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Biomedical subjects

F Baker

Publications and source records attributed to F Baker.

At least 37 records · Page 2Linked to original sources
PubMed1997

Role of an improvement in acid-base status and nutrition in CAPD patients.

Short-term correction of metabolic acidosis in normal and uremic subjects has been shown to decrease protein degradation, but the long-term effects of better correction of acidosis on nutrition in ESRF are unknown. The aim of this study was to assess the possible benefits, in the nutritional state and morbidity, of improved correction of acidosis in the first year of treatment with continuous ambulatory peritoneal dialysis (CAPD). Two hundred consecutive new CAPD patients were randomized, in a single-blind fashion, to receive a high (HA; lactate 40 mmol/liter) or low (LA; lactate 35 mmol/liter) alkali dialysate for one year. Calcium carbonate and sodium bicarbonate were also used to correct acidosis in the HA group. At one year, the venous serum bicarbonate and arterial pH were 7.44 +/- 0.004 and 27.2 +/- 0.3 mmol/liter in the HA group, and 23.0 +/- 0.3 mmol/liter and 7.4 +/- 0.004 in the LA group (P < 0.001). Dialysis dose, at one year or at the point of leaving the study (HA 8.0 +/- 0.1 liters/day vs. LA 8.5 +/- 0.3 liters/day) was not significantly different (P = 0.18). At one year, the increase in body weight in the HA group (6.1 +/- 0.66 kg) was higher than in the LA group (3.71 +/- 0.56 kg, P < 0.05). The increase in midarm circumference in the HA patients (1.26 +/- 0.16 cm) was significantly higher than the increase in the LA patients (0.61 +/- 0.16 cm, P < 0.05). The increase in triceps skinfold thickness were not significantly different (HA 2.5 +/- 0.41 mm vs. LA 1.24 +/- 0.38 mm, P = 0.1). Serum albumin was 37.8 +/- 0.4 g/dl at one year in the HA group, and 38.2 +/- 0.5 g/dl in the LA group (NS). Dietary protein intake at one year (HA 0.9 +/- 0.2 g/kg/day vs. LA 1.0 +/- 0.1 g/kg/day) was not significantly different. There were fewer hospital admissions in the HA group (1.13 +/- 0.16 per patient per year) compared to the LA group (1.71 +/- 0.22 per patient per year, P < 0.05). The HA patients spent less days in hospital per year than the LA patients (16.4 +/- 1.4 days/year vs. 21.2 +/- 1.9 days/year; P < 0.05). It is concluded that better correction of metabolic acidosis leads to greater increases in body weight and midarm circumference, but not triceps skinfold thickness, in the first year of CAPD. The improvement in morbidity, in terms of number of admissions and days in hospital per year, may be associated with the improvement in nutritional state.

Acid-Base Equilibrium↗
PubMed1996

Coping with the physical and psychosocial sequelae of bone marrow transplantation among long-term survivors.

We used a situation-specific approach to investigate common problems and associated coping processes among long-term survivors of bone marrow transplantation (BMT). Surveys were returned by 156 of the 191 (82%) eligible BMT survivors. Work and finance problems were endorsed relatively infrequently by respondents; physical problems and existential concerns were much more common. Problem occurrence was significantly related to demographic and treatment variables. The choice of coping mechanisms was related to the type of problem being faced: Significant effects were observed for four coping mechanisms from the COPE Inventory-active coping, suppression of competing activities, restraint, and acceptance. The differences were between one type of problem, infertility concern, and one or more of three other categories of problems (other physical problems, existential concerns, and work/finance problems) nominated by survivors. Some methodological considerations and directions for future research are outlined.

Adaptation, Psychological↗
PubMed1996

Amino acid profiles and muscle protein composition in rats with a reduced renal mass in the fed state.

In severe chronic renal failure (CRF) with associated metabolic acidosis, abnormalities in protein metabolism and amino acid (AA) profiles in the fed state are well described. To evaluate the effect of early uraemia and the influence of acid-base status on protein metabolism and AA profiles, three groups of pair-fed rats were studied: group I - rats with 1+ 1/2 nephrectomy; group II - rats with 1+ 1/2 nephrectomy receiving NaHCO3 supplementation, and group III - sham-operated rats with NaHCO3 supplementation. After 4 weeks, serum creatinine values were similar in groups I and II (111 +/- 5 and 119 +/- 4 mumol/l) and higher than in group III (51 +/- 5 mumol/l, p < 0.0001); HCO-3 was reduced only in group I (22.4 +/- 0.8 mmol/l) compared to group II (28.3 +/- 0.6 mmol/l, p < 0.001) and group III (28.2 +/- 1.3 mmol/l, p < 0.001). In the uraemic animals (groups I and II) arterial AA profiles showed increased levels of phenylalanine, glycine, glutamate, proline and alanine. The marked increase of threonine in group I was corrected by NaHCO3 supplementation in group II. The total nonessential AA were higher both in group I (1,832 +/- 53 mumol/l, p < 0.05) and group II (1,788 +/- 103 mumol/l, p < 0.05) than in group III (1,542 +/- 54 mumol/l). These results are similar to those described in the fed state of uraemic patients. Intracellular AA changes were detected, especially in group II namely increased glycine and a decrease in threonine and serine levels. No signs of malnutrition or changes in alkali-soluble protein (ASP) or ASP/DNA ratio in liver and muscle were observed. These results show that AA abnormalities in the fed state occur early in the course of CRF, and that the marked increase of threonine is corrected by NaHCO3 supplementation. These data suggest that either an impaired utilization of the ingested proteins might occur before the appearance of major alterations in endogenous protein metabolism or acid-base status might alter AA metabolic rate per se.

Acid-Base Equilibrium↗
PubMed1996

Empirically selected instruments for measuring quality-of-life dimensions in culturally diverse populations.

We describe a process for developing and testing the cultural equivalence of quality-of-life (QOL) instruments that may be used across culturally diverse populations. QOL instruments dealing with satisfaction with various life domains, psychological distress, and physical health and functioning were reviewed by African-American and Hispanic community advisory boards, translated into Spanish and back-translated to ensure translation adequacy, administered to samples of 100 patients from each of the ethnic minority populations by indigenous nurse interviewers, and examined for psychometric adequacy. Ten QOL measures showed adequate reliability and validity for further use in the assessment of QOL with African-American and Hispanic patients. Three other measures failed to meet the defined standards. A dimension shown to be particularly difficult to address across culturally diverse groups is family functioning. Procedures for achieving cultural equivalence of QOL measures have been shown to be practical and productive. Measures are identified that may be used with some confidence to assess varied dimensions of QOL with culturally diverse groups.

Adult↗
PubMed1995

Peritonitis rate: traditional versus low calcium dialysate.

The results of nonrandomized retrospective studies have suggested that low calcium dialysate (LCD; ionized calcium concentration 1.25 mmol/L) is associated with a higher peritonitis rate than traditional dialysate (TD; ionized calcium concentration 1.75 mmol/L). For this reason, 86 consecutive new continuous ambulatory peritoneal dialysis patients were randomized, in a single-blind fashion, to TD or LCD for 1 year. The results were analyzed on an intention-to-treat basis, no matter what fluid or what modality of treatment was being used at the end of the year. The two groups were well matched at baseline. At 1 year, 28 of 43 TD patients were still on continuous ambulatory peritoneal dialysis (one had a catheter changed due to peritonitis), four had a working transplant, one had recovered renal function, nine had died, and one had been transferred to hemodialysis because of peritonitis. Twenty-seven of 43 LCD patients were on continuous ambulatory peritoneal dialysis (one catheter change), nine had a working transplant, six had died, and one was on hemodialysis. There were 17 proven (33 possible) peritonitis episodes in 417 patient-months in the TD group. In the LCD group, there were 17 (35 possible) episodes in 432 patient-months. The proven peritonitis rate was 0.49 episodes/patient/yr in the TD group versus 0.48 episodes/patient/yr in the LCD group (P = NS). In conclusion, there is no controlled evidence that LCD is associated with a higher incidence of peritonitis than TD.

Calcium↗
PubMed1994

In vitro parameters and treatment outcome in head and neck cancers treated with surgery and/or radiation: cell characterization and correlations with local control and overall survival.

PURPOSE: To determine whether in vivo parameters (surviving fraction at 2 Gy, alpha values, and calculated cell growth fraction) were predictive of the treatment outcome. METHODS AND MATERIALS: Biopsies were obtained from patients with a head and neck tumor. In vitro parameters were determined using the CAM plate assay. Cell characterization by cytogenetic analysis was performed on 19 different cell cultures. In 25 additional cell cultures, cell clonogenicity was tested using the Courtenay Mills assay. RESULTS: Biopsies were obtained from 156 patients with a head and neck tumor and the oropharynx was the predominant primary site. In vitro parameters were obtained in 113 cases (72%) (SF2 in 93 cases and calculated cell growth fraction in 103 cases). Cell characterization showed that cells in CAM plates were diploid with no clonal chromosome abnormalities and gave colonies in soft agar with a mean cloning efficiency of 1.610(-3). Only patients treated with surgery and/or radiation (76), were considered eligible for in vitro parameters and treatment outcome correlation studies. The mean follow-up is over 2 years (range 9-47 months). The local control rate was significantly higher (p = 0.04) for patients with alpha values above the cut-off point of 0.07 Gy-1 (69% vs. 38% at 2 years). The local control rate was also significantly higher (p = 0.04) for patients with calculated cell growth fraction values about the cut-off point of 0.06% (70% vs. 48% at 2 years). Moreover for these latter patients the overall survival rate was also significantly higher (p = 0.004) (54% vs. 26% at 2 years). It is worth noting that alpha and calculated cell growth fraction values below the cut-off points identified a small group of patients (about 20%) who were at a significantly high risk of local failure. From a pragmatic point of view, as only radiosensitivity or calculated cell growth fraction values could be obtained in a certain number of experiments due to technical reasons, the treatment outcome of patients who had either alpha and/or calculated cell growth fraction values below the cut-off levels (about 30% of all patients) was analyzed. This group of patients fared significantly worse (p = 0.02) in terms of local control (50% vs. 68% at 2 years) and (p = 0.04) overall survival (36% vs. 50% at 2 years). CONCLUSION: These results suggest that in vitro parameters using the CAM plate assay, might be useful in predicting the treatment outcome of patients with a head and neck tumor treated with surgery and postoperative radiation, or radiation alone. However, they must be considered as preliminary because the cut offs used in the study were chosen for exploratory purposes. Only a multivariate analysis including all clinical and biologic factors will allow us to draw any firm conclusions.

Carcinoma, Squamous Cell↗
PubMed1994

Psychosocial sequelae of bone marrow transplantation.

Bone marrow transplantation is a particularly arduous treatment and a source of considerable stress for patients and their families. Psychological sequelae include psychological distress, concern about loss of control, physical complications, sexual dysfunction, difficulties in social relationships, occupational disability, and financial consequences. Patient education that can help BMT recipients and their families know what to expect at the different stages of treatment may help alleviate anxiety and fear of the unknown. Communication should be individualized according to the needs of the particular patient and family. The patient's ability to use information should be considered in deciding what to convey to him or her. To be most effective, patient education should take place throughout the BMT process and should be multidisciplinary.

Anxiety↗
PubMed1994

Quality of life of bone marrow transplant long-term survivors.

Adult survivors of bone marrow transplantation not in life threatening relapse were surveyed with a mailed questionnaire 6-149 months after transplant. Of 171 eligible patients, 157 were contacted and 135 (86%) responded. Survivors showed a high degree of overall satisfaction with major life domains but were least satisfied with their bodies, level of physical strength and ability to attain sexual satisfaction. Positive and negative affect were higher than general population samples and less tension, fatigue, confusion and depression were displayed than comparison groups. Multiple regression analyses showed that self-esteem and level of current physical functioning made significant contributions to predicting multiple quality-of-life outcomes. Previous graft-versus-host disease was predictive of low satisfaction with life domains. Lack of social support was predictive of anger and Negative Affect. Transplantation at a younger age was related to overall life satisfaction, vigor and Positive Affect. Women showed more Negative Affect than men. Time since transplant related to level of confusion among patients. Most survivors reported high levels of perceived quality of life on multiple indicators. Self-esteem, current level of physical functioning, social support and age at bone marrow transplantation were predictive of quality of life outcomes.

Adolescent↗
PubMed1993

Community support services and functioning of the seriously mentally ill.

A cohort of 729 chronically mentally ill patients receiving community support services (CSS) were followed over a nine-month period. Receiving needed community support services was shown to predict change in client functioning as measured by the Global Assessment Scale (GAS) even after the initial values on the GAS, as well as demographic, psychiatric, residential and medication maintenance variables were considered. Adequacy of social support from family, friends and others also contributed to predicting change in global functioning of the CSS patients.

Adolescent↗
PubMed1993

Personal changes, dispositional optimism, and psychological adjustment to bone marrow transplantation.

We investigated the number and direction of personal changes experienced by long-term survivors of bone marrow transplantation (BMT) and the relationships of those changes and dispositional optimism to psychological adjustment (current and future life satisfaction and mood). Surveys were returned by 86.0% (N = 135) of all eligible long-term survivors; respondents primarily were young males who were 6 to 149 months post-BMT. Subjects reported more positive changes in the relationship and existential/psychological domains and more negative changes in the physical health domain; there was no difference on the plans/activities domain. Negative changes were more strongly related to adjustment than were positive changes. The number of negative changes reported was significantly related to current and future life satisfaction and negative mood after controlling for demographic and illness variables and dispositional optimism. The interaction term for negative and positive changes was significantly related to future life satisfaction after controlling for all other variables.

Adaptation, Psychological↗
PubMed1993

Early increase in glomerular leucocyte number after a reduction in renal mass: implications for the pathogenesis of glomerulosclerosis.

1. Adult female Wistar rats underwent uninephrectomy (n = 8) through a flank incision, or a sham operation (n = 7). One to two weeks later the kidney was perfused in situ and glomeruli were isolated from cortical tissue by sequential sieving, and partially digested. Glomerular leucocytes were labelled with a mouse monoclonal antibody against leucocyte common antigen followed by a fluorescein-labelled anti-mouse immunoglobulin to allow counting. 2. In a further group of animals 24 h albumin excretion and glomerular size were measured 2 weeks after either uninephrectomy (n = 6) or sham operation (n = 6). 3. Glomerular leucocyte number was significantly increased in uninephrectomized animals (15.7 +/- 0.9 versus 8.9 +/- 0.4, P < 0.001), with some glomeruli having leucocyte numbers comparable with those seen in glomerulonephritis. 4. Albuminuria was not increased 2 weeks after uninephrectomy (233 +/- 35 versus 170 +/- 42 micrograms/24 h, not significant), and glomerular size was unchanged. Light microscopical appearance was normal. 5. An increase in glomerular leucocyte number is an early response in what was previously considered a non-immunological lesion. It precedes the development of renal scarring and may be important in the pathogenesis of this process.

Albuminuria↗
PubMed1993

Effects of acid loading on serum amino acid profiles and muscle composition in normal fed rats.

1. Impaired body growth, loss of lean body mass and negative nitrogen balance are common findings in chronic renal failure. Enhanced endogenous protein catabolism in skeletal muscle induced by co-existent metabolic acidosis seems to be an important aetiological factor. 2. In uraemic patients abnormalities in blood amino acid profiles are present after a protein meal, suggesting impaired metabolism of ingested proteins. 3. This study demonstrates that acidosis induces changes in arterial amino acid profiles in fed non-uraemic rats. These included increased levels of threonine, histidine, proline, serine and glycine, and decreased levels of tryptophan. These changes are similar to those found in uraemic patients after a protein meal, suggesting a pathogenic role of acidosis in the impairment of exogenous protein metabolism. 4. Intracellular amino acid levels in the muscle tissue partly reflect the changes in the extracellular level. 5. Acidotic animals had a decreased body weight gain and a reduced alkali-soluble protein/DNA ratio in muscle cells compared with controls. 6. In conclusion, the results show that acidosis per se modifies the circulating amino acid profile in fed rats, resulting in a pattern similar to the post-prandial amino acid changes described in uraemic patients. These abnormalities occur together with impaired growth of skeletal muscle cells.

Acidosis↗
PubMed1993

Working together in Europe.

With the recent formation of the Federation of Occupational Health Nurses within the European Community (FOHNEC) there is now hope for closer cooperation between European OHNs. Frances Baker, UK delegate to the Federation, describes events leading to its formation and outlines its aims.

European Union↗