Biomedical subjects

C Toman

Publications and source records attributed to C Toman.

10 recordsLinked to original sources

PubMed2001

Clinical practice guidelines: necessary but not sufficient for evidence-based patient education and counseling.

While clinical practice guidelines provide direction for the management of specific diseases or particular clinical problems, there are major gaps between guidelines and their implementation. The purpose of this paper is to illustrate how an existing guideline can be used to develop an evidence-based patient education program. Congestive heart failure (CHF) represents a range of complex, chronic illnesses which offer little hope of cure yet require symptom management by health care providers, patients, and their families. Successful self-monitoring, self-care, and decision making are based on acquisition of appropriate knowledge and management skills. We describe a comprehensive teaching program in which the content was built on the clinical evidence from the Agency for Health Care Policy and Research recommendations for CHF, and the implementation process was built on adult education evidence, adapted to health issues and patient learning challenges.

Evidence-Based Medicine↗

PubMed2001

George Spence: surgeon and servant of the Hudson's Bay Company, 1738-41.

At the beginning of his medical career, George Spence signed a contract with the Hudson's Bay Company (HBC) as surgeon for the Fort Albany fur trading post located on James Bay in British North America. During his first three years (1738-41), Spence encountered formidable personal and professional challenges which can be partially reconstructed through examination of surgeon's journal for 1740-41. By unique good fortune, two other corroborating journals exist for Albany from the same year: the journal of another HBC servant and the regular post journal. Spence's is the only surgeon's journal in the HBC archives prior to 1846 and one of very few such journals from any period of the company's history. This paper examines everyday medical practice in one fur trading context from the perspective of HBC employees and the recipients of medical care. George Spence's significance lies partially in the ordinary nature of his practice in contrast to heroic historical accounts, and partially in his contribution toward knowledge of an earlier context in medical history than has been previously analyzed. I have drawn on concepts from labour and professionalization history to analyze the seemingly contradictory position of the surgeon as both an autonomous professional and a servant in relation to the HBC. While Spence successfully fulfilled his role as surgeon, he struggled to meet expectations as a servant of the company. His struggle was partially based on emerging professional ideologies, and partially based on changing labour relationships within a pre-industrial society.

Canada↗

PubMed2001

Blood work. Canadian nursing and blood transfusion, 1942-1990.

The extension of blood transfusion to civilian populations was contingent on the availability of a nursing workforce capable of taking on increasingly responsible roles. Nurses assumed a variety of roles as they incorporated blood work into patient care and, in the process, enabled, embodied, and engendered it as nurses' and women's work. Initially, the student workforce facilitated transfusion through roles that were congruent with nursing's domestic roots. Later, it constrained the expansion of blood work because of its perpetually novice nature. Delegation constituted one strategy by which a limited number of persons could become experienced and autonomous in a particular role. As long as the skill remained limited, nurses shared its associated power and status, which differentiated them within the work culture. A few women were able to shape blood work to their advantage, using their expertise either as job security or as a bargaining point to negotiate better working conditions. However, when the skill was routinized and dispersed among many nurses, it became dirty work. The examination of one specific technology that shifted from medicine into nursing contributes insights to current issues of expanded roles and delegated skills. Nurses need to question seriously what is gained and lost as they take on and let go of technologies. They need to consider what kinds of knowledge will be needed and how best to develop it. Finally, they need to reflect how changes might complicate care giving and nurses' work.

Blood Transfusion↗

PubMed1998

Hospital to home evidence-based education for CHF.

Congestive heart failure (CHF) is a significant health problem in Canadian adults and continues to be a leading cause of morbidity and mortality. It has been cited as the most rapidly growing category of cardiovascular disorder. There is little likelihood that patients experiencing CHF will leave the health care system until death. Typically, they move between health care sectors, being repeatedly admitted and discharged from each. In our system today, where institutional and community sectors are separately organized, separately funded and poorly linked at the point of service delivery, these patients are at high risk for discontinuity of care.

Evidence-Based Medicine↗

PubMed1995

"Wish you were here...".

Camp is one of the most popular summer destinations for children and youth. Their enthusiasm is infectious; more and more adults are now taking part. Summer camp offers a change of pace (not always slower); a change of environment (not always outdoors); and, a change of expectations (where else could you wear the same clothes for a whole week?). It's also a chance to be accepted as you are, or try new roles with no expectation of perfection. Little wonder that camp appeals to all ages.

Adaptation, Psychological↗

PubMed1995

Nursing criteria for patient progression post myocardial infarction.

Nurses play a pivotal role in the evaluation of patients with coronary artery disease, since many symptoms are subtle and arise while carrying out activities. Consistency among nursing staff in interpreting patient readiness for activity is crucial to ensure that patients are progressing steadily or to determine if a delay in their progression is warranted. While there have been studies on patient reaction to myocardial infarction and on the physiological effects of activity and/or nursing interventions on myocardial patients, no studies could be found that have examined the criteria used by nurses to assess when patients are ready to increase, decrease or maintain a level of activity according to specific activity protocols. This descriptive study examined the criteria utilized by experienced staff nurses in determining post myocardial patients' readiness to progress through the institution's designated activity levels. The results indicated that in-depth criteria were utilized by these experienced nurses and that patient situations existed whereby it was difficult to determine patient readiness. Factors were discovered that were perceived to enhance or inhibit patient's progression through designated activity levels. Recommendations from this study support the need to (a) examine the use of current activity protocols for their utility in nursing decision making, (b) consider the experiential base of practicing nurses as well as the working environment in any further development of activity protocols.

Activities of Daily Living↗

PubMed1993

In vivo gene therapy of hemophilia B: sustained partial correction in factor IX-deficient dogs.

The liver represents a model organ for gene therapy. A method has been developed for hepatic gene transfer in vivo by the direct infusion of recombinant retroviral vectors into the portal vasculature, which results in the persistent expression of exogenous genes. To determine if these technologies are applicable for the treatment of hemophilia B patients, preclinical efficacy studies were done in a hemophilia B dog model. When the canine factor IX complementary DNA was transduced directly into the hepatocytes of affected dogs in vivo, the animals constitutively expressed low levels of canine factor IX for more than 5 months. Persistent expression of the clotting factor resulted in reductions of whole blood clotting and partial thromboplastin times of the treated animals. Thus, long-term treatment of hemophilia B patients may be feasible by direct hepatic gene therapy in vivo.

Animals↗

PubMed1992

Hepatic gene therapy: persistent expression of human alpha 1-antitrypsin in mice after direct gene delivery in vivo.

The liver represents an excellent target organ for gene therapy. The current strategy for hepatic gene therapy involves the isolation of primary hepatocytes from a resected liver lobe, transduction of therapeutic genes in vitro followed by autologous hepatocellular transplantation. This ex vivo approach is a rather complex procedure in its entirety; thus, a simple method for direct gene delivery into hepatocytes in vivo has been developed. The procedure involves partial hepatectomy followed by the portal vein infusion of recombinant retroviral vectors. Histological analysis of hepatocytes after in vivo delivery of a recombinant retrovirus bearing the E. coli beta-galactosidase gene showed that 1-2% of the parenchymal cells were transduced. Direct hepatic transfer of human alpha 1-antitrypsin cDNA under the transcriptional direction of the albumin promoter-enhancer led to constitutive expression of the human protein in the sera of recipients at concentrations of 30-1,400 ng/ml for at least 6 months. The experimental animals showed no signs of illness and histologic analysis of the liver revealed no evidence of pathologic abnormalities. The results suggest that the in vivo approach is an attractive alternative for hepatic gene therapy.

Albumins↗

PubMed1990

Mac-1 (CD11b/CD18) mediates adherence-dependent hydrogen peroxide production by human and canine neutrophils.

Human neutrophils exposed to protein-coated polystyrene or cultured endothelial monolayers produce large quantities of H2O2 in response to soluble stimuli that elicit little or no secretion of reactive oxygen species from cells in suspension. To characterize the mechanisms involved in this adherence-dependent respiratory burst, we have investigated the possible role of one integrin known to participate in the adhesion of neutrophils to endothelial cells, CD11b/CD18 (Mac-1). H2O2 production was examined with chemotactic factor-stimulated human and canine neutrophils exposed to protein-coated surfaces and cultured human and canine endothelial cells. The two protein-coated surfaces used were type I collagen-coated glass or plastic, a surface to which neither human nor canine neutrophils adhered, and keyhole limpet hemocyanin (KLH)-coated glass or plastic, a surface to which human and canine neutrophils adhered only after chemotactic stimulation. FMLP-stimulated human neutrophils and platelet activating factor-stimulated canine neutrophils failed to produce detectable H2O2 when in contact with type I collagen, but secreted large amounts of H2O2 when adherent to KLH or endothelial cell monolayers. FMLP-stimulated neutrophils from patients with CD18-deficiency failed to adhere to any of these surfaces and failed to produce H2O2 under these conditions. mAb reactive with CD18 and CD11b were equally effective in markedly inhibiting the adhesion of normal human neutrophils to these surfaces and markedly inhibited the production of H2O2. A mAb reactive with CD18 blocked adhesion of stimulated canine neutrophils, and mAb directed against both CD18 and CD11b blocked H2O2 production by canine neutrophils on KLH and endothelium. A nonbinding mAb and a mAb reactive with CD11a did not inhibit H2O2 production of human cells on KLH or endothelial monolayers, and nonbinding and binding control mAb did not inhibit H2O2 production by canine neutrophils. These results indicate that Mac-1 (CD11b/CD18) can mediate adhesion-dependent H2O2 production by human and canine neutrophils exposed to chemotactic factors.

Antibodies, Monoclonal↗

PubMed1989

Cooperative interactions of LFA-1 and Mac-1 with intercellular adhesion molecule-1 in facilitating adherence and transendothelial migration of human neutrophils in vitro.

The adherence of human neutrophils to human umbilical vein endothelial cells (HUVEC) is partially dependent on the CD11/CD18 family of glycoproteins on the neutrophil and ICAM-1 on the HUVEC. The CD18 heterodimer involved in this adherence was evaluated in vitro using subunit-specific monoclonal antibodies (MAbs). The adherence of unstimulated neutrophils to IL-1-stimulated HUVEC was significantly inhibited by anti-CD11a but not CD11b MAbs, while the adherence of fMLP-stimulated neutrophils was significantly inhibited by both anti-CD11a and -CD11b. Anti-CD11a, but not anti-CD11b MAbs, reduced the adherence of unstimulated neutrophils on purified ICAM-1 to the same low level untreated neutrophils exhibited on a control protein, glycophorin. Stimulation with fMLP significantly increased neutrophil attachment to purified ICAM-1, but not to the control protein. Anti-CD11b MAbs reduced this chemotactically augmented adherence to that of unstimulated neutrophils, and in combination with anti-CD11a MAbs reduced adherence to that on the control protein. The results in this report indicate that unstimulated neutrophils exhibit LFA-1-dependent attachment to ICAM-1, and chemotactic stimulation enhances the attachment of human neutrophils to ICAM-1 by a Mac-1-dependent process.

Adult↗