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Biomedical subjects

L Walker

Publications and source records attributed to L Walker.

At least 55 records · Page 3Linked to original sources
PubMed2000

Improving patient compliance with asthma therapy.

Patients fail to comply with asthma medication for a variety of reasons. These range from physical inability to use an inhaler, through simple forgetfulness, to a conscious decision not to use medication as prescribed due to internal or cultural health beliefs or socioeconomic factors. In some patients, poor self-care because of deep-rooted psychological factors (i.e. factors of which patients have only limited awareness) can affect compliance. Poor doctor-patient communication can be the cause in many other individuals. Thus, there is no single solution that will improve compliance in all patients. Simplifying the regimen or providing memory aids will be sufficient for some patients, while education or psychological counselling will be more appropriate for others. Doctors can also use a range of communication skills to improve the way in which they present information, motivate patients and reinforce progress. These approaches, plus respect for patients' health beliefs and involving them in treatment decisions, can help foster an atmosphere of mutual responsibility and concordance over medicine taking.

Administration, Oral↗
PubMed2000

Understanding men's health and illness: a gender-relations approach to policy, research, and practice.

Men's health has emerged as an important public concern that may require new kinds of healthcare interventions and increased resources. Considerable uncertainty and confusion surround prevailing understandings of men's health, particularly those generated by media debate and public policy, and health research has often operated on oversimplified assumptions about men and masculinity. A more useful way of understanding men's health is to adopt a gender-relations approach. This means examining health concerns in the context of men's and women's interactions with each other, and their positions in the larger, multidimensional structure of gender relations. Such an approach raises the issue of differences among men, which is a key issue in recent research on masculinity and an important health issue. The gender-relations approach offers new ways of addressing practical issues of healthcare for men in college environments.

Gender Identity↗
PubMed2000

Intensive care nurses' experiences with end-of-life care.

BACKGROUND: With much attention being focused on how patients die and whether or not they are provided appropriate care, the care of dying patients in intensive care units must be described and improved. OBJECTIVES: To describe end-of-life care in intensive care units as perceived by critical care nurses who have taken care of dying patients. METHODS: A semistructured interview guide was developed and revised after pretesting in a focus group of faculty clinicians with extensive, recent experience in intensive care. Four focus groups were held with randomly selected nurses from 4 intensive care units in 2 hospitals; participants had 2 years or more of experience and were working half-time or more. Tapes from each focus group were transcribed and reviewed by the investigators before the subsequent group met. Category labels were developed, and topics and themes were determined. RESULTS: "Good" end-of-life care in the intensive care unit was described as ensuring that the patient is as pain-free as possible and that the patient's comfort and dignity are maintained. Involvement of the patient's family is crucial. A clear, accurate prognosis and continuity of care also are important. Switching from curative care to comfort care is awkward. CONCLUSIONS: Disagreement among patients' family members or among caregivers, uncertainty about prognosis, and communication problems further complicate end-of-life care in intensive care units. Changes in the physical environment, education about end-of-life care, staff support, and better communication would improve care of dying patients and their families.

Adult↗
PubMed2000

Comparing the effectiveness of video and written material for improving knowledge among sleep disorders clinic patients with limited literacy skills.

BACKGROUND: Health care professionals often use written material or video recordings to teach their patients without knowing which is more effective for comprehension of the information. METHODS: Patients watched either an instructional videotape about sleep apnea or read a newly designed brochure, then responded to a structured questionnaire containing 11 knowledge-based questions and 1 open-ended question (requesting suggestions for improvement of the brochure or videotape). RESULTS: Mean reported educational level was grade 12, and mean reading level was between grade 7 and 8. Using video significantly improved only two areas of knowledge for low-level (below grade 8) readers: defining sleep apnea (66% vs 43%) and identifying what continuous positive airway pressure (CPAP) does for the patient (94% vs 78%). Patients requested material with more diverse cultural representation, more information on treatment and outcomes, and fewer polysyllabic words. CONCLUSIONS: Emphasis on diagnosis and treatment, explained using simple words, should be reflected in the content of patient education brochures or videos. Providing information by video alone may have limited benefits.

Adolescent↗
PubMed1999

Heterogeneity of coronary heart disease risk factors in Indian, Pakistani, Bangladeshi, and European origin populations: cross sectional study.

OBJECTIVE: To compare coronary risk factors and disease prevalence among Indians, Pakistanis, and Bangladeshis, and in all South Asians (these three groups together) with Europeans. DESIGN: Cross sectional survey. SETTING: Newcastle upon Tyne. PARTICIPANTS: 259 Indian, 305 Pakistani, 120 Bangladeshi, and 825 European men and women aged 25-74 years. MAIN OUTCOME MEASURES: Social and economic circumstances, lifestyle, self reported symptoms and diseases, blood pressure, electrocardiogram, and anthropometric, haematological, and biochemical measurements. RESULTS: There were differences in social and economic circumstances, lifestyles, anthropometric measures and disease both between Indians, Pakistanis, and Bangladeshis and between all South Asians and Europeans. Bangladeshis and Pakistanis were the poorest groups. For most risk factors, the Bangladeshis (particularly men) fared the worst: smoking was most common (57%) in that group, and Bangladeshis had the highest concentrations of triglycerides (2.04 mmol/l) and fasting blood glucose (6.6 mmol/l) and the lowest concentration of high density lipoprotein cholesterol (0.97 mmol/l). Blood pressure, however, was lowest in Bangladeshis. Bangladeshis were the shortest (men 164 cm tall v 170 cm for Indians and 174 cm for Europeans). A higher proportion of Pakistani and Bangladeshi men had diabetes (22.4% and 26.6% respectively) than Indians (15.2%). Comparisons of all South Asians with Europeans hid some important differences, but South Asians were still disadvantaged in a wide range of risk factors. Findings in women were similar. CONCLUSION: Risk of coronary heart disease is not uniform among South Asians, and there are important differences between Indians, Pakistanis, and Bangladeshis for many coronary risk factors. The belief that, except for insulin resistance, South Asians have lower levels of coronary risk factors than Europeans is incorrect, and may have arisen from combining ethnic subgroups and examining a narrow range of factors.

Adult↗
PubMed1999

Identification of an SCF ubiquitin-ligase complex required for auxin response in Arabidopsis thaliana.

The plant hormone auxin regulates diverse aspects of plant growth and development. We report that in Arabidopsis, auxin response is dependent on a ubiquitin-ligase (E3) complex called SCFTIR1. The complex consists of proteins related to yeast Skp1p and Cdc53p called ASK and AtCUL1, respectively, as well as the F-box protein TIR1. Mutations in either ASK1 or TIR1 result in decreased auxin response. Further, overexpression of TIR1 promotes auxin response suggesting that SCFTIR1 is limiting for the response. These results provide new support for a model in which auxin action depends on the regulated proteolysis of repressor proteins.

Amino Acid Sequence↗
PubMed1999

The Notch/Jagged pathway inhibits proliferation of human hematopoietic progenitors in vitro.

The cell surface receptor Notch1 is expressed on CD34+ hematopoietic precursors, whereas one of its ligands, Jagged1, is expressed on bone marrow stromal cells. To examine the role of Notch signaling in early hematopoiesis, human CD34+ cells were cultured in the presence or absence of exogenous cytokines on feeder layers that either did or did not express Jagged1. In the absence of recombinant growth factors, Jagged1 decreased myeloid colony formation by CD34+ cells, as well as 3H-thymidine incorporation and entry into S phase. In the presence of a strong cytokine signal to proliferate and mature, (interleukin 3 [IL-3] and IL-6, stem cell factor [SCF], and G-CSF), Jagged1 did not significantly alter either the fold expansion or the types of colonies formed by CD34+ cells. However, in the presence of SCF alone, Jagged1 increased erythroid colony formation twofold. These results demonstrate that Notch can modulate a growth factor signal, and that in the absence of growth factor stimulation, the Jagged1-Notch pathway preserves CD34+ cells in an immature state.

3T3 Cells↗
PubMed1999

Medicaid eligibility workers discuss Medicaid estate planning for nursing home care.

This study was part of a multiphase project examining the perceptions of elder law attorneys, certified financial planners, and Medicaid eligibility workers regarding Medicaid estate planning (MEP) for nursing home care. Focus group methodology (5 groups, N = 32 participants) was used to explore the perspectives and experiences of Medicaid eligibility workers, who are responsible for interpreting, administering, and enforcing federal and state regulations. Findings describe factors influencing MEP, enforcement of regulations, and potential policy responses to MEP. Participants identified numerous impediments to effective implementation of current regulations. Recommendations for improved policy include redefinition of spousal assessment policies, other valuable consideration determinations, and penalty period formulas.

Aged↗
PubMed1999

Endovascular Doppler guide wire in renal arteries. Correlation with angiography in 20 patients.

RATIONALE AND OBJECTIVES: To evaluate the feasibility of endovascular Doppler recording in renal arteries and to compare the reliability of Doppler parameters for detection of renal artery stenosis. METHODS: The authors examined 36 renal arteries in 20 patients with a 0.018" endovascular flow wire. Peak systolic velocity and the renal artery-to-aortic peak were measured in the main renal artery. From intrarenal waveforms, acceleration, acceleration time, and the renal resistive index were obtained. Spectral analysis with consensus scoring of early systolic peak was also performed. RESULTS: Twelve significantly stenosed renal arteries and 26 normal renal arteries were examined with the Doppler guide wire, without complications. Peak systolic velocity was the only parameter significantly different in renal artery stenosis (P = 0.037). Peak systolic velocity also differed significantly between hypertensive and normotensive patients. Tardus parvus was specific for severe renal artery stenosis. CONCLUSIONS: Endovascular Doppler is a safe and accurate method for the determination of velocity measurements and may be useful during percutaneous renal artery revascularization.

Aged↗
PubMed1999

How RhoGDI binds Rho.

Like all Rho (Ras homology) GTPases, RhoA functions as a molecular switch in cell signaling, alternating between GTP- and GDP-bound states, with its biologically inactive GDP-bound form maintained as a cytosolic complex with RhoGDI (guanine nucleotide-exchange inhibitor). The crystal structures of RhoA-GDP and of the C-terminal immunoglobulin-like domain of RhoGDI (residues 67-203) are known, but the mechanism by which the two proteins interact is not known. The functional human RhoA-RhoGDI complex has been expressed in yeast and crystallized (P6(5)22, unit-cell parameters a = b = 139, c = 253 A, two complexes in the asymmetric unit). Although diffraction from these crystals extends to 3.5 A and is highly anisotropic, the experimentally phased (MAD plus MIR) electron-density map was adequate to reveal the mutual disposition of the two molecules. The result was validated by molecular-replacement calculations when data were corrected for anisotropy. Furthermore, the N-terminus of RhoGDI (the region involved in inhibition of nucleotide exchange) can be identified in the electron-density map: it is bound to the switch I and switch II regions of RhoA, occluding an epitope which binds Dbl-like nucleotide-exchange factors. The entrance of the hydrophobic pocket of RhoGDI is 25 A from the last residue in the RhoA model, with its C-terminus oriented to accommodate the geranylgeranyl group without conformational change in RhoA.

Binding Sites↗
PubMed1999

Validity of three measures of severity of AIDS for use in health services research studies.

Policy makers and hospital managers often use severity adjustments as a control for patient mix differences when evaluating outcomes of care. Unfortunately, few indices are carefully examined and therefore the evaluations based on these methods of severity adjustment are suspect. This paper examines the accuracy of three indices for measuring the severity of illness of AIDS patients. We examine the Diagnosis-Based Severity Index (DBSI), a modified version of DBSI referred to as MDBSI and the Composite Laboratory Index (CLI) in predicting survival of AIDS patients at one medical centre. We analysed the correlation between indices and months of survival. We also examined the percentage of variance in survival months explained by each index separately and together. Finally, we used survival analysis to examine whether DBSI classifies patients in groups with distinct patterns of survival. Only patients who had died were included in the analysis so that information on the patients' full course of illness was available. Of the 91 patients abstracted, 81 cases had date of AIDS, date of death, and the CLI. These 81 cases were the focus of the analysis. Both CLI and DBSI were predictive of months of survival but were not correlated to each other. Predictions of months of survival were improved if both indices were used together rather than separately. Survival analysis confirmed that patients classified by DBSI had distinctly different survival patterns. Each index measures different aspects of the severity of the patient's condition and when possible both indices should be used together. When laboratory data are not available, e.g. in Medicaid administrative files, the use of DBSI may be reasonable.

Acquired Immunodeficiency Syndrome↗
PubMed1999

'We want an allocation to theatre!' Diploma level nursing students have their say.

The aim of this study was to ascertain the perceptions of diploma level nursing students towards theatre nursing and whether these perceptions had any influenced on their choosing a career in operating department nursing. The study was qualitative in its approach, using a questionnaire as the main research tool, to focus on thirty-three second year diploma level nursing students. The main findings were that 94% of the students felt that a set allocation to the operating theatre would be invaluable, as it would enhance the nursing care they gave to their patients on the ward. The study also found that the students did not have a real understanding of the theatre nurse's role, with only one third of the students seeing the theatre nurse carrying out patient care. This perceived lack of patient care had a major effect on them not wishing to choose theatre nursing as a career, once qualified. The results of this study suggest that the profile of theatre nursing must be raised to attract greater numbers of students to the speciality.

Attitude of Health Personnel↗