From theory to practice: capturing the uniqueness of nursing.
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Aged↗
Biomedical subjects
Christine Smith
Publications and source records attributed to Christine Smith.
Declarative memory, awareness, and transitive inference.
A characteristic usually attributed to declarative memory is that what is learned is accessible to awareness. Recently, the relationship between awareness and declarative (hippocampus-dependent) memory has been questioned on the basis of findings from transitive inference tasks. In transitive inference, participants are first trained on overlapping pairs of items (e.g., A+B-, B+C-, C+D-, and D+E-, where + and - indicate correct and incorrect choices). Later, participants who choose B over D when presented with the novel pair BD are said to demonstrate transitive inference. The ability to exhibit transitive inference is thought to depend on the fact that participants have represented the stimulus elements hierarchically (i.e., A>B>C>D>E). We found that performance on five-item and six-item transitive inference tasks was closely related to awareness of the hierarchical relationship among the elements of the training pairs. Participants who were aware of the hierarchy performed near 100% correct on all tests of transitivity, but participants who were unaware of the hierarchy performed poorly (e.g., on transitive pair BD in the five-item problem; on transitive pairs BD, BE, and CE in the six-item problem). When the five-item task was administered to memory-impaired patients with damage thought to be limited to the hippocampal region, the patients were impaired at learning the training pairs. All patients were unaware of the hierarchy and, like unaware controls, performed poorly on the BD pair. The findings indicate that awareness is critical for robust performance on tests of transitive inference and support the view that awareness of what is learned is a fundamental characteristic of declarative memory.
Adolescent↗
A novel EXT1 splice site mutation in a kindred with hereditary multiple exostosis and osteoporosis.
CONTEXT: Hereditary multiple exostosis (HME) is an autosomal dominant disorder characterized by the development of benign cartilage-capped tumors at the juxta-epiphyseal regions of long bones. HME is usually caused by mutations of EXT1 or EXT2. OBJECTIVE: The objective of this study was to investigate a three-generation Austrian kindred with HME for EXT1 and EXT2 mutations and for abnormalities of bone mineral density (BMD). METHODS: DNA sequence and mRNA analyses were used to identify the mutation and its associated consequences. Serum biochemical and radiological investigations assessed bone metabolism and BMD. RESULTS: HME-affected members had a lower femoral neck BMD compared with nonaffected members (z-scores, -2.98 vs. -1.30; P = 0.011), and in those less than 30 yr of age, the lumbar spine BMD was also low (z-scores, -2.68 vs. -1.42; P = 0.005). However, they had normal mobility and normal serum concentrations of calcium, phosphate, alkaline phosphatase activity, creatinine, PTH, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, osteocalcin, and beta-crosslaps. DNA sequence analysis of EXT1 revealed a heterozygous g-->c transversion that altered the invariant ag dinucleotide of the intron 8 acceptor splice site. RT-PCR analysis using lymphoblastoid RNA showed that the mutation resulted in skipping of exon 9 with a premature termination at codon 599. DNA sequence abnormalities of the osteoprotegerin gene, which is in close proximity to the EXT1 gene, were not detected. CONCLUSIONS: A novel heterozygous acceptor splice site mutation of EXT1 results in HME that is associated with a low peak bone mass, indicating a possible additional role for EXT1 in bone biology and in regulating BMD.
Adolescent↗
A longitudinal study of home care clients and their informal carers.
The objective of the longitudinal study was to monitor physical and cognitive changes in a population of 330 older people being supported at home by health services. The participants were 75 years and older and classified as having moderate-to-high needs. A total of 210 primary informal carers were recruited to determine their specific needs and how they coped as dependency levels of their care-recipients changed. Data were collected using six different tools. Two questionnaires were mailed out to participating carers. Assessments of care recipients were carried out at three sampling points over the study period. The clients showed a significant increase in physical dependency and an overall increase in cognitive impairment over time. Only 32% of carers lived with care recipients, and changes in dependency, cognitive changes, lack of respite and performing activities of daily living were all major stressors for informal carers. The needs of informal carers are reported and discussed in the context of recommendations of the Commission on the Future of Health Care in Canada.
Age Distribution↗
Assessing cognitive impairment in older people: the Watson clock drawing test.
A non-random sample of 331 community-based clients aged 75 years and over, who were being cared for at home, were involved in a longitudinal study to assess cognitive impairment (CI). The clock drawing test (CDT) using the Watson et al (1993) scoring protocol was used to determine its utility as a tool for community nurses to assess CI. In the first phase of the study, 294 CDTs were used in analysis and 58.8% (n = 172) of participants were cognitively impaired. Subsequent assessments at 9 months and 18 months using both the CDT and the Mini-Mental State Examination (MMSE) confirmed the high initial level of cognitive impairment among the sample. Over the course of the study 37 participants who had high CDT scores were admitted to institutional care and their cognitive status continued to decline. Among those who remained in the community, the percentage with some degree of cognitive impairment remained high, and over the course of the study there was a significant linear decline in the mean MMSE score. The CDT takes less time to administer than the MMSE and appears to be a more sensitive tool for detecting early changes in cognition. The CDT could therefore be useful as an initial assessment tool by community mental health nurses to help facilitate early intervention for older clients who are beginning to experience cognitive changes.
Aged↗
New ways of working in primary care nursing.
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Community Health Nursing↗
Confirmation of QTL effects and evidence of genetic dominance of honeybee defensive behavior: results of colony and individual behavioral assays.
The stinging and guarding components of the defensive behavior of European, Africanized, hybrid, and backcross honeybees (Apis mellifera L.) were compared and analyzed at both colony and individual levels. Hybrid and Africanized backcross colonies stung as many times as Africanized ones. European backcross colonies stung more than European bees but not as many times as Africanized or Africanized backcross colonies. The degree of dominance for the number of times that worker bees stung a leather patch was estimated to be 84.3%, 200.8%, and 145.8% for hybrid, backcross European, and backcross Africanized colonies, respectively. Additionally, both guards at the colony entrance and fast-stinging workers of one European backcross colony had a significantly higher frequency of an Africanized DNA marker allele, located near "sting1," a QTL previously implicated in stinging behavior at the colony level. However, guards and fast-stinging bees from a backcross to the Africanized parental colony did not differ from control bees in their frequency for the Africanized and European markers, as would be expected if large genetic dominance effects for sting1 exist. These results support the hypothesis that genetic dominance influences the defensive behavior of honeybees and confirm the effect of sting1 on the defensiveness of individual worker bees.
Agonistic Behavior↗
Assessment and management of pain and distress in the neonate.
Pain management is an integral focus of neonatal care. This article reviews the physiology and impact of neonatal pain and distress and pain assessment tools, as well as clinical interventions and current controversies in the management of pain and distress in neonates. Current guidelines to enhance the recognition and treatment of pain are highlighted.
Analgesia↗
The effects of back massage before diagnostic cardiac catheterization.
CONTEXT: Admission to the hospital for a diagnostic cardiac catheterization can be perceived as a threat to one's health status. Autonomic nervous system arousal, particularly the sympathetic division, can elicit negative physiological and psychological human responses as a reaction to this threat. OBJECTIVE: The purpose of this study was to measure the effects of a 20-minute back massage on the physiological and psychological human responses of patients admitted for a diagnostic cardiac catheterization. DESIGN: A randomized clinical trial design was used. Data were compared in a repeated measures design before massage (T1), immediately following the back massage or standard care (T2), and 10 minutes later (T3). SETTING: A large urban academic medical center. PARTICIPANTS: Forty-six subjects admitted from home for a diagnostic cardiac catheterization. MAIN OUTCOME MEASURES: Heart rate, heart rate variability, blood pressure, respiration, peripheral skin temperature, pain perception, and psychological state. INTERVENTION: A 20-minute back massage. RESULTS: There was a significant difference between subject effect for group, with a reduction in systolic blood pressure in the treatment group (F = 8.6, P < .05). In addition, main effects were noted for time for diastolic blood pressure (F = 5.44; P < .006), respiration (F = 10.6; P < .005), total Profile of Mood States score (F = 5.9; P < .001) and pain perception (F = 4.09; P < .04) in both groups. CONCLUSIONS: A 20-minute back massage appeared to reduce systolic blood pressure in patients awaiting a diagnostic cardiac catheterization, while preparatory time in the cardiac catheterization laboratory appeared to reduce diastolic blood pressure, respiration, perceived psychological distress, and pain.
Adaptation, Psychological↗