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Biomedical subjects

S Cowley

Publications and source records attributed to S Cowley.

At least 19 recordsLinked to original sources
PubMed2001

The palliative management of fungating malignant wounds--generalising from multiple-case study data using a system of reasoning.

The project focused on individual experiences, from 45 participants, of living with a fungating wound and the performance of wound dressings in reducing the impact of the wounds on daily living. A case study design was adopted. This posed a key methodological challenge in the form of the contentious epistemological issue, characterised in the literature as the "nomothetic-idiographic dilemma". This issue concerns the nature of knowledge generated from an individual case and its generalisability. A system of reasoning was adopted as the analytic strategy, within a theory-driven evaluation, to abstract general issues from the case study data to construct explanations of symptom control and dressing performance. The latter were generalised beyond the individual cases with the use of theory. This paper focuses on the methodological issues that are inherent in the use of a case study design and the nature of the evidence generated. The system of reasoning is described and illustrated using data from a single participant with advanced uterine cancer and a fungating nodule in the groin.

Activities of Daily Living↗
PubMed2001

Outcome of pseudoseizures in children and adolescents: a 6-year symptom survival analysis.

Outcome was studied of all children and adolescents with pseudoseizures without epilepsy, who were referred and treated as in-patients and/or day patients in the tertiary psychiatric ward at Birmingham Children's Hospital, UK between 1988 and 1994. Information was derived from case-note data. Freedom from seizures for six months was defined as 'cure', as no recurrences after this period were noted. Kaplan-Meier survival analysis was used. Seventeen patients were identified: 15 females and two males; mean age at presentation to the tertiary psychiatric service was 12 years 9 months (SD 26 months; range 8 years 3 months to 15 years 9 months). Fourteen participants recovered and resumed regular school attendance. Three were lost to follow-up due to being referred on to other agencies before recovery because they became too old for the service. Recovery followed an exponential distribution, with a mean symptom survival time following treatment of 1.5 years. These results are consistent with a treatment effect. Younger age at presentation, female sex, having more types of seizures, and not receiving both in-patient and outpatient treatment were associated with better outcome. The deteriorating prognosis with age at treatment suggests prompt identification may be important in ensuring a good outcome.

Activities of Daily Living↗
PubMed2001

The biology of HIV infection.

This article reviews the cell and molecular biology of human immunodeficiency virus (HIV), emphasizing the features that lead to opportunistic infection by organisms such as mycobacteria. Mycobacteria, especially M. avium complex and M. tuberculosis infections, are closely associated with HIV disease. HIV is a very small retrovirus and its high mutation rate leads to extremely variable viral populations, both within and between individuals. It is coated with glycoprotein 120 (gp120), which it uses to bind to and infect a range of CD4+ leukocytes, depending on the co-receptor specificity. T cell-tropic HIV strains tend to use the CXCR-4 chemokine receptor, while macrophage-tropic strains tend to use the CCR-5 chemokine receptor. Immunosuppression is induced in a number of ways. As well as frank depletion of virus-infected T cells, antigen-specific T cell clones can be selectively deleted by mechanisms such as defective antigen presentation by HIV-infected macrophages (activation-induced cell death). Changes in cytokine production in HIV infection are also proposed. All this leads to falling T cell counts, B cell dysregulation and macrophage dysfunction. Opportunistic infections exploit this immunosuppressed environment. Certain infections are prevalent, reflecting factors such as environmental exposure to pathogens, poor mucosal defences and subcellular interactions between HIV and, e.g. viral or mycobacterial infections. Opportunistic infection exacerbates immune destruction by HIV, producing a vicious cycle that is ultimately fatal.

AIDS-Related Opportunistic Infections↗
PubMed2000

Generalising to theory: the use of a multiple case study design to investigate needs assessment and quality of care in community nursing.

This paper outlines the detail of the case study method used in a project commissioned by the English National Board for Nursing, Midwifery and Health Visiting (ENB) to investigate the changing educational needs of community nurses with regard to needs assessment and quality of care in the context of the NHS and Community Care Act, 1990. It explains the methodological procedures and analytic processes which led to integration of data across the whole study, focusing on the role of a prior theoretical framework in case study design. Recently qualified practitioners (health visitors and district nurses) were observed during a regular shift (N=134 visits), concentrating on their practice of assessing needs, and on liaison and collaboration within teams and across sectors. They were interviewed after the observation period (N=33 practitioners), to determine the extent of formality they attached to each assessment, and elicit information about aspects which may be embedded in everyday practice as well as those recorded for explicit requirements.The preliminary analysis resulted in the modification of a model for assessing service quality, and identified various points where a 'policy-practice gap' might arise between policies and practice in both the health service and education. The practicalities of operationalising a multiple case study design into research are highlighted, and the mechanism for 'generalising to theory' illustrated.

Community Health Nursing↗
PubMed2000

A taxonomy of needs assessment, elicited from a multiple case study of community nursing education and practice.

The role and expectations of community nurses in carrying out needs assessments changed when an internal quasi-market was introduced to the British health service under the National Health Service (NHS) & Community Care Act 1990. This paper reports on a study commissioned by the English National Board for Nursing, Midwifery and Health Visiting (ENB) to investigate the changing educational needs of community nurses with regard to needs assessment in the context of this legislation. A multiple case study design was utilized and four cases identified, incorporating the geographical variation in England. Recently qualified practitioners (health visitors and district nurses) were observed during a regular shift (n=134 visits), concentrating on their practice of assessing needs, and on liaison and collaboration within teams and across sectors. Participants were interviewed after the observation period (n=33 practitioners), to determine the extent of formality they attached to each assessment, and to elicit information about aspects which may be embedded in everyday practice. Single and multiple case analyses across the four cases used an iterative process of pattern-matching, replication logic and explanation building. The preliminary analysis yielded a descriptive 'taxonomy' which could serve as a basis for classifying the variants of needs assessment and help to clarify the whole phenomenon. When applied further to the data, this revealed the complex interactions between the different ideals (relating to policy, nursing and ascribed worth), the various types (purpose, formality/specificity and complexity) and timing (in relation to client, service and practice issues) within needs assessment.

Community Health Nursing↗
PubMed2000

Purified lipopolysaccharide from Francisella tularensis live vaccine strain (LVS) induces protective immunity against LVS infection that requires B cells and gamma interferon.

Previous results have demonstrated that nonspecific protective immunity against lethal Francisella tularensis live vaccine strain (LVS) or Listeria monocytogenes infection can be stimulated either by sublethal infection with bacteria or by treatment with bacterial DNA given 3 days before lethal challenge. Here we characterize the ability of purified lipopolysaccharide (LPS) from F. tularensis LVS to stimulate similar early protective immunity. Treatment of mice with surprisingly small amounts of LVS LPS resulted in very strong and long-lived protection against lethal LVS challenge within 2 to 3 days. Despite this strong protective response, LPS purified from F. tularensis LVS did not activate murine B cells for proliferation or polyclonal immunoglobulin secretion, nor did it activate murine splenocytes for secretion of interleukin-4 (IL-4), IL-6, IL-12, or gamma interferon (IFN-gamma). Immunization of mice with purified LVS LPS induced a weak specific anti-LPS immunoglobulin M (IgM) response and very little IgG; however, infection of mice with LVS bacteria resulted in vigorous IgM and IgG, particularly IgG2a, anti-LPS antibody responses. Studies using various immunodeficient mouse strains, including LPS-hyporesponsive C3H/HeJ mice, muMT(-) (B-cell-deficient) knockout mice, and IFN-gamma-deficient mice, demonstrated that the mechanism of protection does not involve recognition through the Lps(n) gene product; nonetheless, protection was dependent on B cells as well as IFN-gamma.

Animals↗
PubMed1999

Resources revisited: salutogenesis from a lay perspective.

Health visitors are being pressured to move away from their traditional role in health promotion and public health to focus more closely on people with established clinical disorders. This is partly because of a paucity of theoretical explanations against which to assess interventions directed explicitly at promoting health rather than only preventing disease. However, there are growing public health concerns about increasing inequalities and rising numbers of disadvantaged groups in the UK as well. This paper revisits a grounded theory study that revealed how, in the absence of a need for clinical intervention, health visitors appear to assess needs by treating health as a process fuelled by the accumulation and use of 'resources for health'. Wider theories about salutogenesis ('health creation') and research showing the importance of health and social capital demonstrate the potential of this idea, and were combined with the health visiting study to create a theoretical framework for analytical purposes. Semi-structured interviews with the main carer in 50 families with resident children were analysed using this framework, to provide a lay perspective on how people consider they maintain their health. The analysis demonstrated the usefulness of treating health as a process and of focusing on the development of health-related resources rather than only on presenting problems. The processes of developing capacity were shown to be more important than the presence or absence of specific resources. Links with personal empowerment were apparent; cultural patterns that evolved across generations and neighbourhoods revealed possible pathways to social cohesion. Practice approaches that enhance or inhibit the development of these health-creating resources were identified, and considered in the light of emerging public health needs.

Attitude to Health↗
PubMed1999

Implementing new health visiting services through action research: an analysis of process.

An action research project based in a single fundholding practice on the South Coast of England aimed to identify needs relevant to families with resident children, then to use the contracting system to redirect health visiting practice to meet those needs. The naïvety of this plan was well recognised, so the processes that occurred during implementation of the proposed changes were recorded throughout. An analysis of these participant observation data revealed various organisational constraints and facilitators that arose during contract negotiations. Two new full time health visiting posts were established, each with an innovative and somewhat controversial focus. One health visitor was employed to establish a community development project in an underserved area of the town, while the other was to provide a home visiting service for the families of school aged children. The processes involved in structuring decisions about 'health needs' and how these are best met are analysed for each of the two new posts. The analysis reveals powerful influences that affect the implementation of new health visiting services.

Child↗
PubMed1999

Identifying approaches to meet assessed needs in health visiting.

An action research project, based in a single fundholding practice on the south coast of England, aimed to identify the health needs of families with resident children, then use the contracting system to redirect health visiting services to meet those needs. After assessing the health needs, it was necessary to assess the potential of a range of health visiting approaches that might be proposed to meet those needs. This paper explains how the approaches were assessed for use in the local area and why funding for two additional, innovative posts was deemed necessary. Despite the unsophisticated evidence base for health visiting interventions, a case can be made for commissioning particular service approaches by using a combination of survey data and results from controlled and uncontrolled service evaluations. The supportive focus of health visitor home visiting remains an appropriate use of existing resources, but the usual intensity of visiting may be insufficient for full effectiveness. To rationalize such services by targeting them only at individuals with established needs risks an exacerbation of deteriorating health trends across an area. Alternatively, augmenting home visiting with a community development approach to improve the adverse social environments in which families live may help to change the underlying factors that contribute to ill-health and prove more widely cost-effective.

Adult↗
PubMed1999

A serine residue in ClC-3 links phosphorylation-dephosphorylation to chloride channel regulation by cell volume.

In many mammalian cells, ClC-3 volume-regulated chloride channels maintain a variety of normal cellular functions during osmotic perturbation. The molecular mechanisms of channel regulation by cell volume, however, are unknown. Since a number of recent studies point to the involvement of protein phosphorylation/dephosphorylation in the control of volume-regulated ionic transport systems, we studied the relationship between channel phosphorylation and volume regulation of ClC-3 channels using site-directed mutagenesis and patch-clamp techniques. In native cardiac cells and when overexpressed in NIH/3T3 cells, ClC-3 channels were opened by cell swelling or inhibition of endogenous PKC, but closed by PKC activation, phosphatase inhibition, or elevation of intracellular Ca2+. Site-specific mutational studies indicate that a serine residue (serine51) within a consensus PKC-phosphorylation site in the intracellular amino terminus of the ClC-3 channel protein represents an important volume sensor of the channel. These results provide direct molecular and pharmacological evidence indicating that channel phosphorylation/dephosphorylation plays a crucial role in the regulation of volume sensitivity of recombinant ClC-3 channels and their native counterpart, ICl.vol.

Animals↗
PubMed1998

An exploratory study of demand for the health visiting service within a marketing framework.

A small exploratory study was carried out to consider the concept of demand for the health visiting service from the clients' perspective. Because of the internal market introduced to the British health system under the National Health Service and Community Care Act, the idea of 'marketing' was used as a conceptual framework to underpin the study. Guided interviews were carried out with a sample of nine mothers of pre-school children to elicit the reasons why clients access the service, what they value about it and how they think it could be improved. A detailed qualitative analysis of these data indicates that demand for health visiting relates, in the first instance, to clients' knowledge of the service. This knowledge, and the extent to which the service meets their expectations, appear to influence the value the women place on health visiting and their subsequent use of it. A cycle is described, which illustrates critical points at which health visiting responses affect demand and use of service. The implications of the study for health visiting and for marketing the service are discussed.

Community Health Nursing↗
PubMed1997

Molecular identification of a volume-regulated chloride channel.

A volume-regulated chloride current (ICl.vol) is ubiquitously present in mammalian cells, and is required for the regulation of electrical activity, cell volume, intracellular pH, immunological responses, cell proliferation and differentiation. However, the molecule responsible for ICl.vol has yet to be determined. Although three putative chloride channel proteins expressed from cloned genes (P-glycoprotein, pICln and ClC-2 ) have been proposed to be the molecular equivalent of ICl.vol, neither P-glycoprotein nor pICln is thought to be a chloride channel or part thereof, and the properties of expressed ClC-2 channels differ from native ICl.vol. Here we report that functional expression in NIH/3T3 cells of a cardiac clone of another member of the ClC family, ClC-3, results in a large basally active chloride conductance, which is strongly modulated by cell volume and exhibits many properties identical to those of ICl.vol in native cells. A mutation of asparagine to lysine at position 579 at the end of the transmembrane domains of ClC-3 abolishes the outward rectification and changes the anion selectivity from I- > Cl- to Cl- > I- but leaves swelling activation intact. Because ClC-3 is a channel protein belonging to a large gene family of chloride channels, these results indicate that ClC-3 encodes ICl.vol in many native mammalian cells.

3T3 Cells↗
PubMed1997

Analysing clinical practice guidelines. A method of documentary analysis.

This paper will describe a method of documentary analysis used in a study examining the validity of clinical guidelines issued to health visitors to assist them in identifying families requiring increased health visitor support. This forms the preliminary work for a wider study examining how health visitors decide to increase support to vulnerable families. Although a number of published research texts discuss the value of records and documents as important data sources for health service researchers, there is relatively little information available about the processes of documentary analysis. This paper offers one method for analysing clinical practice guidelines, it describes the development of a critique and analysis tool and explores the strengths and weaknesses of this particular analysis instrument.

Community Health Nursing↗
PubMed1997

Shigella serogroups identified from adult diarrhoeal out-patients in Addis Ababa, Ethiopia: antibiotic resistance and plasmid profile analysis.

Fifty shigella strains were isolated from 700 diarrhoeal samples collected from adult diarrhoeal out-patients in Addis Ababa. Among the isolates, serogroup A comprised 28%, B 44%, C 18% and D 10%. Among all shigella serogroups, highest resistance was encountered to tetracycline (74%), ampicillin (70%), cephalothin (64%), trimethoprim-sulfamethoxazole (52%) and chloramphenicol (50%) while least resistance was observed to gentamicin (0%), polymyxin B (10%) and nalidixic acid (14%). Gentamicin, polymyxin B and nalidixic acid were found to be the drugs of choice for cases of shigellosis. All drug resistant isolates analysed for plasmids contained multiple plasmids ranging from 1.8 to greater than 21 Kilobases.

Adolescent↗
PubMed1997

Salmonella serogroups identified from adult diarrhoeal out-patients in Addis Ababa, Ethiopia: antibiotic resistance and plasmid profile analysis.

Forty five Salmonella strains were isolated from 700 diarrhoeal samples collected from adult diarrhoeal out-patients in Addis Ababa. Among the isolates, serogroup C comprised 31.1%, B 24.4%, S.typhi 15.6%, D 13.3%, A 8.9% and E 6.7%. Among the isolates, 71.1% were resistant to tetracycline, 68.9% to ampicillin, 66.7% to cephalothin, 57.8% to trimethoprim-sulphamethoxazole, 53.9% to kanamycin, 46.7% to chloramphenicol and less than 31.8% of the isolates were resistant to other drugs. Among S.typhi isolates, 28.6% were resistant to chloramphenicol and this shows the emergence of chloramphenicol resistant S.typhi strains in Ethiopia. Gentamicin and polymyxin B were found to be the drugs of choice for cases of salmonellosis including S.typhi. All drug resistant isolates analysed for plasmids contained multiple plasmids ranging in sizes from 1.8 to greater than 21 Kilobases.

Adolescent↗
PubMed1996

Establishing a framework for research: the example of needs assessment.

This paper explains the early planning stage of a study commissioned by the English National Board which will investigate the changing educational needs of community nurses with regard to needs assessment and quality of care in the context of the NHS and Community Care Act 1990. Two focus groups, comprising 22 participants altogether, generated data which were used to augment and clarify issues explored in an initial literature review. Some of the methodological issues are explained. Traditional community nursing approaches to needs assessment appeared to value process and integration, while the new legislation emphasizes the separateness of assessment; there is a danger that it may be seen as a single event. The consumer views were both supportive and critical about each of the approaches; some important insights were gained, and a confident basis from which to launch the study identified. The approach offers one possible way to clarify the starting point of a project when carrying out a standard literature review seems insufficient. This may occur with under-researched or rapidly changing phenomena, or if a field of interest is the subject of multiple interpretations or lack of consensus.

Community Health Nursing↗