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Biomedical subjects

R Harper

Publications and source records attributed to R Harper.

At least 19 recordsLinked to original sources
PubMed1992

Validating the SF-36 health survey questionnaire: new outcome measure for primary care.

OBJECTIVES: To test the acceptability, validity, and reliability of the short form 36 health survey questionnaire (SF-36) and to compare it with the Nottingham health profile. DESIGN: Postal survey using a questionnaire booklet together with a letter from the general practitioner. Non-respondents received two reminders at two week intervals. The SF-36 questionnaire was retested on a subsample of respondents two weeks after the first mailing. SETTING: Two general practices in Sheffield. PATIENTS: 1980 patients aged 16-74 years randomly selected from the two practice lists. MAIN OUTCOME MEASURES: Scores for each health dimension on the SF-36 questionnaire and the Nottingham health profile. Response to questions on recent use of health services and sociodemographic characteristics. RESULTS: The response rate for the SF-36 questionnaire was high (83%) and the rate of completion for each dimension was over 95%. Considerable evidence was found for the reliability of the SF-36 (Cronbach's alpha greater than 0.85, reliability coefficient greater than 0.75 for all dimensions except social functioning) and for construct validity in terms of distinguishing between groups with expected health differences. The SF-36 was able to detect low levels of ill health in patients who had scored 0 (good health) on the Nottingham health profile. CONCLUSIONS: The SF-36 is a promising new instrument for measuring health perception in a general population. It is easy to use, acceptable to patients, and fulfils stringent criteria of reliability and validity. Its use in other contexts and with different disease groups requires further research.

Adolescent↗
PubMed1992

Components of nurse innovation: a model from acute care hospitals.

Components that promote nurse innovation in acute care hospitals are explicated in the Acute Care Nursing Innovation Model. Grounded in nursing care delivery systems and excellent management-organizations perspectives, nurse executives and 30 nurse "intrapreneurs" from 10 innovative hospitals spanning the United States shared their experiences and insights through semistructured, tape-recorded telephone interviews. Guided by interpretive interactionist strategies, the essential components, characteristics, and interrelationships are conceptualized and described so that others may be successful in their innovative endeavors. Successful innovation is dependent on the fit between and among the components; the better the fit, the more likely the innovation will succeed.

Creativity↗
PubMed1991

Imaging of hippocampal neural activity in freely behaving animals.

We examined intrinsic activity of neurons in the cat dorsal hippocampus following stimulation of the posterior medial hypothalamus and following a 2.5 mg/kg intravenous administration of cocaine. Posterior hypothalamic stimulation elicited banding of optical activity in the dorsal hippocampus, suggestive of spatial organization of neural activity underlying synchronous rhythmical slow wave activity. Cocaine administration resulted in a major decline in reflected light at 700 nm, possibly representing diminished oxygenation to the underlying tissue. The activity was examined by a new technique which uses principles of reflectance at specific bandwidths of light during cellular activity, and allows acquisition of images in the freely behaving animal. The imaging device consists of a 1.6 mm diameter coherent optic fiber bundle of 25 microns fibers attached to a 128 x 128 pixel charge-coupled device (CCD) array which can be cooled to reduce thermal noise. The target is illuminated by a light emitting diode array producing light at a number of operator-selectable narrow bandwidths which permits assessment of physiological characteristics of neural tissue. The CCD output is digitized, stored by computer, and the resulting images are averaged to obtain a greater signal-to-noise ratio. The procedure shows considerable promise for providing on-line, real-time indications of activity in localized brain regions.

Animals↗
PubMed1991

rHuEPO treatment improves brain and cognitive function of anemic dialysis patients.

Twenty-four patients with chronic renal failure, stabilized on hemodialysis, were treated with recombinant human erythropoietin. Before treatment, all patients were anemic (mean Hct = 23.7%). Hematocrits reached normal levels (36.5%) after three months of treatment. Brain event-related potentials and neuropsychological tests were used to assess changes in brain and cognitive functions associated with the correction of anemia. Assessments were done prior to and after three and twelve months of rHuEPO treatment. The P3 component of the event-related potential increased in amplitude significantly with treatment, while its latency was unaffected. Of the four neuropsychological tests administered, scores on two improved significantly with treatment, and the other two approached significance. Taken together, these findings suggest that the correction of anemia to hematocrits near normal in uremic patients by rHuEPO treatment improves brain and cognitive function by raising levels of sustained attention, thus increasing speed and efficiency of scanning and perceptual-motor functions and enhancing learning and memory. These findings also suggest that anemia, either directly or indirectly, may impair brain function.

Anemia↗
PubMed1991

Early and late results of surgery for Wolff-Parkinson-White syndrome.

Surgical treatment for accessory atrioventricular connections was performed in 60 patients with Wolff-Parkinson-White syndrome between 1981 and 1986. The initial procedure successfully divided 69 of 73 pathways identified preoperatively, including 39 of 40 left free wall pathways, 23 of 24 posteroseptal pathways, six of seven right free wall pathways, and one of two anteroseptal pathways. Three additional pathways were identified for the first time during follow-up. The primary procedure was successful in curing 53 (88%) of the 60 patients and in dividing 69 (91%) of the total of 76 pathways. Subsequent procedures increased the overall clinical cure rate to 97%. The surgery was performed with low morbidity and no perioperative or late mortality. Patients were followed-up for a mean of 6.4 years (range four to nine years). No patient showed clinical or electrocardiographic evidence of recurrence of a pathway which had been divided surgically. We conclude that regardless of pathway site, surgical treatment carries a low risk and has a high probability of avoiding lifelong antiarrhythmic therapy.

Adolescent↗
PubMed1979

Respiration during the first six months of life in normal infants: II. The emergence of a circadian pattern.

The objective of the present study was to investigate the emergence of circadian patterns in respiratory rates. Twenty-five neurologically normal infants were monitored for 12-hours during the first week of life and at one, two, three, four and six months of age. Each minute of the recordings of EEG, eye movements, somatic activity, respiration, ECG and temperature was coded into Active sleep (AS), Quiet sleep (QS), Indeterminate (IN) and Awake (AW). The night was divided into four equal intervals and a computer program calculated the mean respiratory rate for each interval as a function of state and age. During the first week of life group means of respiratory rates increased linearly with each interval in all states. A circadian pattern with lowered respiratory rates between 10:00 p.m. and 1:00 a.m. emerged at different ages in different sleep states. This pattern was first seen at one month of age in AS and IN, and at three months in QS. It was also observed in AW at three months of age, suggesting that the circadian rhythm is not solely an expression of the sleep wakefulness cycle. Feeding patterns contributed to but did not explain these observations.

Age Factors↗
PubMed1978

Acute myocardial infarction in women. The influence of age on complications and mortality.

The prognostic implications of a past history of ischaemic heart disease, site of infarction, ectopic ventricular dysrhythmias (ventricular premature beats (VPB) more than one in 10 sinus beats, and/or ventricular tachycardia (VT), ventricular fibrillation (VF), atrioventricular blocks (AVB), bundle branch blocks (BBB)) and the occurrence of electrical and/or mechanical complications during stay in the Coronary Care Unit (CCU) were analysed in 154 women with definte (WHO Class 1) acute myocardial infarction, admitted sequentially to the CCU over a four-year period. The prognosis in these women was then compared with the prognosis in a group which represented the general male population in the CCU and an age-matched group of men. The results showed that the long-term prognosis in women with acute myocardial infarction is remarkably similar to age-matched groups of men.

Acute Disease↗
PubMed1978

Effect on survival after myocardial infarction of long-term treatment with phenytoin.

A prospective, randomised, open trial was performed in 150 patients to test for any beneficial effects on 2-year mortality of long-term antiarrhythmic therapy with phenytoin in patients with acute myocardial infarction. Patients were stratified according to age, sex, past history of myocardial infarction, and the presence of absence of electrical or mechanical complications in the course of acute infarction. They were then randomised to treatment or control groups (74 v. 76). The former received phenytoin in doses aimed at maintaining plasma phenytoin levels between 40 and 80 mumol/litre. All patients entered the study before discharge from the coronary care ward. Plasma phenytoin levels were in the therapeutic range in between 51 and 75 per cent of subjects at any follow up visit. There were 19 withdrawals from the treatment group, 10 of which were the result of side effects. There were 5 withdrawals from the control group. According to the original intention to treat, there were 18 deaths at 2 years in the treatment group and 14 deaths in the control group. There was no reduction in the incidence of instantaneous or sudden deaths. Deaths on treatment were not associated with a low phenytoin plasma level. Phenytoin treatment showed no beneficial effects on mortality and was associated with a high incidence of side effects.

Adult↗
PubMed1977

Estimation of ventricular refractoriness in man by the extra stimulus method.

The effective right ventricular refractory (EVRP) period was estimated in 24 patients using the extra stimulus technique. All patients were paced from the right ventricle at basic pacing intervals of 400, 500, 600 and 800 ms, respectively. In all patients the EVRP decreased when the basic pacing rate was increased. At the same basic pacing rate there was a wide variation in the EVRP between individual patients. Within an individual patient, however, providing the position of the pacing electrode remained stable, there was no significant variation in the EVRP when estimations were performed 15-30 min apart. Thus the technique can be used to assess the effect of a drug on the EVRP in an individual patient.

Adult↗
PubMed1976

Wenckebach phenomenon in the exit area from a transvenous pacing electrode.

An unusual type of exist block from a transvenous pacing electrode was recorded in a 63-year-old man with an acute inferior infarct and cardiogenic shock. The pacemaker artefact to QRS interval increased gradually till there was loss of capture. A gradual change from I:I pacing rhythm to 4:3 and 3:2 Wenckebach cycles was recorded. This was followed by a fixed 2:I pacemaker artefact to QRS block.

Electrocardiography↗
PubMed1976

Inhibition of demand pacemakers caused by potentials associated with inspiration.

A 69-year-old man with a permanent demand pacemaker and a unipolar electrode system had intermittent failure of pacing during deep inspiration. Pacing was not interrupted when the unit was switched to fixed rate mode by an external magnet. Thus, the problem was not caused by a change in electrode position or to a loose connexion. The likely cause was inhibition by non-cardiac potentials, possibly myopotentials associated with respiration.

Aged↗
PubMed1976

Learning theory and gestalt therapy.

This article discusses the theory and operations of Gestalt Therapy from the viewpoint of learning theory. General comparative issues are elaborated as well as the concepts of introjection, retroflextion, confluence, and projection. Principles and techniques of Gestalt Therapy are discussed in terms of learning theory paradigm. Practical implications of the various Gestalt techniques are presented.

Attitude of Health Personnel↗