PubMed Health⌕ Search

Biomedical subjects

C Collins

Publications and source records attributed to C Collins.

At least 73 records · Page 4Linked to original sources
PubMed1995

Beyond patient dependency: family characteristics and access of elderly patients to home care services following hospital discharge.

Access to Skilled Nursing and Home Health Aid services among elderly patients (N = 580) and their family caregivers post hospital discharge was examined using logistic regression. A majority of the sample (65%) were referred for Skilled Nursing services while only 28% were referred for Home Health Aid services. Caregiving situations in which the spouse was the primary caregiver were less than half as likely to be referred for either service when compared to non-spouses. As expected, ADL limitations were a significant predictor of referral for both services. Women patients with the same ADL limitation as men were only about a fourth as likely to be referred for Home Health Aid services as men. Findings are discussed in terms of access to care and the need for policy to consider more than patient limitations in the referral criteria.

Activities of Daily Living↗
PubMed1995

Clinical nurse practitioner in a surgical team.

The role of a nurse taking on many of the duties of PRHO in a surgical team is described with the responsibilities, relationships and limitations. A nurse can carry out almost all of the elective activity of a PRHO and significantly relieve the pressure of work on others. She cannot completely substitute for PRHOs out of hours. As more consultants are appointed without additional medical members of the team, it is suggested that two consultant teams might be best served by one PRHO working with one Clinical Nurse Practitioner.

Education, Nursing, Continuing↗
PubMed1995

Amplification of chromosomal region 20q13 in invasive breast cancer: prognostic implications.

Amplification of the chromosome 20q13 region was recently discovered in breast cancer by comparative genomic hybridization and subsequently further defined by fluorescence in situ hybridization with specific probes. The target gene of the amplification remains unknown. Here, fluorescence in situ hybridization with a cosmid probe for the minimal region of amplification (RMC20C001) was used to study 20q13 amplification in 132 primary breast carcinomas and 11 metastases. The size of the amplicon was studied with four flanking probes. Thirty-eight (29%) primary tumors and 3 (27%) metastases showed increased copy number of the RMC20C001 probe (>1.5-fold relative to the p-arm control). Nine (6.8%) of the primary tumors were highly (>3-fold) amplified. Although the size and location of the amplified region varied from one tumor to another, only the RMC20C001 probe was consistently amplified. 20q13 amplification was significantly associated with a high histological grade (P = 0.01), DNA aneuploidy (P = 0.01), and high S-phase fraction (P = 0.0085). High-level amplification was also associated with short disease-free survival of patients with node-negative breast cancer (P = 0.002). We conclude that high-level 20q13 amplification may be an indicator of poor clinical outcome in node-negative breast cancer and that this chromosomal region is likely to contain a gene with an important role in breast cancer progression. A large definitive study is warranted to assess the independent prognostic value of 20q13 amplification.

Adult↗
PubMed1994

Increased copy number at 20q13 in breast cancer: defining the critical region and exclusion of candidate genes.

Studies by comparative genomic hybridization have indicated that a major new locus for DNA amplification in breast cancer is 20q13 and suggested that this genetic event is associated with aggressive clinical behavior. We used interphase fluorescence in situ hybridization with anonymous cosmid probes and gene-specific P1 clones to determine the minimal common region of increased copy number and to study involvement of known genes at 20q13. Based on high-level copy number increases (3 to 10-fold) found with one or more probes in 5 of 14 (35%) breast cancer cell lines and in 3 of 36 (8%) primary tumors, the critical region was narrowed to approximately 1.5 megabases at 20q13.2 defined by fractional length pter values 0.81-0.84. Previously known genes were excluded as candidates, implying that this chromosomal region harbors a novel oncogene that contributes to the malignant progression of breast cancer.

Breast Neoplasms↗
PubMed1994

Infectious disease surveillance during emergency relief to Bhutanese refugees in Nepal.

OBJECTIVE: To implement simplified infectious disease surveillance and epidemic disease control during the relocation of Bhutanese refugees to Nepal. DESIGN: Longitudinal observation study of mortality and morbidity. SETTING: Refugee health units in six refugee camps housing 73,500 Bhutanese refugees in the eastern tropical lowland between Nepal and India. INTERVENTIONS: Infectious disease surveillance and community-based programs to promote vitamin A supplementation, measles vaccination, oral rehydration therapy, and early use of antibiotics to treat acute respiratory infection. MAIN OUTCOME MEASURES: Crude mortality rate, mortality rate for children younger than 5 years, and cause-specific mortality. RESULTS: Crude mortality rates up to 1.15 deaths per 10,000 persons per day were reported during the first 6 months of surveillance. The leading causes of death were measles, diarrhea, and acute respiratory infections. Surveillance data were used to institute changes in public health management including measles vaccination, vitamin A supplementation, and control programs for diarrhea and acute respiratory infections and to ensure rapid responses to cholera, Shigella dysentery, and meningoencephalitis. Within 4 months of establishing disease control interventions, crude mortality rates were reduced by 75% and were below emergency levels. CONCLUSIONS: Simple, sustainable disease surveillance in refugee populations is essential during emergency relief efforts. Data can be used to direct community-based public health interventions to control common infectious diseases and reduce high mortality rates among refugees while placing a minimal burden on health workers.

Adolescent↗
PubMed1994

The N-terminal cyclophilin-homologous domain of a 150-kilodalton tumor recognition molecule exhibits both peptidylprolyl cis-trans-isomerase and chaperone activities.

A cyclophilin-related protein has recently been found to be involved in tumor recognition by natural killer cells. The N-terminal end of this 150-kDa surface molecule (NK-TR) is homologous to cyclophilin/peptidylprolyl cis-trans-isomerase. We have constructed a soluble bacterial fusion protein between the cyclophilin-homologous domain of the NK-TR molecule and glutathione S-transferase (GST) to test for the presence of peptidylprolyl cis-trans-isomerase and chaperone activities and for cyclosporin A binding. The purified NK-cyp-GST fusion protein is shown to accelerate the isomerization of the prolyl peptide bond of the substrate N-succinyl-Ala-Ala-Pro-Phe-p-nitroanilide with a kcat/KM value of 7.4 x 10(5) M-1 s-1. The isomerase activity of the NK-TR cyclophilin homolog has been determined to be relatively insensitive to inhibition by the immunosuppressive drug cyclosporin A, with an IC50 value of 770 nM as compared to 19 nM for human cyclophilin. Furthermore, the NK-cyp-GST fusion protein has been found to participate in the protein folding process as a chaperone by preventing the aggregation of early folding intermediates of carbonic anhydrase. The implications of the finding of both peptidylprolyl cis-trans-isomerase and chaperone activities within the N-terminal domain of a large, cell type-restricted, surface molecule are discussed.

Amino Acid Isomerases↗
PubMed1994

Molecular cytogenetics of human breast cancer.

Our studies of human breast cancer using CGH and FISH with precisely mapped probes have revealed a surprising amount of intratumor and intertumor heterogeneity in human breast cancers. However, some regions of abnormal copy number are found frequently. We believe that the regions of frequent abnormality harbor novel cancer genes, and that identification of these is important for diagnosis, prognostication, and the development of new therapies.

Breast Neoplasms↗
PubMed1994

The market and health sector reform.

A new international orthodoxy has developed on health sector reform. The dominant theme of the orthodoxy is the alleged benefits of market style reforms for health development. This is shaping changes formulated, and being implemented, in the British NHS and other European health services (including Central and Eastern Europe), Latin America and a number of developing health systems in Africa and Asia. Sets out a ten-point description of the orthodoxy. Contends that the orthodoxy is showing distinct signs of restricting the analysis and development of health management and planning. This is a matter for considerable concern as the adoption of market-style reforms can generate unforeseen and, in some cases, negative consequences. There is clearly a need for strengthening management research and development as a basis for effective health sector reform.

Consumer Behavior↗
PubMed1994

Patterns of predeath service use by dementia patients with a family caregiver.

OBJECTIVE: To describe site of death and patterns of predeath service use (hospital, nursing home, and in-home services) among persons with dementia who have a family caregiver. DESIGN: Family caregivers who experienced the death of their relative while participating in a 5-year longitudinal study were surveyed retrospectively about service use patterns in the 90 days before the death of their relative. SETTING: Community. SUBJECTS: Eighty-two family caregivers of a person with dementia who experienced the death of their relative while participating in a longitudinal study (n = 326) were included in this analysis. All participants were providing care to a relative with dementia in the home at entry into the study. MAIN OUTCOME MEASURES: Survey items were used to identify site of death and measure use of the following services in the 90 days before death: hospital, nursing home, skilled nursing services, home health aides, and physician home visits. RESULTS: Sixty-nine percent of the caregivers were spouses, and 28% were adult children. Family caregivers had been providing care for an average of 6 years (SD = 3.9) before the death of their relative. The most frequent setting for patient death was home (42%), followed by nursing home (32%) and hospital (26%). The average number of days spent at home in the 90 days before death by the sample was more than 60 days. Thirty-four percent of the dementia patients were cared for exclusively in the home in the 90 days before death, and 34% spent more than half of the 90 days before death at home. Hospital stays were brief, and less than one-fourth of the sample spent all of the 90 days before death in an institutional setting. Twenty-one percent of the sample used no in-home services in the 90 days before death, 48% of the sample did not use skilled nursing services, and only 27% received a physician home visit. CONCLUSIONS: The results of this study suggest that dementia patients who have a family caregiver receive a significant proportion of their care at home in the 90 days before death. A hospice approach may help address the needs for assistance of families who provide terminal care in the home for a relative with dementia.

Aged↗
PubMed1994

Community service issues before nursing home placement of persons with dementia.

Family caregivers of persons with dementia (N = 98) [corrected] who placed their relative in a nursing home while participating in a longitudinal study were surveyed about their experiences with community services (adult day care, in-home services, and physician home visits). One third (34%) of the sample reported that at least one service issue (affordability, eligibility, access, or service quality) had a strong influence on the nursing home placement, whereas 40% reported that the availability of at least one additional service would have delayed the nursing home placement of their relative. Caregivers who were employed reported higher levels of unmet service needs. The results of this study support the existence of a group of dementia caregivers with a high need for and willingness to use community service interventions in the preinstitutional period.

Aged↗
PubMed1994

Decentralization and primary health care: some negative implications in developing countries.

Decentralization is a highly popular concept, being a key element of Primary Health Care policies. There are, however, certain negative implications of decentralization that must be taken into account. These are analyzed in this article with particular reference to developing countries. The authors criticize the tendency for decentralization to be associated with state limitations, and discuss the dilemma of relating decentralization, which is the enhancement of the different, to equity, which is the promotion of equivalence. Those situations in which decentralization can strengthen political domination are described. The authors conclude by setting out a checklist of warning questions and issues to be taken into account to ensure that decentralization genuinely facilitates the Primary Health Care orientation of health policy.

Developing Countries↗
PubMed1994

International experience and health sector reform: the challenge for developing health systems.

Health sector reform is a priority issue in many countries and there is great scope for an international exchange of experiences. We should not be amiss, however, to the problems and dangers of such international exchange. Focusing on the situation of developing countries, three critical problems are identified: tendencies to the universalism of a market approach, a one-way transmission of ideas, and the lack of policy analysis. In order to contribute to a more constructive process of international exchange, four recommendations are proposed in the areas of training and the approach to management, management research, strengthening health policy analysis, and developing new exchanges between countries.

Communication↗
PubMed1994

The role of the supervisor and training.

The supervision of health personnel has always been important in the health sector. The introduction of decentralization and quality assurance, however, has made it even more relevant. This paper looks at the various roles of the supervisor and indicates key criteria for understanding the possible burden of supervision. An important factor here is the training of supervision, and this is discussed in terms of the content and means of training. Finally, it is suggested that improvements in supervision can be developed through action research.

Administrative Personnel↗
PubMed1993

Measurement and prediction of the short-term response of soft tissue sarcomas to chemotherapy.

BACKGROUND: Preoperative chemotherapy has been advocated for the treatment of soft tissue sarcomas, yet there is little information about how these tumors respond pathologically to therapy or whether tumor response can be predicted from a pretreatment biopsy. METHODS: Biopsy was done of 25 intermediate- or high-grade soft tissue sarcomas before they were treated with three cycles of doxorubicin and cisplatin and resected. The authors compared the pathologic features of the treated tumors with clinical and radiologic evidence of response to identify the pathologic features that best reflected chemotherapeutic effect. They analyzed the pretreatment biopsy specimens by light microscopic study and flow cytometry to identify parameters that predict short-term response to chemotherapy. RESULTS: In the treated tumors, the clearest indicator of early chemotherapeutic effect was the percentage of the resected mass composed of viable neoplasm. Eleven of 25 resection specimens contained less than 15% viable neoplasm (patients with pathologic response); 9 of these had 5% or less. Flow cytometric estimates of the proliferative rate in the initial biopsy specimen predicted early chemotherapeutic effect; 7 of 10 tumors with S-phase fractions (SPF) greater than 6% responded pathologically, whereas only 3 of 12 tumors with lower SPF responded (P = 0.041). Initial tumor grade, cell type, percent tumor necrosis, mitotic rate, cellularity, and ploidy did not predict chemotherapy response. CONCLUSION: These results indicate that soft tissue sarcomas often respond dramatically to chemotherapy, that the amount of residual viable sarcoma is an indicator of short-term effect, and that flow cytometric estimates of cell proliferation predict early response to chemotherapy.

Adolescent↗
PubMed1993

Mapping of the human NMDA receptor subunit (NMDAR1) and the proposed NMDA receptor glutamate-binding subunit (NMDARA1) to chromosomes 9q34.3 and chromosome 8, respectively.

A role for the N-methyl-D-aspartate (NMDA) receptor in the molecular pathology underlying Huntington disease (HD) has been proposed on the basis of neurochemical studies in HD and the ability of the NMDA receptor to mediate neuronal cell death. The molecular cloning of the human NMDA receptor subunit (NMDAR1) and a proposed glutamate-binding subunit of the NMDA receptor (NMDARA1) have provided an opportunity to test the hypothesis that either of these genes might be directly involved in the causation of HD. We have mapped NMDAR1 to 9q34.3 using in situ hybridization studies and NMDARA1 to human chromosome 8 using a somatic cell hybrid panel. Because the gene causing HD has been localized to chromosome 4p16.3, the chromosome assignments reported here are inconsistent with either of these genes playing a causative role in the molecular pathology of HD. However, it is noteworthy that the gene for torsion dystonia has also been localized by genetic studies to 9q34.3, the same regional map location as NMDAR1.

Animals↗
PubMed1993

Isolation of new nonsense and frameshift mutants in the immunoglobulin mu heavy-chain gene of hybridoma cells.

In order to expand the experimental material available for genetic and biochemical analyses of the natural immunoglobulin genes, we have isolated a variety of mutant mouse hybridoma cell lines. Some of these mutants have partial or complete deletions of the mu gene. Other mutants have nonsense or frameshift mutations in the exons encoding the variable and the second and third constant region domains of the mu heavy chain. When combined with earlier mutant data, this collection of genotypically and phenotypically tight mutants of known sequence spans most of the 10 kb of the mu gene, providing material for a variety of studies of genetic recombination and mRNA metabolism.

Amino Acid Sequence↗