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Biomedical subjects

C Foster

Publications and source records attributed to C Foster.

179 records · Page 10Linked to original sources
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Insulin resistance in non-insulin-dependent diabetes mellitus is associated with microalbuminuria independently of ambulatory blood pressure.

Microalbuminuria in both insulin-dependent (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM) is a marker for insulin resistance. Microalbuminuria is also associated with hypertension, itself an insulin-resistant state. Therefore, in order to examine the independent relationships of microalbuminuria with blood pressure and insulin resistance, we measured ambulatory blood pressure (Takeda TM-2420), insulin resistance (modified Harano method), and urinary albumin excretion rate (overnight urine collection) in 36 subjects with NIDDM. Albumin excretion correlated with 24-h systolic blood pressure (r = 0.49, p = 0.003), and insulin sensitivity (r = -0.39, p = 0.007). Microalbuminuric subjects had reduced insulin sensitivity compared with normoalbuminuric subjects [Mean (SD) 2.95 (0.33) versus 4.67 (0.56) ml.kg-1.min-1; p = 0.013]. In multivariate analysis including ambulatory blood pressure and insulin resistance, urinary albumin excretion was associated primarily with insulin resistance, with smaller contributions from glycated hemoglobin and male gender. These data suggest that microalbuminuria in NIDDM, although associated with hypertension, is also independently associated with insulin resistance.

Albuminuria↗
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Emergency management of carotid artery rupture.

Rupture of the carotid artery has been one of the most feared postoperative complications in head and neck cancer patients. Traditional management of carotid artery rupture has been disappointing, and morbidity and mortality have been high. Experience with carotid artery rupture at the authors' institution over the past 20 years has been reviewed. The current method of management seems to result in a decreased number of neurologic sequelae and episodes of rebleeding. Of the last 23 carotid ruptures encountered, four occurred while the patient was at home. Two patients had neurologic complications, and there were two deaths. Only one episode of rebleeding occurred. All patients except one were discharged from the hospital. These patients were managed according to an established protocol, and the results of the authors' experience are reported and analyzed. Preoperative preparation prior to ligation is explained, and prognostic indicators and risk factors are reviewed.

Adult↗
PubMedDate not supplied

The effects of gloves on grip strength and three-point pinch.

No-glove, leather-glove, nitrile-glove, and vinyl-glove conditions were evaluated to determine their effects on grip strength and three-point pinch. Forty-one adult volunteers from a local university and local hospital participated in the two-day study. The order of testing was randomly assigned. A hydraulic hand dynamometer and a hydraulic pinch gauge were used to evaluate grip strength and three-point pinch with no glove and with each glove type. Grip strength and three-point pinch were tested on separate days. Grip strength test results showed statistically significant differences (p < 0.05) for no glove vs. leather glove, no glove vs. nitrile glove, no glove vs. vinyl glove, leather glove vs. nitrile glove, and leather glove vs. vinyl glove, but no statistically significant difference for nitrile glove vs. vinyl glove. Three-point pinch test results also showed statistically significant differences (p < 0.05) for no glove vs. leather glove, leather glove vs. nitrile glove, and leather glove vs. vinyl glove, but no statistically significant differences for no glove vs. nitrile glove, no glove vs. vinyl glove, and nitrile glove vs. vinyl glove. The results indicate that glove type may have clinical applications for occupational and physical therapists whose patients use gloves in the workplace.

Adolescent↗
PubMedDate not supplied

First-pass radionuclide angiography during bicycle and treadmill exercise.

BACKGROUND: Treadmill testing is usually preferred over cycle ergometry because of the greater sensitivity in diagnosing coronary artery disease. Treadmill testing has only recently been used with radionuclide angiography (RNA) because patient motion makes RNA imaging difficult. In this study we evaluate the comparability of treadmill and cycle exercise RNA with a dual isotope motion correction technique. METHODS AND RESULTS: Volunteer patients (n = 27) performed first-pass RNA during maximal exercise using both cycle ergometer and treadmill. Exercise capacity was greater during treadmill exercise (8.1 +/- 2.4 vs 7.5 +/- 2.2 METs). Twenty-three of 27 treadmill and all cycle ergometer exercise studies were technically adequate. Maximal heart rate was greater during treadmill exercise (150 +/- 24 vs 143 +/- 25 beats * min-l), however, systolic blood pressure was greater during cycle ergometry (174 +/- 23 vs 188 +/- 25 mmHg), resulting in no difference in heart rate times systolic blood pressure (25.7 +/- 7.2 vs 26.9 +/- 6.0). There were no differences between treadmill and cycle ergometer for peak exercise left ventricular ejection fraction (56% +/- 13% vs 57% +/- 14%) (r = 0.89). Calculated left ventricular end-diastolic volume was not different at rest (183 +/- 42 ml vs 176 +/- 44 ml) but differed significantly at peak exercise (282 +/- 75 ml vs 231 +/- 60 ml). The clinical impression, based on wall motion and left ventricular ejection fraction was very similar between treadmill and cycle ergometer. CONCLUSION: Treadmill exercise RNA is feasible, with about 85% of studies likely to be technically adequate. The overall clinical results are very similar to cycle exercise RNA, although the ordinarily expected advantages of treadmill exercise were largely absent.

Adult↗
PubMedDate not supplied

Time course of recovery during cardiac rehabilitation.

PURPOSE: Exercise-based rehabilitation programs improve effort tolerance in patients with cardiovascular disease. Little is known regarding the time course of recovery of objective and subjective indices of exercise tolerance. METHODS: Twenty-six patients were studied at 0, 4, 8, and 12 weeks following early entry into rehabilitation following acute myocardial infarction (AMI), coronary artery bypass graft surgery (CABGS), or valve surgery. Exercise tolerance was assessed objectively by percent predicted cycle power output (%PO), and subjectively by a self-efficacy questionnaire for ambulatory (ASE) and muscular (MSE) items and by a disease-specific, health-related, quality-of-life questionnaire (HRQL). RESULTS: With the exception of percent predicted cycle power output, all exercise tolerance measures improved throughout the rehabilitation program. Extrapolation of recovery curves suggest that recovery to 85% predicted can be achieved in 10, 11, 18, and 21 weeks for a disease-specific, health-related, quality-of-life questionnaire, self-efficacy questionnaire for ambulatory items, muscular items, and power output, respectively. CONCLUSIONS: The data demonstrate that evaluation of both objective and subjective indices of exercise tolerance may be important in documenting outcomes of participation in structured rehabilitation programs. The time course of recovery of objective and subjective indices of exercise tolerance may not be highly correlated.

Adult↗
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Why do research ethics committees disagree with each other?

Research ethics committees have to ensure that research projects are asking sensible questions and are designed so that the questions will be answered, that the research subjects who are involved will not come to unnecessary harm, and that the autonomy of the research subjects will be respected. Where research proposals cannot fulfill all these criteria, research ethics committees have to perform a delicate balancing act amongst competing moral claims. These arise when, for example, the research is non-therapeutic or the research subjects are incompetent to give consent. Given that the balance of conclusions is so sensitive, it is hardly surprising that different committees sometimes disagree with each other.

Congresses as Topic↗
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Product notebook: a catheter anchoring device.

A prospective multi-center study was conducted to assess the use of a catheter anchoring device. Fifty-nine patients with catheters ranging in size from 8 to 30 French used 164 devices. The device was easy to apply and remove, facilitated catheter repositioning, prevented tension at the insertion site, and did not cause skin problems in the majority of patients. Compared to previous methods used, the mean wear-time for all catheters increased by 2 days when the anchoring device was used. When wear-time was correlated to catheter diameter, type, and location it was seen that patients with non-urinary catheters of less than 20 Fr diameters benefitted most from this device. Patients with foley catheters had the shortest wear-times.

Adult↗
PubMedDate not supplied

Ethical review of multi-centre research: a survey of local research ethics committees in the south Thames region.

OBJECTIVE: To generate baseline data about the standards of practice of local research ethics committees (LRECs) in order to describe accurately the situation of ethical review procedures prior to the establishment of multi-centre research ethics committees (MRECs). DESIGN: The LERECs in the South Thames NHS Region were asked to describe their current practices, and to send us a copy of their application forms and guidance notes for researchers. RESULTS: All of the 27 LRECs approached for the survey responded. The results indicate that there are generally high standards of practice, and that most LRECs work in accordance with published guidelines. CONCLUSION: The problems that researchers face in seeking to obtain ethical approval for multi-centre research (pages 242-5) do not seem to have been caused by substandard LRECs. Hence the new system needs to sustain the high standards of practice whilst confronting the difficulties.

Attitude↗
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Ethical review of multi-centre research: a survey of multi-centre researchers in the South Thames region.

OBJECTIVE: To generate baseline data about the experiences of researchers applying to five or more local research ethics committees (LRECs) for ethical review. The new multi-centre review system will be compared with these data. DESIGN: Ninety-seven researchers, whose status as multicentre researchers was unclear, were identified from various sources in the South Thames Region. They were each sent a questionnaire asking for their views on the substance of ethical review and their experiences of the process of ethical review. RESULTS: Of the completed questionnaires, 24 fitted the multicentre criteria of applying to five or more LRECs. Responses showed dissatisfaction with LRECs' treatment of the scientific aspects of research, but satisfaction with aspects relating to consent and protection of patients' welfare. Respondents experienced great difficulty in the administration of the process of ethical review. CONCLUSIONS: The need for a new system of ethical review for multi-centre research is beyond doubt. It remains to be seen whether it will be an improvement.

England↗