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Biomedical subjects

R Skidmore

Publications and source records attributed to R Skidmore.

At least 19 recordsLinked to original sources
PubMed2001

Seclusion & restraint. Understanding recent changes.

1. Seclusion and restraint must be a last resort, emergency response to a crisis situation that appears to present imminent risk of harm to the patient, staff, or others. 2. JCAHO-accredited hospitals billing for Medicare or Medicaid must meet HCFA requirements to maintain compliance. 3. Policy writers and administrators must carefully scrutinize all applicable regulatory standards to ensure all requirements are met.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2001

Least to most restrictive interventions. A continuum for mental health care facilities.

While this article does not propose to provide answers to the many questions prompted by the new Patient's Rights CoP (1999) or the newly revised JCAHO standards on seclusion and restraint (JCAHO, 2000), a prudent plan of action for any organization serving patients with a behavioral component to their treatment would be to adopt a policy of least restrictive intervention prior to consideration of seclusion and restraint in response to emergency patient care needs. It was the authors' intent to present a representative sample of the available literature and from that to develop a continuum of intervention possibilities ranging from least to most restrictive. In addition, suggestions found in the literature for implementation of least to most restrictive programs have been provided.

Humans↗
PubMed1998

Myofibroblastoma of breast--an appraisal of cytoskeletal phenotypes.

Myofibroblastoma of the breast is a recently described entity. Since its first description in 1987, less than 50 cases have been reported. We present the first (reported) myofibroblastoma to be detected as a non-palpable mass on a routine screening mammogram and emphasize the importance of not mis-diagnosing this rare cellular lesion as malignant on frozen section. Review of the literature demonstrates changes in the clinical presentation of myofibroblastomas. Once considered more common in men than in women, myofibroblastomas are now being reported with increasing frequency in women. The age at presentation is a decade earlier, and not surprizingly, the size of the earlier detected lesion is smaller. Recently four different cytoskeletal phenotypes (V, VA, VAD and VD) of myofibroblastomas have been described, depending upon the vimentin (V), actin (A), and desmin (D) immunoreactivity. Whereas vimentin reactivity is universal, actin and desmin immunoreactivity is variable, desmin being more frequently positive than actin. As more is known about the clinical behavior of myofibroblastomas, their rate of recurrence and malignant potential, if any, the relationship of the cytoskeletal content to prognosis may become clearer. Currently, complete immunohistochemical analysis and electron microscopic examination of this interesting breast lesion is recommended. List of abbreviations-Vimentin (V), actin (A), and desmin (D), vimentin and actin (VA), vimentin and desmin (VD), vimentin, actin and desmin (VAD).

Actins↗
PubMed1995

HSP70 induction during exercise and heat stress in rats: role of internal temperature.

The purpose of this study was to determine if the accumulation of the 72-kDa heat shock protein (HSP70) is elevated in response to a prolonged bout of submaximal exercise in which colonic temperature (Tco) remained at control levels. Sprague-Dawley rats were randomly assigned to one of four testing groups [n = 8 per group; ambient temperatures (Ta) for each condition are included]: 1) control (cool/rest; Ta = 24 degrees C); 2) cool and exercise (cool/exercise; Ta = 14 degrees C); 3) nonexertional heating (heat/rest; Ta = 42 degrees C); 4) heat and exercise (heat/exercise; Ta = 32 degrees C). All interventions were approximately 60 min in duration. An exercise bout consisted of treadmill running at 17 m/min and 0% grade, while the heat/rest and heat/exercise experiments consisted of heat exposure that was terminated when Tco reached 41 degrees C. Baseline Tco was similar for all four groups. In the cool/rest and cool/exercise groups, final Tco was not different from the baseline values, nor was it different between these two groups. In the heat/rest and heat/exercise groups, heating rates were similar. Tissue samples were obtained from the gastrocnemius, soleus, and extensor digitorum longus (EDL) muscles of the left hindlimb and the left ventricle 30 min after a trial was completed. An enzyme-linked immunosorbent assay specific for HSP70 was used to directly quantitate absolute levels of HSP70 in tissues. There were significant main effects of both heating and exercise for HSP70 levels in the gastrocnemius, soleus, and left ventricle (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1995

HSP70 accumulation in tissues of heat-stressed rats is blunted with advancing age.

To determine whether aging results in reduced accumulation of the 70-kDa heat shock protein (HSP70) in response to a thermal challenge, experiments were conducted in conscious and freely moving mature (12-mo-old) and senescent (24-mo-old) male Fischer 344 rats. Rats were assigned to a euthermic control group or a nonexertionally heated group that was exposed to an ambient temperature of 42 degrees C until colonic temperature reached 41 degrees C. Samples were subsequently obtained from the liver and myocardium, and absolute levels of both the constitutive and inducible forms of HSP70 were quantitated. Heat-stressed rats had significantly elevated HSP70 levels in the liver compared with the euthermic groups. Post hoc comparisons revealed that heat stress elicited marked elevations in liver HSP70 in mature rats compared with age-matched control animals. In contrast, HSP70 values were unchanged in the senescent heated group vs. the control group. In the myocardium, heat stress produced marked increases in HSP70 levels in both the mature and senescent groups compared with age-matched control animals, with accumulation significantly blunted in the senescent vs. mature rats. Thus the increases in liver and myocardial HSP70 accumulation in response to nonexertional heat stress are attenuated with senescence. Because these proteins are postulated to protect cells from injury and enhance cellular recovery from heat stress, the data suggest that an aging organism has a reduced ability to properly maintain cellular function and integrity after a thermal challenge.

Aging↗
PubMed1994

Influence of compression stockings on lower-limb venous haemodynamics during laparoscopic cholecystectomy.

Lower-limb venous haemodynamics were studied prospectively in 40 patients (24 women, 16 men of median age 52 years) undergoing laparoscopic cholecystectomy. Patients were randomized to wear compression stockings during surgery or no stockings. All received subcutaneous heparin prophylaxis. Venous capacitance and outflow were measured non-invasively before, during and after pneumoperitoneum. In the group without compression stockings (20 patients) venous capacitance and outflow decreased during pneumoperitoneum in most patients. In the group wearing stockings (20 patients) the changes were less pronounced or abolished. There was a significant difference between the groups in venous capacitance and outflow ratios at mid-operation: median (interquartile range) 0.89 (0.56-1.16) and 0.89 (0.56-1.15) respectively in the group without stockings versus 1.48 (1.09-2.19) and 1.71 (1.20-2.19) respectively in that with stockings (P < 0.001). Pneumoperitoneum creates a significant resistance to venous return. Compression stockings counteract the changes observed.

Adult↗
PubMed1994

Waveform shape analysis: extraction of physiologically relevant information from Doppler recordings.

1. Doppler recordings were made from the brachial artery of healthy female subjects during a series of manoeuvres which altered the pressure-flow characteristics of the vessel. 2. Changes were induced in the peripheral circulation of the forearm by the application of heat or ice-packs. A sphygmomanometer cuff was used to create graded occlusion of the vessel above and below the point of measurement. Recordings were also made whilst the subjects performed a standardized Valsalva manoeuvre. 3. The Doppler recordings were analysed both with the standard waveform indices (systolic/diastolic ratio, pulsatility index and resistance index) and by the method of Laplace transform analysis. 4. The waveform parameters obtained by Laplace transform analysis distinguished the different changes in flow conditions; they thus had direct physiological relevance, unlike the standard waveform indices.

Adult↗
PubMed1990

Fetal Doppler shift waveforms in intrauterine growth retardation: laplace transform analysis technique.

An approach to the analysis of fetal blood flow velocity/time waveforms is described using a Doppler shift flowmeter. The waveform shape is described in terms of its Laplace transform. Variations in the value of the dominant coefficient in the Laplace transform in the descending thoracic aorta appear to distinguish growth retarded from normally grown fetuses early in pregnancy. Growth retardation was defined by an index of size specifically aimed at detecting the disproportionately grown fetus. Simpler methods of waveform shape description fail to detect the growth retarded fetus early in the second trimester.

Aorta, Abdominal↗
PubMed1989

Operative assessment of femorodistal bypass grafts using a new Doppler flowmeter.

Operative measurements using a newly developed Doppler flowmeter were made on 47 in situ femorodistal bypass grafts performed for critical ischaemia. Graft blood flow, peripheral resistance and impedance were measured before and after the injection of 15 mg papaverine down the graft. The proportion of retrograde blood flow at the distal anastomosis was also measured. The success of a graft at 1 month was defined by patency on duplex ultrasound scanning, a rise in the Doppler ankle pressures and an improvement in the clinical state of the limb. By these criteria the 1-month primary success rate was 35 out of 47 (74 per cent). Graft blood flow was of little value in predicting graft outcome but, combined with segmental pressures, accurately located six of eight technical problems which were successfully corrected. After papaverine, the peripheral resistance of all the successful grafts fell below one peripheral resistance unit (PRU). No single measurement was able to completely distinguish between success and failure, although discriminant analysis of all measurements was able to predict success with a sensitivity of 100 per cent and specificity of 97 per cent. A simpler combination of a peripheral resistance after papaverine less than 1 PRU and a retrograde blood flow less than 33 per cent predicted success, with a sensitivity of 97 per cent and specificity 83 per cent. These criteria have been validated on a further 26 grafts, achieving a sensitivity of 88 per cent and a specificity of 75 per cent. Simple operative measurements, using a newly developed Doppler flowmeter, enable the detection of technical problems and the accurate prediction of the early outcome of femorodistal grafting.

Adult↗
PubMed1989

A new approach to the noninvasive measurement of cardiac output using an annular array Doppler technique--I. Theoretical considerations and ultrasonic fields.

This paper describes the development of a Doppler flowmeter capable of measuring blood volume flow rate without the need to measure the vessel lumen area or beam-vessel angle. It requires the production of a uniform wide ultrasound beam to encompass the whole vessel and thus to produce a Doppler spectrum which corresponds to all the flowing blood, and a narrow reference beam placed within the lumen to compensate for various unknown quantities, such as tissue attenuation. The general definition of volume flow rate is described and applied to a new flowmeter, which allows an absolute value of volume flow rate to be measured independently of vessel size, beam-vessel angle, and tissue attenuation. By electronically apodising an annular array transducer in transmission and reception, a uniform wide beam and a narrow reference reception beam are produced. Theory to predict these beam patterns is developed and a computer simulation is made. The ultrasonic fields obtained from an annular array transducer in water are compared with the theoretical fields.

Adult↗
PubMed1989

A new approach to the noninvasive measurement of cardiac output using an annular array Doppler technique--II. Practical implementation and results.

An experimental Doppler flowmeter system has been developed which can noninvasively measure blood flow volume rate in a vessel. It is based on the attenuation compensated technique and does not require knowledge of the vessel size or beam-vessel angle. In vitro results have shown that the measurement of volume flow rate is independent of vessel angle to within +/- 4%, and independent of vessel diameter to within +/- 5%. Flow rate linearity is better than +/- 3%. A good comparison has been obtained, in vivo, of aortic diameters measured by an imaging system and with this flowmeter; the r value was 0.98. The noninvasive measurement of cardiac output using this flowmeter has been compared with conventional dilution techniques in 54 patients, with a resulting correlation coefficient of r = 0.96.

Aorta↗
PubMed1989

LaPlace transform analysis of femoral artery Doppler signals: the state of the art.

A followup study was conducted to validate our previous experience with the LaPlace Transform Analysis (LTA) method for processing Doppler ultrasound signals from the common femoral artery to detect significant stenosis of the aorto-iliac segment. The first phase used the same instantaneous mean velocity signal processor as used in the prior study. A comparison of the Doppler examinations with angiograms in 98 legs yielded a sensitivity = 92% and sensitivity = 94% in the identification of 50% or greater stenosis of the aorta-iliac segment, results almost identical to the last study. Because of theoretical disadvantages of using the instantaneous mean velocity signal we carried out a second phase using a peak velocity detector. In 148 limbs sensitivity = 87% and specificity = 98%. The presence or absence of superficial femoral artery occlusion did not affect the accuracy of the waveform analysis in the detection of proximal disease. The LTA parameter related to distal resistance, G, was not found to have clinical value in the assessment of the femoral-popliteal segment.

Arterial Occlusive Diseases↗
PubMed1988

Pulse-generated runoff: a new method of determining calf vessel patency.

A non-invasive method of determining calf vessel patency before femorodistal bypass has been developed. This pulse-generated runoff (PGR) system generates blood flow in patent calf arteries by means of a pulsatile cuff even if the existing Doppler signal is inaudible. PGR was compared with pre-operative arteriography in 95 ischaemic limbs and both were compared with the peripheral resistance measured at operation in 62 limbs. There was a highly significant correlation between the PGR and arteriogram scores (rs = 0.74, P less than 0.001) but PGR tended to detect more patent vessels than arteriography. The peripheral resistance correlated better with PGR than arteriography (rs = -0.71 and -0.54 respectively, P less than 0.001). PGR is a simple, non-invasive method of determining calf and foot vessel patency pre-operatively.

Adult↗
PubMed1987

An analogue mean frequency estimator for the quantitative measurement of blood flow by Doppler ultrasound.

Ultrasonic Doppler-shifted signals from blood can be displayed in various forms using either analogue or digital processing techniques. One of the most commonly extracted parameters from the Doppler spectrum is the mean frequency envelope. This waveform can be used for the interpretation of physiological changes within man and can also be used for the estimation of volume flow rate within a vessel. This paper describes a practical implementation of an analogue, instantaneous mean frequency estimator and its use in the measurement of blood flow volume. The circuit is linear to within two per cent and operates over a frequency range of 200 Hz to 10 kHz. It can extract a velocity-time envelope from a Doppler signal within noise and performs well in a clinical environment. It is relatively inexpensive compared with digital signal processing techniques and requires minimal setting up. Simple connection to a Doppler velocimeter using phase quadrature demodulation will produce a directional output.

Blood Flow Velocity↗