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Biomedical subjects

M England

Publications and source records attributed to M England.

At least 19 recordsLinked to original sources
PubMed2006

Using intranasal lidocaine to reduce food intake.

OBJECTIVE: Develop a dose-response curve for the effect of intranasal lidocaine on food intake. DESIGN: Healthy obese subjects had food intake, ratings of hunger, desire to eat, craving and fullness measured at lunch after an overnight fast. Four treatments were given as nose drops (0.5-0.6 ml per nostril) 5 min before the meal in a double-blind manner with a four period crossover design including a 7-day washout between periods. The treatments were saline, 2.5, 10 and 25 mg lidocaine per nostril. The order of administration was randomly assigned to each subject. Electrocardiograms, vital signs, chemistry panels, complete blood counts (CBC) and nasal inspections were carried out before and after each dose. SUBJECTS: Forty-seven subjects were screened, 34 were randomized and 20 subjects completed all four study periods in the trial. The subjects were 39+/-12.5 (s.d) years of age, had a weight of 91+/-13.0 kg, a height of 167+/-10.3 cm, 56% were women, 47% were African-American and 53% were Caucasian. MEASUREMENTS: Food intake, rating of hunger, desire to eat, craving and fullness are measures of efficacy. Adverse events, electrocardiograms, vital signs, chemistry panels, nasal inspections, CBC and physical exams are measures of safety. RESULTS: The mean reduction in food intake vs saline control in the 20 subjects completing all four study periods was 3.3+/-7% (s.d), 4.2+/-8.5% and 7.4+/-7.3% in the 2.5 mg, 10 and 25 mg per nostril groups, respectively (P=NS). Hunger and desire to eat in subjects who completed at least one study period decreased dose dependently (P<0.03, at the 25 mg per nostril dose). There were no clinically significant changes in safety measures, electrocardiograms, vital signs, chemistry panels, CBC or nasal inspections. CONCLUSION: Intranasal lidocaine reduced hunger and the desire to eat, but this did not translate into a significant reduction in food intake suggesting that intranasal lidocaine will not have value in treating obesity.

Administration, Intranasal↗
PubMed2005

Analysis of nurse conversation: methodology of the process recording.

Analysis of nurse conversation: methodology of the process recording The study explored elements of effective nurse-client interaction between a nurse and a nursing home resident on the third day of the client's recovery from surgery. The interaction was recorded from memory in the form of a process recording then divided into unique conversation segments. Two nurses independently used seven typologies to classify segments of the conversation. Cohen's coefficient kappa for inter-rater reliability of the classifications was 0.98. Findings from the study revealed that two-thirds of the nurse's conversation was effective and consistent with the orientation phase of the nurse-client relationship. The nurse communicated her role through the provision of leadership, resources and help, and technical expertise. Her approaches were rather evenly divided between making requests, giving information, and affirming the client's experience. One-third of the conversation was oriented toward assessment and diagnosis, one half toward treatment of the client's experiences, and the rest toward planning and evaluation. Themes identified in the client's conversation included issues of dependency, disorientation to time, unresolved grief, separation anxiety, and the client's need for validation. These findings are valuable for illuminating the contribution that nurse conversation makes to evidence-based clinical practices. They also have implications for further refinements in the use of the process record and multiple coding schemes for the study of the nurse-client relationship.

Adult↗
PubMed2001

Commentary. Balancing sedation and analgesia in the critically ill.

The authors have presented a template for a systematic approach to comforting critically ill patients that can be modified to suit institutional preferences. In this algorithm, the cause of patient discomfort is sought with the priority given to pain and then to anxiety. Special attention is directed to the identification of correctable causes of pain and anxiety with application of nonpharmacologic techniques or medications to control patient discomfort. This step is followed by subsequent reassessment of the need for sedation or anxiolysis and titration or discontinuation of therapy as able. The benefits of protocol-driven care are becoming increasingly evident, and the authors believe the algorithm outlined here provides a rational and practical approach to patient management. It also prompts the caregiver to reevaluate patients' needs and to keep to patients at target sedation levels. Doing so can promote cost effectiveness, reduce side effects caused by drugs, and decrease morbidity and ICU stay. Any treatment protocol or algorithm is simply a guide to therapy and cannot address every clinical situation. The importance of individualized care and physician or care team judgment must be emphasized.

Algorithms↗
PubMed2001

Morphological diversity of dying cells during regression of the human tail.

During normal human development a number of transient structures form and subsequently regress completely. One of the most prominent structures that regress during development is the human tail. We report here a histological and ultrastructural study of cell death in the cranial and caudal (tail) parts of the neural tube in 4 to 6-week-old human embryos. Initially, the human tail is composed of tail bud mesenchyme which differentiates into caudal somites, secondary neural tube, notochord and tail gut. Later on, these structures gradually regress by cell death. During the investigated period, we observed two morphologically distinct types of dying cells. The well-described apoptotic type of cell death was observed only in the cranial neural tube that forms during primary neurulation. The other type of cell death characterized by necrotic morphology was observed in the tail mesenchyme and in the caudal neural tube that forms during secondary neurulation. This morphological diversity suggests that besides differences in origin and fate there are different mechanisms of developmental cell death between two parts of the human neural tube. We can speculate that the apoptotic type of cell death is associated with the precise control of cell numbers and that the other morphologically distinct type of cell death is responsible for the massive removal of transitory structures.

Abortion, Induced↗
PubMed2001

The carotid artery as alternative access for endoluminal aortic aneurysm repair.

Endograft treatment of aortic aneurysms has become a common procedure in many centers. However, not all patients are candidates for this new technology, because of their vascular anatomy and device limitations. One common problem is iliofemoral occlusive disease, which when present, even in a moderate degree, may preclude introduction of the large-diameter delivery devices currently in use. We present a case of a high-risk male patient with a thoracic aortic aneurysm and severe occlusive disease of the iliac arteries. An alternative approach for device delivery through the carotid artery was used and the procedure was successful with no neurologic complications. We recommend this technique for highly selected patients with an aneurysm who can undergo tube endograft repair without feasible access through the iliac or femoral arteries.

Aneurysm, False↗
PubMed1997

Self-coherence, emotional arousal and perceived health of adult children caring for a brain-impaired parent.

An important concern for nurses is the ability of adult children to provide effective care to a dependent parent without sacrificing their own health and well-being. The purpose of the study was to examine 'sense of self-coherence' as an inner resource for the attenuation of distress in a sample of 168 adult children who were involved with the care of a brain-impaired parent. Subjects were interviewed twice in their homes in order to obtain data on variables for: self-coherence, emotional arousal, perceived health, and crisis. Findings from the study indicate that adult children with crisis experience in the previous 6 months of caregiving had higher scores for emotional arousal, lower scores for self-coherence, and lower ratings of perceived health than did adult children with no crisis experience. In addition, there was a negative relationship between self-coherence and emotional arousal and a positive relationship between self-coherence and perceived health. Both of these relationships were significantly stronger in the presence of crisis experience than in the absence of crisis experience. Finally, there was a negative relationship between emotional arousal and perceived health that was equally apparent in both the presence and absence of crisis experience. The findings suggest that self-coherence is an inner resource that emerges in filial crisis to modulate the emotional impact of the situation. The implication is that measures of self-coherence could be used to assess an adult child's preparedness to appraise and cope with emotional responses to filial crisis events. This information could help nurses anticipate and target resources for vulnerable adult children so that they are less adversely affected by the demands of parent care.

Adaptation, Psychological↗
PubMed1996

Theoretical and psychometric analysis of caregiver strain.

The purpose of the study was to establish the validity and reliability of an instrument for the measurement of caregiver strain, the Parent Caregiver Strain Questionnaire (PCSQ), with data from 283 adult children who were providing care to a neurologically impaired patient. Principal axis factor analysis of data rotated to an oblimin solution revealed five well-defined, first-order factors that explained 59% of the total variance in caregiver strain. The five-factors were interrelated with caregiver strain as theoretically predicted. Coefficient alphas for the five factors were in the range from .74 to .93. The findings provide beginning evidence of the adequacy of the PCSQ, and favor continued investigation into the theoretical and psychometric properties of the instrument.

Aged↗
PubMed1996

Sense of relatedness and interpersonal network of adult offspring caregivers: linkages with crisis, emotional arousal, and perceived health.

A descriptive correlational design was used to explore factors that influence the well-being of 168 adult offspring who were caring for a dependent parent. Subjects were queried about their health, relationships within their interpersonal networks, and experiences with crisis in the previous 6 months of caregiving. The findings suggest that although relatedness and interface with an interpersonal network are interrelated with one another in both crisis and noncrisis situations, relatedness appears to be more important for adult offsprings' sense of well-being in the presence of crisis than in the absence of crisis. In contrast, adult offsprings' interface with an interpersonal environment appears to be more important for their sense of well-being in the absence of crisis than in the presence of crisis. The results have implications for ways in which nurses can help adult offspring sustain the will and strength to thrive in the role of filial caregiver.

Activities of Daily Living↗
PubMed1996

Content domain for caregiver planning identified by adult offspring caregivers.

The purpose of the study was to generate a description of caregiver planning and explain how the concept advanced knowledge of lay caregiver decision-making. Nearly 2,000 decisions of 168 adult offspring caregivers were classified into one of 12 categories using an a priori taxonomic structure for caregiver planning. Coefficient kappas for intra- and inter-rater reliability of the classifications ranged from .97 to .81. The computer program, Ethnograph, and existence theory then were used to organize the classifications in a more detailed manner given the a priori taxonomic structure. Findings from the study showed that the content of the subjects' decisions produced a relatively detailed, complete, and reliable description of caregiver planning. This information can help nurses and lay caregivers to further develop an ongoing pattern of decision-making about caregiving.

Adult↗
PubMed1996

Salutogenic psychosocial nursing practice.

Public affirmation of core principles for relating with clients is needed in order to assure continued viability of quality nursing practice in this era of competition and managed health care. Practitioners of professional nursing can reassert their legitimate claim to quality nursing care through an emphasis on the practice of salutogenic psychosocial nursing. The presumption is that clients, families, and communities who benefit from salutogenic nursing care are more likely to heal and stay well because they have developed competencies for managing the details of their health situations. This paper presents key characteristics of salutogenic psychosocial nursing, along with their implications for assuring quality nursing practice.

Environment↗
PubMed1996

Adequacy of two organizing principles for the classification of lay caregiving decisions.

The specific aims of this study were to examine two organizing principles for caregiver planning and the consistency with which four nurses independently classified 1,096 caregiving decisions into one of 12 categories of a taxonomic structure. The typology for classification consisted of a coordinate for goal structure made up of three categories and a coordinate for human need orientation-made up of four categories. The 3-by-4 classification schema was used to develop a coding manual of theoretical and operational definitions for 12 mutually exclusive cell categories of caregiver planning. The criterion for consistency of the nurses' classification judgments was the assignment of a caregiving decision to a cell category identical to the a priori assignment of the principal investigator. The findings from the study provide initial support for content validity of the organizing principles for caregiver planning and interrater reliability of the nurses' judgments when controlling for the effect of chance agreements. The nurses "correctly" classified 63.75% of the targeted caregiving decisions and did not "incorrectly" classify 83.74% of the decisions. The respective coefficient kappas for agreements made on the basis of goal structure and human need orientation were .72 and .65.

Classification↗
PubMed1995

Effects of variations in flow on aortic valve area in aortic stenosis based on in vivo planimetry of aortic valve area by multiplane transesophageal echocardiography.

This study provides evidence that acute changes in stroke volume and cardiac output do not result in significant alterations in the anatomic AVA measured with multiplane TEE in patients with AS of moderate or severe degree. Thus, TEE could be useful in the assessment of severity of AS in both low- and high-output states.

Adult↗
PubMed1995

Validation of an enzyme immunoassay for serodiagnosis of acute Q fever.

An enzyme immunoassay was validated for the serodiagnosis of acute Q fever. Minimum positive tests were determined for both serial dilutions and a single dilution of patient sera. To establish the specificity of the test, 152 serum samples were tested from individuals with no evidence of past Coxiella burnetii infection. Diagnostic titers were set at > or = 128 for the IgM and IgG responses to phase I, at > or = 512 for the IgM response to phase II and at > or = 1,024 for the IgG response to phase II Coxiella burnetii. These titers gave a false-positive rate of < or = 1%. Alternatively, testing a single dilution of sera (1:128) gave specificities ranging from 97.3 to 98.7%. Tests with the greatest sensitivities, using serially diluted early convalescent-phase sera, were the IgM (84%) and IgG (80%) responses to phase II Coxiella burnetii. At a single serum dilution, 92% of early convalescent sera had a positive IgG response to phase II Coxiella burnetii. With a high specificity and good sensitivity, the EIA can be used to diagnose acute Q fever with a single convalescent serum specimen. The duration of a positive response was greater than five years.

Coxiella burnetii↗
PubMed1993

Outcome of pregnancy in diabetic women in Soweto, South Africa 1983-1992.

A specialized service for pregnant diabetic women of African ethnic origin from Soweto was introduced in May 1983 at Baragwanath Hospital. Modern methods of management were used, including home blood glucose monitoring. A total of 354 pregnancies (147 gestational, 207 pregestational) were managed over an 8 1/2 year period. All but 12 women were treated with insulin. Mean capillary blood glucose (+/- SD) ranged from 5.8 +/- 0.8 mmol l-1 in the insulin-dependent group to 6.2 mmol l-1 in the gestational group (p < 0.01). Although maternal hypoglycaemia was common (14.4%) in the insulin-dependent patients, no ill effects were noted. The highest Caesarean section rate was in the gestational group (56%), the lowest in the insulin-dependent group (39.8%) (p < 0.01). Mean (+/- SD) neonatal weights were similar in the insulin-dependent and non-insulin-dependent groups (3131 +/- 627.9 g and 3236 +/- 674.3 g resp. p = NS); offspring of the gestational group were heavier than the insulin-dependent group (3384.4 +/- 657.5 g) (p < 0.01). Neonatal hypoglycaemia occurred in less than 5% of offspring overall. The combined perinatal mortality was 6.1%, stillbirths accounting for the majority (63.6%) of deaths. Major congenital abnormalities occurred in 6(1.7%) of the offspring. The perinatal mortality of the 'control' group of 146 women was 26.1%. Glucose intolerance persisted in at least 34.7% of gestational diabetic women postpartum. This study suggests that a specialized service for pregnant diabetic women from a Third World community can be implemented with good effect and limited expense. Late presentation of pregestational diabetic women is a problem.

Adult↗
PubMed1992

Multiplane transesophageal echocardiography. Imaging planes, echocardiographic anatomy, and clinical experience with a prototype phased array OmniPlane probe.

Multiplane transesophageal echocardiography is a new exciting development in echocardiography. We examined the methodology and echo-anatomic correlations of multiplane transesophageal echocardiography and its clinical applications in 100 patients. We used a 5-MHz phased array multiplane (OmniPlane) transesophageal probe. In this instrument, the transducer array can be steered through 180 degrees from any transducer location. This provides a vast assembly of imaging planes, allowing for detailed visualization of all dimensions of cardiac anatomy. This report presents our observations on the echocardiographic anatomy seen in various image planes and the unique clinical potential of multiplane transesophageal echocardiography in the diagnostic assessment of cardiovascular disorders. This technique appears to provide incremental diagnostic information that enhances the interpretative ability. Less esophageal probe manipulation is required with consequent decrease in patient discomfort. We conclude that multiplane transesophageal echocardiography enhances the versatility of transesophageal examination and offers many new avenues for developments such as three-dimensional echocardiography.

Echocardiography↗