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Biomedical subjects

J McClelland

Publications and source records attributed to J McClelland.

At least 19 recordsLinked to original sources
PubMed2002

An Australian survey of in-patient protocols for quadriceps exercises following anterior cruciate ligament reconstruction.

Current practices regarding in-patient strengthening exercise prescription following anterior cruclate ligament (ACL) reconstruction are scarcely addressed in the literature and remain unreported for Australian hospitals. An observational, questionnaire-based study was used to Investigate in-patient quadriceps strengthening practices in Australian hospitals after ACL reconstruction. Questionnaires were returned by 248 hospitals (76% response rate) and of these 88 hospitals reported performing ACL reconstructions. These hospitals were surveyed to determine the types of quadriceps strengthening exercises prescribed during the in-patient period. Information was sought regarding routine management strengthening practices. A variety of quadriceps exercises such as static quadriceps contractions (SQC), straight leg raises (SLR) and inner range quadriceps (IRQ) were frequently prescribed, although no standard practice currently exists. Static quadriceps exercises were prescribed by 91% of hospitals surveyed, IRQ exercises were used by 30%, and 49% reported using SLR exercises. Current literature tends to support the performance of SQC and SLR exercises during the early postoperative period following ACL reconstruction. Conversely, current clinical practice is incongruent with regard to the scientific recommendations for IRQ performance.

Anterior Cruciate Ligament↗
PubMed2001

Comparison of EMLA cream versus placebo in children receiving distraction therapy for venepuncture.

UNLABELLED: Eutectic mixture of local anaesthetics (EMLA) cream is used routinely as a local anaesthetic prior to venepuncture in children. Despite this, however, a significant proportion of children will still be distressed. Cognitive-behavioural interventions, such as distraction by breathing and blowing exercises, have been used and found to be helpful as alternative coping strategies. There is, however, a paucity of data regarding effectiveness. We have evaluated the efficacy of distraction therapy as a coping strategy before and during venepuncture, and in these children evaluated the need for EMLA using a prospective, randomized, double-blind, placebo-controlled clinical trial. Twenty-eight children attending for venepuncture were recruited, median age 6 y (range 4-8 y), and randomly allocated to receive either EMLA or a placebo cream. All were given distraction therapy prior to and during the procedure by a play specialist. Venepuncture was carried out by one investigator. A modified paediatric pain assessment chart was used for objective pain score at the end of the procedure. After one exclusion, the treatment group (17 children) and the placebo group (10 children) were similar: median age of 6 and 7 y (range 4-8), median baseline and post-procedure heart rate and oxygen saturation. The median (interquartile range) for total pain score in the treatment group was 1 (0 to 4.5) and in the control group 1 (0 to 2.3). There was no significant difference in pain score between the two groups (Mann-Whitney test, p = 0.7). The 95% confidence interval for the difference in pain score was -1.0 to +3.0. CONCLUSIONS: The low pain score in both groups suggests the effectiveness of distraction therapy, although factors such as skill of the operator and previous experience of the patient group are of relevance. There was no significant difference in the pain score between the EMLA and placebo groups, suggesting that in this age group if carefully selected children receive distraction during venepuncture EMLA may not be necessary.

Adolescent↗
PubMed2000

The North Carolina Black Churches United for Better Health Project: intervention and process evaluation.

The North Carolina Black Churches United for Better Health project was a 4-year intervention trial that successfully increased fruit and vegetable (F&V) consumption among rural African American adults, for cancer and chronic disease prevention. The multicomponent intervention was based on an ecological model of change. A process evaluation that included participant surveys, church reports, and qualitative interviews was conducted to assess exposure to, and relative impact of, interventions. Participants were 1,198 members of 24 intervention churches who responded to the 2-year follow-up survey. In addition, reports and interviews were obtained from 23 and 22 churches, respectively. Serving more F&V at church functions was the most frequently reported activity and had the highest perceived impact, followed by the personalized tailored bulletins, pastor sermons, and printed materials. Women, older individuals, and members of smaller churches reported higher impact of certain activities. Exposure to interventions was associated with greater F&V intake. A major limitation was reliance on church volunteers to collect process data.

Adult↗
PubMed1999

Non-painful sensory phenomena after spinal cord injury.

OBJECTIVES: Non-painful sensory phenomena or "phantom" sensations are common after spinal cord injury. However, the physiological mechanisms responsible for these sensations are poorly understood. The aim of this study, therefore, was to document in a prospective fashion the time course, prevalence, and features of non-painful sensory phenomena after spinal cord injury, and to determine whether there was a relation between the presence of these sensations and completeness, level of injury, and type of spinal cord injury. METHODS: Patients admitted to an acute spinal injuries unit were interviewed after admission and at several time points over a 2 year period to determine the presence and characteristics of non-painful sensations. Sensations were divided into simple and complex, with complex referring to sensations that incorporated a sensation of volume, length, posture, or movement. RESULTS: The present study showed that the large majority (90%) of patients experience either type of sensation and most complex sensations (60%) are first experienced within 24 hours after the injury. Complex sensations were more common in those patients who had complete spinal cord injuries. The presence of either type of sensation did not seem to be related to the level of injury or the type of injury (cord syndrome). A relatively small proportion (22%) of patients reported that the postural sensations were related to their position at the time of injury and sensations were more commonly related to a familiar, comfortable, or often used position before the spinal cord injury. CONCLUSION: Complex sensations such as postural illusions seem to be due to functional changes in the CNS that may occur almost immediately after spinal cord injury. These sensations may be related to a strong sensory memory "imprint" that has been established before injury.

Adolescent↗
PubMed1998

Awareness of cancer-related programs and services among rural African Americans.

African Americans are at increased risk for cancer and represent an important target population for programs such as Healthy People 2000, the Cancer Information Service (CIS), and the 5 a Day for Better Health Initiative. Yet, awareness of such programs among rural blacks is unknown. This study assessed awareness of these programs and determined related knowledge and beliefs among rural African Americans. It was undertaken as part of the baseline survey for the Black Churches United for Better Health project, a National Cancer Institute-funded initiative. A minority of respondents (n = 3737) demonstrated name recognition of Healthy People 2000 (23.4%), the CIS (42.4%), and the 5 a Day Program (40.7%). Far fewer (7.4%) were able to correctly identify the recommended daily number of servings of fruits and vegetables. Reported family history of cancer was associated with a greater tendency believe that eating more fruits and vegetables can prevent disease. These findings underscore the need for efforts to reach the rural black community with culturally sensitive and stage appropriate cancer prevention messages. Knowledge of family history of cancer may play an important role in targeting subgroups and delivering effective cancer prevention messages.

Black or African American↗
PubMed1997

Relationship between surgery and pain following spinal cord injury.

Pain is a significant problem following spinal cord injury (SCI) and has a major influence on quality of life and the ability to engage in rehabilitation. Surgery is often indicated in the management of spinal cord injury to stabilise the spine and prevent further neurological deficit. However, the relationship between surgical intervention and the presence of pain following SCI is unclear. We performed a prospective, longitudinal study of 100 individuals with traumatic SCI to determine the prevalence of different types of SCI pain at 2, 4, 8, 13, 26 and 52 weeks following SCI and to determine whether there was a relationship between surgical intervention and the presence or absence of specific types of SCI pain. We found that surgical intervention was associated with a significantly higher prevalence of musculoskeletal pain at 2 weeks but not at 4, 8, 13, 26 and 52 weeks following injury, when compared with those who did not have surgery. There were no significant differences in the prevalence of visceral, neuropathic at level or neuropathic below level pain in the surgical and non-surgical groups at any stage. The results from this study suggest that apart from an increased prevalence of musculoskeletal pain at 2 weeks following SCI in those who undergo surgery, there is no significant relationship between surgical intervention and the presence of SCI pain.

Follow-Up Studies↗
PubMed1994

Primary disease effects and associations.

1. Although graft survival for most primary disease processes are similar at one year, significant divergence occurs by 5 years. ALP, IGA, and PC had the highest 5-year graft survival rates (72.8%, 71.2%, and 68.5%, respectively) whereas HTN and NS, the lowest (51.8% and 46.0%, respectively). 2. When primary diseases are grouped by pathogenic, pathophysiologic, and clinical similarities, the group of diseases with systemic manifestations had the lowest 5-year graft survival (55%), and the group including cystic and inherited diseases had the highest 5-year graft survival (69%). Black recipients had a predominance of "systemic" primary diseases (57%). 3. Despite having overall lower graft survival than Whites (p < 0.00001), there was no significant difference between Black and White 3-year graft survival for recipients with PC, ALP, IGA, and SLE. 4. PC recipients enjoyed excellent long-term graft survival (69%). Black recipients with PC had a 5-year graft survival rate of 64.6%. Recipients with PC had decreased posttransplant dialysis need, decreased early rejection rate, and better HLA matching than most other recipients. 5. Recipients with SLE as their primary disease had among the highest fraction of grafts lost to rejection (45.4% of all grafts lost) and the highest pretransplant sensitization rate (59.6%). 6. Recipients with HTN as their primary disease had overall lower 5-year graft survival (58% versus 63% in Whites, 44% versus 47% in Blacks), a lower rate of early allograft function (10% versus 12%, p < 0.00001), and more posttransplant dialysis needs (28.8% of patients requiring dialysis vs 23.5%, p < 0.00001) than recipients without HTN. Blacks with HTN had the lowest long-term graft survival (44.4%) of any other single group. 7. IDDM patients who expressed DR3 and/or DR4 alleles had significantly higher graft survival than patients without these DR groups. Whites expressing DR3 and DR4 and DR3 or DR4 alleles had better overall HLA matching (p < 0.001) and graft survival (75.4% and 70.7% versus 58.5% and 65.1%, p < 0.00001) than Blacks with similar DR expression. 8. SPK recipients had better 5-year graft survival than KAT recipients (66.2% versus 54.6%, p < 0.000001). This effect is most likely due to the selection of "better" lower-risk patients for SPK grafts.

Adolescent↗
PubMed1993

Los Angeles organ sharing: twenty-six-year report.

1. The Los Angeles Transplant Society and the Regional Organ Procurement Agency of Southern California (ROPA) was established in November 1967. ROPA was the first such organization in the United States. 2. The use of simple cold storage and shipment of kidneys by commercial airline resulted from pioneering concepts developed in the Los Angeles area from 1968-1969. 3. In the 26-year period of ROPA's operation, it has coordinated 8,446 kidney transplants. 4. All kidneys transplanted in 1993 were allocated according to the UNOS point system. 5. Allocating all kidneys under the point system has not significantly disadvantaged either large or small transplant centers in the greater Los Angeles area. 6. Racial distribution of recipients: 13% Black (compared with Los Angeles population of 12% and 6% donor population). Blacks represent 20% of the recipient waiting list. Hispanic recipients were 31% (compared to Los Angeles population of 40% and donor population of 30%). Hispanics comprised 28% of the waiting list. 7. The average waiting times for centers in the Los Angeles area ranged from 14-19.4 months. Transplanted patients waited an average of 16.3-22.1 months. 8. "Required request" had a significant effect on the number of referrals but did not produce a meaningful increase in the number of kidneys transplanted.

Cryopreservation↗
PubMed1992

The timing of brain morphological changes in schizophrenia and their relationship to clinical outcome.

The present study is an examination of ventricular and temporal lobe size in 50 DSM-III-R first-episode schizophreniform or schizoaffective patients who were ill for less than 6 months. Two-year clinical follow-up and magnetic resonance imaging (MRI) scan analyses are also reported from data collected on an initial group of 30 first-episode schizophrenic patients and controls. Left ventricular enlargement, which was present in our previously published report of first-episode cases of schizophrenia, is not present to the same extent in this larger group of schizophreniform patients closer to the onset of their illness, and no temporal lobe volume reduction was detected. However, lateral ventricular size at the time of the first-episode was generally correlated with outcome--the larger the ventricles, the poorer the outcome. No mean change in ventricular or temporal lobe size was found at rescanning 2 years later, but the degree of ventricular change was inversely correlated with the number of hospitalizations and the amount of time spent in hospital; it did not correlate with temporal lobe size. When rescanned, some patients showed change greater than 20% in ventricular size and 10% in temporal lobe size. Thus, these findings need further evaluation by serial scans over a longer time period before it can be determined that no progression of brain structural abnormalities is occurring as part of the pathology of schizophrenia, even in a subgroup of patients.

Adult↗
PubMed1992

Kidney allocation under the UNOS point system: an update.

1. The 1,480 patients awaiting cadaveric renal transplants at 14 Southern California transplant centers as of December 3, 1992, were compared with patients transplanted using a point system for one kidney and a hospital-based allocation for the second, or the current system allocating all locally procured kidneys by the point system with regard to several demographic parameters. 2. Of 1,472 waiting patients with sensitization data, 8.5% were broadly sensitized (> 80% PRA). Of the 737 kidneys allocated by the point system, 7% went to broadly sensitized patients, compared with 3% of 438 kidneys allocated by the hospitals (p < 0.001). 3. Of 1,470 waiting patients with information available, 23% were awaiting a repeat transplant. Under the point system, 18% of kidneys were used for repeat transplants compared with 9% of hospital-allocated kidneys (p < 0.001). 4. Of 1,434 waiting patients where the time waiting was available, 26% had waited 1-2 years, 12% 2-3 years, and 6% more than 3 years. Under the point system, patients waiting longer received significantly more kidneys than those recently added to the list: 35% had waited 1-2 years, 21% 2-3 years and 14% more than 3 years (p < 0.001). Kidneys allocated by the hospitals were transplanted to patients in approximately the same proportions as the waiting list: 29% to those waiting 1-2 years, 10% 2-3 years, and 3% more than 3 years. 5. Racial distribution of recipients was not significantly different under either allocation system from that of the waiting list. Whites comprised 39% of waiting patients, the same as the population of Los Angeles County.(ABSTRACT TRUNCATED AT 250 WORDS)

California↗
PubMed1991

Familial thyroid disease and delayed language development in first admission patients with schizophrenia.

One hundred consecutive first admission patients with a DSM-III-R diagnosis of schizophrenia, schizoaffective disorder, or schizophreniform disorder were compared with 100 randomly selected community controls. Childhood histories of physical, medical, and perinatal trauma, as well as physical and cognitive development, were examined by structured interviews with all available mothers of patients and controls. The prevalence of specific psychiatric disorders and several medical illnesses among first degree and more distant relatives was determined by family history questionnaires. The patient group did not have an excess of childhood head injuries, serious infections, or perinatal/birth complications compared with controls. With social class level taken into account, it was found that the acquisition of reading skills occurred significantly later in patients than controls. Family histories of schizophrenia and thyroid disorders were significantly more frequent among patients than controls. These data fail to indicate any childhood physical or medical environmental trauma that could lead to an increased risk for schizophrenia, although patients were substance abusers to a greater extent than controls. This study also confirms the already known contribution of familial factors and suggests an association of the inheritance of thyroid disorders with schizophrenia. Delayed development of reading skills suggests that precursers of illness may appear early in life before psychosis is evident.

Adult↗
PubMed1990

Circadian variation in ventricular electrical instability associated with coronary artery disease.

Although sudden cardiac deaths and ischemic cardiac events clearly occur in a circadian pattern, such a pattern has not been shown for primary arrhythmic events. Because primary arrhythmic events are thought to play an important role in sudden cardiac death, a large series of ventricular stimulation studies was analyzed to determine whether circadian variation in ventricular electrical instability exists. If such a circadian variation could be shown, it could have implications for the conduct and interpretation of electrophysiologic testing and the etiology of circadian variation in sudden cardiac death. Results of 2 drug-free ventricular stimulation studies performed 4 to 28 hours apart in each of 162 patients with coronary artery disease were analyzed. Rate and duration of induced arrhythmia, number of extrastimuli required to induce arrhythmia and changes in these factors between the 2 tests in each patient were analyzed. Comparisons were made by half-day, by hour and in a temporally continuous manner to eliminate errors associated with any single method. No significant circadian variation was found in any electrophysiologic measure of ventricular electrical instability despite adequate statistical power. These findings show that the time of day during which ventricular stimulation tests are performed does not affect test results, and therefore does not need to be controlled during electrophysiologic studies. If these findings are parallel to those in ambulatory patients with coronary artery disease, then circadian changes in ventricular electrical instability may not play as important a role in the circadian pattern of sudden cardiac death as had been previously thought.

Cardiac Pacing, Artificial↗