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J F Sweeney

Publications and source records attributed to J F Sweeney.

29 records · Page 2Linked to original sources
PubMed1994

Diagnostic peritoneal lavage: volume of lavage effluent needed for accurate determination of a negative lavage.

While the ability of diagnostic peritoneal lavage (DPL) to 'rule out' occult intra-abdominal injuries has been well established, the volume of lavage effluent necessary for accurate prediction of a negative lavage has not been determined. To address this, 60 injured adults with blunt (N = 45) or penetrating (N = 15) trauma undergoing DPL were evaluated prospectively through protocol. After infusion of 1l of Ringer's lactate solution, samples of lavage effluent were obtained at 100 cm3, 250 cm3, 500 cm3, and 759 cm3, and when no more effluent could be returned (final sample). DPL was considered negative if final sample RBC count was < or = 100,000/mm3 for blunt injury and < 50,000/mm3 for penetrating injury. The conclusion is that at 100 cm3 of lavage effluent returned, negative results are highly predictive of a negative DPL (98 per cent), though 250 cm3 of lavage effluent is required to predict a negative DPL uniformly (100 per cent).

Abdominal Injuries↗
PubMed1994

Candida antigen titer is a marker of neutrophil dysfunction after severe injury.

UNLABELLED: Trauma patients with positive Candida antigen titers have high mortality rates. Death is the result of sepsis and multi-organ system failure. Considerations of host immunity to Candida led us to concurrently study the function of neutrophils (PMNs) from severely injured adults with positive titers (n = 20), patients with negative titers matched for age, sex, and injury (n = 20), and volunteers (n = 20). Anticandidal PMN function was determined using a 3H-glucose incorporation assay. RESULTS are expressed as mean percentage of growth inhibition +/- SEM. RESULTS: PMN, from all groups inhibited Candida growth, although PMNs from titer-positive patients demonstrated less growth inhibition. In vitro cytokines granulocyte macrophage-colony stimulating factor [(GM-CSF), interferon-gamma (IFN-gamma), and interleukin 8 (IL-8)] improved function of PMNs from each group and corrected the impaired anticandidal function of PMNs from titer-positive patients, with GM-CSF being most effective. CONCLUSIONS: Seriously injured patients with positive Candida antigen titers have PMNs with impaired anticandidal function, which can be restored by cytokines. These findings begin to explain why seriously injured patients with positive Candida antigen titers have increased mortality and to offer hope of therapeutic intervention.

Adult↗
PubMed1994

Monocytes overcome lymphocyte dysfunction in injured adults with elevated Candida antigen titers.

OBJECTIVE: Severely injured adults with elevated Candida antigen titers have increased mortality from sepsis, in part because of known neutrophil (PMN) dysfunction. Since PMN function is modulated by monocytes and lymphocytes, this study was undertaken to determine the ability of monocytes and lymphocytes isolated from injured adults with elevated Candida antigen titers to activate the anticandidal function of normal PMNs. METHODS: Lymphocytes with or without monocytes, isolated from 18 injured adults with elevated titers, were cultured in the presence or absence of heat-killed Candida albicans for 48 hours. Culture supernatants were harvested, diluted 1:40, 1:160, and 1:640, and tested for the ability to stimulate the anticandidal function of normal PMNs using an 3H-glucose incorporation assay. Monocytes and lymphocytes isolated from nine volunteers were studied for comparison. RESULTS: Supernatants of lymphocytes from healthy volunteers that were cultured with heat-killed C. albicans significantly augmented normal PMN anticandidal function. Supernatants of lymphocytes from injured adults with elevated titers that were cultured with heat-killed C. albicans did not significantly augment normal PMN anticandidal function. Supernatants of monocytes or lymphocytes from both groups of patients were able to upregulate PMN anticandidal function. CONCLUSIONS: Lymphocytes from injured adults with elevated Candida antigen titers are defective in their ability to stimulate PMN anticandidal function. Monocytes from these patients can respond to Candida exposure and overcome the lymphocyte functional defect seen in injured patients with elevated titers.

Adult↗
PubMed1994

Elevated Candida antigen titers are associated with neutrophil dysfunction after injury.

This study was undertaken to determine if impaired neutrophil (polymorphonuclear leukocytes [PMNL]) function is associated with an elevated Candida antigen titer after injury. PMNL from eight severely injured adults with Candida antigen titers of > or = 1:4 (titer positive) were evaluated for the ability to inhibit growth of Candida albicans in vitro by using a [3H]glucose incorporation assay. PMNL from eight severely injured adults with titers of < 1:4 (titer negative) and from eight healthy volunteers were studied for comparison. PMNL from the titer-positive patients had suppressed ability to inhibit C. albicans growth compared with PMNL from titer-negative patients and healthy volunteers. In vitro, PMNL function against C. albicans could be augmented significantly by cytokines. Granulocyte macrophage-colony-stimulating factor was most potent at augmenting function, followed by interleukin-8 and gamma interferon. Injured patients with elevated candida antigen titers have impaired PMNL function against C. albicans, and this function can be restored by cytokines.

Adult↗
PubMed1993

Impaired polymorphonuclear leukocyte anticandidal function in injured adults with elevated Candida antigen titers.

Per protocol, adults with an Injury Severity Score of 18 or greater underwent Candida antigen titer measurements weekly. If titers were 1:4 or greater, neutrophil function against Candida albicans was determined with use of a tritiated glucose incorporation assay, and polymorphonuclear leukocytes obtained from healthy blood donors were studied concurrently for comparison. Polymorphonuclear leukocytes from healthy blood donors and injured patients with elevated titers were able to inhibit C albicans growth in a dose-dependent fashion. Polymorphonuclear leukocytes from injured patients with elevated titers had a significantly depressed ability to inhibit Calbicans growth compared with those from healthy blood donors at all effector cell-to-target cell ratios tested. Cytokine-treated polymorphonuclear leukocytes from healthy blood donors and injured patients with elevated Candida antigen titers demonstrated significantly improved anticandidal activity at all ratios of polymorphonuclear leukocytes-to-Candida. Granulocyte macrophage-colony stimulating factor was the most potent cytokine at reconstituting polymorphonuclear leukocyte function, followed by interferon gamma and interleukin 8. In conclusion, an elevated Candida antigen titer in injured adults is associated with impaired polymorphonuclear leukocyte antifungal activity. This depressed activity can be reconstituted by the addition of cytokine.

Adult↗
PubMed1993

Lymphocyte dysfunction in injured adults with elevated Candida antigen titers.

BACKGROUND: Lymphocytes play an important role in the activation of polymorphonuclear neutrophil (PMN) antimicrobial functions. This study was undertaken to evaluate the ability of lymphocytes from severely injured adults with elevated Candida antigen titers to activate the anticandidal function of normal PMNs. METHODS: Lymphocytes from 13 injured adults with elevated Candida antigen titers (titer+) were isolated and incubated with or without heat-killed C. albicans. After a 48-hour incubation, cell culture supernatants were harvested and tested for the ability to activate the anticandidal function of normal PMNs. Lymphocytes from 13 volunteers and 13 injury-matched patients with negative Candida antigen titers (titer-) were studied for comparison. RESULTS: The patients with titer+ and titer- were well matched in terms of age, sex, Injury Severity Score, units of blood transfused, and length-breadth of antibiotic therapy. Patients with titer+ had a higher incidence of bacterial infections than did patients with titer-. Only 2 of the 13 patients with titer+ had a positive Candida culture. Lymphocytes from the volunteers and patients with titer- released large amounts of a PMN-activating factor(s) when exposed to C. albicans. Lymphocytes from the patients with titer+ were defective in their ability to release this activating factor(s) after exposure to C. albicans. CONCLUSIONS: Although culture evidence of Candida was uncommon, injured adults with elevated Candida antigen titers have lymphocyte dysfunction and often suffer documented bacterial infections.

Adult↗
PubMed1992

Gastric pseudolymphoma. Not necessarily a benign lesion.

Gastric pseudolymphoma is thought to be a benign process. This report documents the malignant behavior of a gastric pseudolymphoma that was thought to be benign until a distant malignant B-cell lymphoma was demonstrated. Subsequent evaluation traced the B-cell lymphoma back to the gastric "pseudolymphoma." This finding stresses the relationship between gastric pseudolymphoma and gastric lymphoma, and the malignant potential of gastric pseudolymphoma. Multimodal tissue evaluation using histology, immunohistochemistry, and flow cytometry is essential. Surgical resection is the primary therapy for gastric pseudolymphoma.

Adult↗
PubMed1992

Is the cervical spine clear? Undetected cervical fractures diagnosed only at autopsy.

Undetected cervical-spine injuries are a nemesis to both trauma surgeons and emergency physicians. Radiographic protocols have been developed to avoid missing cervical-spine fractures but are not fail-safe. Three case reports of occult cervical fractures documented at autopsy in the face of normal cervical-spine radiographs and computerized tomography scans are presented.

Adolescent↗
PubMed1990

The learner-centredness of two registered general nursing and two registered mental nursing courses as perceived by third-year nursing students.

Using the conceptual framework of the Nottingham Andragogy Group, two first-level British courses in general nursing and two in psychiatric nursing were studied to investigate their degree of perceived learner-centredness. Boydell's Scale for Measuring the Learner-Centredness of a Course was administered to a non-random sample of all 172 third-year students at three schools of nursing. Preference for learner-centred nursing education was investigated using Boydell's Preferred Teaching Style Rating Scale with the student sample and by 31 nurse teachers. Results indicated that first-level nursing courses were perceived to be highly teacher-centred in terms of planning, direction, sequence, pace and evaluation of learning. The climate of learning proved to be moderately learner-centred though teacher-student relationships were perceived as formal. Variety of learning approach was seen as limited with a tendency towards positivism rather than relativism of knowledge. Both students and teachers of nursing expressed a slight preference for teacher-centred courses despite the former's dissatisfaction with lack of participation in determining learning objectives. Significantly greater perceived learner-centredness of a psychiatric course was attributed to variations in the philosophy of learning within a particular school rather than to the course per se.

Adult↗
PubMed1989

Student profiling as a basis for continuous assessment of clinical progress during a registered mental nurse course (1988).

Interest in profiling of student progress has spread in recent years from general education. Nurse educationalists have been searching for alternative methods of monitoring continuous assessment schemes. The advantages, disadvantages and rationale for the introduction of student profiling of clinical progress into a mental health nursing course are discussed. The role, function and support required by clinical supervisors are considered in the operationalisation of a 'Profile Grids' format of student profiling. An example of a student profile document for a psychodynamic nursing elective experience is included, depicting statements of competence set out in profile grids format. Guidelines for completion of documentation and monitoring of the Central Manchester Health Authority scheme are also described.

Clinical Competence↗