Biomedical subjects
K Andrews
Publications and source records attributed to K Andrews.
Managing the persistent vegetative state.
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The dialysis encapsulation process: the role of endocytosis.
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Use of fluorescent probes for describing the process of encapsulation by hypotonic dialysis.
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Assessment of the percutaneous endoscopic gastrostomy feeding tube as part of an integrated approach to enteral feeding.
The insertion of percutaneous endoscopic gastrostomy has been well documented. The possible benefits for patient nutrition and nursing practice have, however, not been assessed. We report a study of enteral feeding by percutaneous endoscopic gastrostomy in 30 patients, the majority with a persistent vegetative state. All patients had previously been fed through a nasogastric tube using manual administration and a dietitian assessed protein calorie intake. Based upon body mass index (weight/height2), midarm circumference and triceps skinfold thickness, 20 (67%) were malnourished, with 10 patients having a body mass index less than 17 (severe malnutrition); attributed to high rates of both tube displacement and feed regurgitation. Patients were observed over six to 12 months after percutaneous endoscopic gastrostomy insertion combined with overnight continuous pump feeding. All patients attained a body mass index greater than 17, and 17 (56%) of the total number achieved the normal range with no change in protein-calorie intake (pre: 2110 kcal, post: 1880 kcal). Complications of percutaneous endoscopic gastrostomy in the study group included peritonitis (one), tube site infection (two) and displacement (two); all without serious sequelae. As part of an integrated approach percutaneous endoscopic gastrostomy proved a safe and efficient method of enteral feeding and justifies wider consideration in the United Kingdom.
A systematic approach can reduce side-effects. A protocol for pain relief in neonates.
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Prevalence, characteristics and factors associated with falls among the elderly living at home.
Attempts to determine the underlying causes of falls have come to conflicting conclusions, partly because subject groups studied have not been representative of all elderly people. Two hundred and three randomly selected people of 75 years and over, living at home, were visited and questioned about falls experienced in the previous 12 months, and about factors that might be related to falling. Eighty-six subjects (42.4%) had suffered one or more falls during this time, and of fallers, 49 (59.3%) were injured, 9 of them seriously. Women were slightly more likely to have had falls and were more likely to have suffered injury, but no increase in frequency of falls with age was demonstrated. Only a minority of fallers (43.0%) sought medical attention following their fall. Falls outside the home accounted for 39.5% of falls and these were more likely to be due to simple trips or slips. Analysis of the factors related to falls showed a considerable overlap between fallers and non-fallers. Fallers had significantly greater dependency and cognitive impairment, more physical symptoms, and higher scores for anxiety and depression, but there was no association with postural hypotension, neurological abnormalities, or measurements relating to nutritional state. The factors found to be significant on discriminant analysis were combined to determine a "fall risk score". This type of easily calculated score might be of use to medical and paramedical personnel for assessing the risk of falling among the elderly living at home.
Identification of a cloned sequence activated during multi-stage carcinogenesis in mouse skin.
Differential screening of cDNA libraries made from chemically induced malignant mouse skin squamous cell carcinomas (SCC) identified three sequences, including one called mal2, that were upregulated in their expression at both the benign papilloma and malignant SCC stages. The mal2 plasmid cDNA clone (containing a 350 bp insert) was used to screen lambda phage cDNA libraries made from chemically induced SCCs. Two of the largest mal2-related cDNA inserts obtained from the phage libraries were sequenced. In addition a mal2-related genomic clone was obtained by hybridization probing of a mouse spleen genomic DNA library. The sequence of the genomic clone overlapped and was identical with both the mal2 plasmid and lambda cDNA clones. Identity was found between the mal2 cDNAs, the mal2 genomic sequence and the cDNA sequence for a mouse hyperproliferative keratin called K6. A synthetic oligonucleotide specific for the 3' untranslated region of the mal2 or keratin K6 gene was used in Northern analyses to demonstrate elevated steady-state levels of K6 keratin transcripts in SCCs induced by various protocols involving both chemical and ionizing radiation initiation of tumors as well as complete chemical and radiation carcinogenesis protocols. Metastatic lung lesions derived from SCCs generated by repeated doses of benzo[a]pyrene showed moderate levels of K6 keratin transcripts, whereas normal lung showed very low levels of K6 transcripts. The overexpression of the mal2 or keratin K6 gene in malignant SCCs was independent of the protocol, either chemical or radiation, that was used to induce the tumors.
Primary nursing and the role of the nurse preceptor in changing long-term mental health care: an evaluation.
The main aims of this action research study were to implement primary nursing in two long-term psychiatric rehabilitation/continuing-care wards and to investigate the effects of the intervention of the quality of nursing care provision. This evaluation took the form of a quasi-experimental time series analysis. A package of measures together with a number of peripheral indicators was used before primary nursing was introduced on each ward and again after primary nursing had become established. The results showed that the implementation of primary nursing led to nurses being more accountable for care, resident who were seen to be more self-sufficient and independent and wards which had an improved environment for care and rehabilitation.
Encapsulation by hypotonic dialysis in human erythrocytes: a diffusion or endocytosis process.
Human erythrocytes subjected to controlled hypotonic dialysis are capable of encapsulating and retaining drugs. Under selected conditions encapsulation has been reported to occur by an endocytosis process. The mechanism by which encapsulation occurs under conditions which are conducive for endocytosis to occur was studied. An analysis of the percentage of cells with endocytic vacuoles was made for cells dialyzed to optimal and suboptimal osmotic pressures for encapsulation. No differences were found with approximately 20% of cells from all preparations containing vacuoles. Transmission electron micrographs of cells in different stages of carrier cell preparation reveal endocytic vacuoles both with and without hemoglobin. However, based on the percentage of exogenous substance encapsulated, encapsulation appears to occur primarily by diffusion and secondarily by endocytosis.
Rehospitalization after initial rehabilitation for acute spinal cord injury: incidence and risk factors.
Many acute spinal cord injury (SCI) patients require rehospitalization after discharge from initial rehabilitation. Previous studies of rehospitalization for these patients have been cross-sectional with respect to time since injury (in years), and have not allowed for comparison of patients with equal exposure to the risk of medical complications once they have reentered the community. To examine the incidence, cause, and monetary cost of rehospitalizations during the first year after discharge from initial rehabilitative care (day 365), the medical records of 88 consecutive, acute SCI patients who completed initial rehabilitation at a regional model SCI care system were reviewed. Cases were excluded from the study if the patient was lost to follow-up before day 365. All readmissions to the regional SCI care system during the follow-up period were reviewed for primary diagnosis, length of stay (LOS), and hospital charges incurred. Thirty-four patients (39%) were readmitted at least once by day 365. There was a total of 47 readmissions; mean LOS was 11.9 +/- 2.1 days per admission (+/- 1SE), and mean hospital charge per admission was $9,683. Univariate comparisons between the characteristics of patients who were readmitted vs those who were not indicated that the readmitted group was less educated (11.8 +/- 2.1 years vs 12.9 +/- 0.3 years, p less than 0.05) and had a substantially longer initial rehabilitation LOS (88.9 +/- 6.6 days vs 72.9 +/- 5.1 days, p less than 0.05). Readmissions were less common among patients who were discharged at Frankel class C or D (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Biological and molecular aspects of radiation carcinogenesis in mouse skin.
The process of mouse skin carcinogenesis can be operationally subdivided into at least three stages which have been termed initiation, promotion, and progression. Ionizing radiation has been found to be a weak initiator of malignant squamous cell carcinomas (SCCs) when radiation was followed by repeated treatments of the skin with the tumor promoter 12-O-tetradecanoyl-phorbol-13-acetate (TPA). Besides SCCs, ionizing radiation was found to induce, independent of tumor promoters, basal cell carcinomas (BCCs), a tumor histology not normally seen with chemical carcinogens and mouse skin. Fractionated doses of 1 MeV electrons were found to enhance the conversion of chemically induced benign papillomas to malignant SCCs. In addition to the biological studies, questions related to dominant transforming genes and differential gene expression in the radiation-initiated mouse skin tumors have been explored. Distinct non-ras dominant transforming gene(s) have been detected in radiation-initiated, TPA-promoted SCCs. Differences in the expression pattern of tumor-associated genes were seen in comparing chemically to radiation-induced benign and malignant skin tumors. Therefore, ionizing radiation has been shown to be active in the initiation of malignant skin tumors and progression of benign to malignant tumors in the mouse skin. The ability to divide the process of carcinogenesis into multiple stages in the mouse skin model has facilitated mechanistic studies that may elucidate the molecular pathways involved in radiation-versus chemically induced tumor development.
Intraperitoneal administration of carrier erythrocytes in dogs: an improved method for delivery of L-asparaginase.
Carrier erythrocytes were prepared to encapsulate L-asparaginase by a hypotonic dialysis process. Dogs received either intravenous or intraperitoneal injections of cells containing both L-asparaginase and the marker [3H]inulin. The route of administration had no effect on the circulating survival of carrier erythrocytes. For enzyme therapy, intraperitoneal injection of a large volume of cells is technically feasible. Cells circulate with a maximum of 30% of the cells reaching circulation 24 h after injection. Those cells reaching circulation have a 7-day half-life for the encapsulated enzyme L-asparaginase.
The Medical Treatment Act.
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A study of staffing levels in hospital wards for severely physically disabled patients.
This paper reports on an investigation of the workloads of the different grades of nursing staff caring for severely physically disabled patients in a long-term rehabilitation hospital. Results of nurse activity sampling and assessment of patients' severities of disability on three wards are presented in the form of tables and bar-charts. Wide variation of types and severities of patients' disability within and between the three wards was evident. Qualitative trends relating patients' severities of disability to times spent feeding patients, total nursing hours per patient (12-hr) day, and trained/untrained staff ratios were revealed. The question of grade mix is briefly discussed.
Absorbed radiation by various tissues during simulated endodontic radiography.
The amount of absorbed radiation by various organs was determined by placing lithium fluoride thermoluminescent chip dosimeters at selected anatomical sites in and on a human-like X-ray phantom and exposing them to radiation at 70- and 90-kV X-ray peaks during simulated endodontic radiography. The mean exposure dose was determined for each anatomical site. The results show that endodontic X-ray doses received by patients are low when compared with other radiographic procedures.
What would occupational therapists do if they had more staff?
Eighteen per cent of 203 departments responding to a questionnaire felt they had sufficient staff, and this group had, on average, significantly more therapists than those who felt that they had insufficient staff. Treatment was mainly concentrated on individual therapy though, in some units, excessive time was spent on administration and travelling. Very little therapy time was spent on diversional activities but this was one area, along with treating more patients and increasing pre-discharge home visits, which they would like to develop if more staff were available. Little additional time would be spent in research, teaching or community therapy.