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Biomedical subjects

J Macfie

Publications and source records attributed to J Macfie.

At least 19 recordsLinked to original sources
PubMed2006

ESPEN Guidelines on Enteral Nutrition: Pancreas.

The two major forms of inflammatory pancreatic diseases, acute and chronic pancreatitis, require different approaches in nutritional management, which are presented in the present guideline. This clinical practice guideline gives evidence-based recommendations for the use of ONS and TF in these patients. It was developed by an interdisciplinary expert group in accordance with officially accepted standards and is based on all relevant publications since 1985. The guideline was discussed and accepted in a consensus conference. In mild acute pancreatitis enteral nutrition (EN) has no positive impact on the course of disease and is only recommended in patients who cannot consume normal food after 5-7 days. In severe necrotising pancreatitis EN is indicated and should be supplemented by parenteral nutrition if needed. In the majority of patients continuous TF with peptide-based formulae is possible. The jejunal route is recommended if gastric feeding is not tolerated. In chronic pancreatitis more than 80% of patients can be treated adequately with normal food supplemented by pancreatic enzymes. 10-15% of all patients require nutritional supplements, and in approximately 5% tube feeding is indicated.

Acute Disease↗
PubMed2006

Ethical and legal aspects of enteral nutrition.

European ethical and legal positions with regard to EN vary slightly from country to country but are based on a common tradition derived from Graeco Roman ideas, religious thought and events of the 20th century. The Hippocratic tradition is based on 'beneficience' (do good) and 'non-maleficience' (do no harm). Religious thinking is based upon the presumption of providing food and drink by whatever means unless burden outweighs benefit. The concept of 'autonomy' (the patients right to decide) arose following in the decades after the Second World War and is enshrined in Human Rights law. The competent patient has the right to participate in decision making and to refuse treatment although the doctor is not obliged to give treatment which he or she considers futile or against the patient's interests. The incompetent patient is protected by law. The fourth principle is that of 'justice' i.e. equal access to healthcare for all. The law regards withholding and withdrawing treatment as the same. It also defines the provision of food and drink by mouth as basic care and feeding by artificial means as a medical treatment. It requires doctors to act in the best interests of the patient.

Decision Making↗
PubMed2001

Dissociation in maltreated versus nonmaltreated preschool-aged children.

OBJECTIVE: Dissociation is linked to the experience of child maltreatment for adults and for school-aged children. The goals of the current paper were: First, to extend existing research and examine the link between child maltreatment and preschool-aged children; and second, to examine which subgroups of maltreated preschoolers are most likely to evidence dissociation. METHOD: A well-validated measure of dissociation in children, The Child Dissociative Checklist (CDC; Putnam, Helmers, & Trickett, 1993), was utilized in a sample of low SES maltreated and nonmaltreated preschoolers (N = 198). A measure of internalizing and externalizing symptoms was also utilized. The maltreated children were assessed for sexual abuse, physical abuse, neglect, and also for severity, chronicity, and multiple subtypes of maltreatment. RESULTS: The sexually abused, physically abused, and neglected groups each demonstrated more dissociation than did the nonmaltreated group. Dissociation in the clinical (psychopathological) range was associated with physical abuse. Moreover, maltreatment severity, chronicity, multiple subtypes, and internalizing and externalizing symptomatology were each related to dissociation. CONCLUSIONS: Child maltreatment is a factor in dissociation in preschool-aged children as it is in older children and in adults. Sexual abuse, physical abuse, neglect, severity, and chronicity are all implicated. Developmentally sensitive interventions that look beyond comorbidity with behavioral symptoms for dissociative preschool-aged children are needed.

Analysis of Variance↗
PubMed2001

The development of dissociation in maltreated preschool-aged children.

Dissociation reflects disruptions in the integration of memories, perception, and identity into a coherent sense of self, and may develop following childhood maltreatment. The preschool years were identified as an important period for the development of dissociation. However, prior research has not examined the development of dissociation during this time. In order to address this gap, evidence of dissociation in 45 maltreated children, assessed for sexual abuse, physical abuse, and neglect, was compared with dissociation in 33 nonmaltreated children. Rather than depend on adult observer reports of behavior, the study sought to gain an understanding of dissociation from the child's own point of view. Because self-reports have limitations with such young children, a measure of dissociation evidenced in children's narrative story-stem completions was utilized. Maltreated children, especially physically abused children and sexually abused children, demonstrated more dissociation than did nonmaltreated children. Moreover, during the preschool period maltreated and nonmaltreated children followed different trajectories such that dissociation increased for maltreated children but did not do so for nonmaltreated children. Findings suggest that although the self is normatively integrated during the preschool period, it becomes increasingly fragmented for some maltreated children. Results are discussed in terms of cascading effects of maltreatment throughout development, and the importance of developmentally sensitive interventions.

Child Abuse↗
PubMed2000

Narrative representations of caregivers and self in maltreated pre-schoolers.

This study examined narrative representations of parents and of self, as well as child behavior during the assessment, in maltreated (N = 56) and demographically comparable non-maltreated (N = 37) pre-school-aged children in a one-year longitudinal study. Maltreated children evidenced more negative representations of parents and of self at Time 2, including the juxta-position of both a negative and a grandiose self. Over time there was a marginal interaction such that maltreated children portrayed fewer disciplining parent representations and nonmaltreated children portrayed more. Also over time, maltreated children portrayed marginally more grandiose self-representations and nonmaltreated children fewer. Furthermore, maltreated children demonstrated less responsivity to the examiner over time and nonmaltreated children demonstrated more. The deleterious effects of maltreatment on representations of self and of others, especially as development proceeds, are discussed, and the importance of providing attachment-informed intervention prior to the consolidation of these negative representations is highlighted.

Child Abuse↗
PubMed2000

Narrative representations of moral-affiliative and conflictual themes and behavioral problems in maltreated preschoolers.

Examined whether maltreated preschoolers are more likely than nonmaltreated preschoolers to have fewer moral-affiliative and more conflictual narrative representations and whether these representations mediate child behavior problems. A structured narrative story-telling task was administered to assess representations, and independent ratings of behavior problems were obtained from teachers. The narratives of maltreated children contained more conflictual and fewer moral-affiliative themes. Maltreated children also exhibited more internalizing and externalizing behavior problems. A partial mediation effect of conflictual representations on the relation between child maltreatment and externalizing behavior problems was found. The results demonstrate the relation between child maltreatment and children's organization of their life experiences and their behavioral symptomatology.

Child Abuse↗
PubMed1999

Effect of maltreatment on preschoolers' narrative representations of responses to relieve distress and of role reversal.

A total of 80 low-socioeconomic status maltreated preschoolers were contrasted with 27 nonmaltreated preschoolers on their narrative representations. The children completed story stems, taken from the MacArthur Story-Stem Battery (MSSB; I. Bretherton, D. Oppenheim, H. Buchsbaum, R. N. Emde, & the MacArthur Narrative Group, 1990), that introduced stressful family situations. Using the MacArthur narrative coding manual (J. Robinson, L. Mantz-Simmons, J. Macfie, & the MacArthur Narrative Group, 1992), coders rated portrayals of parental and child character responses, as well as participant responses, to relieve children's distress. They also rated role reversal (children caretaking their parents) from the narrative emotion coding manual (S. L. Warren, L. Mantz-Simmons, & R. N. Emde, 1993). Maltreated preschoolers portrayed parents and children as responding less often--yet themselves as stepping into the story more often to relieve children's distress--than did nonmaltreated preschoolers. Abused children (sexually, physically, or both) portrayed the most participant responses, and neglected children (with no abuse) portrayed the fewest child responses. Role reversal was associated with physical abuse.

Child Abuse↗
PubMed1998

A prospective study of serum pancreatic elastase-1 in the diagnosis and assessment of acute pancreatitis.

BACKGROUND: Serum amylase gives a poor estimate of both the true incidence and the severity of acute pancreatitis (AP). METHODS: We evaluated serum pancreatic elastase-1 (PE-1) prospectively in 567 patients in whom AP was suspected. In established AP, severity was assessed using the Glasgow Criteria, and C-reactive protein, amylase, and serum PE-1 were evaluated over 5 days. RESULTS: The sensitivity, specificity, and diagnostic efficiency of serum PE-1 were 0.66, 0.85, and 0.84, respectively. The diagnostic accuracy of serum PE-1 was 0.80, and that of amylase 0.97. Serum PE-1 did not correlate with disease severity or the development of complications, but it fell more slowly than the serum amylase in the week after admission. CONCLUSIONS: The serum PE-1 level correlated closely with the serum amylase but conferred no benefit as a diagnostic test, nor did it provide further prognostic information.

Acute Disease↗
PubMed1997

Representations of self and other in the narratives of neglected, physically abused, and sexually abused preschoolers.

The MacArthur Story Stem Battery was used to examine maternal and self-representations in neglected, physically abused, sexually abused, and nonmaltreated comparison preschool children. The narratives of maltreated children contained more negative maternal representations and more negative self-representations than did the narratives of nonmaltreated children. Maltreated children also were more controlling with and less responsive to the examiner. In examining the differential impact of maltreatment subtype differences on maternal and self-representations, physically abused children evidenced the most negative maternal representations; they also had more negative self-representations than nonmaltreated children. Sexually abused children manifested more positive self-representations than neglected children. Despite these differences in the nature of maternal and self-representations, physically and sexually abused children both were more controlling and less responsive to the examiner. The investigation adds to the corpus of knowledge regarding disturbances in the self-system functioning of maltreated children and provides support for relations between representational models of self and other and the self-organizing function that these models exert on children's lives.

Child Abuse↗
PubMed1996

Administration of peripheral parenteral nutrition: a prospective study comparing rotation of venous access sites with ultrafine cannulas.

Peripheral veins have been used successfully for patients requiring short- to medium-term total parenteral nutrition. This study prospectively compares two methods of peripheral parenteral nutrition (PPN). Forty-six patients requiring parenteral nutrition (PN) were identified prospectively. Fifty courses of PPN were prescribed using a standardized PPN formula of 9.3 g nitrogen, 1400 kCal, 2500 ml (KABI II, Pharmacia). Patients were randomized to receive PPN via 23G, 15 cm flexane catheters (Nutriline) inserted into an antecubital vein which remained in-situ with a continuous infusion over 24 h, or to receive 12-h cyclical infusions through peripherally sited 18G catheters (Venflon) which were removed postinfusion and reinserted into the contralateral forearm on alternate days. Data collected included duration, complications and cost of materials for each prescribed course. A scoring system to determine patient anxiety and depression and a questionnaire regarding patients' perspectives were evaluated. Fifty courses were prescribed, 26 by rotation of veins (RV) and 24 by Nutriline (N). Mean duration of feeding was 7.9 and 8.6 days, respectively; cost of materials were comparable 6.48/day (RV) vs 5.17/day (N); 2 RV patients failed to complete their course (no access [P< 0.05], whilst 9 N patients failed to complete their course (4 severe phlebitis, 2 no venous access, 2 septicaemia, 1 dislodged). Five patients required CPN (RV, N 3) while 4 remaining patients were fed by an alternative PPN method. The overall incidence of anxiety was 20% and of depression 16%, with no significant difference between groups. The majority of patients (87%) found mobility restricted. Twelve-hourly infusions via alternate forearm veins were significantly more successful than continuous infusions via Nutriline, both in terms of completion of the prescribed course and less venous morbidity. This study confirms that rotation of forearm veins allows affordable and successful PN administration to the majority of patients, with low PN-related morbidity.

Journal Article↗
PubMed1996

U.S. experience with the AddVent VDD(R) pacing system. AddVent Phase I Investigators.

The AddVent pacemaker generator and model 1328C AV single-pass lead is a new pacemaker system capable of VDD or VDDR modes. The purpose of this study was to present the initial experience with AddVent in the United States and Canada. Between May 10, 1995 and May 3, 1996, 53 devices were implanted in 52 patients and followed for a mean of 217 (+/- 39) days. At the predischarge, 1-, 3-, and 6-month follow-up evaluations, atrial sensing thresholds and ventricular sensing and capture thresholds were measured in the supine, sitting, and standing positions to evaluate stability of atrial sensing with respect to body posture at rest. At the 1-month follow-up, a treadmill exercise test was performed to evaluate atrial sensing during exercise and to evaluate two new features of the AddVent called "sensor-mediated rate smoothing" and "preferential P wave sensing." Atrial sensing thresholds were not significantly different (P > 0.05) among body postures for any follow-up period or among follow-up periods for each posture. At rest, the percentage of appropriately tracked P waves observed was > 99% at each follow-up period. During treadmill exercise, the percentage of appropriately tracked P waves was > 98.7%. Appropriate preferential P wave sensing and sensor-mediated rate smoothing (VDDR mode) was observed. The AddVent pacing system provides safe and effective pacing therapy. Several features of VDDR pacing offer advantages over standard VDD pacing.

Aged↗
PubMed1995

Randomized trial of pelvic drainage after rectal resection.

UNLABELLED: Most surgeons continue to advocate routine use of drains after pelvic anastomoses. Several recent studies have, however, demonstrated that patients gain little or no benefit from such drainage and that drains may indeed be a source of morbidity to some. PURPOSE: The aim of this trial was twofold: 1) to determine whether use of a high pressure, closed suction pelvic drain was associated with reduced morbidity; 2) to investigate the influence of drainage on postoperative fluid collections after rectal resection. METHODS: A consecutive series of 100 patients was randomized to receive either no drain (n = 48) or a high pressure, closed suction intraperitoneal drain for seven days (n = 52). The two groups were similar in terms of age, sex, diagnosis, and type of anastomosis. Patients underwent postoperative pelvic ultrasound and water-soluble contrast studies on day 7. RESULTS: There were six deaths (three drain, three no drain). Clinically significant anastomotic leak occurred in seven patients (five drain, two no drain), and a radiologic leak was demonstrated in another five patients (two drain, three no drain), each of whom remained well. Presence or absence of a drain did not influence rate of morbidity and mortality. Pelvic fluid collections were more likely to be demonstrated if a drain was used; however, this did not reach statistical significance. Neither pus nor feces emerged from the drain in any patients in whom a leak occurred. CONCLUSION: Use of a pelvic drain after rectal resection did not confer any benefit to the patient.

Adolescent↗
PubMed1994

Comparative audit of colorectal resection with the POSSUM scoring system.

Comparison of outcome after colorectal resection between different surgical units is difficult. Crude rates of morbidity and mortality may give a distorted picture as such rates fail to account for variations in case mix and physiological status of patients. The simple and validated scoring system POSSUM (Physiological and Operative Severity Score for enUmeration of Mortality and morbidity) was used to compare outcome after colorectal resection in two units. Consecutive series of patients who underwent colorectal resection in unit 1 (a university teaching hospital) or unit 2 (a district general hospital) were scored with the POSSUM system. Postoperative complications and 30-day mortality were recorded. In unit 1, 66 patients underwent colorectal resection with a mortality rate of 6 per cent and a morbidity rate of 9 per cent. In unit 2 the rates of mortality and morbidity were 9 and 26 per cent respectively for 182 patients undergoing colorectal resection. However, application of POSSUM predicted a mortality rate of 5.2 per cent for patients in unit 1 and 9.8 per cent for those in unit 2 with predicted morbidity rates of 11.2 and 23.9 per cent respectively. Direct comparison of outcome between these two units would be misleading. Application of POSSUM allows more realistic comparative audit of colorectal resection.

Adult↗