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Biomedical subjects

S M Robinson

Publications and source records attributed to S M Robinson.

At least 19 recordsLinked to original sources
PubMed1998

Psychological effect of witnessed resuscitation on bereaved relatives.

BACKGROUND: Established practice is for the relatives of critically ill patients to be excluded from the clinical area during resuscitation. We aimed to discover whether relatives wanted to be present during the resuscitation of a family member and whether witnessing resuscitation had any adverse psychological effects on bereaved relatives. METHODS: In this pilot study, relatives of patients who required resuscitation were given the option to remain with the patient during resuscitation or were not given this choice and directed to the relatives' room (control group). The unit of randomisation was the patient who required resuscitation and not the relatives. One close relative was paired with each patient. All relatives were accompanied by a chaperone who gave emotional support and provided technical information on the resuscitation. Relatives were followed up 1 month after the resuscitation. We used a questionnaire to ask about the decision to be present or absent during resuscitation. Bereaved relatives also completed five standardised psychological questionnaires to assess anxiety, depression, grief, intrusive imagery, and avoidance behaviour. FINDINGS: 25 patients underwent resuscitation (13 in witnessed resuscitation group, 12 in control group). Three patients in the witnessed group survived, all the control-group patients died. Two relatives in each group were lost to follow-up. Thus, eight relatives who witnessed resuscitation and ten control-group relatives were followed up. There were no reported adverse psychological effects among the relatives who witnessed resuscitation, all of whom were satisfied with their decision to remain with the patient. The clinical team became convinced of the benefits to relatives of allowing them to witness resuscitation if they wished, so the trial was terminated. INTERPRETATION: In the context of the emergency department, routine exclusion of relatives from the resuscitation room may no longer be appropriate.

Adolescent↗
PubMed1998

Evaluation of benzalkonium chloride chemoneurolytic proximal gastric vagotomy.

BACKGROUND: Transmucosal chemoneurolytic injection of benzalkonium chloride (BAC) has previously been shown to duplicate operative proximal gastric vagotomy (PGV) in controlling gastric acid secretion. In this study, BAC was evaluated as to efficacious dose, methods of delivery, and systemic toxicities. METHODS: Sham celiotomy, operative PGV controls, transmucosal injections through a gastrotomy, and transserosal injections of BAC (saline controls, 0. 625, 1.25, 2.5, 5.0, 10 mg BAC/kg body wt) were administered to Sprague-Dawley rats. After 3 months the rats underwent Congo red testing (CRT), horseradish peroxidase (HRP) neuronal staining, and necropsy. The color density change of the gastric mucosa from basic to acidic demonstrated by the CRT at the time of necropsy was used to calculate the residual anatomic acid-secreting area. Prior to necropsy, subserosal HRP injections into the anterior and posterior stomach walls assayed vagal neuronal viability via retrograde axonal flow. Results were compared by an ANOVA. RESULTS: The results demonstrated that 1.25-10 mg/kg transmucosal BAC replicated the results of operative PGV; 2.5 mg/kg was found to be the most effective dose. All injection groups including saline controls demonstrated similar diminished vagal retrograde axonal flow by HRP testing consistent with local BAC chemoneurolytic effects. No systemic toxic symptoms were observed after tail vein intravenous BAC 1.25, 2.5, and 5.0 mg/kg. CONCLUSIONS: These efficacy studies have demonstrated BAC's potential utility in the performance of endoscopic transmucosal chemoneurolytic PGV.

Animals↗
PubMed1997

Renoprotective effects of the 21-aminosteroid U74389G in ischemia-reperfusion injury and cold storage preservation.

Free radical mediated lipid peroxidation (LPO) has been implicated in the pathogenesis of ischemic-reperfusion injury (IRI). To address the renoprotective effect(s) of LPO inhibition, the efficacy of the 21 aminosteroid U74389G was evaluated in three IRI models. In Model 1 51 unilateral nephrectomized rats that underwent 60 min of warm ischemia followed by a 72-hr reperfusion interval were treated with the test vehicle only, or 3, 6, or 12 mg/kg of U74389G intravenously, 5 min pre- or postischemia. In Model 2 Sprague-Dawley rats underwent sham operation (n=9), or 45 min of warm ischemia and 10 min of reperfusion with U74389G (6 mg/kg; n=10) or test vehicle only (n=10) administered intravenously over 10 min beginning 5 min prior to clamp release. After reperfusion, LPO was determined by assay of snap frozen tissue for thiobarbituric acid (TBA) concentrations (nmol/g tissue weight). In Model 3 domestic lean maid pigs (14-18 kg) underwent left nephrectomy with 30 min of warm ischemia, Collins C-4 flush, and 24 hr of cold storage preservation. Heterotopic autotransplantation and immediate contralateral nephrectomy was then performed in Group A-nonischemic controls (n=4), Group B-ischemic controls (n=5), and Group C-U74389G (6 mg/kg) administered preischemia and at autotransplantation (n=5). In Model 1 maximal renoprotection was demonstrated with the 6 mg/kg dose of U74389G administered after ischemia (ischemic control 72-hr serum creatinine (Cr) = 8.01+/-1.1 mg% vs. 3.32+/-0.96 mg%; ischemic control creatinine clearance = 0.069+/-0.03 ml/min vs. 0.206+/-0.04 ml/min; P<0.05). In Model 2 TBA levels were significantly lower in U74389G treated animals (88.5+/-10.0 vs. ischemic controls = 296.8+/-81.4; P=0.02). In Model 3 graft survivals were 100%, 0%, and 60% respectively. Peak Cr and BUN (mg%) were significantly greater in Group C vs. Group A, (Group A Cr = 8.59+/-0.63 vs. Group C = 12.8+/-1.01; Group A BUN = 64.1+/-2.73 vs. Group C = 104.9+/-12.21)--however, by day 10, thee were no significant differences in renal function: (Group A Cr = 2.15+/-0.3 vs. Group C = 2.10+/-0.06; Group A BUN = 27.0+/-6.0 vs. Group C = 31.1+/-6.4). These results support the beneficial effects of LPO inhibitors in models of ischemia-reperfusion, as well as preservation/transplantation, and suggest that this renoprotection correlates with decreased membrane lipid peroxidation.

Animals↗
PubMed1997

Resting metabolic rate in young Polynesian and Caucasian women.

OBJECTIVE: To investigate whether resting metabolic rate (RMR) differs between Caucasian and Polynesian women. DESIGN: Cross-sectional comparison. SUBJECTS: Eighty-two (42 Caucasian, 40 Polynesian) healthy women aged between 18 and 27 y. MEASUREMENTS: RMR (indirect calorimetry) and body composition (fat-free mass and fat mass derived from oxygen-18 dilution measurement of total body water). RESULTS: RMR was similar in the Caucasian (6956 +/- 1291 (s.d.) kJ/d) and Polynesian (7125 +/- 1290 kJ/d) groups while fat-free mass was significantly lower in the Caucasian group (45.3 +/- 6.8 vs 51.0 +/- 6.4 kg, P < 0.002). After adjustment for fat-free mass and fat mass, RMR was lower in the Polynesian than the Caucasian groups (6783 +/- 904 vs 7281 +/- 901 kJ/d, P = 0.023). CONCLUSION: The significantly lower relative RMR observed in Polynesian compared to Caucasian women may predispose Polynesian women to eventual onset of obesity.

Adult↗
PubMed1997

Prediction of percentage body fat from anthropometric measurements: comparison of New Zealand European and Polynesian young women.

The prediction of total body fat from simple anthropometric measurements was examined in 42 white (New Zealand European and 40 Polynesian women aged 18-27 y. Percentage body fat (%BF) was determined from measurements of total body water (TBW) by 18O dilution. Mean (+/- SD) body mass index (BMI; in kg/m2) averaged 29.2 +/- 7.9 (range: 16.5-48.0) for the New Zealand European group and 31.2 +/- 7.9 (range: 19.8-51.8) for the Polynesian group, %BF calculated from TBW was similar in the two groups (40.5 +/- 9.9% for the New Zealand European compared with 39.1 +/- 7.5% for the Polynesian group). BMI was significantly correlated with height in the Polynesian group but not in the New Zealand European group. The relation between BMI and %BF was curvilinear for both groups. At a fixed %BF, BMI was higher in the Polynesian group than in the New Zealand European group. A BMI of 30 for the New Zealand European group corresponded to a BMI of 34 for the Polynesian group at an equivalent %BF (42%). Prediction equations for %BF developed from skinfold thicknesses or girth measurements were ethnicity dependent. We conclude that the BMI criterion for obesity in whites requires revision for use in Polynesians.

Adipose Tissue↗
PubMed1996

Evaluation of the thromboxane A2 synthetase inhibitor OKY-046 in a warm ischemia-reperfusion rat model.

The pathophysiology of ischemia-reperfusion renal injury is mediated, in part, by the generation of the vasoconstricting prostanoid thromboxane A2 (TXA2). This study was undertaken to evaluate the renoprotective effects, as well as the optimal timing and dosage, of a selective thromboxane synthetase inhibitor, OKY-046, in a unilateral nephrectomized, 60 min ischemia, 72 hr reperfusion, rodent model. Forty-one rats were subjected to right nephrectomy only (group A), or right nephrectomy with 60 min of left renal ischemia and treatment with inactive vehicle only (group B), or 2 mg/kg or 4 mg/kg of OKY-046 administered intravenously before (groups C and D) or after (groups E and F) pedicle clamping. Outcome variables included animal survival; change in kidney weight; 0, 24, and 72 hr plasma creatinine (CR); urea nitrogen (BUN); thromboxane B2 (TXB2) and 6-keto prostaglandin F(1alpha) (6 kPGF(2alpha)) levels; creatinine clearance (CRCL); and histologic evidence of renal injury. Animal survival and postperfusion kidney weight were not significantly different among the groups. However, renal functional parameters were significantly improved with the 2 mg/kg dose of OKY-046 administered after renal ischemia. (group B 72 hr Cr= 8.01 +/- 1.1 mg% vs. group E=3.99 +/- 1.5 mg%, and group B 72 hr BUN=241.3 +/- 32.8 mg% vs. group E=52.6 +/- 22.5 mg%). The CRCL was also improved in group E vs. group B, although these results did not reach statistical significance (group B=0.069 ml/min vs. group E=0.194 ml/ min). The 24 hr TXB2 levels were significantly increased in group B (0 hr=754.1 +/- 219.4 pg/ml vs. 24 hr=2055.9 +/- 550.0 pg/ml), and pre- or posttreatment with OKY-046 abrogated this increase (group C 0 hr=517.1 +/- 80.9 pg/ml vs. 24 hr=384.7 +/- 251.5 pg/ml, and group E 0 hr=781.6 +/- 390.4 pg/ml vs. 24 hr=183.0 +/- 81.4 pg/ml). The 24 hr 6 kPGF(1alpha) levels decreased in all groups, whereas 72 hr 6 kPGF(1alpha) levels increased above baseline in groups A, C, and E, but not in group B. These data demonstrate the beneficial effects of thromboxane A2 synthesis inhibition in the setting of ischemia-reperfusion injury and suggest that this renoprotection correlates with late vasodilatory prostanoid synthesis.

6-Ketoprostaglandin F1 alpha↗
PubMed1996

Effect of a preprinted form on the management of acute asthma in an accident and emergency department.

OBJECTIVE: To assess the effect of a preprinted form on the documentation of clinical data and compliance with the national guidelines for the management of asthma. METHODS: Prospective audit six months before and after introduction of the form. RESULTS: Use of the form improved the documentation of past asthma history (69% v 93%, P < 0.001), current treatment (81% v 95%, P < 0.01), predicted peak flow (23% v 75%, P < 0.001), per cent predicted peak flow (1% v 62%, P < 0.001), and respiratory rate (81% v 95%, P = 0.007). Compliance with the British recommendations for treatment improved with use of the form (50% v 89%, P < 0.001) The prescription of steroids on discharge did not improve significantly (26% v 44%, P > 0.05). CONCLUSIONS: The preprinted form resulted in enhanced documentation of data and conformity with current guidelines for the management of asthma.

Acute Disease↗
PubMed1995

Influence of jet direction on pulmonary vein flow patterns in severe mitral regurgitation.

Pulmonary vein flow patterns measured with transesophageal echocardiography have been used recently to assess the severity of mitral valve regurgitation. This study was designed to determine whether regurgitant jet direction selectively influences the pattern of flow in right and left pulmonary veins. Thirty-seven patients undergoing mitral valve repair or replacement for severe valvular regurgitation were studied intraoperatively with biplane transesophageal echocardiography. Regurgitant jets were classified by color flow mapping as central or wall, with the latter further classified as septal, lateral, anterior, or posterior in the two orthogonal scan planes. Pulmonary vein flow patterns were measured with pulsed wave Doppler ultrasonography and categorized as showing normal, blunted, or reversed systolic flow. Right and left pulmonary vein flow patterns were identical in the majority of patients studied (78%). Eight patients had discordant flow patterns. In seven of eight patients, the more abnormal pattern was seen in the right pulmonary vein, despite the fact that the regurgitant jets were directed centrally in four of these seven patients. Since discordant pulmonary vein flow patterns occurred in 5 of 15 patients (33%) with central jets, but in only 3 of 22 patients (14%) with eccentric wall jets, it is unlikely that mitral regurgitation jet direction per se causes predictable and selective unilateral alteration in pulmonary vein flow patterns.

Adolescent↗
PubMed1995

Competency assessment: a systematic approach.

An established clinical development plan was expanded to form a framework for a competency assessment model. Each nursing competency has a technical, interpersonal and critical thinking component. Behaviors describe all areas from novice to expert. The framework identifies and supports a professional model of nursing practice.

Clinical Competence↗
PubMed1994

Chronic topical application of all-trans-retinoic acid in man does not affect corneocyte surface area.

The potential therapeutic activity of topically applied novel analogues of retinoic acid is currently measured in many different animal models. In most cases, the technique used is invasive and biopsy specimens are required. Furthermore, efficacy in these models is not a guarantee of success in treatment of humans. Therefore, predictive human pharmacology tests are required in order to quantify a retinoid effect on human skin before conducting large clinical trials. The aim of this study was to determine whether changes in corneocyte surface area could be used as a predictive measure for the efficacy of topical retinoids in man. Topical applications of all-trans retinoic acid gel (Aberel), salicylic acid gel and the gel vehicle were made once daily for 4 weeks to skin of the lumbar region of healthy human volunteers. Corneocytes were recovered from these three treated zones as well as from one zone of untreated skin, and their surface areas were measured by image analysis using a MOP-Videoplan. The results showed that at no point during the 4 weeks of daily application to healthy human skin was there a statistically significant difference in the surface area of corneocytes recovered from Aberel, salicylic acid-, vehicle-treated or untreated sites. No specific effect of retinoic acid could be detected. However, although no between-treatment differences were found, significant cyclical changes in the mean surface areas with respect to baseline were observed.

Administration, Topical↗
PubMed1994

The management of operable breast cancer in Scotland surgeons' opinions. The Scottish Cancer Trials Breast Group.

This report gives the responses of general surgeons in Scotland to two questionnaires. Satisfactory rates were obtained: 82% for the more detailed survey in 1988 and 62% for the second survey (1991), where nonrespondents were not followed up. In 1988 the rationale was the poor participation in the Scottish breast conservation trial while the 1991 survey further investigated the diversity of surgical opinion identified in the first. The limited trial support in 1988 was mainly due to reluctance to accept all treatment options. The majority were prepared to consider trial participation although 47% believed this compromised doctor-patient relationships. Although breast-conserving therapy was widely supported, many different views on management were encountered, both in the degree of influence of specific factors and in the decisions taken in relation to them. We believe these surveys have re-inforced a need for management guidelines, particularly as around half the patients with symptomatic breast cancer were being treated in non-specialist units.

Breast Neoplasms↗