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Biomedical subjects

L McClure

Publications and source records attributed to L McClure.

16 recordsLinked to original sources
PubMed2005

Effects of age and pregnancy on the circulatory activin response of sheep to acute inflammatory challenge by lipopolysaccharide.

The release of activin A in response to intravenous injection of the bacterial cell-wall component lipopolysaccharide (LPS) was investigated in an ovine model of acute inflammatory challenge in newborn and adult sheep, and in non-pregnant and pregnant ewes. Neonatal lambs (<20 days of age) showed a quantitatively similar response in terms of circulating concentrations of activin A, its binding protein follistatin and the cytokine interleukin-6 compared with adult ewes challenged with an equivalent dose (300 ng/kg bodyweight) of LPS. The fever response and plasma tumour necrosis factor-alpha release in response to LPS, however, were significantly (P < 0.01) less in lambs than in the adult group. Pregnant ewes in the last trimester of gestation had similar responses to LPS, in all aspects measured, compared with their non-pregnant counterparts, apart from an ablated fever response. Although the adult and neonatal sheep responded to LPS, a similar response was not apparent in the fetal circulation, possibly due to a protective effect of the placenta. A 10-fold increase in the dose of LPS (from 300 ng to 3 microg/kg bodyweight) given to neonatal lambs elicited an increase in several cytokine responses measured, with a significant (P< 0.05) increase in follistatin release. In contrast, the amount of activin released by the increased dose of LPS was similar to that invoked by the lower dose. The effect of tolerance to LPS was investigated by giving a second challenge of LPS 5 days after the initial injection. In all animals studied, there was an ablated (P < 0.05) response to the subsequent LPS injection, apart from a similar temperature-response profile. These data provide further evidence that activin A concentrations in the bloodstream are acutely responsive to inflammatory challenge in post-natal life and suggest that the response forms a significant component of the innate immune system.

Activins↗
PubMed2001

The effects of patient communication skills training on the discourse of older patients during a primary care interview.

OBJECTIVES: To test the effects of a communication skills training intervention on older patients' discourse during a primary care interview. DESIGN: A quasi-experimental design involving two intervention conditions. SETTING: The Family Practice Center of a university-based clinic. PARTICIPANTS: Thirty-three patients averaging age 72 and 9 family practice physicians. INTERVENTION: A communication skills training booklet received approximately 3 days before the scheduled appointment and a 30-minute face-to-face follow-up session before seeing the physician. MEASUREMENTS: Patients' seeking, providing, and verifying of information were coded from transcripts of the 33 interviews. RESULTS: Trained patients engaged in significantly more seeking and providing of information than untrained patients. Additionally, trained patients obtained significantly more information from physicians than did untrained patients, both in terms of the number of total information units and the number of units per question asked. CONCLUSION: Patient communication skills training appears to be an effective means of enhancing patients' participation in the medical interview without increasing the overall length of the interview.

Aged↗
PubMed2001

Fit for purpose: does specialist community nurse education prepare nurses for practice?

This paper sets out to explore the experience of newly qualified community nurses, one year on in practice, and to establish if the specialist course prepares them for the reality of practice. It presents a piece of action research evaluating the education process for community nurses through a series of cycles of self-reflection which lead to recommendations for both policy and curriculum changes. Our findings show that community nurses are very positive about their new roles and their work with clients and patients, that they are able to use their newly acquired analytical skills in their practice, but felt inadequately prepared for the reality of practice. Our most significant finding was the lack of preparation for the world of work, the pressure of work and the pace of activity in the health service. As curriculum planners we realized that the course fell short in preparing for actual practice. As a result, changes to the course are underway and in partnership with local health trusts we have set up a support programme for newly qualified community nurses. Our work in community nurse education builds upon the findings from the Peach Report (1999), which only looked at pre-registration nursing and midwifery education.

Clinical Competence↗
PubMed2001

School-age caregivers: perceptions of school nurses working in central England.

Children are caring for invalid relatives in Britain today, often at the expense of their own development. Research indicates these children are vulnerable to a wide range of problems. A preliminary investigation was conducted on the experiences of school nurses in central England to ascertain what they know about school-age caregivers, their awareness of how caring affects their health, and their perception of support available for caregivers. Eighteen school nurses participated in a qualitative investigation, which indicated that given recognition and resources, school nurses could identify school-age caregivers, their health needs, and, in cooperation with other agencies, provide these children with the necessary support.

Age Factors↗
PubMed2000

The effects of communication skills training on patients' participation during medical interviews.

Recent models of physician-patient communication emphasize information exchange in promoting partnership. Although considerable attention has been given to physicians' information exchange, little research has examined patients' communication contributions. The purpose of this research was to test the effectiveness of a training booklet designed to enhance patients' communication skills in information exchange. A nested design was used, such that 25 physicians each saw six patients, two patients in each of three communication skills interventions (i.e. trained, informed, control). The dependent variables included several discourse categories designed to assess patients' information seeking, provision, and verifying. Results indicate that trained patients engaged in more effective and efficient information seeking, provided physicians with more detailed information about their medical condition, and used more summarizing utterances to verify information they received from physicians. Additionally, dyads consisting of trained patients demonstrated a more patient-controlled style of communication than did dyads consisting of informed or untrained patients.

Adult↗
PubMed1997

Vitamin D receptor polymorphisms, bone mineral density, and bone metabolism in postmenopausal Mexican-American women.

Common polymorphisms in the vitamin D receptor (VDR) gene have been shown to correlate with bone mineral density (BMD). However, attempts to replicate the original findings in other populations have yielded variable results. These disparities may reflect ethnic or environmental differences in the expression of the VDR effect upon BMD. We examined a relatively ethnically homogeneous group of 103 healthy postmenopausal Caucasian women of Mexican descent living in Northern California. We determined the VDR genotype and measured the BMD at the lumbar spine and femoral neck by dual-energy X-ray absorptiometry, as well as several biochemical indices of mineral metabolism. The prevalence of the BB genotype, associated in previous studies with the lowest BMD, was 8% and highly linked to the tt genotype. Absolute and age-adjusted BMD at both hip and spine showed a trend toward lower BMD in the BB, AA, and tt genotypes, but this trend did not achieve statistical significance. There were no consistent intergroup differences in change in BMD over 2 years of follow-up, nor in mean serum concentrations of 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, osteocalcin, or total urinary pyridinolines. Intact parathyroid hormone concentrations were significantly higher in subjects with the AA genotype, with a trend toward higher values in those with the BB and tt genotypes as well. Our data suggest that there may be a decrease in BMD associated with the B, A, and t alleles, but the intergroup difference in BMD is 0.2-0.5 standard deviations (SD) at the lumbar spine and 0.3 SD at the femoral neck, decreases that are smaller than previously reported. Given the relatively low prevalence of the BB/tt genotype in Mexican-American Caucasians, a larger sample would be required to detect a significant association between VDR alleles and differences in BMD of the magnitude suggested by our data. We conclude that a genotype effect of this magnitude, if present, would be clinically relevant, but the impact on BMD is too small to detect with statistical significance in a study of this size.

Aged↗
PubMed1993

Total-body irradiation and autologous bone marrow transplant in the treatment of high-risk Ewing's sarcoma and rhabdomyosarcoma.

PURPOSE: In an effort to improve outcome in patients with metastatic or high-risk localized Ewing's sarcoma family of tumors (ESF) and rhabdomyosarcoma (RMS), we explored the role of consolidation therapy with total-body irradiation (TBI) plus autologous bone marrow transplantation (ABMT). PATIENTS AND METHODS: Ninety-one patients were entered onto one of three consecutive protocols from 1981 to 1986. Induction therapy consisted of four or five cycles of vincristine, doxorubicin, and cyclophosphamide (VAdriaC); in the earlier series, patients received one or two cycles with dactinomycin instead of doxorubicin. Irradiation of the primary site was used for local control. Patients who attained a complete response (CR) to induction therapy were eligible for consolidation with 8 Gy TBI plus VAdriaC and ABMT. RESULTS: Nineteen patients were ineligible for consolidation after failing to achieve or maintain a CR following induction therapy; all 19 are dead of disease. Seven eligible patients elected to forgo consolidation; three of seven are long-term event-free survivors. Sixty-five patients received consolidation therapy; 20 of 65 are long-term event-free survivors. A local control rate of 83% was achieved using radiation therapy as the primary modality of local control. Patients with metastatic disease at diagnosis fared substantially worse than did patients with localized tumors (6-year event-free survival [EFS] rate, 14% v 38%; two-sided P [P2] = .008). CONCLUSIONS: Consolidation of patients with metastatic or high-risk localized pediatric sarcomas with 8 Gy TBI plus ABMT has failed to improve the outcome of this group of patients. Metastatic disease at diagnosis continues to confer the poorest prognosis. New therapeutic strategies are needed to consolidate more effectively the remissions that can be achieved in the majority of these patients.

Adolescent↗
PubMedDate not supplied

Defining the future for school nursing.

This article examines some of the health needs of school-age children and adolescents within a changing society, and explores how school nurses can respond, and are responding to these needs. The author also considers an educational programme designed for school nurses of the future, which should enable graduate school nursing specialists to take their place alongside other community nursing and teaching colleagues.

Adolescent↗
PubMedDate not supplied

Organization development in the healthcare setting.

Organization development (OD) is useful in the corporate setting, and it can successfully be applied to the healthcare environment if it undergoes certain changes. OD processes must became more prescriptive, develop management-oriented methods, use structure-oriented interventions, and generally adapt to the healthcare setting. This article illustrates how healthcare organizations can benefit from new versions of OD.

Culture↗