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Biomedical subjects

D McDowell

Publications and source records attributed to D McDowell.

At least 19 recordsLinked to original sources
PubMed1999

Pergolide mesylate for cocaine abuse: a controlled preliminary trial.

A small, controlled study was conducted to assess whether pergolide mesylate has clinical promise as a treatment for cocaine abuse prior to embarking on a larger, randomized, double-blind, controlled trial. Fourteen individuals were placed on placebo for 2 weeks, followed by a 24-week single-blind study in which they were placed on pergolide for 12 weeks, followed by placebo for 12 weeks. Another 14 patients received single-blind placebo for two weeks and then were randomized into a 24-week double-blind, placebo-controlled, multiple baseline design. Initially, patients enrolled in the study were placed on risperidone (n = 9) or placebo (n = 5). During the first 12 weeks, retention was worse for those receiving pergolide compared to risperidone or placebo. Neither risperidone nor pergolide were more efficacious in reducing cocaine use than placebo. Although earlier open studies found pergolide to show promise as a treatment for cocaine abuse, this study did not support these earlier findings. Comparing an agent to both an active control and placebo group may better predict whether a promising new agent will have clinical utility compared to the standard open trial.

Adult↗
PubMed1998

Problem of amputations in patients with newly diagnosed diabetes mellitus.

A reduction of 50% or more in diabetes-related amputations is a primary target of the St Vincent Declaration. This is thought to be achievable because both primary and secondary preventative healthcare strategies are effective in reducing the incidence of diabetic foot ulceration and progression to amputation. Unfortunately there is a group who cannot benefit from preventative health care, that is, newly diagnosed diabetic patients with already established severe complications. Using our population-based district diabetes information system we investigated, during the period 1 January 1992 to 31 December 96, the incidence and prevalence of lower extremity amputations (LEAs) and the proportion occurring in patients newly or recently diagnosed as having diabetes. Seventy-nine diabetic patients (59 male, 20 female) were recorded as having had 94 LEAs, the incidence of diabetes-related LEA being 475 per 100,000 diabetic patient-years. Of these LEAs 16 (20.2%) were performed within 1 year of diabetes being diagnosed. This study highlights an appreciable and previously unrecognized problem: patients presenting with established complications of diabetes who cannot benefit from secondary preventative healthcare. These patients pose a potential obstacle to achieving targets for reductions in diabetes-related amputations.

Adult↗
PubMed1998

V antigen of Yersinia pestis inhibits neutrophil chemotaxis.

V antigen (V), a secreted protein encoded by the 70 kb low-calcium response plasmid of Yersinia pestis, is an essential virulence factor. In animal models, it inhibits the early host inflammatory response to infection which is associated with decreased blood and tissue levels of proinflammatory cytokine synthesis. To elucidate further the pathogenetic mechanism(s) of V, in vitrosystems are needed to measure and analyse relevant functional activities of V. We studied the effect of V on the migration of neutrophils to a chemoattractant both in vivo and in vitro. Peripheral injection of V was associated with a reduction in the number of PMN migrating into s.c. sponges and i.p. exudates. Similarly, pre-incubating human peripheral blood neutrophils with >/=ng/ml V significantly inhibited the in vitro chemotactic response to the peptide chemoattractant FMLP. The inhibitory activity of V was inactivated by heat and was neutralized by rabbit polyclonal anti-V IgG as well as by sera from mice surviving infection with Y. pestis. Recombinant polyhistidine-tagged V fusion proteins retained biological activity compared to V proteins lacking the tag. Inhibition of chemotaxis appears to be the first demonstration of an in vitro biological effect of V and may be a useful model to elucidate its molecular mechanism of action.

Animals↗
PubMed1996

Spirituality and the treatment of the dually diagnosed: an investigation of patient and staff attitudes.

Spirituality is a neglected area of study and research in the treatment of addictions. The role of spirituality in the treatment of the dually diagnosed has received particularly scant attention. One hundred and one patients on an in-patient dual-diagnosis unit, as well as the 31 members of the nursing staff who treat them were surveyed. Patients and staff were questioned about their spiritual beliefs and what was the role of spirituality in the patients' recovery from addiction. Staff were questioned about their own spirituality and what they think the patients' level of spirituality is. In addition the staff were asked what they think the patients' view of spiritually is. Results indicate that the patients and staff are equally spiritually oriented. The patients view spirituality as essential to their recovery and value spiritual programming in their treatment more than some concrete items. The nursing staff underestimated both the patients' level of spirituality and this importance placed on spiritual issues. The authors suggest that more attention should be given by staff to spirituality in the treatment of this population.

Adult↗
PubMed1996

Medical student and patient attitudes toward religion and spirituality in the recovery process.

This study compares the views on spirituality of dually diagnosed patients (diagnosed with both substance abuse and general psychiatric disorders) and medical students in order to investigate their respective orientations toward spirituality and their views of the importance of spirituality in the treatment of addiction. We administered a modified version of Feagin's "Orientation to Life and God Scale" to assess religious and spiritual orientation in both the patients and students. A second series of items was developed and administered in order to compare the patients' and students' perceptions of the relative importance of a religious and spiritual orientation in substance abuse treatment. A third series of items was also given to compare the nature of religious and health-related services on the inpatient unit that patients and students most wanted to see improved. We found that the medical students responsible for treating substance abuse are significantly less religiously and spirituality oriented than the patients they treat, and that the students do not indicate that spirituality is an important component in the care of these patients. It may be clinically relevant to train medical students in the potential importance of spirituality in addiction treatment so that they can incorporate spirituality into the treatment of addictions.

Adult↗
PubMed1995

Evaluating graduate and undergraduate nursing students' computer skills to determine the need to continue teaching computer literacy.

1. INTRODUCTION. This descriptive study examined undergraduate and graduate nursing students' perceptions of their computer literacy skills to determine whether faculty should continue teaching basic computing skills in nursing programs. As in Bryson's study [1] the computer literate nurse is one who understands the concepts of hardware, software, and operating systems; who is able ot use the computer to learn; and who is able ot use such applications as word-processing, spreadsheets, and databases. Zeimer [2] predicted that by 1994 students entering nursing schools would be prepared to use computers and that further teaching of computer skills would not be needed. Some faculty, however, have felt that students are not entering nursing programs prepared to use computers. 2. TOOLS. A Level of Computer Experience (LCE) tool was developed to measure the computer literacy skills of students entering the first of three Masters' level nursing informatics courses over a six-year period. The instrument's 25 items determined experience with: operating systems, hardware, learning tools, applications, and information systems (IS) life cycle (design, selection, implementation, evaluation and project management). The instrument was modified for undergraduate students; this eliminated the items relating to the IS life cycle since these items reflect advanced skills. The resulting instrument was composed of the first 16 items of the original Level of Computer Experience tool. For each item, a four pint Likert scale allowed respondents to choose from the words "none," "some," "moderate," and "extensive" to describe their level of experience. For scoring purposes each word was assigned a numerical value as follows: none = 1, some = 2, moderate = 3, and extensive =4. 3. DATA. The LCE was administered to 65 sophomore nursing students and 74 graduate nursing informatics students. Undergraduate scored 4 items (use of microcomputer, use of IBM type computer, keyboard skills and use of WordPerfect). This score was above the 2 or 'some' experience level. Mean scores for all other items ranged between 1 and 2. Graduate informatics students also had higher mean scores for the 4 items. No mean scores reached the 'moderate' level for either group. One-way analysis of variances showed significant differences between the undergraduate and graduate students on the item concerning use of statistical packages. 4. CONCLUSIONS. In this population, both graduate and undergraduate nursing students continue to possess low levels of computer literacy skills. Since many students come into nursing programs without the capability of using information technology in practice, schools need to continue providing a way for students to obtain computer literacy skills.

Baltimore↗
PubMed1991

Central tumour necrosis: a cause for the acute presentation of benign meningiomas.

Occasionally, large benign intracranial tumours which have existed for many years present as a relatively acute problem. The mechanisms underlying the sudden change are sometimes unclear but infarction of the benign tumour, subsequent cerebral oedema and an increase in intracranial pressure have been reported. The authors describe such a case of focal infarction in a meningioma with a precise chronology of the clinical, radiological and pathologic findings.

Adult↗
PubMed1990

Neurocysticercosis--two Australian cases.

Two cases of neurocysticercosis, one with multiple small lesions and the other with a single cerebral cyst, are reported. Both patients presented with focal seizures and headaches years after likely exposure to Taenia solium eggs. These cases represent susceptible populations in Australia--migrants from and travellers in endemic areas.

Adult↗
PubMed1989

Agoraphobia with and without current panic attacks.

MMPI and SCL-90-R profiles of agoraphobics with and without current panic attacks are presented. Agoraphobics with current panic attacks were more elevated on Psychopathic Deviate (4), Psychasthenia (7), and Social Introversion (0) scales of the MMPI. On the SCL-90-R agoraphobics with current panic attacks had higher scores on Interpersonal Sensitivity, Anxiety, Phobic Anxiety, and Total/90.

Adult↗
PubMed1989

Plasma lipids: when to measure after myocardial infarction?

Current medical textbooks do not give clear advice on the optimal time to measure plasma lipids following myocardial infarction. Many physicians still defer the measurement for three months. We studied the plasma lipids in 132 patients with myocardial infarction. Measurements were made on admission and 24, 48 and 72 hours later and 103 patients had their plasma lipids measured at three months. Forty-three patients had hypercholesterolaemia (cholesterol greater than 7 mmol/1) at admission. Total cholesterol and low density lipoprotein fell appreciably in the first three days after myocardial infarction. The former returned almost to its admission level by three months, whilst the latter did not. Triglycerides showed no important changes, whilst high density lipoprotein levels had significantly increased at three months. Total cholesterol levels at three months were different from the 24, 48 and 72 hour values. Our findings suggest that plasma lipids should be measured on admission after myocardial infarction. Deferring the measurement by one or two days will give results which may not reflect pre-infarction levels.

Adult↗
PubMed1989

Alprazolam, propranolol, and placebo in the treatment of panic disorder and agoraphobia with panic attacks.

Fifty-five patients completed a 5-week double-blind study comparing alprazolam, propranolol, and placebo in the treatment of panic disorder and agoraphobia with panic attacks. There was no concomitant behavioral treatment. Patient and therapist rating scales included Sheehan's Panic and Anxiety Attack Scales, the Marks-Sheehan Phobia Scale, the Hamilton Anxiety Scale, the Hamilton Depression Scale, and the Side Effects Checklist. The results generally support the efficacy of alprazolam, but not propranolol, in the treatment of panic disorder and agoraphobia with panic attacks. The significance of the results are discussed, as well as a number of the unique aspects of our procedures and patient population.

Adolescent↗
PubMed1988

Porphyria cutanea tarda in association with the human immunodeficiency virus infection.

A 42 year old heterosexual male with symptomatic human immunodeficiency virus infection presented with a 2-week history of tense blistering skin lesions following azidothymidine therapy. Urinary porphyrin excretion confirmed the diagnosis of porphyria cutanea tarda. The blisters resolved following the withdrawal of the drug but recurred when rechallenged. Three other cases of porphyria cutanea tarda, not associated with azidothymidine, who subsequently developed acquired immunodeficiency syndrome have recently been described. If azidothymidine is not the precipitating agent, it is possible that human immunodeficiency virus itself can impair porphyrin metabolism, leading to the clinical and biochemical features of porphyria cutanea tarda.

Acquired Immunodeficiency Syndrome↗