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Biomedical subjects

J M Walsh

Publications and source records attributed to J M Walsh.

72 records · Page 4Linked to original sources
PubMed1976

A normative approach to the definition of primary health care.

Primary care is the subject of many pronouncements and many recommendations for change in the literature on health care organization and delivery. Heretofore, there has been no attempt to assess the degree of agreement on the meaning of the term. This paper reports on a normative process used to construct 92 statements about important elements of primary care, and to rank these statements according to their relative degrees of importance in primary care. Three panels--nationally recognized "experts" on primary care, consumers, and public health nurses and social workers--participated in the development as well as the ranking of the statements. The rankings of the national experts are discussed in detail, and brief comparisons are made with the rankings of the consumer and public health worker panels. Experts gave a high ranking to the statements concerned directly with medical services and their linkages. All gave attention to equality and patient dignity. Consumers stressed the need to improve access to primary care services. Public health workers emphasized improvement in both access and the quality of the relationship between patients and providers. The overall findings suggest that increasing the base of participation in primary care planning may bring greater attention to patient defined needs, and that broadening of medical care objectives from medical care to a more inclusive health care is not imminent.

Community Participation↗
PubMed1976

Assessment of vertical excursions and open-sea psychological performance at depths to 250 fsw.

A series of 10 two-man descending vertical excursion dives was carried out in the open sea from an ocean-floor habitat off the coast of Puerto Rico by four aquanauts saturated on a normoxic-nitrogen breathing mixture at a depth of 106 fsw. The purpose of these dives was two-fold: to validate laboratory findings with respect to decompression schedules and to determine whether such excursions would produce evidence of adaptation to nitrogen narcosis. For the latter, tests designed to measure time estimation, short-term memory, and auditory vigilance were used. The validation of experimental excursion tables was carried out without incidence of decompression sickness. Although no signs of nitrogen narcosis were noted during testing, all subjects made significantly longer time estimates in the habitat and during the excursions than on the surface. Variability and incomplete data prevented a statistical analysis of the short-term memory results, and the auditory vigilance proved unusable in the water.

Analysis of Variance↗
PubMedDate not supplied

Immunogold confirmation that utrophin is localized to the normal position of dystrophin in dystrophin-negative transgenic mouse muscle.

It has been shown previously that when utrophin is highly expressed in mice which lack dystrophin, the muscle pathology is prevented. Immunohistochemical evidence strongly suggests that utrophin in these transgenic mice occupies the position normally filled by dystrophin, although it is not possible to establish this firmly at the level of the light microscope. Using the higher resolution provided by the electron microscope, we demonstrate here by immunogold labelling with both monoclonal and polyclonal antibodies that utrophin, in both its truncated and full-length forms, is indeed specifically located in the subcellular position usually occupied by dystrophin in normal muscle. Moreover, when double-labelling of utrophin and beta-dystroglycan was carried out, colocalisation of the two labels was often seen, indicating an association of the two proteins. Furthermore, when both utrophin and dystrophin were labelled in a transgenic line in which both were simultaneously expressed, the sites of both proteins were in the same zone in relation to the plasma membrane. When both proteins were present, the density of labelling of each was reduced compared with when they are expressed individually, suggesting that there is a finite number of binding sites. These results constitute further support for the view that utrophin might be therapeutically substituted for dystrophin in dystrophic muscle.

Animals↗
PubMedDate not supplied

An evaluation of selected oral fluid point-of-collection drug-testing devices.

Point-of-collection oral fluids drug-testing devices are being marketed for a variety of medico-legal purposes where they may complement existing technologies and be used to detect drugs following recent ingestion. To assess the utility of these devices for use in drugged-driving investigations, we performed a laboratory evaluation of four devices and those results were published previously. In the study reported here, two more devices, Oratect(R) (Branan) and Uplink(R) (OraSure), were evaluated for their ability to detect amphetamines, cocaine, opiates, and cannabinoids. An additional device, Drugwipe (Securtec), was evaluated for the detection of cocaine and cannabinoids. Each of the devices was assessed for their ability to meet the manufacturers' claimed cutoff concentrations and to meet cutoffs proposed for federal workplace programs. In general, the Branan and OraSure devices detected amphetamine, methamphetamine, opiates, and cannabinoid metabolite (THC-COOH) well in the concentration ranges approximating those proposed by the Substance Abuse and Mental Health Services Administration (SAMHSA), but all three devices performed poorly in detecting Delta9-tetrahydrocannabinol (THC) at the proposed SAMHSA cutoff. The ability to accurately and reliably detect cocaine was dependent on the individual device, and the Branan and Securetec devices were more effective than OraSure at detecting parent cocaine.

Equipment Design↗
PubMedDate not supplied

Periodic lateralized epileptiform discharges--long-term outcome in adults.

We reviewed the long-term outcome of 39 adults whose electroencephalograms (EEGs) showed acute periodic lateralized epileptiform discharges (PLEDs). Parameters studied included outcome, presence or absence of a seizure disorder (both prior to and subsequent to the PLEDs), seizure type and frequency, and etiology of the PLEDs. The mortality rate was 41%, as 16 of 39 patients died during their hospitalization or within 2 months of discharge. Of the 23 survivors, 7 (30%) had a significant decline in their ability to provide self-care. A recent stroke (13 patients, 33%) was the most frequent cause of PLEDs. In this subgroup particularly, poor outcome, i.e., death or functional decline, was common (10 of 13 patients). Thirty-six patients had seizures just prior to or during the hospitalization when PLEDs were observed; focal motor seizures were the most common type (n = 22). Patients with a history of seizures prior to the occurrence of PLEDs continued to have seizures following discharge. In addition, 4 of 9 patients with new onset seizures associated with PLEDs had subsequent seizures.

Adult↗
PubMedDate not supplied

The behavioral toxicity of a tributyltin ester in the rat.

The behavioral toxicity of an organic tin compound under consideration for use in marine antifouling paint was assessed using a Sidman avoidance paradigm. The assessed compound, an organometallic polymer (tributyltin [methacrylic-CO-methylmethacrylate] ester), is from a group of alkyltin compounds of which triethyl and tributyltin are known to be toxic. Rats were tested under a free-operant avoidance procedure for 6 months while ingesting the polymer in their drinking water. At the beginning of the 5th month significant behavioral changes became evident, reflected in increases in shock rate, decreased responding, and a shifting of the interresponse time distribution. Performance improved upon withdrawal of the contaminant suggesting that limited exposure to the polymer may not result in permanent behavioral dysfunction.

Analysis of Variance↗
PubMedDate not supplied

Incidence of phrenic neuropathy after isolated lung transplantation. The Loyola University Lung Transplant Group.

BACKGROUND: Isolated lung transplantation is a viable therapeutic option for many patients with end-stage pulmonary disease. Other intrathoracic surgical procedures have a well documented incidence of phrenic nerve dysfunction, although the incidence after lung transplantation has not been studied. METHODS: Thirty-one patients who underwent lung transplantation were evaluated for evidence of phrenic nerve dysfunction and subsequent recovery. Risk factors contributing to the incidence of injury were examined. Phrenic nerve injury was defined by two separate diagnostic tests (Transcutaneous Phrenic Nerve Conduction Studies and Fluoroscopic evaluation of diaphragmatic movement) used in combination. RESULTS: Of the 27 patients who were completely evaluated after the operation, eight had defining criteria for nerve injury--an incidence of 29.6%. Of those affected, the majority of injuries (89%) resulted in complete paralysis of the affected hemidiaphragm. The highest incidence of injury occurred in patients who underwent bilateral single lung transplantation (41%), with the right phrenic nerve being injured most often (78%). Fortunately, no significant postoperative morbidity was attributable to the occurrence of phrenic nerve injury when compared with those patients who did not sustain injury. CONCLUSIONS: The analysis of possible risk factors resulted in the hypothesis that the likely mechanism of injury in these patients was due to stretching or direct instrumentation of the nerve, and thus measures should be instituted to minimize the possibility of injury.

Adult↗
PubMedDate not supplied

Prevention training and medical residency.

We developed a questionnaire to assess training and perceived competence in prevention skills during medical residency. We asked residents at a university training program about 20 prevention interventions recommended by the U.S. Preventive Services Task Force. Primary care and categorical medicine residents rated the adequacy of training and the perceived relevance to clinical practice of these interventions as well as basic skill and knowledge areas (such as patient education) on five-point Likert-type scales (1 = very inadequate or very unimportant and 5 = very adequate or very important). Fifty-eight residents (n = 19 primary care and 39 categorical medicine) completed the questionnaire (response rate = 63%). Primary care residents felt significantly (P < .05) more competent than categorical medicine residents in 14 of the 20 prevention interventions. Primary care residents rated the adequacy of training in eight of 10 basic skill and knowledge areas significantly (P < .05) higher than did categorical medicine residents. For both groups of residents, mean relevance scores significantly exceeded mean perceived competence scores in 18 of 20 prevention interventions and in all 10 skill and knowledge areas. Primary care residents felt more competent than categorical medicine residents in performing most prevention interventions. However, residents in both training programs rate the relevance of several basic skill and knowledge areas as higher than their perceived competence, suggesting training underemphasis. Both primary care and categorical medicine training programs could use this instrument to assess the adequacy of their training in these areas.

Clinical Competence↗