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Biomedical subjects

G Holden

Publications and source records attributed to G Holden.

At least 19 recordsLinked to original sources
PubMed2004

Improvement in efficacy of chemoradiotherapy by addition of an antiangiogenic agent in a murine tumor model.

BACKGROUND: Chemoradiotherapy improves survival for some cancer patients. Methods of enhancing treatment response would further enhance survival rates. The effect of the addition of an antiangiogenic agent to a chemoradiotherapy regime has not previously been examined. MATERIALS AND METHODS: C57B16 mice were inoculated with 1 x 10(6) Lewis lung carcinoma cells into the flank and randomized to 1 of 10 treatment groups when tumor volume approached 1000 mm(3). Animals received combinations of standard doses of intraperitoneal cisplatin, 5-fluorouracil, and the antiangiogenic agent genistein, together with 10 or 20 Gy of external beam radiotherapy. Animals were sacrificed at day 6 when tumor volume, microvessel density, and serum VEGF were determined. RESULTS: Mean (SEM) tumor volume in the chemoradiotherapy group was 762 (212) mm(3) versus 565 (79) mm(3) in the chemoradiotherapy plus genistein group (P = 0.04, unpaired t-test). The addition of genistein produced a significant reduction in tumor microvessel density (P = 0.01) as well as serum VEGF levels (P < 0.05) compared to those animals receiving chemoradiation alone. CONCLUSIONS: This study provides proof of principle that chemoradiation can be enhanced by the addition of an antiangiogenic agent to the regime and suggests that further examination of such regimes is warranted.

Angiogenesis Inhibitors↗
PubMed2001

BB-10010, an analog of macrophage inflammatory protein-1alpha, protects murine small intestine against radiation.

Irradiation of the small intestine can result in depletion of the epithelial stem cell compartment and is often the dose-limiting factor for radiotherapeutic treatment of tumors in the abdominal and pelvic region. Since mitotic cells are most sensitive to radiation, significant radioprotection can be achieved by reducing the number of cells in mitosis at the time of irradiation. We have previously shown that administration of macrophage inflammatory protein (MIP) -1alpha induces a transient 50% reduction in the number of mitotic cells in small intestinal crypts, including the stem cell region, and therefore, MIP-1alpha pretreatment before radiation exposure could result in a substantial reduction of the side effects associated with radiotherapy. Groups of adult mice were exposed to different doses of radiation (6, 8, 10, or 12 Gy), with or without prior administration of 200 microg BB-10010/kg 3 hr before irradiation and radiation damage was assessed by means of the microcolony survival assay. MIP-1alpha pretreatment resulted in significantly increased numbers of surviving crypts (10%) when compared to untreated irradiated animals. The observed radioprotective effects of MIP-1alpha in the small intestine should translate into reduced side effects in a clinically relevant radiotherapy context and could allow larger doses of radiation to be delivered to patients with tumors in the abdominal or pelvic region.

Animals↗
PubMed2000

Cognitive-behavioral predictors of asthma morbidity in inner-city children.

Asthma is a growing health problem among children in the United States, particularly in urban, inner-city areas. This article examines the relationship between cognitive-behavioral aspects of asthma management (caretaker asthma knowledge, expectations, and problem-solving) and asthma morbidity in a sample of 1,376 inner-city children with physician-diagnosed asthma. In the analyses, baseline symptom severity served as a covariate, and the average of the 3-, 6-, and 9-month follow-up data served as the outcome measure. Children of caregivers with ineffective problem-solving strategies had significantly more days of wheezing over a 14-day period. Ineffective problem-solving capabilities were also associated with poorer functional status; however, positive caregiver expectations were associated with better functional status. Of the cognitive-behavioral factors studied in a high-risk urban population, caregiver problem-solving skills and expectations emerged as meriting further investigation and possible intervention.

Asthma↗
PubMed1999

Division of responsibility for asthma management tasks between caregivers and children in the inner city.

This investigation examined caregiver and child perceptions of the division of responsibility for asthma management tasks in families. The study sample included 789 children with asthma, aged 6 to 9 years, who lived in the inner city. These children and their primary caregivers completed the Asthma Responsibility Interview. The correlation between the caregiver's and child's ratings of the child's responsibility was low (.19), with children rating themselves as more responsible than their caregivers rated them. Caregiver and child ratings of the child's responsibility increased with the child's age; however, caregivers' ratings of their own responsibility remained constant over the age range studied. Kappa statistics ranged from -.03 to .12, with up to 16% of children reporting less responsibility for self-care than was indicated by the caregiver. More than one third of families reported four or more asthma caregivers. The discrepancy between the caregiver's and child's perceptions and the involvement of multiple caregivers raise the possibility of unintentional nonadherence.

Asthma↗
PubMed1997

Psychosocial characteristics of inner-city children with asthma: a description of the NCICAS psychosocial protocol. National Cooperative Inner-City Asthma Study.

Previous research has demonstrated a significant reciprocal relationship between psychosocial factors and asthma morbidity in children. The National Cooperative Inner-City Asthma Study investigated both asthma-specific and non-specific psychosocial variables, including asthma knowledge beliefs and management behavior, caregiver and child adjustment, life stress, and social support. This article presents these psychosocial characteristics in 1,528 4-9-year-old asthmatic urban children and their caretakers. Caretakers demonstrated considerable asthma knowledge, averaging 84% correct responses on the Asthma Information Quiz. However, respondents provided less than one helpful response for each hypothetical problem situation involving asthma care, and most respondents had more than one undesirable response, indicating a potentially dangerous or maladaptive action. Both adults and children reported multiple caretakers responsible for asthma management (adult report: average 3.4, including the child); in addition, children rated their responsibility for self-care significantly higher than did adults. Scores on the Child Behavior Checklist indicated increased problems compared to normative samples (57.3 vs. 50, respectively), and 35% of children met the criteria for problems of clinical severity. On the Brief Symptom Inventory, adults reported elevated levels of psychological distress (56.02 vs norm of 50); 50% of caretakers had symptoms of clinical severity. Caretakers also experienced an average of 8.13 undesirable life events in the 12 months preceding the baseline interview. These findings suggest that limited asthma problem-solving skills, multiple asthma managers, child and adult adjustment problems, and high levels of life stress are significant concerns for this group and may place the inner-city children in this study population at increased risk for problems related to adherence to asthma management regimens and for asthma morbidity.

Adult↗
PubMed1997

The hospital social work self-efficacy scale: a partial replication and extension.

The Hospital Social Work Self-Efficacy Scale (HSWSE) was developed to assess social workers' confidence about their ability to perform hospital social work. The scale was originally tested with master's-level social work students. This partial replication and extension included both students and professional social workers. In addition, we used a new scale to assess construct validity and added another hospital to assess external validity. In general, findings continue to support the use of the HSWSE. In addition, anecdotal evidence suggests that this is an outcome measure that practitioners see as easy to use, specific, and highly relevant.

Educational Measurement↗
PubMed1996

A pilot study of fieldwork rotations vs. year long placements for social work students in a public hospital.

A comparison of two types of fieldwork was undertaken with 26 social work students in a large urban hospital. The first group was assigned to a traditional, year long placement. The second group was assigned to three successive placements of approximately 10 weeks each. The impact of these two types of placement on students' general sense of self-efficacy, self-efficacy regarding specific hospital social work activities and perceptions of the work environment, was assessed. Initial results suggest that both groups produce virtually no change in students' general sense of self-efficacy, yet produce positive changes in students' self-efficacy regarding hospital social work. In addition, results suggest that the fieldwork rotation used in the second group may produce somewhat more positive views of the work environment.

Attitude of Health Personnel↗
PubMed1995

Delivery of home care services after discharge: what really happens.

Social workers in hospitals develop discharge plans for in-home patient care with little systematic feedback about postdischarge implementation. A telephone follow-up study of patients discharged from an urban teaching hospital in 1990 was undertaken to determine the extent to which discharge plans for home services were carried out and to identify factors associated with unsuccessful implementation. Overall, 72 percent of the patients received all, 19 percent some, and 9 percent none of the planned home care services. Great variability was found in service delivery: Registered nurse visits were the most successfully delivered type of service; 24-hour companions were the least successfully delivered service. Further, over one-third of patients experienced termination or reduction of services between discharge and the follow-up interview 21 to 28 days after discharge. Such unexpected and varied outcomes suggest the need for development of discharge follow-up programs that move beyond hospital walls to ensure that patients receive needed services.

Adolescent↗
PubMed1995

Predictors of patient and proxy satisfaction with discharge plans.

If patients are not readily available, family members or others sometimes are used as substitute informants when evaluating consumer satisfaction. Little is known, however, about the extent to which responses of patients and proxies are interchangeable. In this study, patients (N = 225) or significant others (N = 115) provided an overall rating of discharge plans, as well as information on psychosocial, health, and post-hospital service related factors, at 3-4 weeks post-discharge. While no difference was found between mean plan ratings for the two groups, substantial differences were found in factors predicting satisfaction for patients and for proxies. Results indicate that care should be taken in using proxy ratings in the place of patient ratings, particularly when developing strategies for enhancing consumer satisfaction. Findings are discussed as they relate to continuity of care initiatives and programs for enhancement of desirable health utilization behaviors, in the context of managed care.

Aftercare↗
PubMed1995

Decisions regarding the order of opening multiple high-risk cases: a pilot study in an urban hospital.

Decision making is central to social work practice. Decision making has been extensively researched outside of the field of social work. Within the field some work has been done regarding decision making, but much remains to be done. A pilot study was undertaken to describe how hospital social workers decide to open a specific case when they have to choose among multiple high-risk cases and the guidelines for case openings do not dictate a specific choice. The results indicate that social workers in this setting do not view the various established high-risk factors as equally important. Rather, decisions were based on an integration of explicit and implicit high risk factors developed by workers over time.

Case Management↗
PubMed1994

Coping with childhood asthma: caretakers' views.

Childhood asthma is a chronic health condition that affects more than 1 million school-age children and their families. Asthma is the leading cause of school absences and accounts for a substantial amount of activity limitation in children. A small pilot study of caretakers of African American and Hispanic school-age children with asthma explored the effects of the illness on families and the coping strategies used by caretakers. Large and significant correlations were found between the perceived impact in the areas of financial burden, social and familial isolation, and personal strain. Caretakers reported using active coping, planning, religion, and acceptance of the illness most frequently. The authors suggest the value of making conceptual distinctions between the burden imposed by the illness and the coping skills used by caretakers.

Adaptation, Psychological↗
PubMed1993

Decision making in social work: a review.

Decision making is a core practice activity for all social workers. They make decisions about career and professional relationships, about clients and interventions and they must react to the decisions of others. This article provides an overview of decision making theory and research, beginning with the wider realm of decision making literature taken from other disciplines and moving on to specific applications within the field of social work. Areas for continued research on decision making in social work are noted.

Decision Making↗