PubMed Health⌕ Search

Biomedical subjects

N Sykes

Publications and source records attributed to N Sykes.

16 recordsLinked to original sources
PubMed2006

The use of benzodiazepines in palliative care.

BACKGROUND: Benzodiazepines are widely used in palliative care, but few studies have attempted to study their use. AIM: To determine the frequency and nature of benzodiazepine prescribing in a palliative care setting. METHOD: The notes of a consecutive series of 100 patients who had died or been discharged from the hospice were studied. Demographic, illness and prescription data were noted. The indication for the administration of benzodiazepines, their effectiveness and any adverse effects were recorded. RESULTS: Notes were found on 93 patients. Some 54 (58%) were prescribed benzodiazepines either by the hospice or their General Practitioner. Younger patients and those on opioids or antipsychotics were more likely to be prescribed benzodiazepines. Most administration of benzodiazepines occurred within the last three weeks of life in response to symptoms of anxiety or less specific distress. CONCLUSIONS: A relatively high proportion of patients was prescribed benzodiazepines. The role of benzodiazepines at different stages of palliative care merits further study.

Aged↗
PubMed2005

Analysis of IMGSAC autism susceptibility loci: evidence for sex limited and parent of origin specific effects.

BACKGROUND AND METHODS: Autism is a severe neurodevelopmental disorder, which has a complex genetic predisposition. The ratio of males to females affected by autism is approximately 4:1, suggesting that sex specific factors are involved in its development. We reported previously the results of a genomewide screen for autism susceptibility loci in 83 affected sibling pairs (ASP), and follow up analysis in 152 ASP. Here, we report analysis of an expanded sample of 219 ASP, using sex and parent of origin linkage modelling at loci on chromosomes 2, 7, 9, 15, and 16. RESULTS: The results suggest that linkage to chromosomes 7q and 16p is contributed largely by the male-male ASP (MLS = 2.55 v 0.12, and MLS = 2.48 v 0.00, for the 145 male-male and 74 male-female/female-female ASP on chromosomes 7 and 16 respectively). Conversely linkage to chromosome 15q appears to be attributable to the male-female/female-female ASP (MLS = 2.62 v 0.00, for non-male and male-male ASP respectively). On chromosomes 2 and 9, all ASP contribute to linkage. These data, supported by permutation, suggest a possible sex limited effect of susceptibility loci on chromosomes 7, 15, and 16. Parent of origin linkage modelling indicates two distinct regions of paternal and maternal identity by descent sharing on chromosome 7 (paternal MLS = 1.46 at approximately 112 cM, and maternal MLS = 1.83 at approximately 135 cM; corresponding maternal and paternal MLS = 0.53 and 0.28 respectively), and maternal specific sharing on chromosome 9 (maternal MLS = 1.99 at approximately 30 cM; paternal MLS = 0.02). CONCLUSION: These data support the possibility of two discrete loci underlying linkage of autism to chromosome 7, and implicate possible parent of origin specific effects in the aetiology of autism.

Autistic Disorder↗
PubMed2000

Opioid use in last week of life and implications for end-of-life decision-making.

This study was prompted by public and professional concern that the use of opioids for symptom control might shorten life. We retrospectively analysed the pattern of opioid use in the last week of life in 238 consecutive patients who died in a palliative care unit. Median doses of opioid were low (26.4 mg) in the last 24 h of life and patients who received opioid increases at the end of life did not show shorter survival than those who received no increases. The doctrine of double effect therefore need not be invoked to provide symptom control at the end of life.

Aged↗
PubMed1995

On withholding nutrition and hydration in the terminally ill: has palliative medicine gone too far? A reply.

Patients who are dying of cancer usually give up eating and then stop drinking. This raises ethical dilemmas about providing nutritional support and fluid replacement. The decision-making process should be based on a knowledge of the risks and benefits of giving or withholding treatments. There is no clear evidence that increased nutritional support or fluid therapy alters comfort, mental status or survival of patients who are dying. Rarely, subcutaneous fluid administration in the dying patient may be justified if the family remain distressed despite due consideration of the lack of medical benefit versus the risks. Some cancer patients who are not imminently dying become dehydrated from reversible conditions such as hypercalcaemia. This may mimic the effects of advanced cancer. These conditions should be sought and fluid replacement therapy should be given along with the specific treatments for the condition.

Brain Diseases↗
PubMed1989

Isolation and characterization of a B lymphocyte mutant with altered signal transduction through its antigen receptor.

A receptor surface Ig (sIg) signaling variant of WEHI-231 was constructed to investigate components and linkages between various signaling events associated with signal transduction through sIg. Unlike the wildtype, crosslinking of sIgM on VS2.12-cl.2 did not result in downregulation of proliferation. Similarly, receptor crosslinking was uncoupled from inositol phospholipid (PI) hydrolysis and upregulation of c-fos expression in the variant. The signaling defect in VS2.12-cl.2 appears to be proximal to phospholipase C activation as direct G protein activation by A1F4- triggers PI hydrolysis and bypassing PI hydrolysis using phorbol diester stimulation of protein kinase C restores the inhibitable phenotype and the ability to upregulate c-fos. Even more interesting, sIg-linked Ca2+ responses by VS2.12-cl.2 are equivalent to these observed in the wildtype WEHI-231. These latter results suggest that contrary to current thought, sIg-generated signals may not be coupled to Ca2+ fluxes entirely via inositol phospholipid hydrolysis. Thus, VS2.12-cl.2 is a new and powerful tool with which to analyze signaling through sIg at the molecular level.

Antibodies↗
PubMed1989

Signalling through sIgA on a novel murine B lymphoma.

A novel murine B lymphoma expressing membrane-associated IgA was isolated and used to compare mechanisms of signal transduction by sIgM and sIgA. Like other isotypes so far studied, crosslinking of sIgA by anti-immunoglobulin antibodies stimulates hydrolysis of inositol phospholipids and causes elevation of intracellular free calcium. Furthermore, signals generated through sIgA are coupled to elevation of c-fos proto-oncogene expression. Coupling appears to be through the protein kinase C rather than through the Ca2+ component of sIg signalling as phorbol diester, but the Ca2+ ionophore cannot mediate this effect. Thus these results, coupled with those from earlier studies, show that early signal transduction through surface immunoglobulin appears to be similar regardless of the particular isotype involved in binding ligand.

Animals↗
PubMedDate not supplied

[The hospice approach to pain and problems in home palliative care].

Author points to principles upon which not only the control of pain but also of all other symptoms depends: an appreciation of symptoms as a psychosomatic phenomenon, an accurate diagnosis of the cause of the symptom and in reference to pain application of the World Health Organisation's Analgesic Ladder for Cancer Pain. He takes these principles for granted and elaborates on the use of drugs and to lesser extent, other techniques which are used in hospice practise. Morphine is metabolised into M6G i M3G, the first being significantly more potent an analgesic as morphine. Its late and prolonged presence is probably basic for continuous morphine application instead of "as required" way. Author is giving very precise recommendations for per os and parenteral dose titration, discussing the side-effects and data about the related drugs, the analgesia in neuropathic pain and the special techniques like radiation, nerve blocks and epidural analgesia. Speaking about the palliative home care problems the author explains the most important factors enabling a family to continue their care at home. The author keeps discussing the poor appetite, vomiting, dysphagia, constipation. Respiratory problems are elaborated with more details especially those in "death rattle", with the optimal drug option recommendation, and many technical details.

Home Nursing↗