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Biomedical subjects

D Hutchings

Publications and source records attributed to D Hutchings.

16 recordsLinked to original sources
PubMed2007

Effectiveness and acceptability of non-pharmacological interventions to reduce wandering in dementia: a systematic review.

BACKGROUND: Wandering occurs in 15-60% of people with dementia. Psychosocial interventions rather than pharmacological methods are recommended, but evidence for their effectiveness is limited and there are ethical concerns associated with some non-pharmacological approaches, such as electronic tracking devices. OBJECTIVE: To determine the clinical and cost effectiveness and acceptability of non-pharmacological interventions to reduce wandering in dementia. DESIGN: A systematic review to evaluate effectiveness of the interventions and to assess acceptability and ethical issues associated with their use. The search and review strategy, data extraction and analysis followed recommended guidance. Papers of relevance to effectiveness, acceptability and ethical issues were sought. RESULTS: (i) Clinical effectiveness. Eleven studies, including eight randomised controlled trials, of a variety of interventions, met the inclusion criteria. There was no robust evidence to recommend any intervention, although there was some weak evidence for exercise. No relevant studies to determine cost effectiveness met the inclusion criteria. (ii) Acceptability/ethical issues. None of the acceptability papers reported directly the views of people with dementia. Exercise and music therapy were the most acceptable interventions and raised no ethical concerns. Tracking and tagging devices were acceptable to carers but generated considerable ethical debate. Physical restraints were considered unacceptable. CONCLUSIONS: In order to reduce unsafe wandering high quality research is needed to determine the effectiveness of non-pharmacological interventions that are practically and ethically acceptable to users. It is important to establish the views of people with dementia on the acceptability of such interventions prior to evaluating their effectiveness through complex randomised controlled trials.

Aged↗
PubMed2006

A systematic literature review of the effectiveness of non-pharmacological interventions to prevent wandering in dementia and evaluation of the ethical implications and acceptability of their use.

OBJECTIVES: To determine the effectiveness and cost-effectiveness of non-pharmacological interventions (excluding subjective barriers) in the prevention of wandering in people with dementia, in comparison with usual care, and to evaluate through the review and a qualitative study the acceptability to stakeholders of such interventions and identify ethical issues associated with their use. DATA SOURCES: Major electronic databases were searched up until 31 March 2005. Specialists in the field. REVIEW METHODS: Selected studies were assessed and analysed. The results of two of the efficacy studies that used similar interventions, designs and outcome measures were pooled in a meta-analysis; results for other studies which reported standard deviations were presented in a forest plot. Owing to a lack of cost-effectiveness data, a modelling exercise could not be performed. Four focus groups were carried out with relevant stakeholders (n = 19) including people with dementia and formal and lay carers to explore ethical and acceptability issues in greater depth. Transcripts were coded independently by two reviewers to develop a coding frame. Analysis was via a thematic framework approach. RESULTS: Ten studies met the inclusion criteria (multi-sensory environment, three; music therapy, one; exercise, one; special care units, two; aromatherapy, two; behavioural intervention, one). There was no robust evidence to recommend any non-pharmacological intervention to reduce wandering in dementia. There was some evidence, albeit of poor quality, for the effectiveness of exercise and multi-sensory environment. There were no relevant studies to determine the cost-effectiveness of the interventions. Findings from the narrative review and focus groups on acceptability and ethical issues were comparable. Exercise and distraction therapies were the most acceptable interventions and raised no ethical concerns. All other interventions were considered acceptable except for physical restraints, which were considered unacceptable. Considerable ethical concerns exist with the use of electronic tagging and tracking devices and physical barriers. Existing literature ignores the perspectives of people with dementia. The small number of participants with dementia expressed caution regarding the use of unfamiliar technology. Balancing risk and risk assessment was an important theme for all carers in the management of wandering. CONCLUSIONS: There is no robust evidence so far to recommend the use of any non-pharmacological intervention to reduce or prevent wandering in people with dementia. High-quality studies, preferably randomised controlled trials, are needed to determine the clinical and cost-effectiveness of non-pharmacological interventions that allow safe wandering and are considered practically and ethically acceptable by carers and people with dementia. Large-scale, long-term cohort studies are needed to evaluate the morbidity and mortality associated with wandering in dementia for people both in the community and in residential care. Such data would inform future long-term cost-effectiveness studies.

Confusion↗
PubMed2002

Genetic linkage of systemic lupus erythematosus with chromosome 11q14 (SLEH1) in African-American families stratified by a nucleolar antinuclear antibody pattern.

Systemic lupus erythematosus (SLE) is an autoimmune disease with complex genetics. We evaluated pedigrees multiplex for SLE that had an affected with antinucleolar antibodies to increase the homogeneity for genetic linkage analysis. We found a significant linkage effect on chromosome 11q14 at marker D11S2002 in African-American Pedigrees. This effect produced a maximum LOD score of 5.62 using a dominant inheritance model with 95% penetrance in males and 99% penetrance in females. The results were supported by multipoint linkage analysis. Fine mapping of the region with two additional markers within 6 cM of D11S2002 further provided evidence of linkage in this region. Linkage at D11S2002, named SLEH1, was previously found in some of these same African-American pedigrees multiplex for SLE, but who were stratified by hemolytic anemia (Kelly et al, submitted). In conclusion, an important SLE susceptibility gene, SLEH1 at 11q14, is identified in African-Americans when stratifying pedigrees by antinucleolar autoantibodies.

Black People↗
PubMed2001

Linkage analysis of angiotensin-converting enzyme (ACE) insertion/deletion polymorphism and systemic lupus erythematosus.

Previous studies have suggested an association between systemic lupus erythematosus (SLE) and an insertion/deletion polymorphism in the angiotensin-converting enzyme gene (ACE). This polymorphism consists of a 250-bp insertion/deletion of an alu repeat in the 16th intron of the ACE gene. Individuals homozygous for the deletion have a higher level of circulating enzyme. Due to the important role of this enzyme in regulating the renin--angiotensin and kallikrein--kininogen systems, it is possible that the ACE insertion/deletion may play a role in SLE, which can include vasculitis and vascular changes. Using primers flanking the insertion/deletion site, we have examined the ACE gene in lupus patients and family members using genomic DNA obtained from the Lupus Multiplex Registry and Repository (LMRR). We were unable to detect significant linkage or genetic association between the ACE gene and SLE.

Family Health↗
PubMed1997

Cell-mediated and humoral immune responses in broiler chickens maintained on diets containing different levels of vitamin A.

Broiler chickens were examined for the effects of low (400 IU/kg), standard (1,500 IU/kg), or high (15,000 IU/kg) dietary vitamin A (VitA) levels on immune responsiveness postimmunization to Newcastle disease virus (NDV). A control pair-fed group (1,500 IU/kg) was included to compensate for the reduced feed intake associated with diet containing the low level of VitA. Interdigital skin reactions to phytohemagglutinin (PHA) and CD4:CD8 T lymphocyte ratios were significantly reduced in chickens fed the low VitA diet, whereas their antibody responses to NDV were significantly increased as compared to birds that consumed the 1,500 to 15,000 VitA diet ad libitum. On the other hand, birds on the high VitA diet had reduced lymphocyte responses to concanavalin A and pokeweed, but not to PHA. No effect of dietary VitA was observed for natural killer activity, nor on levels of percentage of cells expressing Class II MHC antigens among groups that consumed feed ad libitum. The results indicated that both humoral and cellular immune responses were modulated by levels of VitA in the diet, and suggest that VitA-deficient chickens developed a T helper (Th)2 immune response, whereas the chickens fed highly enriched VitA diet showed a Th1 immune response.

Animals↗
PubMed1994

Processing considerations for an EC latex coating system: influence of curing time and temperature.

The influence of curing time and curing temperature for a commercially available ethylcellulose latex coating dispersion (Aquacoat) were evaluated using response surface methodology. Levels for the factor curing time ranged from 30 to 300 minutes while levels for curing temperature ranged from 45 degrees to 75 degrees C. Responses, A, kappa, and gamma, were derived from regression analysis of the dissolution profiles and correspond to the maximum amount of drug released over the 12 hour sampling period, the rate of release, and the inflection point of the dissolution profile, respectively. The nature of the response surface was dramatically influenced by the plasticizer incorporated into the coating formula. When dibutyl sebacate was employed as the plasticizer, faster release resulted (higher A and kappa values, lower gamma values) when samples were exposed to higher curing temperatures or were stored for longer periods of time. Paradoxically, when tributyl citrate was used as the plasticizer, slower release resulted when samples were exposed to more rigorous conditions. Overall, curing temperature had a more dramatic effect than curing time.

Cellulose↗
PubMed1991

Pharmacokinetics and bioavailability of papaverine HCl following intravenous, peroral, rectal, vaginal, topical and buccal administration in beagle dogs.

This in vivo study was designed to obtain bioavailability data and a definite pharmacokinetic profile of papaverine HCl in Beagle dogs following intravenous (IV), peroral (PO), rectal, vaginal, topical, and buccal administration of different papaverine HCl formulations. Blood samples were analyzed by high-performance liquid chromatography. The pharmacokinetic parameters were determined using either a curve fitting program (RESID) or a compartment model independent program (AUC-RPP). The plasma concentration-time profiles show that papaverine HCl pharmacokinetics is best described by an open two-compartment model. The absolute bioavailability of papaverine HCl was determined to be 57.2 per cent, 25.2 per cent, 53.2 per cent, 3.2 per cent and 7.5 per cent, respectively, following P.O., rectal, vaginal, topical and buccal administration.

Administration, Buccal↗
PubMed1989

Role of interferon-gamma in inducing cytotoxicity of peripheral blood mononuclear leukocytes to bovine herpesvirus type 1 (BHV-1)-infected cells.

In the present study, the possible role of interferon (IFN)-gamma on the induction of cytotoxic activity of peripheral blood mononuclear leukocytes (PBML) from BHV-1-immune cattle was investigated. Supernatants obtained from BHV-1-immune PBML, stimulated under conditions similar to those required to demonstrate cytotoxicity, contained an antiviral substance capable of inducing 2'-5'-oligoadenylate synthetase activity in MDBK cells and MHC class II antigen expression on epithelial cells. These supernatants also contained IFN-alpha, but were devoid of tumor necrosis factor and interleukin-2 biological activities. Further studies during primary infection and hyperimmunization with BHV-1 showed that IFN-gamma production and non-MHC-restricted cytotoxicity against BHV-1-infected targets always occurred concomitantly, suggesting that they represent an important part of the detectable CMI responses mounted against this virus. Furthermore, it was also demonstrated that cytotoxicity of PBML against BHV-1-infected cells was reduced with the addition of antibodies to bovine IFN-gamma to the cytotoxic assay. Bovine recombinant IFN-gamma was able to enhance the in vitro cytotoxic activity of PBML from immune cattle, but not from their nonimmune counterparts. This suggests that other factors, in addition to IFN-gamma, may be essential in the development of non-MHC-restricted cytotoxic responses during BHV-1 infection.

Animals↗
PubMed1983

Comparison of intravenous and topical lidocaine in attenuating the cardiovascular responses to endotracheal intubation.

We administered lidocaine intravenously or topically to the larynx to compare the cardiovascular response to intubation between the two techniques and to determine if these responses were related to blood levels of lidocaine. Sixteen patients were randomly selected into group A (100 mg intravenous lidocaine) or group B (160 mg topical lidocaine). Neither method was completely effective in abolishing hypertension and tachycardia on intubation. The increase in pulse rate (PR) was more significant than the rise in mean arterial pressure (MAP) and was of longer duration. Significant increases in MAP were evident for less than two minutes in group A and less than three minutes in group B. Significant increases in PR were observed for approximately four minutes in group A and six minutes in group B. The average lidocaine blood level in group A was approximately 20 times that in group B at the time of intubation. The more prolonged and more significant increase in PR observed in group B indicates that intravenous administration of lidocaine may be superior to topical administration.

Administration, Topical↗
PubMed1981

Follow-up to: "Tension headaches: what form of therapy is most effective?'.

In an earlier study the authors reported on the relative effectiveness of three psychological methods of treating tension headache. This paper reports follow-up data on each procedure and focuses on variables seemingly related to long-term success. Follow-up occurred at 3, 6, and 12 months and involved 1 week of self-report records of headache activity and medication dosage. For the 30 original subjects, follow-up information was available for 23, 20, and 18 subjects, respectively, at each of the three follow-up periods. Questionnaire and physiological data indicated that the type of treatment offered was relevant only in explaining initial success. Continued practice of relaxation procedures seemed more important in explaining long-term outcomes. The relationship between type of training and continuing practice seemed to involve several heretofore unspecified "placebo' variables, which were explored and found to influence long-term success rates. Treatment procedures can presumably be modified to include these new variables, thus strengthening this therapeutic process.

Biofeedback, Psychology↗
PubMedDate not supplied

The hardiness of hospice nurses.

Hardiness is a developing concept of particular relevance and interest to nursing. Hardiness is defined as a personality construct that is an amalgam of three main elements: control, challenge and commitment. Kobasa asserts that an investment of committed energy serves to strengthen a person under stress or when faced with challenges. Hospice nurses confront a myriad of challenges associated with the rapidly changing needs of dying people and their friends and families. This author suggests that the very nature of palliative care requires mobilization of the same three constituents of hardiness, i.e., control, challenge, and commitment, blended with the key hospice elements of critical competence and compassionate care. This article considers a possible relationship between hardiness and hospice nurses, suggesting that not only are hospice nurses hardy, but that the very practice and philosophy of palliative care is predicated on a triad of control, challenge, and commitment harnessed in concert for the delivery of skilled, compassionate care to dying persons.

Clinical Competence↗
PubMedDate not supplied

Communicating with metaphor: a dance with many veils.

Health practitioners face many challenges when caring for and communicating with dying persons. As truth-tellers, we search for ways to communicate with honesty, sensitivity, and compassion. Creative use of language is one aspect of caring. Metaphorical communication can be a healing modality, one consistent with communication as an art. This article suggests that metaphor is a powerful and sensitive form of language that offers a range of characteristics particularly suitable for the art and the challenge of communicating with dying people. Metaphor, as figurative language, provides a permissible way of saying one thing and meaning another. It allows us to share a truth without the glare of reality. This author contends that metaphor is mysterious, creative, invitational, safe, open to interpretation, respectful and playful. The creative and judicious use of metaphor provides health care practitioners with many veils--veils that shield the dying from the glare of their prognosis, veils particularly valuable and suited in communicating with our palliative patient population.

Communication↗
PubMedDate not supplied

Partnership in education: an example of client and educator collaboration.

This article describes one education strategy designed to assist nursing staff in the process of "learning to surrender" the service providers' need to direct client decision-making. Using the health promotion principle of "client as expert," a nurse educator and a client with advanced multiple sclerosis co-present an inservice class about the importance of personal empowerment and environmental mastery for maintaining physical and psychological well-being in the face of a chronic disorder. This collaborative strategy provided the client a forum from which to share his personal experience and professional knowledge to influence attitudes and provide valuable information to nursing staff in a long-term care facility. Collaborating with the client to bring information to nursing staff is one means to foster a climate of client empowerment, influence staff perceptions and communicate the unique experiences of the client.

Chronic Disease↗