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Biomedical subjects

C Delaney

Publications and source records attributed to C Delaney.

At least 37 records · Page 2Linked to original sources
PubMed1995

Scoliosis and lung function in spinal muscular atrophy.

The notes and radiographs of 43 patients with a confirmed diagnosis of spinal muscular atrophy were reviewed. A significant inverse linear relationship between the severity of scoliosis and the percentage of predicted vital capacity and peak flow was found. The patients who stood had a significantly better lung function than patients who were confined to a wheelchair, and their scoliosis deteriorated significantly more slowly. Sixteen patients underwent surgical spinal stabilisation, 4 with Harrington instrumentation and 12 with segmental spinal instrumentation, at an average age of 12 years and 11 months. The average curve correction achieved was 40%. The decline in lung function seen pre-operatively was not only reversed, but a significant improvement was found at final follow-up.

Adolescent↗
PubMed1995

Fosinopril: pharmacokinetics and pharmacodynamics in congestive heart failure.

Fosinoprilat, the active product of fosinopril, is eliminated by a hepatic pathway, in addition to the renal pathway shared by other angiotensin converting enzyme inhibitors. Congestive heart failure (CHF) may elevate drug plasma concentrations caused by a reduction in steady-state volume of distribution (Vss) and/or an impairment of clearance. This study compared the pharmacokinetics and pharmacodynamics of fosinopril (intravenous and oral) in 10 patients with established CHF and 10 age-, sex-, and weight-matched normal control subjects. There were no statistically significant differences between the patients with CHF and the control patients with respect to maximum drug concentration (Cmax) or area under the plasma concentration-time curve from 0 to infinity. Absolute bioavailability was approximately 29%. Vss was similar, and protein binding was 99% in both groups. The oral half-life of fosinoprilat was significantly longer than the intravenous half-life for both the patients with CHF and normal subjects, without statistically significant differences between the study groups. Median time to reach Cmax occurred at 4 hours in each group and corresponded to maximum angiotensin converting enzyme inhibition, which was essentially complete through 12 hours and markedly reduced through 24 hours. Thus these data indicate that patients with CHF can receive fosinopril without undue increases in fosinoprilat concentrations. This probably is due to the dual excretory pathways.

Administration, Oral↗
PubMed1995

The nursing minimum data set, standardized language, and health care quality.

Providers and consumers of health care have been attempting to define quality for the past several decades. The article describes one of nursing's contributions to the multidisciplinary health care quality revolution: its ability to provide a more complete and holistic picture of the consumer (patients/clients). Nursing's focus on responses to health care problems, not just illness events in isolation, provides insight into causes and effective management strategies for health problems. The Nursing Minimum Data Set (NMDS) documents patient/client responses, interventions, patient-sensitive outcomes, and resource consumption. By implementing the NMDS, nursing collaborates with other health care professionals to identify the needs of patient populations as well as the needs of individual patients. The article examines the relationship of the NMDS to other health care databases used in quality measurement, describes the integral role of standardized language in implementing the NMDS, provides examples of NMDS data analyses to address specific aspects of quality measurement, and outlines a methodology for using nonstandardized data.

Humans↗
PubMed1993

Temporal relationship of acinar and microvascular changes in caerulein-induced pancreatitis.

A study in rats investigated the temporal relationship between acinar cell changes and alterations in the local microvasculature in oedematous pancreatitis produced by administration of caerulein 5 micrograms kg-1 h-1. Samples were taken from experimental and control animals after 15 min, 30 min, 1 h and 2 h of caerulein infusion. Transmission electron microscopy showed ultrastructural acinar cell changes after 15 min whereas the earliest microvascular changes were seen after 30 min. Ultrastructural alterations in the acinar cells thus preceded local microvascular changes. Microvascular distortion appears to be a consequence and not a cause of pancreatitis in the caerulein model.

Animals↗
PubMed1992

Standardized nursing language for healthcare information systems.

Since a substantial component of health care delivery is reflected in nursing's work, it is imperative that nursing expedites implementation of a standardized language that reflects nursing's work and ultimately allows outcome evaluation. This paper will summarize the state of development and related issues of standardized language in nursing, including: Nursing Minimum Data Set, Taxonomies of Nursing Diagnoses, Nursing Interventions, Outcomes, and the Nursing Management Minimum Data Set. The Nursing Minimum Data Set, including nursing care, patient or client demographic, and service elements, reflects a standardized collection of essential nursing data used by multiple data users in the health care delivery system across all types of settings. The nursing care elements include nursing diagnosis, nursing intervention, nursing outcome, and intensity of nursing care. Currently, more than 100 nursing diagnoses have been accepted for clinical testing by the North American Nursing Diagnosis Association (NANDA) and have been incorporated into a taxonomy of nursing diagnoses that reflects patient responses to actual or potential health problems that nursing can address. A current formulation of a taxonomy of nursing interventions for the treatment of the nursing diagnoses yielded 336 nursing intervention labels organized at three or four levels of abstraction. Concomitant with these endeavors is the necessity for identifying outcomes associated with each diagnosis and its treatment. Concepts and a classification for indicators of these outcomes are being reviewed. Last, to address the contextual covariates of patient outcomes, a collection of core variables needed by nurse managers to make management decisions and compare nursing effectiveness across institutions and geographic regions is under development. In summary, standardized measures to determine cost effective, high quality, appropriate outcomes of nursing care delivered across settings and sites are being developed.

Classification↗
PubMed1992

Spinal stabilisation in Duchenne muscular dystrophy.

Of 55 patients with Duchenne muscular dystrophy offered surgical stabilisation of the spine, 32 accepted and 23 refused. We compared both groups pre-operatively and at six-month intervals in respect of survival, forced vital capacity, peak expiratory flow rate and severity of scoliosis. In the nonoperated patients, the forced vital capacity deteriorated by a mean of 8% per annum; in the operated group it remained static for 36 months and diminished slightly thereafter. Spinal stabilisation resulted in an improvement in the peak expiratory flow rate which was maintained for up to five years. In the nonoperated patients the scoliosis progressed from a mean of 37 degrees to a mean of 89 degrees at five years; in the stabilised spines it was improved from a mean of 47 degrees to a mean 34 degrees at five years. There was significantly improved survival in the patients who had undergone spinal stabilisation.

Adolescent↗
PubMed1991

The role of 3 hour distal oesophageal pH monitoring in gastro-oesophageal reflux.

It has been suggested in the literature that an eight hour period of distal oesophageal monitoring is adequate for the diagnosis of reflux in symptomatic patients. The aim of this study was to investigate whether 3 hour intra-oesophageal pH-metry could be substituted for the eight hour test period without loss of sensitivity in the diagnosis of GOR. Twenty patients were tested, 10 of whom had classical De Meester symptoms of GOR and 10 asymptomatic patients served as controls. All were commenced on 3 hour ambulant pH monitoring of the distal oesophagus. This was followed by a separate period of 8 hour testing. Each test had a 50% supine time period. The following variables were determined: (i) number of reflux episodes (ii) number longer than 5 minutes (iii) longest episode of reflux, (iv) percent of time that pH was below 4. Results are analysed using the 'Esophogram' computer program. 8 hour monitoring resulted in a positive diagnosis of GOR in 10 of 10 patients, giving an overall sensitivity of 100%. 3 hour testing was positive in 8 patients (sensitivity of 80%). The best correlations were obtained when comparing total reflux episodes, and the percent of total time pH less than 4, but overall the tests correlate poorly for individual variables. None of the controls had positive 3 or 8 hour testing. We conclude therefore, that 3 hour pH metry may be a useful screening test to confirm symptomatic reflux, and can be performed within a single clinic visit. If negative, arrangements must be made for more prolonged monitoring.

Female↗
PubMed1990

The effect of caerulein induced pancreatitis on the hepatic microvasculature.

A three-dimensional morphological study of the hepatic microvasculature in caerulein induced oedematous pancreatitis was performed using scanning electron microscopy (SEM) vascular casts and transmission electron microscopy (TEM) of hepatocytes and hepatic sinusoids. TEM studies provided ultrastructural evidence of hepatocellular damage while SEM views demonstrated gross irregularity of the sinusoidal outline with abruptly terminating sinusoidal buds and extravasation of cast material, findings which were similar to those previously reported in the pancreas itself using the same model and which were supported by TEM cross-sectional views of the hepatic sinusoids. The results suggest that caerulein induced pancreatitis is associated with extrapancreatic microvascular damage which may be an important factor in the pathogenesis of extrapancreatic organ impairment associated with acute pancreatitis.

Amylases↗
PubMed1989

Synaptic density of caudate-putamen and visual cortex following exposure to ethanol in utero.

Pregnant Long-Evans rats were fed a liquid diet containing ethanol (30% of total calories) during days 3-19 of gestation. Controls were given ad libitum access to liquid diet lacking ethanol, or pair-fed isocaloric amounts based on consumption by the animals in the ethanol group. Brain development of female offspring was evaluated by analysis of electron micrographs of caudate-putamen and visual cortex. Numbers of presynaptic terminals and synaptic junctions (synaptic density) per unit area were compared for 14- and 28-day-old offspring of dams from the three treatment groups. Synaptic density of the caudate-putamen and visual cortex was not affected by ethanol at 14 or 28 days. Although exposure to ethanol during a period comparable to the first two trimesters of human development with minimal or no undernutrition did not affect numerical density of synapses in visual cortex or caudate-putamen, synaptogenesis of caudate-putamen was altered in offspring of pair-fed animals.

Animals↗
PubMed1989

Concordance between different measures of small sensory and autonomic fibre neuropathy in diabetes mellitus.

This study presents concordance data from 3 different tests of small nerve-fibre function on the same diabetic patients and also examines the effects of hyperglycaemia. Thus the TTT-Glasgow automated thermal threshold test, EAR-Electrically evoked axon reflex flare, and GOE-Gastric emptying of a mixed sold/liquid meal and oesophageal emptying of a solid bolus were all measured on 25 diabetic patients. The TTT, EAR and GOE all gave values ranging from within the normal reference range for non-diabetics to markedly dysfunctional readings. Mean warm perception (WPT) on the foot dorsum averaged 0.73 degrees C +/- 0.93 for normal controls, but was 4.67 degrees C +/- 3.99 in the 25 diabetics. Cold perception thresholds (CPT) were 0.48 degrees C +/- 0.55 for normal subjects and 3.75 degrees C +/- 4.28 for diabetics. In the same normal subjects the mean EAR flare laser flux responses (for 8 and 16 noxious TENS pulses) was 2.8 V.min, while for diabetics the mean was 0.2 V.min. Solid and liquid gastric 50% emptying times and oesophageal emptying for non-diabetics were within normal range (mean 78 min and 18 min, 18 sec respectively) but for the 25 diabetics emptying times ranged from normal to very prolonged (mean 114 min and 30 min, 68 sec respectively). A plot of 3 measured variables (TTT, EAR and GOE) showed a high degree of correspondence between the gastro-oesophageal emptying delays and the presence of reduced electrical axon reflex and elevated thermal thresholds. Of 25 patients, 6 could be classed as within normal limits on all 3 variables, but 8 of 25 displayed objective evidence of C-fibre neuropathy--thermal perceptual impairment (C- and A-delta sensory fibres), reduced neurogenic inflammatory flare (peptidergic nociceptive afferents) and delayed gastro-oesophageal emptying (vagal afferent/efferent fibres).

Autonomic Nervous System↗
PubMed1988

Development of axonal-oligodendroglial relationships and junctions during myelination of the optic nerve.

The early stages of myelination were examined in optic nerves of rats aged 12-15 days. The initial association between oligodendroglial processes and bare axons involves no junctional specialization, as the axoglial extracellular space remains unaltered. Following ensheathment by a collar of glial cytoplasm, at least one full rotation of mesaxon was evident before compact myelin formed. Furthermore, myelin was generally evident before a second rotation was completed. In longitudinal sections, an axoglial junction was always observed beginning on the first paranodal loop, continuing through to the last (or outermost) loop. Thus, the formation of myelin and elaboration of a junctional complex in the paranodal region follow a promyelination phase and appear to be synchronous (and possibly related) events. Although the paranodal plasmalemma and axolemma are in close apposition, there is a material in the extracellular space that precipitates phosphotungstic acid, a characteristic that appears to be featured in a number of different types of cell junctions.

Animals↗
PubMed1988

Effects of topical capsaicin on normal skin and affected dermatomes in herpes zoster.

Hyperalgesia and allodynia, lasting for months or even years, occurs in the form of post-herpetic neuralgia in approximately 70% of adults previously infected with the varicella herpes zoster virus. The present study aimed at testing the analgesic desensitising actions and reversibility of repeated application of topical capsaicin on disordered polymodal nociceptors and peptidergic sensory fibres mediating warm and pain sensation. Cutaneous nociceptor desensitisation was measured using the Glasgow automated thermal threshold test (Medelec TTT). For normal subjects (n = 69) the mean forearm warm threshold was 0.15 +/- 0.07 degrees C and the cold threshold was 0.14 +/- 0.10 degrees C. A variable degree of partial desensitisation of herpes-affected skin was found in 15 patients with post-herpetic neuralgia before capsaicin treatment where the mean threshold elevation for warm detection was 1.19 degrees C and 0.7 degrees C for cold detection, compared with the corresponding normal skin. In preliminary studies of 15 patients with post-herpetic neuralgia, good pain relief averaging 30% or 77% occurred in the affected dermatome(s) after 3 to 4 weeks of 0.01% or 0.05% capsaicin cream respectively, applied 3-4 times daily. The warm thresholds, after chronic capsaicin treatment, increased between 0.1 and 7.60 degrees C, the average elevation being 3.69 degrees C. By contrast cold thresholds after capsaicin altered inconsistently and by only an average of 0.08 degrees C. The results suggest that elevation of the warm threshold may indicate the desensitisation achieved by capsaicin treatment of skin polymodal nociceptors. Cold detection, being dependent upon A-delta cold fibre function, is unaffected by capsaicin treatment. There was a poor correlation between pain relief and elevation of warm detection in response to capsaicin treatment. Generally, it was found that those patients with less initial desensitisation to warm detection as a consequence of post-herpetic neuralgia experienced better pain relief after capsaicin was applied. The method used permits determination of the minimum effective desensitising dose of capsaicin, enables patient compliance and progress to be monitored and should allow the prediction of patients likely to achieve the best response to treatment.

Administration, Topical↗
PubMed1985

Effect of exercise on longevity, body weight, locomotor performance, and passive-avoidance memory of C57BL/6J mice.

Studies of human and animal subjects have suggested that exercise may retard aging, help prevent age-related diseases, and prolong life span. Earlier studies focused on the effects of exercise on the heart, skeletal muscles, lungs, metabolism, and longevity. Researchers recently have begun to direct their attention to possible benefits of exercise on the brain. The goals of this study were to examine the effects of voluntary wheel-running exercise on life span, body weight, food and water intake, locomotor performance, and one-trial passive-avoidance memory of mature (10-14 month), middle-aged (20-24 month), and old (28-30 month) C57BL/6J male mice. No significant differences in life span, expressed in months, were found between control and exercised mice when exercise was carried out during maturity, senescence, intermittently across both periods, or continuously throughout maturity and senescence. Exercised adult mice maintained body weight compared to adult controls, an effect not apparent in old mice. Locomotor performance was reduced in old mice, and exercise increased performance much more in adult than in old mice. In the passive avoidance test of recent memory, exercise significantly increased latency, that is, it improved retention, in adult, middle-aged, and old mice. The effect was greatest in middle-aged, next in old, and lowest in adult mice. The findings indicate that exercise may be an important modulator of the rate of aging.

Aging↗
PubMed1982

Contract grading in clinical evaluation.

The use of contracts in grading clinical performance has provided faculty with a solution to two important problems. One has been how to ensure that students are graded consistently among the various faculty who are grading the same clinical component of a course. The second has been to increase the opportunity for individualized attention to student learning needs. We have been pleased to see all the faculty members increase their input and involvement in the continuing modifications of the contract. Although we have taken the major responsibility for the semi-annual revisions of the contract, other faculty members have been increasingly more explicit in their evaluations and suggestions as their experience with the contract has expanded. Their confidence in this method of clinical evaluation has increased with each semester of use. We plan to continue in the refinement of the instrument and will develop materials for the use of other faculty groups who are interested in developing similar contracts. We are also designing a survey to attempt to discover how widespread is the use of contract grading in clinical areas.

Clinical Competence↗