration in production of matrix metalloproteinase (MMP)-2, MMP-9 and urokinase-type plasminogen activator (uPA) due to exposure to a laparoscopic environment was determined by zymography and correlated to invasive capacity by a standard Matrigel-based invasion assay. Incorporation of specific gelatinase inhibitors or antibodies directed at the uPA receptor was utilized to determine the relative importance of proteases. RESULTS: Exposure to the laparoscopic environment significantly enhanced production of the proteases MMP-2, MMP-9 and uPA. A concomitant enhancement of invasive capacity was also observed, being blocked by specific protease inhibitors. Changes in both protease production and aggression were observable for at least 24 h following the removal of the operative environment, indicating the possible long-term effects of the initial insult. CONCLUSION: Exposure to the laparoscopic environment enhances the invasive capacity of colonic adenocarcinomas via a well-defined protease-determined pathway. It therefore appears likely that tumour cells released into the operative field can be made increasingly aggressive by a laparoscopic operative environment and can thus contribute to disease dissemination.

Adenocarcinoma↗
PubMedDate not supplied

Measurement of regional cerebral blood flow, blood volume and oxygen metabolism in patients with sickle cell disease using positron emission tomography.

Regional cerebral blood flow, blood volume, fractional oxygen extraction and oxygen consumption were measured by positron emission tomography in six patients with sickle cell disease to see how oxygen delivery to the brain is maintained in the presence of both anemia and a low oxygen affinity hemoglobin. Both regional cerebral blood flow and blood volume were found to be markedly increased compared to values obtained from 14 normal subjects in the same age range. The mean fractional oxygen extraction was not significantly different in the two groups. Mean oxygen consumption in the two groups was also not significantly different but low values in individual patients with sickle cell disease and the presence of atrophy on the CT-scans of three of them were suggestive of some neuronal loss in patients without any history of nervous system involvement. In view of the known high values of cerebral blood flow and metabolism in childhood, it is suggested that when compounded by anemia and abnormal red cells, a hypercirculatory state may make patients in this age-group particularly prone to ischemic infarction.

Adult↗
PubMedDate not supplied

No evidence for transhemispheric diaschisis after human cerebral infarction.

Forty-four studies of regional cerebral blood flow (rCBF), fractional oxygen extraction (rOER) and oxygen consumption (rCMRO2) were made on twenty-five patients with recent internal carotid artery territory infarcts. The purpose was to study flow-metabolism relationships in the contralateral hemispheres, and to investigate whether contralateral rCMRO2 was depressed as a result of the recent infarcts. Two groups of controls were included for comparison--seventeen normal volunteers, and ten patients with proven extracranial cerebrovascular disease but without evidence of cerebral infarction. The results demonstrated that: contralateral hemispheric rCMRO2 was less variable than regional oxygen availability (the product of rCBF and arterial oxygen content). This was due, in part, to the effect of individual variations in PaCO2 on rCBF, but other uncontrolled factors, such as intracranial pressure, may have had influences. As a result, rCMRO2 did not correlate with rCBF; mean rCMRO2 in the contralateral hemispheres was 12% lower than normal (a significant difference), but was not different from the value found in patients with extracranial vascular disease in whom there was no evidence of infarction or ischemia; contralateral rCMRO2 did not correlate with the size of the infarct in the opposite hemisphere. It is concluded that rCMRO2 cannot be inferred from rCBF measurements in uncontrolled human studies (as frequently done in the past), and that depression of contralateral rCMRO2 may have preceded infarction in the opposite hemisphere, a consequence of the previous influences of diseases that predispose to stroke.

Adult↗
PubMedDate not supplied

A medical diagnostic index for rehabilitation.

This paper records the developments of a computerized database suitable for recording the history, signs and symptoms of handicapping conditions, monitoring recovery, and measuring the impact of different forms of treatment. The original model described was designed for stroke and the paper describes its integration into the routine use of a stroke and rehabilitation unit in a district general hospital.

Activities of Daily Living↗
PubMedDate not supplied

Preoperative screening: what tests are necessary?

The preoperative evaluation often includes more tests than are necessary. This article reviews the usefulness of and indications for nine commonly ordered preoperative tests.

Diagnostic Tests, Routine↗
PubMedDate not supplied

Refining a tool to measure cues to action in encouraging health-promoting behavior--the CHAQ.

A convenience sample of 99 questionnaire respondents was used to develop an instrument to measure "cues to action" for health-promoting behaviors. The questionnaire contained 32 items producing an alpha coefficient of 0.88. Because of the small sample size and limitations of the convenience sample, the authors recommend that their findings be considered preliminary.

Adult↗
PubMedDate not supplied

A 24 hour day.

Explore the source record for details and available documents.

Humans↗
PubMedDate not supplied

Money down the drain?

Recent City scandals have left NHS trusts largely unscathed but not unaffected. BCCI's demise highlighted two weaknesses in most trust's approaches to treasury management. Tom Jones explains.

Accounting↗
PubMedDate not supplied

Developing MSOs in small markets. The community balance sheet approach.

The creation of management services organizations (MSOs) has been a phenomenon of the 1990s. MSOs allow for partnering of health care providers for multiple purposes, including managed care contracting, practice acquisition and management, and achieving financial and administrative economies of scale. Hospitals and physicians can come together to form successful joint ventures if certain critical elements are present, and if success can be defined by the use of a community balance sheet.

Capital Financing↗
PubMedDate not supplied

Antiretroviral adherence and use of alternative therapies among older HIV-infected adults.

OBJECTIVE: To investigate adherence to antiretroviral therapy and use of alternative therapies among older human immunodeficiency virus (HIV)-infected adults, and to assess relationships between antiretroviral adherence and clinical outcomes. METHODS: One hundred older HIV-infected patients, aged 50 and over, treated at two large HIV clinics in Washington, DC, were enrolled. A cross-sectional methodology used structured interviews to investigate antiretroviral regimens, use of alternative therapies, and demographics. Medical records provided viral load and CD4 count within 3 months of interview. RESULTS: The mean self-reported adherence was 94%, and 55 patients reported 100% adherence to antiretroviral therapy. Correlation analysis showed a significant negative correlation between adherence and viral load (r = -312, p = 0.005). There was no significant difference in adherence based on race, gender, mode of transmission, or education. Twenty-one patients (21%) reported the use of an alternative therapy, with several patients using multiple alternative therapies. There was no significant difference in adherence score (p = 0.514) or viral load (p = 0.860) based upon use of alternative therapies. CONCLUSIONS: Older HIV-infected study patients reported high levels of adherence to antiretroviral regimens, and adherence was highly correlated with HIV viral load. Use of alternative therapies did not significantly impact adherence to antiretroviral agents or viral load. High adherence among this older population may be related to older patients' familiarity with medication usage, their increasing awareness of HIV as a disease that requires optimal adherence, and educational efforts promoted by the two clinics in which they are clients.

Anti-HIV Agents↗