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Biomedical subjects

J Darby

Publications and source records attributed to J Darby.

At least 19 recordsLinked to original sources
PubMed2006

Health of caregivers in child care.

BACKGROUND: Child care workers play an important role in caring for children attending child care yet there is little research regarding their health. METHODS: The study consisted of focus groups with child care workers and a survey, conducted as part of a larger study known as the Healthy Child Care Study, which focused on children. The study investigated carers working in formal child care [long day care (LDC) and family day care (FDC)]. RESULTS: Questionnaires to caregivers in centres showed that 86% had taken sick leave in the previous year and 75% of staff had taken leave for infectious illness. Carers in FDC reported that 24% had taken sick leave in the previous year and 12% of carers had taken leave for infectious illness. Of responding caregivers from centres, 22% were cigarette smokers while in FDC homes, 8% of carers smoked. In focus groups, carers reported that their major areas of health concern were stress, infectious illness and physical trauma such as lifting injuries. CONCLUSIONS: Child care workers in LDC took more sick leave than those in FDC but this is not necessarily due to more illness. Child care workers are a diverse and important group that require further research.

Adolescent↗
PubMed2001

Experiences and perceptions of vocational training reported by the 1999 cohort of vocational dental practitioners and their trainers in England and Wales.

OBJECTIVE: To assess the self-reported confidence of vocational dental practitioners (VDPs) in clinical procedures together with vocational trainers' perceptions of the VDPs confidence in the same procedures, immediately after qualification and towards the end of the vocational training year. DESIGN: A questionnaire-based cohort study. SETTING: A general practice study carried out in 1999. SUBJECTS: Vocational Dental Practitioners and vocational trainers in England and Wales. METHOD: VDPs and trainers were asked on a single occasion to grade the clinical confidence of the VDP at the beginning and near the end of vocational training as high, satisfactory or low. RESULTS: Questionnaires were sent to 531 VDPs and 555 trainers; 82 per cent of VDPs and trainers responded. Approximately half the VDPs were male and 57 per cent were white, whilst 89 per cent of trainers were male and 81 per cent white. A large proportion of both VDPs and trainers reported low confidence in orthodontics, molar endodontics and surgical extractions at the start of the training year. Towards the end of training, both groups reported improved confidence levels in most clinical procedures. However, a higher proportion of trainers reported low confidence than their VDPs in most clinical procedures at both time points (p<0.001). VDPs appeared to gain most from experience and training in administration/management and interpersonal skills. CONCLUSION: Vocational training appears to satisfy its aim to enhance clinical and administrative confidence.

Clinical Competence↗
PubMed2000

The intensive care unit as a trauma unit.

The ICU plays a pivotal role in the care of the critically injured patient. From the resuscitative phase of care through the life-support phases and finally the recovery phase, advances in ICU care have been made in recent years. As a result, an improved outcome for traumatically injured patients often is seen, and the third peak in the trimodal distribution of trauma deaths has been affected significantly.

Critical Care↗
PubMed1999

Effect of endotracheal suctioning on cerebral oxygenation in traumatic brain-injured patients.

OBJECTIVE: In patients with severe head injuries, brain damage occurs not only from the primary trauma but also secondarily from a reduction in cerebral oxygenation as a result of brain swelling, ischemia, and elevated intracranial pressure (ICP). However, routine interventions designed to maintain oxygenation, such as endotracheal suctioning (ETS), also may negatively affect the cerebrovascular status by increasing the ICP. The purpose of this study was to determine whether ETS influences cerebral oxygenation in patients with traumatic brain injury. DESIGN: Descriptive, prospective, with repeated assessments within each patient. SETTING: Ten-bed trauma intensive care unit in a university Level I trauma center. SUBJECTS: Nineteen patients who were 16 yrs or older, had acute head injury, a Glasgow Coma Scale score < or =8; external ventricular drain and arterial pressure devices in place, and were intubated and mechanically ventilated. INTERVENTIONS: ETS protocol consisting of administration of four ventilator-delivered breaths at 135% of the patients' actual tidal volume, 100% F(IO)2, before and after suctioning with a standardized catheter at a 16-L flow rate. MEASUREMENTS AND MAIN RESULTS: This study examined cerebrovascular responses as measured by the traditional measures of ICP and cerebral perfusion pressure, as well as middle cerebral artery velocity and jugular venous oxygen tension that occurred during ETS in head-injured adults. The results of this study show that both ICP and cerebral perfusion pressure are increased during ETS. In the majority of patients (84%), the ICP returned to baseline values within 2 mins. CONCLUSIONS: The increase in jugular venous oxygen tension associated with increases in middle cerebral artery velocity and mean arterial pressure suggests that cerebral oxygen delivery was maintained during ETS. Cerebral changes associated with ETS using the described protocol are consistent with the preservation of cerebral oxygenation.

Adolescent↗
PubMed1997

Experience of undergraduates from three London dental schools and trainers from the south east of England on interviews for vocational training in 1996.

OBJECTIVE: To assess the current perceptions, motivations and expectations of trainers and vocational dental practitioners (VDPs) of vocational training (VT) interviews. DESIGN: Questionnaire based study. SETTING: General practice study carried out in 1996. SUBJECTS: Undergraduates from three London dental schools and vocational trainers from south-east England. MAIN OUTCOME MEASURES: Perceptions, motivation and experiences were assessed by a questionnaire. RESULTS: 111 questionnaires were posted to trainers with 72 (65%) returned. 108 (70%) were returned from the dental schools after 155 were posted. Graduates employed in hospital training posts, armed forces and community dentistry were eliminated from the results. Most trainers (74%) had previous experience of VT and 89% of trainers thought that a CV was important for their choice of VDPs. However, only 11% of trainers sought references before interviewing. 34% of VDPs preferred jobs close to their dental school but 75% considered location to be vital to their choice. 67% of VDPs made 10 or more applications and 57% visited 10 or more practices for interviews. 78% of VDPs considered that either genderism or racism was likely to or possibly influenced the trainers choice. However, the converse was not true, 62% of trainers considered it unlikely that the VDPs were influenced by their gender or race. CONCLUSIONS: Trainers and VDPs have different perceptions concerning the protocol of interviews for VT.

Adult↗
PubMed1995

Regional cerebral blood flow and CO2 reactivity in fulminant hepatic failure.

Alterations in cerebral hemodynamics are postulated to contribute to brain herniation, a major cause of death in patients with severe hepatic encephalopathy due to fulminant hepatic failure (FHF). In an effort to identify these changes in cerebral hemodynamics, regional and global cerebral blood flow (CBF) and CO2 reactivity were measured using stable xenon-enhanced computed tomography (Xe/CT) in 24 patients within 72 h of onset of severe hepatic encephalopathy. Regional variations in CBF, most notably, a relative decrease in CBF in the anterior circulation and an increase in CBF in the posterior circulation were found. CBF was significantly lower in FHF patients compared with controls, however, these values are well out of the established ischemic range. FHF patients also showed significant impairment in CBF response to hypoventilation, while the CBF response to hyperventilation remained intact. This study suggests that FHF patients demonstrate early changes in both CBF patterns and CO2 reactivity. The relatively "normal" CBF values obtained in FHF patients in severe hepatic encephalopathy coupled with the lack of vasodilatation to hypoventilation suggest a state of uncoupled CBF and metabolism or "luxury perfusion" that could theoretically contribute to vasogenic edema, brain swelling, and cerebral herniation.

Adult↗
PubMed1995

Candida mediastinitis and septic shock following occult esophageal perforation in a patient with posttraumatic quadriplegia.

Unexplained septic shock was ultimately shown to be caused by Candida mediastinitis after perforation of the cervical esophagus by a dislodged cervical methylmethacrylate construct in a 25-year-old patient with traumatic quadriplegia. Communication between the prevertebral abscess and pleural space further led to the formation of a esophageal-pleural-cervical fistula. Despite antibiotics, surgical removal of the construct, and drainage of the esophagus and mediastinum, the patient died from refractory shock and respiratory failure.

Adult↗
PubMed1995

Evaluating cerebral oxygenation using jugular venous oximetry in head injuries.

When caring for the critically ill patient, a primary objective is to maintain an adequate delivery of oxygen to the tissues. Monitoring and ensuring satisfactory cerebral oxygen delivery in patients at risk for cerebral ischemia presents a significant challenge to the clinician. Cerebral oxygen content usually is determined using blood gas analysis, whereas blood flow to cerebral tissues is inferred from monitoring of the cerebral perfusion pressure. There is an assumption that cerebral oxygen delivery is adequate so long as the cerebral perfusion pressure exceeds 50-60 mmHg in the normal brain and the cerebral arterial oxygen content is normal. The cerebral perfusion pressure, however, is an estimated value calculated as the difference between the mean systemic arterial pressure and the intracranial pressure and provides merely an indirect index of the adequacy of cerebral oxygen delivery. The validity of the cerebral perfusion pressure as an index for cerebral oxygen delivery becomes questionable when the autoregulatory mechanisms of the brain are disturbed, as in severe head injuries. Jugular bulb oxygen monitoring provides a method of evaluating cerebral oxygenation status for early identification of impending ischemia by measuring oxygenation of the mixed cerebral venous blood. In this article, the authors review the physiology of cerebral oxygenation, describe a method of monitoring cerebral oxygenation using jugular bulb oximetry, and review a case study to show how these assessments can affect the nursing care of the head-injured patient.

Brain Chemistry↗
PubMed1993

A duplication in the L1CAM gene associated with X-linked hydrocephalus.

Recently, a mutation in the gene for the neural cell adhesion molecule L1CAM, located at chromosome Xq28, was found in a family with X-linked hydrocephalus (HSAS). However, as the L1CAM mutation could only be identified in one HSAS family, it remained unclear whether or not L1CAM was the gene responsible for HSAS. We have conducted a mutation analysis of L1CAM in 25 HSAS families. The mutation reported previously was not found in any of these families. In one family, however, a 1.3 kilobases (kb) genomic duplication was identified, cosegregating with HSAS and significantly changing the intracellular domain of the L1CAM protein. These results confirm that L1CAM is the HSAS gene.

Alternative Splicing↗
PubMed1992

Effects of dobutamine and dopamine on whole brain blood flow and metabolism in unanesthetized monkeys.

Dobutamine (DO) and dopamine (DA) are positive inotropic agents used clinically to improve cardiac output in patients in acute or chronic heart failure or to counteract intracranial vasospasm. These patients are also at risk for cerebrovascular disease, but studies on the effects of DA on cerebral blood flow (CBF) and metabolism are few and for DO nonexistent. We evaluated the effects on DO and DA on whole brain CBF and cerebral metabolic rates of oxygen (CMRO2) and glucose (CMRglc) in unanesthetized rhesus monkeys. Microelectrodes and catheters inserted in the superior sagittal sinus monitored H2 clearance and sampled cerebral venous blood. Studies were done at low and high doses with control measurements between doses. At 5.10, and 15 microg/kg/min (n = 6), neither systemic nor cerebral variables were affected by either drug. At doses of 50 and 100 microg/kg/min (n = 4), DO and DA increased arterial blood pressure and heart rate by 15 to 30%. Whereas CBF, CMRO2, and CMRglc were clearly unaffected by DO at high doses, they increased by 20-30% with DA, 100 microg/kg/min and although not significant (p >0.05), the consistency and magnitude of the increase along with the likelihood of a type II error led us to conclude that (a) both DO and DA are less effective in monkeys than in humans and (b) whereas DO at all doses tested showed no indication of affecting CBF and CMR, DA increased CBF and CMR by 20 to 30% at a dose of 100 microg/kg/min.

Journal Article↗
PubMed1991

Acute regional cerebral blood flow changes caused by severe head injuries.

To evaluate the changes in cerebral blood flow (CBF) that occur immediately after head injury and the effects of different posttraumatic lesions on CBF, 61 CBF studies were obtained using the xenon-computerized tomography method in 32 severely head-injured adults (Glasgow Coma Scale score (GCS) less than or equal to 7). The measurements were made within 7 days after injury, 43% in the first 24 hours. During the 1st day, patients with an initial GCS score of 3 or 4 and no surgical mass had significantly lower flows than did those with a higher GCS score or mass lesions (p less than 0.05): in the first 1 to 4 hours, those without surgical mass lesions had a mean CBF of 27 cc/100 gm/min, which rose to 44 cc/100 gm/min by 24 hours. Patients without surgical mass lesions who died tended to have a lower global CBF than did those with better outcomes. Mass lesions were associated with a high global CBF and bihemispheric contusions with the lowest flows. By 24 hours after injury, global blood flow increased in groups that originally had low flows and decreased in those with very high initial flows, such that by 36 to 48 hours, most patients had CBF values between 32 and 55 cc/100 gm/min. Lobar, basal ganglion, and brain-stem blood flow values frequently differed by 25% or more from global averages. Brain-stem CBF varied the most but did not correlate with clinical signs of brain-stem dysfunction. Double studies were performed at two different pCO2 values in 10 patients with various posttraumatic lesions, and the CO2 vasoresponsivity was calculated. Abnormal CO2 vasoresponsivity was found with acute subdural hematomas and defuse cerebral swelling but not with epidural hematomas. In patients without surgical mass lesions, the findings suggest that CBF in the first few hours after injury is often low, followed by a hyperemic phase that peaks at 24 hours. Global CBF values vary widely depending on the type of traumatic brain injury, and brain-stem flow is often not accurately reflected by global CBF values. These findings underscore the need to define regional CBF abnormalities in victims of severe head injury if treatment is intended to prevent regional ischemia.

Adolescent↗
PubMed1991

Management options in fulminant hepatic failure.

The diagnosis of FHF carries with it a high mortality rate. Though the early results of OLT for FHF are encouraging, some have called for caution as these results are in a select population and may be similar to the optimistic early reports of now-discredited therapies. However, OLT differs fundamentally from all other interventions and, as such, it is ethically unjustified to withhold potentially life-saving therapy from patients with a predicted mortality in excess of 60%. Therefore, patients with FHF should be transferred at an early stage to an experienced liver unit where the option of liver transplantation can be considered.

Acute Kidney Injury↗
PubMed1987

Brainstem death with persistent EEG activity: evaluation by xenon-enhanced computed tomography.

A patient with brainstem infarction met the clinical criteria for brain death but had persistent EEG activity, complicating our decision to withdraw life support. We evaluated cerebral blood flow with xenon-enhanced computed tomography (Xe/CT), which documented the absence of posterior circulation flow and persistent, low, anterior circulation flow. This information led us to withdraw life support, despite the presence of EEG activity. The Xe/CT method noninvasively measures local cerebral blood flow and may enhance diagnostic certainty in complicated brain-death evaluations.

Brain Death↗
PubMed1986

Linkage analyses of multiple endocrine neoplasia, type 2A (MEN-2A) with 20 DNA polymorphisms: 5% of the genome excluded.

Pairwise linkage analyses are reported between the locus for multiple endocrine neoplasia type 2A (MEN-2A) and 20 restriction fragment length polymorphisms (RFLPs) in a single large kindred which was previously screened for linkage with this form of cancer using 23 blood group and serum protein polymorphisms. No significant, positive lod scores have been obtained so far. These 20 RFLPs have excluded the MEN2 locus from about as much of the genome as did the 23 classical markers previously reported. This is a clear demonstration of the value of RFLPs for linkage studies since these 20 RFLPs were not selected for being the most polymorphic of those available. Over 10% of the human genome has been excluded from linkage with the MEN2 locus in this particular family.

Chromosome Mapping↗
PubMed1985

DNA restriction fragment analysis of the proopiomelanocortin gene in schizophrenia and bipolar disorders.

The method of DNA restriction fragment analysis using gene probes for the proopiomelanocortin (POMC) gene was employed to detect possible molecular variation in the POMC gene in schizophrenia and bipolar illness. No gross structural abnormalities in restriction fragments were observed with the set of restriction enzymes used. Two allelic restriction sites were observed giving rise to fragment length polymorphisms. One of these is a new polymorphism, not previously reported, which will be of value as a linkage marker. The associations between the two DNA polymorphisms that are closely linked to the POMC gene and both schizophrenia and bipolar disorder were investigated. No association was found, thus adding weight to the evidence that there are no alterations in the POMC gene in schizophrenia and bipolar illness.

Base Sequence↗