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D Morgan

Publications and source records attributed to D Morgan.

At least 91 records · Page 5Linked to original sources
PubMed2000

Pulsed lavage: promoting comfort and healing in home care.

The purpose of this study was to determine if hydrodebridement with pulsed lavage facilitates the removal of necrotic tissue, promotes healing, and increases comfort in the homebound patient. Home healthcare provides cost-effective care in the setting that is most conducive to healing. People want to be at home, yet many illnesses require services that cannot be obtained at home. Wound care sometimes falls into this category. Pulsed lavage has expanded treatment options for the homebound patient. Hydrodebridement with pulsed lavage is site specific, avoids cross contamination, and is less expensive than whirlpool therapy. It also may facilitate the removal of necrotic tissue and promote the formation of healthy granulation tissue. The authors performed a retrospective audit to gather data on 28 patients who received pulsed lavage treatments at home. A descriptive analysis of five variables that affect healing was undertaken including mobility/activity, nutritional status, cardiovascular/respiratory status, continence, and sensory perception. All of the clients in the sample achieved a clean, warm, moist wound bed, free of signs and symptoms of infection, absence of necrotic tissue, and the presence of granulation tissue to meet the definition of "ready for healing" as presented in the literature. The majority of clients experienced no pain. Although comorbid conditions required rehospitalization for 35.7% of the sample, the conditions did not interfere with healing. Hydrodebridement with pulsed lavage is a viable nontraumatic, noninvasive, site-specific treatment alternative for patients receiving care in the home.

Aged↗
PubMed2000

Don't beam me up

Explore the source record for details and available documents.

Journal Article↗
PubMed2000

Recent advances in surgery for snoring-somnoplasty (radiofrequency palatoplasty) a pilot study: effectiveness and acceptability.

A prospective study was designed to investigate the effects of Somnoplasty (Radiofrequency palatoplasty) in patients with snoring. A group of 22 patients fulfilling the inclusion and exclusion criteria outlined underwent somnoplasty performed by a single surgeon. Every patient completed a standard questionnaire containing visual analogue scales at six weeks post operatively. The parameters assessed were post-operative pain, change in snoring score, effects on sleep of the patient and bed partner, speech and swallowing, alteration in weight, acceptance of the procedure and recommendation to friends and family. Results of improvement in snoring score were correlated to body mass index (BMI) kg/m2. We conclude that somnoplasty is an effective procedure in elimination of snoring and the success is closely linked to BMI. Best response is obtained in those with BMI < 25 and moderate response is obtained in those with BMI between 25-30. Obese (BMI > 30) patients are more likely to have a poor response. Morbidity associated with the procedure is minimal and patient acceptance is 100%. The long-term success of this procedure needs to be confirmed with further follow up.

Adult↗
PubMed1999

The prognostic value of the World Health Organisation staging system for HIV infection and disease in rural Uganda.

OBJECTIVE: To assess whether the WHO staging classification for HIV provides prognostically valuable and applicable information in rural Uganda. PATIENTS AND STUDY DESIGN: Data were obtained from a population-based cohort of 232 HIV-infected individuals. METHODS: Clinical information was obtained using a detailed questionnaire and ascertained by physical examination. Participants were seen routinely every 3 months and when they were sick. A computer algorithm based on clinical history, examination and laboratory findings was used to stage HIV-positive participants at each routine visit. Kaplan-Meier survival estimates and the Cox proportional hazard model were used to assess the prognostic strength of the clinical and laboratory categories of the system. RESULTS: An attendance rate of 81% and 799 person-years of follow-up were achieved. Survival probability estimates at 6 years from being seen in clinical stages 1, 2, 3 and 4 were 63, 46, 24 and 6% respectively. When staging was revised to incorporate lymphocyte categories, the survival probabilities were 73, 62, 39 and 6% respectively. Unexplained prolonged fever and severe bacterial infection had survival probabilities closer to stage 2 conditions, mucocutaneous herpes simplex virus infection for more than 1 month and crytosporidiosis with diarrhoea for more than 1 month closer to stage 3 and oral candidiasis closer to stage 4 conditions. CONCLUSIONS: Even without the laboratory markers, the clinical category of the WHO staging system is useful for predicting survival in individuals with HIV disease. This is important for areas with limited access to laboratory markers. A simple rearrangement of a few clinical conditions could improve the prognostic significance of the WHO system.

AIDS-Related Opportunistic Infections↗
PubMed1999

Reduced fertility associated with HIV: the contribution of pre-existing subfertility.

BACKGROUND: HIV-1 infection is associated with lower fertility among women in sub-Saharan Africa and this association is not explained by the frequency of sexual intercourse, illness, knowledge of HIV status or infection with other sexually transmitted diseases. Women with fertility problems are at increased risk of marital instability and, therefore, HIV infection; consequently, pre-existing subfertility among HIV-infected women may contribute to the association. OBJECTIVE: This study examines the relationship between HIV-1 infection and the incidence of recognised pregnancy and the role of low gravidity prior to seroconversion in rural Uganda. METHODS: A group of 176 women (80 HIV infected and 96 uninfected) were enrolled into an HIV-1 natural history cohort and invited to attend 3-monthly clinic appointments. Data from clinic visits were analysed to assess the independent effects of HIV infection and age, lactation, illness, reported frequency of sexual intercourse and sexually transmitted diseases (STD) on the risk of pregnancy in the following 3 months. The number of previous pregnancies was recorded at enrolment, and the effect of gravidity was examined for the subgroup of women who were uninfected at enrolment or who enrolled within 2 years of their estimated seroconversion date. RESULTS: During follow-up, 124 pregnancies were observed in 83 women beginning in the 3 months following 47 (7.0%) of 669 visits made by HIV-infected women and 77 (9.5%) of 812 visits by HIV-negative women (P = 0.12). Adjusting for age, lactation, illness, STD and the reported frequency of sexual intercourse, the estimated reduction in the risk of pregnancy associated with HIV infection was 47% [95% confidence interval (CI) 18-66]. Pre-existing low gravidity was strongly associated with a reduced incidence of pregnancy (odds ratio 0.39; CI 0.19-0.81). Additionally, adjusting for low gravidity reduced the estimate of the effect of HIV infection by almost a half, to 25% (95% CI-57-29). CONCLUSION: Low gravidity prior to seroconversion accounts for almost 50% of the observed association between HIV infection and lowered incidence of pregnancy, after adjusting for age, lactation, illness, STD and the frequency of sexual intercourse.

Adolescent↗
PubMed1999

HIV-1 RNA levels in an African population-based cohort and their relation to CD4 lymphocyte counts and World Health Organization clinical staging.

Apart from a small number of reports from people who are based in hospitals, data on viral load in HIV-infected people in sub-Saharan Africa, where most infections occur, are lacking. We report serum HIV-1 RNA levels in a population-based cohort in rural Uganda using the nucleic acid sequence-based amplification procedure (NASBA) test kit and describe their relation to CD4 counts and World Health Organization (WHO) clinical staging. The median (interquartile range [IQR]) viral loads were 87,000 copies/ml (37,500-295,000 copies/ml) in 40 prevalent cases infected for >6 years, and 31,000 copies/ml (7800-174,000 copies/ml) in 65 incident cases with seroconversion dates within the previous 6 years. Although we found a correlation between viral load and absolute CD4 count (p < .0001), there was no evidence for an association with CD4 decline (p = .1). Overall, there was a significant trend of increasing viral load with worsening clinical stage from a median viral load of 15,000 for those in WHO stage 1 (asymptomatic) to 150,600 copies/ml for those in stage 4 (AIDS; p < .001). However, the association was seen only in incident cases. Thus, we found that the NASBA test on serum was a useful indicator of disease stage especially in persons known to be infected for <6 years. Such baseline data are important for vaccine research, and if antiretroviral drugs become available to more than a few people in Africa, it will be important that accurate viral load estimations are available at least in a proportion of people to monitor the effectiveness of treatment, and measure the compliance and emerging resistance to these drugs.

Adult↗
PubMed1999

Phylogenetic relationships of the enigmatic angiosperm family Podostemaceae inferred from 18S rDNA and rbcL sequence data.

The phylogenetic relationships of some angiosperm families have remained enigmatic despite broad phylogenetic analyses of rbcL sequences. One example is the aquatic family Podostemaceae, the relationships of which have long been controversial because of major morphological modifications associated with their aquatic habit. Podostemaceae have variously been associated with Piperaceae, Nepenthaceae, Polygonaceae, Caryophyllaceae, Scrophulariaceae, Rosaceae, Crassulaceae, and Saxifragaceae. Two recent analyses of rbcL sequences suggest a possible sister-group relationship of Podostemaceae to Crassulaceae (Saxifragales). However, the branch leading to Podostemaceae was long, and use of different outgroups resulted in alternative placements. We explored the phylogenetic relationships of Podostemaceae using 18S rDNA sequences and a combined rbcL + 18S rDNA matrix representing over 250 angiosperms. In analyses based on 18S rDNA data, Podostemaceae are not characterized by a long branch; the family consistently appears as part of a Malpighiales clade that also includes Malpighiaceae, Turneraceae, Passifloraceae, Salicaceae, Euphorbiaceae, Violaceae, Linaceae, Chrysobalanaceae, Trigoniaceae, Humiriaceae, and Ochnaceae. Phylogenetic analyses based on a combined 18S rDNA + rbcL data set (223 ingroup taxa) with basal angiosperms as the outgroup also suggest that Podostemaceae are part of a Malpighiales clade. These searches swapped to completion, and the shortest trees showed enhanced resolution and increased internal support compared to those based on 18S rDNA or rbcL alone. However, when Gnetales are used as the outgroup, Podostemaceae appear with members of the nitrogen fixing clade (e.g., Elaeagnaceae, Ulmaceae, Rhamnaceae, Cannabaceae, Moraceae, and Urticaceae). None of the relationships suggested here for Podostemaceae receives strong bootstrap support. Our analyses indicate that Podostemaceae are not closely allied with Crassulaceae or with other members of the Saxifragales clade; their closest relatives, although still uncertain, appear to lie elsewhere in the rosids.

DNA, Ribosomal↗
PubMed1999

Parathyroid hormone secretory response to EDTA-induced hypocalcemia in black and white premenopausal women.

One consistent racial difference in mineral homeostasis is increased efficiency of renal calcium conservation in blacks which could account, in part, for differences in bone density and fracture risk. Since parathyroid hormone (PTH) is the major regulator of calcium homeostasis, we investigated its secretion in black and white women in response to hypocalcemia. Two hour EDTA infusions (50 mg/kg) were performed in 34 premenopausal women (17 black, 17 white). Blood was sampled at 30-minute intervals during the infusion, at 60-minute intervals for 3 more hours, and at 24 hours. Serum ionized calcium decreased identically in both groups with a nadir at 2 hours and returned to baseline within 24 hours. Serum 1-84 PTH levels rose similarly in both groups with a peak PTH level that was slightly higher in black women, and on average, slightly earlier than that in white women. Serum PTH levels remained elevated in both groups at 24 hours with no overall group differences in PTH response. In black, but not white women, serum 25OHD levels correlated negatively with both basal PTH and peak PTH level, achieved with infusion. Serum 1, 25(OH)(2)D levels rose and osteocalcin levels decreased, with no group differences. We conclude that overall, premenopausal black women show no clear differences in PTH secretory activity to an EDTA-induced hypocalcemic stimulus. Basal vitamin D status appeared to be a determinant of the degree of the PTH response in black women, with the peak PTH level being inversely correlated with levels of 25OHD. Since we have previously shown that the skeleton contributes less to acute calcium needs in blacks than in whites, the lack of a racial difference in PTH secretory responsivity suggests that calcium homeostasis is more likely maintained in blacks through greater PTH sensitivity at extraskeletal sites, such as the kidney.

Adult↗
PubMed1999

Effects of neuropeptide Y on the discriminative stimulus and antinociceptive properties of morphine.

Previous research indicates that opioid receptor blockade diminishes the effects of neuropeptide Y (NPY) on feeding and memory. Conversely, NPY attenuates naloxone-precipitated morphine withdrawal. The present study evaluated the effects of NPY on the discriminative stimulus and antinociceptive effects produced by the prototypical mu opioid, morphine. Rats were trained to discriminate 5.6 mg/kg morphine (IP) from saline using a standard two-lever, food-reinforced, drug discrimination procedure. Across a range of doses (3.0, 5.0, and 10 microg), intracerebroventricular (ICV) injection of NPY failed to substitute for, antagonize, or potentiate the discriminative stimulus effects of morphine. A warm-water tail-withdrawal procedure was used to examine the antinociceptive effects of morphine and NPY, alone and in combination. NPY (3.0 and 10 microg, ICV) failed to alter tail-withdrawal latencies from 52 degrees and 56 degrees C water, whereas morphine (1.0-30 mg/kg, IP) produced a dose-related increase in latencies at both water temperatures. A 10-microg dose of NPY also failed to alter the antinociceptive effects of morphine. This study does not support the idea that the discriminative stimulus and antinociceptive effects of morphine are dependent on an NPYergic pathway.

Analgesics, Opioid↗
PubMed1999

Behavioral changes in transgenic mice expressing both amyloid precursor protein and presenilin-1 mutations: lack of association with amyloid deposits.

Mutations in the amyloid precursor protein (mAPP) and in presenilin 1 (mPS1) have both been linked to increased production of the beta-amyloid peptide (A beta). Doubly transgenic mice produced by mating of a parental line carrying the "Swedish" (K670N/M671L) APP mutation with a FAD4 (M146L) mutant presenilin 1 line developed numerous fibrillar A beta deposits by 6 months of age. Prior work demonstrated that mAPP and doubly transgenic (mAPP/mPS1) mice have deficits in Y-maze alternation behavior as early as 3 months of age. Increased activity was also apparent in the mAPP/mPS1 mice at this time point. These changes in Y-maze performance persisted in mAPP/mPS1 mice at 6 and 9 months of age. The mPS1 singly transgenic mice were not impaired on this task at any age. Six- and nine-month-old mice were also tested for spatial navigation behavior in the Morris water maze. In training trials, no differences in escape latency were detected among the four genotypes. In probe trials, no differences were detected in either the time spent in the trained quadrant or the number of platform crossings among the four groups. Histological staining for A beta amyloid deposits indicates that all doubly transgenic mice have amyloid deposits by 6 months of age (roughly 25 mice examined thus far), yet no 3-month-old mice have been found with deposits. A beta immunostaining confirmed that the 9-month-old mice tested behaviorally also have A beta deposits. Thus, doubly transgenic mice exhibited changes in Y-maze performance prior to the formation of amyloid deposits, which are essentially unchanged as the deposits increase in number and size to 9 months of age. Yet these mice fail to reveal impairments in spatial navigation at 6 or 9 months in spite of the increasing plaque burden. These data indicate that A beta deposits alone are not sufficient to cause robust spatial memory impairment in mice of this mixed background lineage and age.

Alzheimer Disease↗
PubMed1999

Discharging older people from hospital to care homes: implications for nursing.

This paper summarizes a research study which explored the experiences of older people being discharged from hospital to nursing and residential homes in the North East of England. While there has been considerable research which has looked at the discharge of patients from hospital to their own homes, little literature could be found which addressed discharge to care homes. While this may reflect an assumption that this form of discharge is less problematic, it is arguable that this is only the case for staff - there is a body of literature on re-location which suggests that the move to a care home is a major life event for older people. Taking a qualitative approach, this study interviewed 20 older people and 17 of their family members after discharge from hospital to a care home. We found that few people had been offered opportunities to discuss their move with nurses, and that older people tended to adopt a stoical attitude. In focus groups, interviews and written responses from 23 members of staff in the hospital and in care homes, we found that there was a lack of clarity over whose role it was to initiate such discussions. The paper concludes with some discussion of the implications for nursing practice of changing care interfaces.

Aged↗
PubMed1999

The burden of mucocutaneous conditions and the association with HIV-1 infection in a rural community in Uganda.

OBJECTIVE: To determine the prevalence of mucocutaneous conditions and their association with HIV-1 infection in a rural community in Uganda. METHODS: In a prospective cohort study, participants were recruited from a large population study and invited to attend a clinic every 3 months for a detailed medical interview and a thorough physical examination. All findings including mucocutaneous findings were coded onto a standard questionnaire. RESULTS: By the end of 1996, 436 participants had provided 1450 person years of observation (pyo); 646 pyo in HIV-positives and 804 pyo in HIV-negatives. Overall, 70% of participants had a skin condition during follow-up, and although skin conditions were significantly more common in HIV-positive subjects, the background level in HIV-negative subjects was high (77.3% and 63.6%, respectively). Herpes zoster, thin/sparse hair, maculo-papular rash and prurigo were significantly more common in the HIV-positives. Kaposi sarcoma, palmar/plantar rash and herpes zoster had positive predictive values for HIV infection of over 80%. Oral conditions were found in over 40% of participants and were significantly more common in HIV-positive subjects. Oral candidiasis and Kaposi sarcoma were significantly more frequent among HIV-positives. CONCLUSION: HIV infection increases the already high burden of mucocutaneous diseases in this rural population. We identified some conditions that are more common in HIV and others that can be used as indicators of HIV infection.

AIDS-Related Opportunistic Infections↗
PubMed1999

Expression of interferon-beta is associated with growth arrest of murine and human epidermal cells.

The cytokine interferon-beta is a regulator of cell replication and function, including invasion and induction of angiogenesis. The goal of this study was to determine whether the expression of interferon-beta by cells in the epidermis correlated with terminal differentiation. In situ hybridization analysis and immunohistochemical staining of formalin-fixed, paraffin-embedded specimens of normal human and murine epidermis and human and murine skin tumors of epithelial origin revealed that only differentiated, nondividing cells of the epidermis expressed interferon-beta protein. Keratinocyte cultures established from the epidermis of 3 d old mice were maintained under conditions permitting continuous cell division or induction of differentiation. Continuously dividing cells did not produce interferon-beta whereas nondividing differentiated cells expressing keratin 1 did. Growth-arrested, undifferentiated keratinocytes also expressed interferon-beta protein. Neutralizing interferon-beta in the culture medium inhibited differentiation, but the addition of exogenous interferon-beta did not stimulate differentiation. These data indicate that interferon-beta is produced by growth-arrested, terminally differentiated keratinocytes.

Animals↗