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Biomedical subjects

M M Grant

Publications and source records attributed to M M Grant.

At least 19 recordsLinked to original sources
PubMed2001

Cognitive disturbance in outpatient depressed younger adults: evidence of modest impairment.

BACKGROUND: Investigations of cognitive disturbances among patients with mood disorders have yielded inconsistent results. Although marked neuropsychologic deficits have been reported in elderly patients and in midlife patients with severe depression, the severity of cognitive impairments in medically healthy younger ambulatory adults with depression has not been well characterized. METHODS: A comprehensive battery of standard neuropsychologic tests and experimental computerized measures of cognitive functioning were administered to unmedicated ambulatory younger adults with mild to moderate nonbipolar depression and to a group of age- and gender-equated healthy subjects. RESULTS: Patients demonstrated a notable absence of widespread cognitive impairment. Deficits in executive functions were observed on the Wisconsin Card Sort Test but not on several other tests. Despite the absence of significant impairment on tests of attention, memory, and motor performance in the total sample, symptom severity and age of illness onset were correlated with poorer performance on some tests of cognitive functioning even after correction for age. CONCLUSIONS: These findings, derived from a large sample of unmedicated depressed outpatients, indicate that major depressive disorder in healthy younger ambulatory adults does not cause appreciable impairments in cognitive functioning in the absence of clinical and course-of-illness features.

Adult↗
PubMed2001

Effects of chronic antidepressant drug administration and electroconvulsive shock on locus coeruleus electrophysiologic activity.

BACKGROUND: The locus coeruleus (LC) is the major noradrenergic cell body group in the brain. Although previous studies have examined changes in electrophysiologic activity of LC neurons produced by antidepressant drugs, only a small number have examined changes that occur with chronic drug administration, which is the therapeutically effective regimen, and only one group of investigators has assessed effects on activated (or "burst") firing of LC neurons under such treatment conditions. The present study assessed changes produced in rats by effective antidepressant treatments-several drugs given chronically (two tricyclic antidepressants, two selective serotonin reuptake inhibitors, and a monoamine oxidase inhibitor) as well as a series of electroconvulsive shocks (ECSs)-in single-unit electrophysiologic activity of LC neurons, measuring effects on spontaneous depolarization rate and also on sensory-evoked burst firing. METHODS: Drugs were administered via osmotic minipumps for either 14 or 30 days; ECSs were administered five times, with a 72-hour interval between each administration. Electrophysiologic recording of LC activity took place under halothane anesthesia on the last day of drug treatment or following a delay of 1 or 5 days after the final ECS. RESULTS: A common effect of all drugs tested and ECS treatment was to decrease LC spontaneous and sensory-evoked burst firing. CONCLUSIONS: The clinical efficacy of antidepressant medication and ECS may be mediated, in part, through reduction of LC neural activity. The findings reported here are consistent with recent indications that LC neurons are hyperactive in depressed individuals and with suggestions that some behavioral changes seen in depression can arise from consequences of rapidly depolarizing LC terminals, such as release of peptides.

Animals↗
PubMed2000

Depression and functioning in relation to health care use in sickle cell disease.

The purpose of the current study was to investigate depression and health care use in patients with sickle cell disease (SCD). Forty-four adults with SCD were interviewed and data from 43 participants, both with (n = 11) and without (n = 32) depression, were used for further analyses. Data from one potential subject were excluded on the basis of diagnosis. The full evaluation included the Structured Clinical Interview for DSM-III-R Disorders (SCID) and the Center for Epidemiologic Studies--Depression Scale (CES-D), as well as measures of psychosocial and behavioral functioning. Good between-instrument agreement was found between the self-report and interview-based measures of depression. However, the functioning data did not entirely support the use of a more stringent cutoff score on the CES-D. Findings suggest that the purpose of the evaluation should be factored into the decision-making process when determining which cutoff score should be utilized (i.e. what is the cost-benefit ratio for false-positives vs. false-negatives). A series of hierarchical regression analyses supported the finding that disease severity alone does not explain the level of functioning displayed by patients. More importantly, the patient's perceived functioning was the best indicator of health care use within a 1-year period. Furthermore, specific interventions that target negative thinking and distorted cognitions, as well as provide psychoeducation, such as cognitive-behavioral therapy, need to be further explored within this population.

Activities of Daily Living↗
PubMed2000

Alternative pharmacotherapy. Patterns of patient use and family physician practice.

BACKGROUND: The use of alternative pharmacotherapies is rapidly increasing. Many persons who use purchased or prepared alternative medications are also cared for by family physicians. We describe patient usage of alternative pharmacotherapies and examine how family physicians handle this in medical practice. METHODS: We recorded data from structured interviews of 178 patients in an academic family medicine practice in a midsized southern city. We then examined the medical records of each participant who reported using some form of alternative pharmacotherapy to determine whether there was discussion of this use with the physician. RESULTS: Approximately one third of the patients reported using some form of alternative pharmacotherapy for 1 year or less, learning about alternative medications mostly from the media, and being generally satisfied with the results. Eighty-four percent of the patients reported not having been asked by their physician about their use of these drugs on the day of their office visit, and more than half reported never having been asked about their use of them. Medical record reviews indicated that for the most part physicians did not document having discussed or making recommendations about the use of alternative pharmacotherapies at any point in their relationship with the patient. CONCLUSIONS: Since many of their patients are using alternative pharmacotherapies, family physicians are encouraged to learn more about what their patients use, to institute easy system-wide changes to facilitate discussion about this use with their patients, to document alternative drugs used, and to give recommendations regarding them.

Adult↗
PubMed1998

Quality of life in breast cancer survivors: implications for developing support services.

PURPOSE/OBJECTIVES: Quality of life (QOL) is becoming more important in regard to breast cancer as treatment advances extend the period of survivorship. The purpose of this article is to share the results of a cancer center's attempt to evaluate the QOL needs of breast cancer survivors in order to provide improved supportive-care services. DESIGN: Descriptive mailed survey. SETTING: A medical center in southern California. SAMPLE: A random sample of breast cancer survivors (N = 298). METHODS: Breast cancer survivors completed a mailed survey that included major outcome variables of QOL and pain. Subjects were stratified by three age groups: younger than 40 years, 40-60 years, and older than 60 years. MAIN RESEARCH VARIABLES: QOL subscales (physical, psychological, social, and spiritual well-being) and overall QOL score and pain as assessed by the Brief Pain Inventory. FINDINGS: Results indicated continued physical demands of breast cancer, including fatigue and pain, as well as psychological burdens related to fear of breast cancer recurrence and anxiety. The social well-being domain indicated some unique aspects of QOL when applied to breast cancer survivorship such as the fear of breast cancer in female relatives. The spiritual well-being domain illustrated the unique QOL aspects of life-threatening illness such as living with uncertainty and maintaining hope. Breast cancer survivors also reported positive aspects and life changes after successfully facing breast cancer. CONCLUSIONS: Breast cancer survivors experience many demands of illness across the physical, psychological, social, and spiritual domains. IMPLICATIONS FOR NURSING PRACTICE: The study's findings can be useful in directing cancer centers' efforts to provide comprehensive care for breast cancer survivors. Nurses play a critical role in leading these efforts for supportive-care services intended to improve the QOL of breast cancer survivors.

Adaptation, Psychological↗
PubMed1997

Quality of life in breast cancer survivors as identified by focus groups.

Currently, over 1,700,000 women are living with breast cancer in the United States. These long-term survivors of breast cancer are challenged to redirect their energy from issues of cancer treatment and early side effects toward quality of life issues related to long-term survivorship, such as menopause, infertility, fear of recurrence, family distress, and uncertainty. In an attempt to obtain patient perspectives on quality of life and health care issues faced by breast cancer survivors, focus group methodology was utilized in the first year of a 2 year study. The sample was stratified to represent three age groups: < 40 years, 40-60 years, and > 60, and was intended to represent different developmental levels believed to have varying experiences with quality of life and potentially divergent needs following breast cancer diagnosis. Results of these focus groups revealed unique quality of life concerns of breast cancer survivors across four domains of physical, psychological, social, and spiritual well being. Each of these domains yields important implications for future research and clinical practice.

Adaptation, Psychological↗
PubMed1997

Physical and psychosocial outcomes in cancer patients: a comparison of different age groups.

In a cross-sectional study, we investigated the relationship between age, physical health, social and economic resources, functional status, activities of daily living (ADL) and disease-related variables of 227 patients with cancer. Using multidimensional outcome measures we examined age differences in three age groups (< 45, 46-65, > 65 years) and identified predictors of performing ADL. The results indicated that older patients have outcomes similar to those of younger patients. There were no significant differences in quality of life, performance status and physical health among the three age groups. The only areas where age-related differences were found were co-morbidity and cancer-related impairments. Patients aged 45-65 years and patients 65 years and older reported a higher level of co-morbidity and more cancer-related impairments than those aged 45 and younger. Although older patients had higher co-morbidity, they showed similar Karnofsky Performance Status (KPS) scores to those of their younger counterparts. The regression analysis revealed social resources, self-reported health, performance status and complexity of care as significant predictors of patients' ADL, but not age, co-morbidity or severity of treatment. The findings support the conclusion that differences in performing ADL between younger and older patients with cancer are minimal and tend to be due to co-morbidity. Thus, treatment should be decided by a patient's physical health rather than by age.

Activities of Daily Living↗
PubMed1997

Self-care responses to illness of patients with various cancer diagnoses.

The purpose of this study was to examine the relationship between self-care responses and variables concerning health status, disease and treatment, socioeconomic resources, demographic characteristics, and health beliefs in a heterogeneous sample of 227 cancer patients referred to home care. Data were collected prior to discharge from the hospital using the OARS Functional Assessment Questionnaire, the Karnofsky Performance Status, the Multidimensional Health Locus of Control Scale, and the Preference for Participation in Care Tool. The results indicated that the variables related to health status, disease and treatment were highly correlated with self-care behavior (SCB), and to a lower extent to self-care preference (SCP). Karnofsky performance status, cancer-related impairments, perceived physical health, and stage of disease were identified as significant predictors of SCB explaining 57% of the variance. Age, gender, education, live-in resources, and perceived mental health were dominant predictors of SCP explaining only 17% of the variance. Further research endeavors should investigate other models that might prove to be better predictors of SCP.

Adult↗
PubMed1995

Anorexia, cachexia, and dysphagia: the symptom experience.

OBJECTIVES: To review the symptoms of anorexia, cachexia, and dysphagia and to provide information on nutritional assessment and interventions. DATA SOURCES: Published studies of anorexia, cachexia, and dysphagia, research abstracts, and review articles. CONCLUSIONS: Anorexia, cachexia, and dysphagia can cause severe alterations in nutrition in cancer patients that may lead to irreversible nutritional compromise and death. Nursing research must focus on symptom management of these three symptoms, the needs of the patient and family, and the impact of dysphagia on quality of life. IMPLICATIONS FOR NURSING PRACTICE: Assessment, objective evaluation, pharmacological interventions, and nutritional counseling are important interventions for patients with anorexia and cachexia. Swallowing therapy, food intake adjustments, oral hygiene, and supportive care are important measures needed by the patient with dysphagia.

Anorexia↗
PubMed1995

Cytokines affect pseudomonas binding to tracheal cells via a neutrophil-mediated process.

Critical illness is often associated with gram-negative bacterial colonization of the airways, increasing the risk of nosocomial pneumonia. Cytokines, released in response to endotoxin, might contribute to this phenomenon by causing changes in epithelial cell binding of bacteria. To investigate this possibility, human monocytes and hamster pulmonary macrophages were cultured without or with Escherichia coli endotoxin (10 micrograms/ml) for 4 and 24 h. Hamster and human tracheal epithelial cells were treated with supernates from monocyte cultures for 24 h, and subsequent binding of 14C-labeled Pseudomonas aeruginosa to the epithelial cells was measured (percent adherence). In separate experiments, recombinant human (rh) tumor necrosis factor-alpha (TNF-alpha) (25 to 100 ng/ml) and interleukin-1 beta (IL-1 beta) (2,000 to 8,000 pg/ml) were added to hamster monolayers. Neither monocyte supernates nor purified cytokines were toxic to the epithelial cells for up to 48 h. There was no significant change in P. aeruginosa adherence to either hamster or human tracheal epithelial cells after 24 h of exposure to culture supernates from either endotoxin-stimulated human monocytes or hamster macrophages. Similarly, purified rhTNF and rhIL-1 exposure did not increase bacterial adherence. However, when polymorphonuclear leukocytes were coincubated with the monocyte supernates and epithelial cells, P. aeruginosa adherence was significantly increased. Moreover, this effect was enhanced by an epithelial cell-derived substance. Thus, while inflammatory cytokines may participate in enhancing bacterial colonization of the lung in vivo, they do not do so by a direct action on tracheal epithelial cells but can act via a neutrophil-dependent mechanism.

Animals↗
PubMed1993

Extended follow-up in 212 long-term allogeneic bone marrow transplant survivors. Issues of quality of life.

A group of 235 allogeneic marrow recipients were contacted at least one year following their BMT to obtain information on their quality of life; 212 (90%) agreed to participate in this survey. A total of 162 adults and 50 pediatric survivors were interviewed during clinic visits (5%) or over the telephone (95%). Changes in productive activity and marital status at the time of interview were studied, as well as the presence of physical symptoms and perception of a general sense of well-being. Older transplant recipients were observed to have a significantly higher incidence of chronic graft-versus-host disease, common colds, and skin changes when compared with pediatric transplant recipients (P < 0.01). Older subjects were also more likely to require any type of regular medication. Younger survivors were rated with a higher Karnofsky performance status and global subjective score. There were no significant differences between patients who received TBI as part of the conditioning regimen and those who did not, with the exception of increased cataract development in pediatric patients receiving TBI (P < 0.008). We conclude that most allogeneic marrow transplant survivors, especially those individuals of younger age at the time of their transplants, are doing well in the domains tested.

Adolescent↗
PubMed1992

Health quality of life and colorectal cancer.

BACKGROUND: Quality of life associated with cancer and radiation treatment includes the dimensions of psychologic and physical well-being, nutrition concerns/side effects, and radiation treatment-related anxiety/adjustment. An understanding of the impact of colorectal cancer and radiation treatment on these aspects of health quality of life can be reached by comparing this diagnostic group to others undergoing similar treatment. METHODS: Thirty-six patients with colorectal cancers, 41 with uterocervical cancers, 43 with genitourinary tumors, 13 with leukemia or bone metastasis, and 129 with head and neck cancers undergoing radiation therapy provided complete health quality of life index (QLI-RT) data during weeks 1 and 3 of treatment and at the first follow-up visit after treatment completion. The QLI-RT was found to be reliable and valid. RESULTS: Those with colorectal cancer had similar QLI-RT summary scores as the other groups at the beginning of treatment and during the follow-up period. QLI-RT scores tended to range from 62 to 84 for the summary score and individual-item scores; this was a narrow span considering the QLI-RT uses a 0-100-mm linear analog-response scale. The exceptions were strength, which elicited scores in the 46-68 range and a couple of responses to worrying about radiation therapy. The largest change in QLI-RT score in relation to the treatment trajectory was 11 mm. CONCLUSIONS: These findings tend to support the notion that patients with cancer try to maintain health quality of life at an acceptable level despite the occurrence of stressful negative events. Future research should explore the stable versus dynamic attributes of health quality of life to learn more about the factors that contribute to the adaptive process that maintains such quality of life at an acceptable level.

Colorectal Neoplasms↗
PubMed1992

Nursing research into quality of life.

This report describes the scope of nursing research in the area of quality of life. The strategy used to identify research reports relied heavily on nursing publications included in the Cumulative Index for Nursing and Allied Health Literature (CINAHL) from 1983 (when the database first included the subject, quality of life) to December, 1991. During this period, over 1,000 references concerning quality of life can be identified through a key-word search of the data set. Nursing investigators defined quality of life in terms of psychological, physical, social/interpersonal, and financial/material well-being. Nursing instruments have been developed to measure one or more of these dimensions of the concept. Nursing journals like Advances in Nursing Science (1985), Seminars in Oncology Nursing (1990), and Progress in Cardiovascular Nursing (1992) dedicated whole issues to the topic. Major nursing associations have supported conferences/talks (American Heart Association Council on Cardiovascular Nursing, Santa Fe, NM, 1991; Oncology Nursing Society, Fall Institute, Annual Quality of Life Lectureship) and provided awards on the subject (Oncology Nursing Society Annual Quality of Life Research Award). The National Center for Nursing Research is launching an intramural programme to address quality of life questions.

Chronic Disease↗
PubMed1992

Uncertainty, appraisal and quality of life.

This study evaluates the influence of different factors in the adaptation process activated by uncertainty in illness on health-related quality of life. The sample included 100 women (mean age = 52.1 years) receiving treatment for newly diagnosed (M = 5.1 months) gynaecological cancer (38 cervical, 26 ovarian, 24 endometrial, 7 uterine, 4 vulvar, and 1 vaginal). Stepwise regression analyses identified mood states, ambiguity about illness-wellness state, danger-focused appraisal and mastery as key predictors of four health-related quality of life scores. The variance accounted for by those variables is reflected in cumulative multiple R2 of 0.56 for total quality of life score, 0.57 for psychosocial well-being, 0.235 for physical well-being and 0.25 for disease/symptom distress. These variances do not reflect the contribution of age, time since diagnosis, metastasis and stage of cancer which were forced to enter the regression equation first. The latter set of variables accounted for a smaller portion of the variance in health-related quality of life (R2 = 0.03-0.195). Coping strategy did not predict health-related quality of life. These findings provide beginning support for conceptualizing health-related quality of life as the outcome of an adaptation process explained by the uncertainty in illness theory. However, uncertainty in illness theory may not be sufficient to predict quality of life outcomes. Future research should consider the addition of discrepancy theory to guide the selection or development of a health-related quality of life measure, to account for the perceived discrepancy between actual experience and expected well-being.

Adaptation, Psychological↗
PubMed1992

Oxygen affects human endothelial cell proliferation by inactivation of fibroblast growth factors.

The fibroblast growth factors (FGF), including endothelial cell growth factor (ECGF)/acidic FGF and basic FGF, are important modulators of endothelial cell replication in vitro and in vivo. Premature infants and adults with lung injuries are often treated with high levels of inspired O2, which can be necessary for survival but potentially injurious to developing lungs and in tissue repair following injury. Human umbilical artery and vein endothelial cells were grown in ECGF- or FGF-supplemented Medium 199 and exposed to ambient levels of O2 from 10 to 95%. Endothelial cell growth, measured by [3H]thymidine incorporation, was inhibited by increasing levels of O2 and ceased above 50% O2. Vein endothelial cells could recover from up to 24 h of hyperoxic exposure when given fresh medium, but not after 48 h. Artery-derived cells were more sensitive to O2 than were vein-derived cells. Complete medium without endothelial cells, preincubated 24 h in 95% O2, lost its ability to support cell growth under normoxic conditions. Exposing individual medium components to high O2 demonstrated that purified natural ECGF and recombinant acidic or basic FGF were all inactivated by O2. Human recombinant superoxide dismutase prevented FGF inactivation. O2 inactivation of essential growth factors could thus have major consequences for lung development or repair of injured capillaries in infants or adults inspiring high levels of O2.

Cell Division↗
PubMed1992

Home care: maintaining quality of life for patient and family.

Cancer affects the family as well as the patient. The home is a primary site of care, which often must be intensive and complex. Attention to home care of the cancer patient is therefore a major concern in maintaining quality of life for both patient and family. The authors explore the major burdens of home care that affect both patient and family and describe four specific interventions that the health care team can initiate to optimize quality of life in these difficult situations.

Aged↗