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Biomedical subjects

J C Clifford

Publications and source records attributed to J C Clifford.

At least 19 recordsLinked to original sources
PubMed1999

Neuronal sensitivity to tetanus toxin requires gangliosides.

Tetanus toxin produces spastic paralysis in situ by blocking inhibitory neurotransmitter release in the spinal cord. Although di- and trisialogangliosides bind tetanus toxin, their role as productive toxin receptors remains unclear. We examined toxin binding and action in spinal cord cell cultures grown in the presence of fumonisin B(1), an inhibitor of ganglioside synthesis. Mouse spinal cord neurons grown for 3 weeks in culture in 20 microM fumonisin B(1) develop dendrites, axons, and synaptic terminals similar to untreated neurons, even though thin layer chromatography shows a greater than 90% inhibition of ganglioside synthesis. Absence of tetanus and cholera toxin binding by toxin-horseradish peroxidase conjugates or immunofluorescence further indicates loss of mono- and polysialogangliosides. In contrast to control cultures, tetanus toxin added to fumonisin B(1)-treated cultures does not block potassium-stimulated glycine release, inhibit activity-dependent uptake of FM1-43, or abolish immunoreactivity for vesicle-associated membrane protein, the toxin substrate. Supplementing fumonisin B(1)-treated cultures with mixed brain gangliosides completely restores the ability of tetanus toxin to bind to the neuronal surface and to block neurotransmitter release. These data demonstrate that fumonisin B(1) protects against toxin-induced synaptic blockade and that gangliosides are a necessary component of the receptor mechanism for tetanus toxin.

Animals↗
PubMed1998

Developing patient and family education services. Innovations for the changing healthcare environment.

As the healthcare environment changes, systems that have served hospitals well for many years no longer meet the current needs of patients, families, and communities. This is particularly true with regard to health education. The authors describe an innovative learning center that offers comprehensive health education services and programs designed to empower consumers with the information and skills needed to maintain health or recover from illness or injury.

Boston↗
PubMed1997

The effects of health care reforms on job satisfaction and voluntary turnover among hospital-based nurses.

OBJECTIVES: Among the consequences of downsizing and cost containment in hospitals are major changes in the work life of nurses. As hospitals become smaller, patient acuity rises, and the job of nursing becomes more technical and difficult. This article examines the effects of changes in the hospital environment on nurses' job satisfaction and voluntary turnover between 1993 and 1994. METHODS: Data were collected in a longitudinal survey of 736 hospital nurses in one hospital to examine correlates of change in aspects of job satisfaction and predictors of leaving among nurses who terminated in that period. RESULTS: Unadjusted results showed decline in most aspects of satisfaction as measured by Hinshaw and Atwood's and Price and Mueller's scales. Multivariate analysis indicated that the most important determinants of low satisfaction were poor instrumental communication within the organization and too great a workload. Intent to leave was predicted by the perception of little promotional opportunity, high routinization, low decision latitude, and poor communication. Predictors of turnover were fewer years on the job, expressed intent to leave, and not enough time to do the job well. CONCLUSIONS: The authors conclude that although many aspects of job satisfaction are diminished, some factors predicting low satisfaction and turnover may be amenable to change by hospital administrators.

Adult↗
PubMed1996

The Harvard Nursing Research Institute's conference summary.

The Harvard Nursing Research Institute organized a national invitational conference on executive nursing leadership in major teaching hospitals and academic health centers. The conference brought together many of the nation's eminent nurse executives and other prominent individuals in healthcare to analyze the unique and complex challenges facing these organizations, expose participants to other perspectives, and articulate specific aims and strategies that might be taken to increase their effectiveness in leading the nursing profession's efforts to shape the ongoing transformation of the healthcare system.

Academic Medical Centers↗
PubMed1994

Provocative exercise maneuver: its effect on nerve conduction studies in patients with carpal tunnel syndrome.

This study examined the influence of a provocative dynamic exercise maneuver on nerve conduction studies (NCS) in three study groups: Group A, controls (n = 10); Group B, patients with clinical carpal tunnel syndrome (CTS), but normal NCS (n = 10); and Group C, patients with clinical CTS and abnormal NCS (n = 10). A wrist flexion-extension exercise was designed to increase pressure on the median nerve within the carpal tunnel to aid diagnosis by revealing latent nerve conduction slowing in patients presenting with clinical CTS but normal NCS. The exercise protocol was sufficient to evoke symptom exacerbation in 50% of the patients. The results showed that 4 minutes of this active provocative maneuver revealed a significant (p < .05) difference in the sensory distal latency (median) for digit IV; however, this was not clinically significant inasmuch as the change in latency was insufficient to meet the a priori criteria for NCS abnormality required for the electrodiagnosis of median nerve abnormality. There was no increase in the distal sensory latencies of those patients whose symptoms were exacerbated, when compared with those patients whose symptoms remained unchanged. There appears little diagnostic value in adding this particular active provocative wrist maneuver to the routine electrodiagnostic evaluation for carpal tunnel syndrome.

Adult↗
PubMed1993

Successful management of chronic pain syndrome.

Managing patients with chronic pain syndrome can be frustrating and unrewarding. Much of the difficulty experienced when managing these patients stems from an incomplete understanding of pain, especially the difference between acute and chronic pain. Pain theory and treatment of chronic pain syndrome are reviewed. An alternative management strategy for chronic pain syndrome is presented and the literature is reviewed.

Chronic Disease↗
PubMed1989

What DRGs mean to the patient and the provider.

What are the effects of DRGs on patients and providers? I have attempted to provide some insights from my own experience and that of others. But I think we must not lose sight of the fact that it is very difficult to determine the specific effects of DRGs in light of all the other environmental factors that contribute to the intensity of patient services and care provider stress and work load. To what extent does the general aging of the population itself contribute to these issues? People would still be getting older, and chronic disease would continue to increase, even if a prospective payment system using DRGs was not in place. Medical technology has not been capped and the explosion of knowledge still directs much of the medical practice related to increased intensity of care. A financially driven health care system was put into place shortly after the implementation of Medicare, when it became obvious how quickly the costs of health care were rising. In many ways it is impossible to say what the specific effects of the DRG system have been on the patient and the provider. Perhaps it is only a little, but, quite frankly, it does not really feel that way to those who are in the mainstream of providing care.

Aged↗
PubMed1989

Electrodiagnosis of mild carpal tunnel syndrome.

Electrophysiologic tests have been reported to detect mild carpal tunnel syndrome (CTS). Such tests include (i) absolute palmar latency of median wrist segment; (ii) comparison of median and radial distal sensory latencies in digit I; (iii) comparison of median and ulnar distal sensory latencies in digit IV; (iv) comparison of median and ulnar palmar latencies; (v) comparison of median and ulnar sensory potential amplitudes in digits II and V. To clarify the clinical utility of these tests, the parameters of all five tests were determined across four carefully established patient subgroups: group A, controls; group B, CTS referrals with normal nerve conduction studies (NCS) and normal needle electromyography (EMG); group C, CTS referrals with abnormal NCS and normal EMG; group D, CTS referrals with abnormal NCS and abnormal EMG. Special attention was focused on patients in group B who represent the diagnostic dilemma. In group B, tests ii and iii each yielded abnormal results in 44% of hands, while the combination of tests ii and iii yielded abnormal results in 51% of hands.

Adult↗
PubMed1988

Plasma 11-deoxycortisol and cortisol following dexamethasone in psychiatric patients.

As it has been suggested that calculating the ratio of cortisol to its biosynthetic precursor, 11-deoxycortisol, may enhance the sensitivity of the dexamethasone suppression test (DST) for depression, cortisol and 11-deoxycortisol were measured in 90 subjects undergoing this test. Among these subjects, post-dexamethasone cortisol and 11-deoxycortisol levels were significantly correlated (r = 0.65, P less than 0.001) and evaluating the ratio of cortisol to 11-deoxycortisol decreased rather than enhanced sensitivity of the DST.

17-Hydroxycorticosteroids↗
PubMed1980

Primary nursing: a contemporary model for delivery of care.

The evolution of nursing care concepts, from the case method to the primary care nursing concept, is reviewed. Of the traditional nursing concepts--case method, and group and functional assignments--the case method provided the highest degree of personalized and continuous care but was too costly. Group- and functional-assignment nursing, and the newer team-nursing concept, were more efficient but placed increasing amounts of patient care in the hands of nonlicensed health care workers. Primary care nursing has decentralized decision making, made nurses professionally accountable for their own practices, and provided continuity of care.

Delivery of Health Care↗