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S Jordan

Publications and source records attributed to S Jordan.

At least 37 records · Page 2Linked to original sources
PubMed2001

The expression of the growth hormone secretagogue receptor ligand ghrelin in normal and abnormal human pituitary and other neuroendocrine tumors.

Ghrelin is a recently identified endogenous ligand of the GH secretagogue (GHS) receptor. It was originally isolated from the stomach, but has also been shown to be present in the rat hypothalamus. It is a 28-amino acid peptide with an unusual octanoylated serine 3 at the N-terminal end of the molecule, which is crucial for its biological activity. Synthetic GHSs stimulate GH release via both the hypothalamus and the pituitary, and the GHS receptor (GHS-R) has been shown by us and others to be present in the pituitary. We investigated whether ghrelin messenger ribonucleic acid (mRNA) and peptide are present in the normal human hypothalamus and in normal and adenomatous human pituitary. RNA was extracted from pituitary tissue removed at autopsy and transsphenoidal surgery (n = 62), and ghrelin and GHS-R type 1a and 1b mRNA levels were investigated using real-time RT-PCR. Both ghrelin and GHS-R mRNA were detected in all samples. Corticotroph tumors showed significantly less expression of ghrelin mRNA, whereas GHS-R mRNA levels were similar to those in normal pituitary tissue. Gonadotroph tumors showed a particularly low level of expression of GHS-R mRNA. Immunohistochemistry, using a polyclonal antibody against the C-terminal end of the ghrelin molecule, revealed positive staining in the homolog of the arcuate nucleus in the human hypothalamus and in both normal and abnormal human pituitary. Pituitary tumor ghrelin peptide content was demonstrated using two separate RIA reactions for the N-terminal and C-terminal ends of the molecule. Both forms were present in normal and abnormal pituitaries, with 5 +/- 2.5% octanoylated (active) ghrelin (mean +/- SD) present as a percentage of the total. We suggest that the presence of ghrelin mRNA and peptide in the pituitary implies that the locally synthesized hormone may have an autocrine/paracrine modulatory effect on pituitary hormone release.

Adult↗
PubMed2001

Expression of 11 beta-hydroxysteroid dehydrogenase isoenzymes in the human pituitary: induction of the type 2 enzyme in corticotropinomas and other pituitary tumors.

One of the defining biochemical features of Cushing's disease is a relative insensitivity to glucocorticoid (GC) feedback, but an analysis of the GC receptor has failed to detect any major abnormalities. However, two isoenzymes of 11 beta-hydroxysteroid dehydrogenase (11 beta HSD), either by converting cortisone (E) to cortisol (F) (type 1) or conversely by converting F to E (type 2), play an important prereceptor role in regulating corticosteroid hormone action at several sites. 11 beta HSD1 and -2 expression within the anterior pituitary gland itself may modulate GC feedback at an autocrine level, and we have speculated that this may be deranged in Cushing's disease. Detection of 11 beta HSD type 1 and 2 immunoreactive protein was performed using fluorescence immunohistochemistry. Double immunofluorescent studies were undertaken on normal pituitary to define the cellular localization of 11 beta HSD isoenzymes using antisera against GH, ACTH, LH, FSH, PRL, and S100, a nonhormonal marker of folliculo-stellate cells. In normal pituitary, positive staining for 11 beta HSD1-immunoreactive protein was observed in GH- and PRL-secreting cells and in folliculo-stellate cells; gonadotrophs, thyrotrophs, and ACTH-positive cells were negative. 11 beta HSD2 immunoreactivity was absent in all cell types. RT-PCR detected 11 beta HSD1 messenger ribonucleic acid (mRNA) expression in the normal pituitary; 11 beta HSD2 mRNA expression was also seen in most normal tissue. By contrast, in ACTH-secreting adenomas 11 beta HSD2 immunostaining was strongly positive in every case of corticotroph adenoma. 11 beta HSD1 immunoreactivity was also observed occasionally, but to a much lesser extent. In other pituitary tumors, both functional and nonfunctional, 11 beta HSD expression was variable in terms of isoenzyme mRNA and intensity of protein staining. The expression of 11 beta HSD1 (which generates F from E) in somatotrophs and lactotrophs suggests an autocrine role for this isoenzyme in the glucocorticoid regulation of pituitary GH and PRL secretion. 11 beta HSD2 expression is markedly induced in ACTH-secreting pituitary tumors and, by converting F to E, may explain the resetting of glucocorticoid feedback control in Cushing's disease.

11-beta-Hydroxysteroid Dehydrogenases↗
PubMed2000

A randomised, prospective, phase III clinical trial of primary bleomycin, ifosfamide and cisplatin (BIP) chemotherapy followed by radiotherapy versus radiotherapy alone in inoperable cancer of the cervix.

BACKGROUND: Phase II studies have shown primary (neo-adjuvant) chemotherapy with bleomycin, ifosfamide and cisplatin (BIP) is active against inoperable cervical cancer. We present here results of a randomised phase III multicentre trial comparing radical radiotherapy with neo-adjuvant BIP chemotherapy followed by radical radiotherapy in patients with inoperable cervical cancer, designed to discover whether this combination might improve survival. PATIENTS AND METHODS: Patients with inoperable cervical carcinoma were randomised to pelvic radiotherapy alone [RT] or two to three cycles of bleomycin 30 units/24-hour infusion, ifosfamide 5 g/m2/24 hours, and cisplatin 50 mg/m2) chemotherapy followed by pelvic radiotherapy (BIP + RT). Randomisation was stratified by stage and radiotherapy centre. RESULTS: One hundred seventy-two eligible women were randomised into this trial; eighty-six to RT and eighty-six to BIP + RT. A total of 190 cycles of chemotherapy were given. Median follow-up for the 47 patients still alive is 9 years with a minimum follow-up of 3 years. Complete or partial response occurred in 51 of 86 (59%) of those randomised to RT and 60 of 86 (69%) of those randomised to BIP + RT. The difference between response rates does not reach statistical significance (chi2 = 2.06, P = 0.15). Median survival is two years with an actuarial survival at five years of 32% (95% confidence interval (95% CI): 25%-39%). There is no significant difference between the treatment groups (chi2log-rank = 0.11, P = 0.74). CONCLUSIONS: This study does not show any survival benefit from the use of neo-adjuvant BIP chemotherapy in advanced cervical cancer.

Adult↗
PubMed2000

The pathogenesis of lung injury following pulmonary resection.

Postpneumonectomy pulmonary oedema (PPO) develops in approximately 5% of patients undergoing pneumonectomy or lobectomy, and has a high associated mortality (>50%). In its extreme form, PPO follows a clinical and histopathological course indistinguishable from acute respiratory distress syndrome. Perioperative fluid overload, impaired lymphatic drainage following node dissection and trauma caused by surgical manipulation have been implicated in the pathogenesis of PPO. However, PPO more probably represents the pulmonary manifestation of a panendothelial injury consequent upon inflammatory processes induced by the surgical procedure, which involves collapse and re-expansion of the operative lung to permit hilar dissection and pulmonary resection. High inspired oxygen concentrations are required to overcome the effects of shunt. Animal studies have shown that pulmonary ischaemia/reperfusion can result in oedema formation, possibly due to the generation of pro-oxidant forces. Moreover, plasma taken from patients undergoing lobectomy or pneumonectomy (but not lesser resections) shows evidence of oxidative damage. Such evidence suggests either that the high inspired oxygen concentrations associated with one-lung ventilation, or ischaemia/reperfusion injury, may modulate post-pneumonectomy pulmonary oedema. Mechanisms by which redox imbalance may result in tissue damage and postpneumonectomy pulmonary oedema are discussed.

Female↗
PubMed2000

Nomenclature for identified pigmentation genes in the mouse.

More than 90 different loci influence pigmentation in the mouse. During the past few years, an increasing number of genes have been identified, and assigned to the corresponding coat color loci and pigmentation mutants. As a consequence, different names have been used in publications for loci, genes and corresponding proteins. In the following article, we present the rules and guidelines for gene nomenclature, and provide the current nomenclature for pigmentation mutants in the mouse.

Animals↗
PubMed2000

Educational input and patient outcomes: exploring the gap.

Over the last two decades, the health care professions in the United Kingdom have seen an unparalleled expansion of continuing professional education (CPE) and development (CPD) programmes; however, there is little empirical evidence that these enhance the care delivered to patients. Further research is also needed to demonstrate that these initiatives are linked to improved patient outcomes. If health care educators are to move towards an 'evidence-based curriculum', some restructuring of courses may be needed. Priorities should be set and decisions made, based on the results of reliable and valid research into the clinical outcomes of CPE. To evaluate courses and demonstrate educational effectiveness solely in terms of student satisfaction is not enough; to survive in the world of evidence-based care, educators must also demonstrate their contribution to clinical effectiveness. However, the neoteric field of impact evaluation lacks not only validated research methods, but also an agreed agenda for future research. Drawing on interviews undertaken with nurses who have participated in education evaluations and the relevant literature, this paper discusses the available data collection instruments and the development of viable research designs and methods, which are urgently needed to assess the outcomes of professional education programmes.

Clinical Nursing Research↗
PubMed2000

The biological sciences in mental health nursing: stakeholders' perspectives.

To date, relatively little attention has been paid to optimizing the development of education programmes to support safe and effective health care professionals. In particular, the wider stakeholders, particularly health service users, are rarely consulted on the knowledge base expected of practitioners. We report here on an evaluation, involving students, lecturers, nurses and service users, aimed at reviewing the bioscience component of the preregistration mental health nursing course. Students and lecturers agreed that the current common foundation course in bioscience was biased towards the adult branch students, and failed to meet the needs of mental health nurses. The mental health lecturers' solution to the 'bioscience problem' was to curtail the input. In contrast, service users described serious shortfalls in professionals' abilities to inform them of common side-effects of medication; these problems were attributable to inadequate educational preparation. The knowledge deficits identified could be rectified by making pharmacology an important part of the mental health education programme. However, for the curriculum to accommodate applied pharmacology, its supporting bioscience, and essential preparation in psychosocial interventions, some restructuring of the biological science programme for mental health nurses will be necessary. Our findings suggest that such restructuring should be informed by service users' views of their needs.

Attitude of Health Personnel↗
PubMed2000

Phylogenetic divergence in leatherside chub (Gila copei) inferred from mitochondrial cytochrome b sequences.

We examined intra-specific phylogenetic relationships in leatherside chub, Gila copei. The complete mitochondrial (mt) cytochrome b gene (1140 bp) was sequenced for 30 individuals from 10 populations that span the geographical distribution of this species. Traditional phylogenetic analyses revealed two deeply divergent and evolutionarily distinct mtDNA clades that are geographically separated in northern and southern drainage basins. Interpopulation sequence variation between clades ranged from 7.7 to 8.1%. The northern clade was genetically more similar and phylogenetically more closely related to the selected out-group Lepidomeda m. mollispinus than to the southern clade, suggesting that the taxonomy of this species may require revision. Sequence variation among populations within clades ranged from 0 to 0.3% in the north and from 0 to 0.7% in the south. Statistical parsimony was used to construct phylogenetic networks of haplotypes within clades. Nested clade analysis revealed that geographical fragmentation has played an important role in genetic structuring within northern and southern clades.

Animals↗
PubMed2000

Bioscience in the pre-registration curriculum: finding the right teaching strategy.

With the transition of pre-registration nursing programmes into higher education, a disproportionate number of problems have arisen in relation to the bioscience component of the curriculum. Therefore, a survey was undertaken to obtain the views of students (n = 294) and staff (n = 57) to identify effective teaching strategies to facilitate students' learning and understanding of this difficult area of the curriculum. In contrast to the staff, the majority of students found all three teaching strategies (lectures, tutorials and laboratory sessions) of approximately equal value to their learning and practice. Our findings suggest that students' problems with the biosciences could be ameliorated by adjustments in curriculum apportionment. Our data would support the continuation of lead lectures and laboratory work in bioscience. However, a tutorial system, specifically designed to overcome the particular difficulties experienced by nursing students in this area, is needed. This should augment, not replace, lectures and teaching laboratories. There was little indication that such a redistribution of resources would be favoured by the majority of the staff.

Attitude of Health Personnel↗
PubMed2000

Cyclin D and cyclin E expression in normal and adenomatous pituitary.

OBJECTIVES: Cyclins play an important role in the regulation of cell progression through the cell cycle. Over-expression of the cyclins has been shown in many different tumour types. Pituitary adenomas are a common form of endocrine neoplasia in the human, but have been little studied in terms of the expression of the principal cyclins regulating checkpoint exit, cyclin D1 and cyclin E. METHODS: We therefore investigated the expression of cyclin D1 and cyclin E in a range of benign and metastatic pituitary tumours. We studied a total of 95 pituitaries, including normal pituitary (n=20), Cushing's disease (n=19), somatotroph tumours (n=19), non-functioning adenomas (n=18), prolactinomas (n=7), aggressive tumours (n=9) and pituitary carcinoma (n=3). All tumours and normal tissue were immunostained for cyclin D1 and cyclin E using a standard technique, and were then subjected to blinded analysis by a single observer and the extent of staining quantified on the basis of 500 cell counts per tissue. The distribution of positive staining between different tissues was analysed by non-parametric test procedures. RESULTS: There was no cytoplasmic staining for cyclin D1 in any tissue. Nuclear staining was generally sparse, but was statistically more frequent in non-functioning and aggressive tumours compared with other tumour types or normal pituitary. Cyclin E was also sparsely expressed, but was specifically increased in corticotroph tumours from patients with Cushing's disease. CONCLUSIONS: We report cyclin D1 over-expression in aggressive and non-functioning pituitary tumours, and that cyclin E expression is more frequently seen in Cushing's disease. The high level of cyclin E expression in Cushing's disease may relate to the low level of p27 protein expression previously reported in corticotroph tumours.

Adenoma↗
PubMed2000

Surgical treatment of carcinoid tumours.

Carcinoid tumours are the most common endocrine tumour of the gut comprising 75% of appendicular tumours and a third of ileal tumours. They are also an incidental finding in 1% of post mortems. Carcinoid syndrome however is rare and it is estimated that two cases would appear in a quarter of a million population over a decade. We have reviewed a consecutive series of carcinoid tumours accrued from 1976-1999 in order to further study the natural history of the disease and also to examine the relationship between pathological tumour size, extent of disease and prognosis for each tumour site. In this 19 year period 145 patients were treated for the disorder. The bronchus was the commonest site (35.9%) with appendix (24.8%) and ileal (13.8%) carcinoids comprising the majority of known primaries. Overall midgut carcinoids comprised 40.7% of the series with the carcinoid syndrome present in 20.3%. A significant group was constituted by those patients presenting with metastatic disease and an uncertain site of primary tumour (9.7%). Metastatic disease was not found on presentation or follow up in any patient with a foregut primary tumour less than 2 cm diameter or a midgut primary tumour less than 1 cm diameter; a direct correlation of size and metastases being found above these levels. Overall survival for all groups was 60% at 5 years with the best prognosis being seen in patients with bronchial or appendicular carcinoids. Other clinical features, pathology, extent of disease and prognosis of carcinoid tumour will be discussed along with the role of current management strategies.

Adult↗
PubMed1999

Self-Assembly of Trisoligonucleotidyls: The Case for Nano-Acetylene and Nano-Cyclobutadiene.

Rapid cooling is the recipe for the self-assembly of nanostructures from trisoligonucleotidyls, a novel class of branched oligonucleotides whose 3'-termini are connected by a trifunctional linker. The topology of the smallest complex is formally equivalent to the topology of acetylene, if a DNA double strand is envisioned as a C-C bond. The model of nano-acetylene is shown.

Journal Article↗
PubMed1999

The biosciences in the pre-registration nursing curriculum: staff and students' perceptions of difficulties and relevance.

This paper considers the problematic position of the biological sciences in pre-registration nurse education--'The Bioscience Question'. There is no consensus and little research on the appropriate content and depth of bioscience knowledge required by nurses. Attempts to apportion curriculum time for the biosciences are confounded by the difficulty experienced by nursing students with this area. Within one university department, a survey was undertaken to investigate the perceptions of pre-registration students, and their teachers, of the teaching and learning of biological science, in comparison with other areas of the curriculum. Our findings concur with others that the biosciences are a source of disproportionate difficulty and anxiety to nursing students. Among the students, but not the lecturers, there was some, by no means universal, support for the suggestion that these problems could be reduced by a reallocation of curriculum time in favour of the biosciences. Although it was agreed that bioscience theory should be related more closely to nursing practice, there was no evidence that this lessened the students' difficulties with the subject. In contrast to lecturers, students felt the biosciences to be one of the areas of the pre-registration curriculum most relevant to clinical practice.

Adaptation, Psychological↗
PubMed1999

Medication management: an exploratory study into the role of community mental health nurses.

The recent emphasis on community care for those with mental illness has changed working patterns and modified inter-professional role boundaries within multi-disciplinary teams. Clients with serious mental illness are usually prescribed medications, which have a wide range of side effects. However, it is uncertain who is responsible for monitoring clients for the side effects of their medications, ensuring clients' and carers' understandings of their prescribed medications and optimizing compliance with medication. This paper discusses the findings of the first phase of an ongoing study designed to assess the role of community mental health nurses (CMHNs) in managing clients' medication and the provision of appropriate continuing professional education. Our respondents were 14 CMHNs, seven of whom were preparing to undertake a pharmacology module as part of a higher education diploma, and seven who were to act as comparators. Data from questionnaires, interviews and clinical observations were triangulated. All respondents felt that issues surrounding clients' medication were not accorded a sufficiently high profile and that it was, in part, their responsibility to expand their roles to meet these unmet needs of clients. Administering and managing clients' medications were considered to be the main area of 'occupational territory' which distinguished CMHNs from social workers. However, the nurses felt that their practice was limited by lack of appropriate educational preparation.

Community Mental Health Services↗
PubMed1999

Assessing educational effectiveness: the impact of a specialist course on the delivery of care.

An exploratory study was undertaken in South Wales to assess the changes in clinical practice brought about by a specialized pharmacology module designed for Community Mental Health Nurses (CMHNs), in our institution. The respondents were the seven CMHNs who completed the course in 1997 and returned to clinical practice, and seven CMHN comparators, matched on the basis of work experience and location. In order to assess the impact of the module, the practice, attitudes and knowledge of the respondents were investigated before and after the course and 6 months later, using semistructured interviews, nonparticipant observation and questionnaires. The three data sets were analysed using the constant-comparative method, and relevant themes were identified and refined. While we obtained some objective measures of positive educational impact, these should be considered in relation to contextual and confounding variables. Both reported and observed behaviours indicated that the main benefit from the course was increased awareness and monitoring of the side-effects of medication. Respondents had not implemented change uniformly; several factors determined how they modified working practices, including service pressures and the support of colleagues.

Cohort Studies↗
PubMed1999

Managing diabetic foot ulcers.

This article discusses optimal care for a diabetic foot wound including use of a protocol with standards for assessment, treatment, and prevention. Patient and family education is also pivotal to the plan's success.

Community Health Nursing↗
PubMed1999

Wound care for persons with diabetes.

This article addresses local wound care in people with diabetes mellitus. An approach is proposed that uses wound depth and color to determine the goals of local wound treatment. Principles of cleansing, debridement, and the use of moisture retentive dressings are discussed. Infection, a significant problem in the diabetic patient, is addressed as an essential part of local wound care in these patients.

Bandages↗