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Biomedical subjects

J Tracy

Publications and source records attributed to J Tracy.

At least 19 recordsLinked to original sources
PubMed2001

Using telemedicine to avoid transfer of rural emergency department patients.

Access to emergency treatment in rural areas can often mean the difference between life and death. Telemedicine technologies have the potential of providing earlier diagnosis and intervention, of saving lives and of avoiding unnecessary transfers from rural hospital emergency departments to urban hospitals. This study examined the hypothetical impact of telemedicine services on patients served by the emergency departments of two rural Missouri hospitals and the potential financial impact on the affected hospitals. Of the 246 patients transferred to the hub hospital from the two facilities during 1996, 161 medical records (65.4 percent) were analyzed. Using a conservative approach, only 12 of these cases were identified as potentially avoidable transfers with the use of telemedicine. Of these 12, 5 were admitted to the hub hospital after transfer. In addition to this conservative estimate of avoidable transfers based on current availability of resources in the rural hospitals, two more aggressive scenarios were developed, based on an assumption of increased service availability in the rural hospitals. Economic multipliers were used to estimate the financial impacts on communities in each scenario. This evaluation study demonstrates the potential value of telemedicine use in rural emergency departments to patients, rural hospitals and rural communities.

Diagnosis-Related Groups↗
PubMed2000

An evaluation of satisfaction with telemedicine among health-care professionals.

A survey was conducted among non-doctor health-care professionals in six rural counties in Missouri. The purpose of the survey was to establish baseline data to evaluate the effect of changes in the health-care sector, especially technology changes, on the job satisfaction, career satisfaction, relationships and communication activities of health professionals. The survey included three rural counties in which integrated telecommunication and interactive video telemedicine services were being installed, but before significant activities had begun, and three comparator counties without substantial integrated telecommunications infrastructure and telemedicine services. During a one-month study period, 1108 questionnaires were distributed. The total response rate was 50.1% (n = 555). Of the respondents, 30.3% indicated that technology in health-care was having a large effect on their work, although only 18.2% indicated that telemedicine and telecommunications were having a large effect. No systematic differences were found among the health professionals in the two communities at the time telemedicine equipment was being installed.

Health Knowledge, Attitudes, Practice↗
PubMed1999

Hope and anxiety of individual family members of critically ill adults.

This correlational study describes levels of hope and states of anxiety of individual family members of critically ill patients and investigates the relationship between hope and state of anxiety. Forty-four family members of critically ill patients participated in the study and revealed a high level of hope and a high level of anxiety within 72 hours of the patient's hospitalization, regardless of personal or situational characteristics. Hope and anxiety were not significantly related in this sample; themes of hope focused on past and present experiences, whereas anxiety centered on death of the loved one. Participants looked to the past, recalling happy times, and to the future, in relation to goals and potential. Family members acknowledged feeling secure, self-confident, and steady, and were able to make decisions because they were not confused about the situation. Nurses are challenged to inspire the family's hope and decrease their anxiety.

Adaptation, Psychological↗
PubMed1999

Cross-education of muscle strength is greater with stimulated than voluntary contractions.

Cross-education enhances the performance of muscles not directly involved in the chronic conditioning of the muscles in a remote limb. Substantial cross-education occurs after training with eccentric contractions or with contractions evoked by electromyostimulation (EMS). Since during EMS and eccentric contractions, skin and muscle afferents are activated that have excitatory effects on contralateral homologous muscles, it was hypothesized that exercise training with stimulated vs. voluntary eccentric contractions would lead to greater cross-education. Thirty-two women were randomly assigned to a voluntary (Vol), an EMS, or remote EMS (rEMS) exercise group and performed 840 voluntary or stimulated eccentric contractions over 6 weeks. All subjects, including nonexercising controls (Con), were tested pre- and posttraining for maximal voluntary and stimulated isometric and eccentric quadriceps strength. Ipsilateral voluntary and stimulated forces increased in all groups. Changes in EMG activity paralleled those in voluntary force in each limb. No changes occurred in grip strength. The great contra- and ipsilateral strength gains after EMS training were most likely related to an additive effect of EMS and muscle lengthening.

Adult↗
PubMed1998

Education for children with disabilities: the rationale for inclusion.

OBJECTIVE: To discuss issues in the education of children with disabilities, particularly with respect to inclusion in mainstream classes. METHODOLOGY: Review of the literature on education for children with disabilities, focusing on the inclusion versus segregation debate. RESULTS: The literature provides no support for segregation and some support for the view that segregated children are disadvantaged. What seems to be important is the way the child is educated rather than where the education takes place. In addition, there are ethical, sociological, and legal arguments in favour of an inclusive educational system. CONCLUSIONS: There are good arguments to encourage inclusive education for children with disabilities. In advising parents, doctors should focus on how rather than where the child with a disability should be educated.

Child↗
PubMed1998

The roles of the bacteriophage T4 r genes in lysis inhibition and fine-structure genetics: a new perspective.

Seldom has the study of a set of genes contributed more to our understanding of molecular genetics than has the characterization of the rapid-lysis genes of bacteriophage T4. For example, T4 rII mutants were used to define gene structure and mutagen effects at the molecular level and to help unravel the genetic code. The large-plaque morphology of these mutants reflects a block in expressing lysis inhibition (LIN), the ability to delay lysis for several hours in response to sensing external related phages attacking the cell, which is a unique and highly adaptive attribute of the T4 family of phages. However, surprisingly little is known about the mechanism of LIN, or how the various r genes affect its expression. Here, we review the extensive old literature about the r genes and the lysis process and try to sort out the major players affecting lysis inhibition. We confirm that superinfection can induce lysis inhibition even while infected cells are lysing, suggesting that the signal response is virtually instantaneous and thus probably the result of post-translational regulation. We identify the rI gene as ORF tk.-2, based on sequence analysis of canonical rI mutants. The rI gene encodes a peptide of 97 amino acids (Mr = 11.1 kD; pI = 4.8) that probably is secreted into the periplasmic space. This gene is widely conserved among T-even phage. We then present a model for LIN, postulating that rI is largely responsible for regulating the gpt holin protein in response to superinfection. The evidence suggests that the rIIA and B genes are not directly involved in lysis inhibition; rather, when they are absent, an alternate pathway for lysis develops which depends on the presence of genes from any of several possible prophages and is not sensitive to lysis inhibition.

Amino Acid Sequence↗
PubMed1998

Normal forces and myofibrillar disruption after repeated eccentric exercise.

To investigate the "rapid-adaptation" phenomenon, we examined force, neural, and morphological adaptations in 12 subjects who performed 100 eccentric contractions with the quadriceps muscle (bout 1) and repeated the same exercise after a 2-wk hiatus (bout 2). Two days after bout 1, quadriceps muscle strength and surface electromyographic (EMG) activity declined approximately 37 and 28%, respectively, in the control group (n = 6). At day 2 after bout 1, significant increases occurred in patellar tendon reflex amplitude (approximately 25%), muscle soreness (fivefold), and serum creatine kinase (220%), and 65 +/- 12% of the total number of pixels in the EMG indicated myofibrillar disruption. At day 7 after bout 1, all variables returned to normal. At day 2 after bout 2, no significant changes occurred in force, EMG, creatine kinase, or soreness, but reflex amplitude increased, and 23 +/- 4% of the total number of pixels in the EMG still indicated myofibrillar disruption. The results suggest that the rapid force recovery following eccentric exercise is mediated at least in part by neural factors and that this recovery may occur independently of cell disruption.

Adaptation, Physiological↗
PubMed1997

The importance of smoking education and preventative health strategies for people with intellectual disability.

Tobacco smoking is a major health problem within our community. To date, little attention has been focused on determining the prevalence of smoking in people with disabilities or in developing appropriate strategies to assist them to stop smoking. Funding from the Victorian Health Promotion Foundation enabled the Developmental Disability Unit at Monash University, Box Hill, Victoria, Australia, to undertake a project investigating smoking in a population of people with intellectual disability. In the first part of the project, the smoking rate among a geographically defined group of people with mild intellectual disability was investigated. A smoking prevalence of 36% was found within the sample group, as compared to a prevalence of 26% within the general Victorian adult population. An association was found between the motivation to quite and the recall of advice to stop smoking. The second part of the project comprised the development and piloting of a smoking education course for people with intellectual disability. The pilot sample was small, but the results were encouraging. Fifty-five per cent of the group either quit smoking or cut down their intake significantly. Seventy-three per cent expressed a desire to stop smoking at the completion of the course, and all participants expressed an increased concern and knowledge about the effects of smoking on their health after completing the course.

Adult↗
PubMed1997

Evaluation of an electronic blood pressure device for epidemiological studies.

An objective method for measuring blood pressure would enhance the usefulness of comparative survey research in hypertension. Previous studies have demonstrated that inexpensive, commercially available machines can achieve satisfactory levels of precision. We evaluated one such device in three field settings. Among 64 untreated hypertensive patients, electronic readings both in the clinic and at home were well correlated with 24 h ambulatory readings (correlation ranged from 0.6 to 0.8), consistently better than measurements obtained by human observers. Evaluation as part of a quality control exercise in an ongoing random population surveys from four countries demonstrated average correlations of 0.92 for systolic and 0.85 for diastolic between human and electronic readings. Subsequent use in survey research involving 4000 individuals in three African communities demonstrated consistency of the electronic devices. These cross-sectional surveys, in which measurements were made by non-professionals, provided qualitative estimates of rural-urban variation in blood pressure, demonstrating the practical utility of the technique. If verified by other evaluative studies, the new generation of semi-automatic electronci blood pressure devices could markedly enhance the comparability of hypertension prevalence studies.

Journal Article↗
PubMed1997

Prevalence of adult diabetes in Ibadan, Nigeria.

Within the framework of an international collaborative network, we measured the prevalence of diabetes mellitus in a traditional Yoruba community in the city of Ibadan, Nigeria. Using a random sampling technique we enrolled a community sample of 247 men and women. Fasting blood glucose (FBG) was measured at the community clinic from a fingerstick using the Companion2 Medisense blood glucose meter. The mean FBG was 4.7 mmol/L and 4.9 mmol/L for men and women, respectively. Using the 1985 WHO criteria, the prevalence of diabetes was 2.8%. There was no significant rise in FBG with age. Compared to the lowest quartile of the body mass index (BMI), there was about a 1.5 fold increased risk of developing elevated FBG. The test of trend between FBG and BMI was however not statistically significant. Despite a modest hypertension rate (22.3%), there was no significant difference in the FBG for hypertensives compared to normotensives. The findings of this study show that the prevalence of diabetes mellitus in this West African community remains low compared to nations in Western societies. However, in comparison to previous estimates from sub-Saharan Africa, the prevalence of adult onset diabetes seems to be on the increase.

Adult↗
PubMed1996

Fatigue effects on muscle excitability.

Repeated isometric or shortening contractions of skeletal muscle cause muscle fatigue but several prior studies have reported an apparent absence of muscle fatigue when humans performed up to 70 lengthening contractions. We pursued the hypothesis that perhaps muscle excitability is a factor that aids force preservation with repeated eccentric actions. Soleus compound muscle action potential (M-wave) latency, peak-to-peak amplitude (PPA), duration, and area under the curve were examined in 12 subjects (mean age 24.3 y) over 4 testing days that included: no exercise, isometric exercise (neutral ankle angle), isokinetic (0.5 rad.s-1) concentric and eccentric exercise of the plantar flexors in the seated position on a Biodex dynamometer. Supramaximal shocks were delivered to the tibial nerve in the popliteal fossa at baseline (3 shocks, 1 min apart), during exercise (1 shock-after each of 5 bouts/10 contractions), and during 10-min recovery. From initial to final contractions, concentric, isometric, and eccentric fatigue was -32, -41 and + 2% (Condition by Trial Interaction, F2,22 = 25.1, p = 0.000). No changes occurred in latency or duration (p > 0.05), but PPA (Condition by Time interaction, F51,561 = 3.7, p = 0.000) increased during isometric and eccentric exercise and remained elevated during recovery. Area increased (F51,561 = 3.1, p = 0.000) significantly during all three exercise conditions and approximated baseline by minute 8 of recovery. It was concluded that although the potentiation of the action potential of individual muscle fibers seems to be the common mechanism underlying the increase in muscle excitability during plantar flexion exercise, it is possible that different factors could cause such a non-specific response.

Action Potentials↗
PubMed1996

Outcome measures of a chronic pain program: a prospective statistical study.

OBJECTIVE: To provide outcome data measuring objective and subjective variables of an individualized, multidisciplinary, comprehensive pain management program. DESIGN: The study is a prospective evaluation of 50 consecutive patients who completed the pain management program. Objective measures were medication use and return to work. Subjective measures included self-reports of pain levels and completion of a Personal Concerns and Goals Assessment (PCGA) examining issues of lifestyle and emotional well-being. These measures were compared at program onset and completion by using appropriate statistical analyses. RESULTS: Objective measures: Medication use by the study subjects decreased overall by 72% within all drug categories. Opioid use was eliminated. Regarding return to work, the study subjects increased their work hours by twofold overall. Of patients working fewer than 30 h per week at program onset, representing 62% of the study population, a fivefold return to work was observed. Subjective measures: Overall pain levels improved by 33%, with an 18 to 47% improvement in all descriptors (average pain levels on good or bad days, average number of good or bad days). Of the PCGA factors, patients improved 24 to 46% in all categories concerning lifestyle and emotional well-being. Correlative analysis of the data produced prognostic information as well as insights into chronic pain development. CONCLUSIONS: This study of objective and subjective outcome measures demonstrates that a comprehensive program employing specific principles and methods produces an effective approach for the management of chronic pain. Patients disabled by chronic pain regain a quality of life that allows them to resume a functioning, productive role.

Adolescent↗
PubMed1996

Motor performance of schizophrenics after mellow and frenetic antecedent music.

Previous research has yielded an inconclusive picture of the effects of music on motor performance. Using a 3-factor within-subjects design [mellow/4:4 time), frenetic/(2:8 time), and white noise music conditions], each of 19 schizophrenic inpatient volunteers performed a Purdue Pegboard and Finger Oscillation (Tapping) Test following 1-min. presentations of 3 types of music. Pegboard performance was higher after frenetic music but unaffected by mellow music; there was no effect on tapping.

Adult↗
PubMed1996

Performance on the Purdue pegboard and finger tapping by schizophrenics after mellow and frenetic antecedent music.

Effects of musical selections on motor performance have been inconsistent. Using a 3-factor within-subjects design [mellow music (4:4 time), frenetic music (2:8 time), and white noise conditions], each of 34 schizophrenic inpatients volunteered to perform the Purdue Pegboard and Finger Oscillation (Tapping) following 1-min. counterbalanced presentations of three types of music. Both pegboard and tapping performance were higher after frenetic music but unaffected by mellow music.

Adult↗
PubMed1994

What do the parents of children with disabilities want from their GP?

When a family come to the GP they bring with them their hopes and expectations for that consultation. Because the author wears two hats, those of 'mother of a child with a disability' and 'doctor', other parents often discuss with her their experiences with the medical profession. This article summarises the features of a medical consultation that are most valued by parents.

Adult↗
PubMed1993

'Two hats can be hard to wear'.

I wear my two hats proudly now, that of a mother of a child with a disability and that of a doctor. My 'mother hat' is not removable. I have tried to separate myself from it at times, but that is too painful--it is a part of me. My 'doctor hat' is rather like a smart balaclava. It is appropriate and useful in specific situations. It can be pulled over my eyes to hide how I feel and, at times, offers some protection. But it can also obscure my vision and sometimes causes me to stumble over obstacles I may otherwise have successfully negotiated.

Adaptation, Psychological↗