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Biomedical subjects

S Thorne

Publications and source records attributed to S Thorne.

At least 19 recordsLinked to original sources
PubMed1998

Early endothelial dysfunction in adults at risk from atherosclerosis: different responses to L-arginine.

OBJECTIVES: We sought to examine endothelial responses to L-arginine in three groups with isolated risk factors: hypercholesterolemia, smoking and insulin-dependent diabetes mellitus (IDDM). BACKGROUND: Endothelial dysfunction occurs early in atherosclerosis, predating clinical disease. We hypothesized that the nature of endothelial injury associated with individual cardiovascular risk factors might be different and that this might affect the response to L-arginine, the substrate for endothelial nitric oxide synthase. METHODS: We studied the effects of intravenous L-arginine on brachial artery flow-mediated dilation (FMD) and glyceryl trinitrate (GTN)-mediated dilation in 36 young subjects (18 to 40 years old) without clinical atherosclerosis: 9 each of normal control subjects, hypercholesterolemic subjects, cigarette smokers and subjects with IDDM. RESULTS: Baseline FMD was significantly impaired in hypercholesterolemic subjects (mean +/- SD 1.7 +/- 2.3%), smokers (1.6 +/- 1.8%) and diabetic subjects (1.8 +/- 1.5%) compared with that in control subjects (6.9 +/- 3.3%, p = 0.001). The response to GTN was not significantly different between the subjects with risk factors and control subjects, apart from those with IDDM, in whom it was significantly impaired (p = 0.026). After infusion of L-arginine, there was no change in FMD in control or diabetic subjects. In hypercholesterolemic subjects and smokers, FMD improved from 1.9 +/- 1.9% to 4.1 +/- 2.1% (p = 0.01) and from 2.0 +/- 1.71% to 3.1 +/- 2.5% (p = 0.02), respectively. CONCLUSIONS: FMD was impaired in all three risk factor groups; however, they responded differently to L-arginine, FMD being improved in hypercholesterolemic subjects and smokers but unchanged in diabetic subjects. These results indicate differing underlying pathophysiologies that may facilitate the design of treatment strategies for subjects with different risk factors.

Adolescent↗
PubMed1998

Nursing's metaparadigm concepts: disimpacting the debates.

Theoretical advances in nursing have been complicated by polarization and extreme positions regarding nursing's approach to its main metaparadigm concepts: person, health, environment and nursing. In this paper, the authors deconstruct some of the central arguments that are used to further this polarization. Using a critical interpretive approach, they explain some of the logical implications imposed by various extreme positions for the larger project of nursing's health and social mandate, and consider the effects of such polarization. On the basis of an appreciation of the serious difficulties inherent in certain philosophical and theoretical positions currently evident within nursing's literature, the authors argue for a less extreme and more integrated reference point for nursing's theory and practice.

Disease↗
PubMed1998

Adapting to and managing diabetes.

PURPOSE: To advance understanding of the lived experience of diabetes as described in published research and theses. Meta-analysis extends the analysis of individual research studies beyond individual experience to incorporate dominant system beliefs and health system ideologies. ORGANIZING FRAMEWORK: Curtin and Lubkin's (1990) conceptualization of the experience of chronic illness. SOURCES: Forty-three qualitative interpretive research reports in six computerized data bases 1980-1996 pertaining to the lived experience of diabetes and published in nursing, in the social sciences, and in allied health journals were used. METHODS: Meta-ethnography in which trustworthiness was achieved by using multiple researchers, identifying negative or disconfirming cases, and testing rival hypotheses FINDINGS: Balance is the determinant metaphor of the experience of diabetes. People learn to balance diabetes through their experience and experimentation with strategies for managing their illness. CONCLUSIONS: Learning to balance is a developmental process in which one learns to assume control of diabetes management. Support for such development requires that nurses know their clients as individuals and value the expertise they have gained in living with diabetes. Control of blood sugar levels within a prescribed range may be a goal established by professionals, but the goal of healthy balance determines a person's willingness to assume an active role in self-care.

Decision Making↗
PubMed1997

A population-based method for the estimation of defibrillation energy requirements in humans. Assessment of time-dependent effects with a transvenous defibrillation system.

BACKGROUND: A weighted logistic regression analysis was developed to allow pooling of patient data for the study of the stability of defibrillation energy requirements with a new nonthoracotomy lead defibrillation system. METHODS AND RESULTS: One hundred twenty patients were prospectively studied with a single-model nonthoracotomy implantable cardioverter defibrillator (ICD) system at the time of implant and at 3 months. The pooled data of all shocks delivered to all patients were fitted to a logistic function to construct a defibrillation voltage/energy dose-response relationship. The crude logit curve was weighted in quartiles according to the average shock energy delivered per patient. Shocks at implant (n = 802; 6.6 +/- 2.5 shocks/patient) and follow-up (n = 292; 2.4 +/- 1.2 shocks/patient) were analyzed. The modeled voltage/energy required for 50% successful defibrillation (95% CI) in the pooled data was 367 V (273, 461) and 9.8 J (6.7, 12.9) at implant and 338 V (264, 412) and 10.5 J (8, 13.0) at follow-up. The conventional measure of lowest successful voltage/energy (95% CI) was 430 V (411, 449) and 12.1 J (11, 13.2) at implant and 415 V (391, 439) and 11.3 J (10, 12.6) at follow-up. There were no statistically significant differences between implant and follow-up energy requirements with either method. CONCLUSIONS: The nonthoracotomy lead system used in this study demonstrated stability of defibrillation energy requirements at implant and 3-month follow-up. A new technique for the estimation of the defibrillation energy dose-response relationship was derived by using a weighted logistic regression analysis.

Aged↗
PubMed1997

Medical schools seeking new ways to cope with funding cutbacks.

Cuts in government funding mean that Canada's medical schools have to seek new ways to raise funds. Susan Thorne examines some of the ways faculties of medicine are coping with change. In the brave new world of medical education, schools are combining classes for medical students and other health professionals, seeking business alliances, encouraging attendance by full-tuition students from other countries and diversifying revenue bases through new programs, such as McGill's new 5-year MD-MBA degree.

Canada↗
PubMed1997

Interpretive description: a noncategorical qualitative alternative for developing nursing knowledge.

Despite nursing's enthusiastic endorsement of the applicability of qualitative research approaches to answering relevant clinical questions, many nurse researchers have been hesitant to depart from traditional qualitative research methods. While various derivations of phenomenology, grounded theory, and ethnography have been popularized within qualitative nursing research, the methodological principles upon which these approaches are based reflect the foundations and objectives of disciplines whose aims are sometimes quite distinct from nursing's domain of inquiry. Thus, as many nurse researchers have discovered, nursing's unique knowledge mandate may not always be well served by strict adherence to traditional methods as the "gold standard" for qualitative nursing research. The authors present the point of view that a non-categorical description, drawing on principles grounded in nursing's epistemological mandate, may be an appropriate methodological alternative for credible research toward the development of nursing science. They propose a coherent set of strategies for conceptual orientation, sampling, data construction, analysis, and reporting by which nurses can use an interpretive descriptive approach to develop knowledge about human health and illness experience phenomena without sacrificing the theoretical or methodological integrity that the traditional qualitative approaches provide.

Humans↗
PubMed1997

Non-invasive measurement of endothelial function: effect on brachial artery dilatation of graded endothelial dependent and independent stimuli.

OBJECTIVE: To examine the relation between endothelial dependent and endothelial independent stimuli of varying intensity and measures of vascular function in the brachial artery of young healthy adults, to determine whether these responses are consistent and can be used to assess endothelial function. DESIGN AND SETTING: High resolution ultrasound was used to measure brachial artery diameter at rest, after reactive hyperaemia induced by forearm cuff occlusion, and after sublingual isosorbide dinitrate (ISDN). Each subject was assigned to a random order of six cuff occlusion times (30 seconds, 1.5, 2.5, 3.5, 4.5, and 8 minutes) and six doses of ISDN (10, 20, 50, 100, 200, and 400 micrograms). SUBJECTS: Three males and three females mean age 31 years (range 25 to 43) with no known risk factors for cardiovascular disease. MAIN OUTCOME MEASURES: Flow mediated, endothelial dependent dilatation was compared to duration of cuff occlusion, peak reactive hyperaemia, and duration of increased flow. Nitrate induced, endothelial independent dilatation was compared to dose of ISDN and change in flow. RESULTS: Vessel dilatation and duration of peak flow change increased with longer duration of cuff occlusion. After 4.5 minutes of occlusion, flow mediated dilatation was mean (SD) 96 (6)% of maximal response and did not increase significantly with longer occlusion times. No significant dilatation occurred after 10 or 20 micrograms of ISDN in any subject. With increasing doses up to 200 micrograms there was an increase in dilatation. Endothelial independent dilatation did not increase significantly with doses of ISDN above 200 micrograms. CONCLUSIONS: Measures of arterial function vary with duration of blood flow occlusion and ISDN dose. Maximum arterial response was reached in all subjects after 4.5 minutes of blood flow occlusion or 200 micrograms of ISDN. Therefore, these variables produce consistent reproducible measures of endothelial function.

Adult↗
PubMed1997

Global consciousness in nursing: an ethnographic study of nurses with an international perspective.

Despite an ideal of international awareness, nursing education and professional organization have traditionally fostered social analysis within a rather local sphere of influence. However, there have always been renegade nurses whose idealism and global perspective have made them challenge the profession, adopt unusual career paths, or even leave nursing in favor of roles that more readily adapt to global awareness. Because the health care of the future demands an increasingly global-policy perspective, it is important to explore the relationship between the social structure of professional nursing and its ideological imperatives. This research employed ethnographic methods to study the experience of nurses involved in balancing what they perceived to be the discrepant perspectives of nursing and global awareness. The findings depict remarkable and inspiring careers within nursing and document the difficulties encountered by nurses in their attempts to apply global awareness to their professional nursing lives. Further, they generate practical implications for nursing education and professional organization to respond to the global trend toward primary health care policy and to prepare nurses to meet the inevitable challenges of the next millennium.

Adult↗
PubMed1996

Medical school tuition fees reach record levels as MD incomes shrink.

At half the country's 16 faculties of medicine, 1996-97 tuition fees are a minimum 16% higher than last year, and more large increases loom on the horizon. Administrators increasingly support the idea that medical students and those in other professional degree programs should assume a greater proportion of the cost of their education because their future earning potential is higher than it is for graduates with other degrees. However, medical students say they are being saddled with huge debt loads. These debts may be harder to repay, because they are rising at the same time physicians' incomes are either stagnant or being cut.

Canada↗
PubMed1996

In Italy, a medical degree often means unemployment or underemployment.

Italy's per capita concentration of physicians is the highest in the Western World, and many of them have to struggle to earn a living as they compete for a decreasing number of prestigious hospital positions. Many Italian doctors have more than one job, and some never find work in medicine.

Employment↗
PubMed1996

On-campus physicians witnessing changes in medical problems faced by university students.

Most Canadian universities offer on-campus health services for their students. Ten years ago minor health problems such as infections, cuts and bruises were the common causes of visits to student health centres, but today medical staff report that students are seeking help for more serious problems such as sexually transmitted diseases, stress, sports injuries, eating disorders and asthma and allergies. Many are also seeking psychiatric counselling.

Canada↗
PubMed1995

Spas accepted part of health care in Czech Republic.

Although the days are gone when a spa holiday was offered as a reward to Communist Party leaders and factory workers who exceed their quotas, spas are still popular in the former Czechoslovakia. Government health care coverage relating to spas extends to fewer medical conditions and may not cover the expense of room and board, but more patients are footing the bill themselves, even though a 3-week stay costs more than the average monthly earnings. Officials predict spas will prosper under new private health insurance plans and expanding consumer spending power.

Czechoslovakia↗
PubMed1995

Staffing shortfall plagues radiation oncology.

Canada's radiation oncologists say a staffing crisis looms within their specialty. A growing number of cancer patients means resources are being stretched, doctors are facing additional stress and waiting lists are becoming longer. "I see no way that we can conceive of meeting our needs by 2000," says Dr. Tom Keane of Toronto's Princess Margaret Hospital. The staffing shortage also extends to the medical physicists who run the radiotherapy machines. Many are being attracted to the US by higher salaries.

Canada↗
PubMed1995

Parents' perceptions of caring for an infant or toddler with diabetes.

Although the incidence rate of diabetes in children under the age of 3 years is increasing dramatically, no previous studies provide information about the day-to-day experience of caring for these infants and toddlers. Because a young child with diabetes is dependent on the parent for his/her very existence, the purpose of this phenomenological study was to gain knowledge and understanding of the parents' experiences so that appropriate interventions could be developed and implemented to support parental care for this unique population. Findings revealed three distinct phases in the parents' experiences: the diagnosis and child's hospitalization; adjusting to care at home; and long-term adaptation. Within these phases, parents described inordinate amounts of stress exacerbated by the child's young age and the complex, intrusive nature of diabetes management. On the basis of these findings, implications for practice are discussed.

Adaptation, Psychological↗
PubMed1994

Elucidation of structural abnormalities of the X chromosome using fluorescence in situ hybridisation with a Y chromosome painting probe.

Particular regions of the X and Y chromosomes share DNA sequence homology to the extent that cross hybridisation occurs. Thus, chromosome painting with a whole Y chromosome probe consistently results in fluorescence on specific regions of the X chromosome as well as the complete Y chromosome. This phenomenon has been exploited to elucidate the structure of unusual X chromosome rearrangements, without Y involvement, in two females.

Adult↗