Biomedical subjects
Publications and source records attributed to G C Forrest.
The psychological care of preterm babies and their families is challenging and at least as demanding for staff as the technical aspects of care. There is growing evidence for the effectiveness of therapeutic interventions in this area, thus ensuring the optimum outcome for the baby, the family and the staff.
The psychosocial functioning of 10 siblings of children with chronic life-threatening illness and their parents was compared with 10 healthy matched controls. The main differences found were in family relationships, with the index siblings expressing more negative emotion in relation to their fathers than controls, index mothers being less involved in social activities and index fathers being less involved with the extended family. No significant differences were found in any of the measures of depression, anxiety and self concept. Index siblings expressed a number of other concerns such as a fear of the break up of their family after the sick child died. The need for increased awareness of the welfare of healthy siblings as well as closer involvement of the fathers is discussed.
We describe a new discrete microprocessor-controlled analyzer, the AN2000, which fully automates fluorometric immunoassays by using a magnetic separation of the solid phase and an alkaline phosphatase label. It can operate in random-access or batch mode with a dwell time typically less than 20 min. The analysis rate is 75 samples per hour and the system can hold refrigerated reagents for as many as 20 different analytes. The substrate and wash buffer are common to all analytes. The system can hold as many as 80 samples at once. The operator can select from the menu-driven operator interface any combination of the available analytes to be run for each sample, using either the touch screen or the keyboard. Results are calculated from a stored calibration curve that is stable for greater than or equal to 1 month. The AN2000 is capable of automating most assay formats because the available timings, volumes, incubations, and wash cycles can be used in any combination.
Forty-five families of children with life-threatening illnesses for up to 10 years were interviewed. The children required many medical disciplines, as well as social, educational and material provisions, and parents described the complex and often distressing job of obtaining that help. They were asked whether they regarded anyone as their co-ordinating cornerstone carer and which qualities of care they most valued. Over three-quarters identified one or more professionals as their cornerstone carer, the most common being paediatricians, domiciliary paediatric nurses and social workers. Nearly a quarter of the families reported not having a cornerstone carer. The ingredients of care especially valued by the parents are described. Families may be better helped and services more rationally used where a cornerstone carer gives support and helps to co-ordinate care in a way that leaves families still feeling in control of their own lives. The issue is raised as to whether patient need or cost/service limitation will be the primary determinant of the way this care is delivered in Britain.
A study evaluating the effectiveness of a school-based social skills programme is described. All children in three year bands of an Oxford middle school were screened for behaviour problems. Subjects selected were allocated at random to eight sessions of social skills training with four booster sessions later or to a no treatment control group. Change was assessed by teacher, parent and self-report measures. Results suggested a significant improvement in social activity, parental report of social behaviour and self-esteem in the treatment as compared to the control group, which persisted at 6 month follow-up. Self-esteem changes were age and gender related. Implications for school-based social skills programmes are discussed.
The parents of children with life threatening or terminal illnesses were interviewed about their experiences of the way in which they were told the diagnosis. The interview was piloted on 25 families and then administered in a semistandardised manner to a further 45 families. Parents were asked how satisfied they were with the initial discussion about the diagnosis: 23 families were satisfied with how much information they were given; 22 with the information concerning prognosis; 20 with the pacing of the information; 33 with who was present; 32 with arrangements for follow up; and 26 were satisfied overall with the initial discussion. Clear patterns emerged about which elements of the discussion parents appreciated or resented. For example, they valued an open, sympathetic, direct, and uninterrupted discussion of the diagnosis in private that allowed sufficient time for them to take the news in and for doctors to repeat and clarify information. They disliked evasive or unsympathetic brief interviews. All parents remembered vividly the manner in which the diagnosis was imparted, and some were still preoccupied with this many years later. Analyses were carried out to test the possibility that reports of satisfaction and dissatisfaction were a function of current depression and anxiety, but no evidence was found for this.
A study of staff stress and job satisfaction was undertaken in a children's hospice. In addition factors were investigated which might be stressful or which helped staff to manage in difficult circumstances. Three quarters were under comparatively little stress and in general showed very few psychological symptoms but a distinct subgroup were under a great deal of stress. A number of factors, notably recent personal bereavement and unresolved grief about a death that had occurred before they came to work at the hospice, distinguished this small group. Job satisfaction was generally high. The main sources of stress were: the sense of impotence staff felt when they were unable to relieve perceived needs or distress; dealing with negative responses in families, and conflicts within the staff group. The most important mitigating factors were: the informal support that staff provided for each other in this small cohesive working unit, the homelike atmosphere of the hospice, and the diversity of professional and personal skills among the staff group. The implications of these findings for reducing stress among staff dealing with dying people are discussed; this includes not only staff on paediatric wards, intensive care and neonatal units, but also community paediatric nurses.
A retrospective study was undertaken of 25 families and their 26 ill children attending the first children's hospice in the United Kingdom. The study examined the family's perceptions of the care offered and the impact of chronic and life threatening illness. Eighteen (72%) of the families felt they had been well supported by the hospice and valued the family like atmosphere, perceiving the staff to be friendly, approachable, and helpful. The actual nature of hospice care, in an environment with other terminally ill children, was, however, considered a drawback for a few families. A number of families still had unmet needs, notably appropriate child minding when away from the hospice. The impact of chronic life threatening illness on the families was substantial. The parents (particularly the mothers), the index children, and their siblings all experienced much higher levels of psychological symptomatology than would have been expected from normal samples. While families felt greatly helped over symptom control, a proportion remained very worried about certain symptoms, particularly breathlessness, seizures, and pain. A high proportion of families were experiencing financial and employment difficulties as a result of their children's illnesses.
An amperometric technique for the quantification of an enzyme immunoassay which utilises a capture antibody covalently attached to a carbon electrode is described. The electrode is used both to separate the assay and to monitor the activity of the bound enzyme label. A 'two-site' immunometric assay with monoclonal antibodies directed against human chorionic gonadotrophin (HCG) was used as the model system. The activity of the enzyme bound to the electrode is determined electrochemically by the use of an electron transfer mediator (dimethylaminomethyl ferrocene) permitting rapid quantification of the analyte without the need for a separate incubation step to measure enzyme activity. The sensitivity of the assay is 9mIU HCG ml-1 in serum (1st International Reference Preparation). The correlation between the amperometric measurement of serum HCG and data for an immunoradiometric assay was r = 0.988. The assay is rapid requiring a total assay time of 20 min per sample, which includes 15 min for antibody-antigen binding.
Thyroxine has been modified with a ferrocene derivative to produce an immunologically reactive conjugate which remains capable of functioning as an electron transfer mediator, shuttling electrons between an oxido-reductase enzyme and an electrode. On binding with an anti-thyroxine antibody the conjugate's ability to function as a mediator is impaired. The conjugate has been used as a tracer in an homogeneous competitive assay to quantify the total thyroxine concentration in serum, the assay being measured electrochemically after the addition of a suitable oxidoreductase enzyme (glucose oxidase) and its substrate (glucose) on completion of antibody/antigen binding. This results in a simple and sensitive assay for thyroxine.
We describe an amperometric technique for quantification of an enzyme immunoassay in which we use a magnetic working electrode, both to separate bound and free analyte and to monitor the electrochemical response. We used a "two-site" immunometric assay with monoclonal antibodies for human choriogonadotropin (hCG) as a model system in which magnetic particles were used as the solid phase. Separation of bound and free label is readily achieved by localizing the particles at the electrode. Activity of the bound enzyme in the environment of the electrode is determined electrochemically, permitting rapid quantification of the analyte without the need for a separate incubation step to measure enzyme activity. The sensitivity of the system is 150 int. units of hCG per litre (1st Int. Ref. Preparation). Correlation between the amperometric measurement of urinary hCG and data for an immunoradiometric assay was r = 0.9. The assay is rapid, requiring a total assay time for each sample of 20 min, which includes 15 min for antibody/antigen binding.
We describe a novel separation procedure for immunoradiometric assays involving monoclonal antibodies in which both radiolabeled and capture antibodies are used in solution, the capture antibody being labeled with fluorescein isothiocyanate (FITC). Separation is achieved by incubation with anti-FITC antibodies on magnetic particles. This technique enhances reaction kinetics relative to those of assays in which a solid-phase capture antibody is used, thus allowing faster reaction times and more economic use of the monoclonal antibodies. The use of anti-FITC magnetic solid phase produces an assay having a highly specific separation method, minimal nonspecific binding, and high sensitivity. The method is illustrated by application to assays for thyrotropin and human choriogonadotropin.
After an earlier study into the practical aspects of the management of perinatal death, a counselling service was introduced for parents whose baby had died in the perinatal period. The service was monitored, and the parents who received the service were compared with a group that did not. Fifty families were allocated randomly either to the counselling (supported) group or to the contrast group, who received routine hospital care. Assessment was carried out at six and 14 months after the death, using a semi-structured interview and two self-rating scales (the general health questionnaire and the Leeds scales). Two of 16 mothers in the supported group showed psychiatric disorder at six months, compared with 10 of 19 in the contrast group (p less than 0.01, Fisher's exact test). There was no significant difference between the two groups at 14 months, when 80% of all the women studied had recovered psychiatric symptoms. Socially isolated women and those who marital relations lacked intimacy had a higher incidence of psychiatric symptoms at six months. Early pregnancy (within six months) was associated with a higher incidence of psychiatric symptoms in the unsupported group. The duration of bereavement reaction after perinatal death was appreciably shortened by support and counselling.
After the loss of a newborn baby the parents are usually too shocked and unfamiliar with the complicated administration procedures to cope with the registration of death and burial (or cremation). The medical and nursing staff also tend to be unfamiliar with the procedures. Some of these can be streamlined, thus reducing the stress caused to parents. By giving positive instruction the staff will in their turn be able to improve their care of the bereaved parents.
We describe a simple fluoroimmunoassay for the determination of thyroxine concentrations in serum. The method, "sequential addition, separation fluoroimmunoassay," involves both thyroxine labeled with fluorescein and magnetizable cellulose/iron oxide particles to which antibodies to thyroxine have been covalently linked. Serum sample or standard is incubated with an excess of the solid-phase antibody; the particles, which now carry most of the antigen in the sample, are sedimented onto a magnet and the supernate, which contains endogenous fluorophores and other interfering factors, is removed and discarded. Excess labeled thyroxine is then added, and, after incubation, the fluorescence in the supernate (free fraction), which is related directly to the amount of thyroxine in the sample is measured. For the whole procedure, including fluorometry, each sample is treated entirely within disposable polystyrene test tubes. Correlation studies with two different radioimmunoassays showed good agreement.
We describe a fully automated continuous-flow radioimmunoassay for methotrexate. [125I]Histamine-labeled methotrexate was used as tracer. Anti-methotrexate serum was coupled to a magnetizable solid-phase and the bound and free fractions were separated with an electromagnetic field. The assay is precise (CV less than 2.5%) and rapid (30 samples per hour), incubation volume is small (about 160 micro L), and incubation brief (10 min). The accurate timing inherent in the system obviates the need to attain equilibrium, so that assay of each sample takes only 15 min. The assay is sensitive (1--100 microgram/L). There is no significant carryover between samples of high and low concentration. Results by the automated method correlated well with those by both a manual assay in which the same reagents and separation technique are used (r - 0.99) and a competitive protein-binding assay (r = 0.96).
We compared conventional charcoal separation of antibody-bound and free antigen with a novel method involving magnetizable particles containing charcoal. The magnetizable charcoal separation method was as effective as the conventional method for a wide range of radioimmunoassays, including those for several steroids and small polypeptide hormones. In a detailed comparison of conventional vs. magnetizable charcoal for radioimmunoassay of aldosterone, the magnetizable charcoal had several advantages: it did not require prior coating with dextran or protein, varied less with time and temperature, required no centrifugation, and took less time for separation. The correlation of results obtained with magnetizable and conventional charcoal separation was excellent (n = 89, r = 0.98, p less than 0.001), and the coefficient of variation for the separation with magnetizable charcoal was 0.5%.
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