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Biomedical subjects

S Woods

Publications and source records attributed to S Woods.

At least 19 recordsLinked to original sources
PubMed2001

Home enteral tube feeding following cerebrovascular accident.

BACKGROUND AND AIMS: In the UK, cerebrovascular accident (CVA) is the third commonest cause of death and the commonest diagnosis in patients receiving home enteral feeding (HETF). This study aimed to use data from the British Artificial Nutrition Survey (BANS) collected between 1996 and 1999 to assess the outcome of patients on HETF, including mortality, return to oral feeding, level of physical activity, and level of dependency, which has resource implications. RESULTS: it is estimated that about 1.7% of all patients suffering a CVA in the UK between 1996 and 1999 received HETF. At one year, 29.6% died while receiving HETF and another 13% returned to oral feeding. Mortality increased with age and was twice as high in those managed in nursing homes compared to those in their own homes. The patients receiving tube feeding spent only 0.6% of their time in hospital. A total of 43.9% of patients were bed-bound at home (1.9% unconscious) and an additional 30.3% were house-bound. Only 21.2% were independent, and the majority were totally dependent on their carers. In CVA patients on HETF the level of dependency was greater than for those with all types of diagnoses (n=12,997). CONCLUSION: This study has described the outcome of a large number of patients receiving HETF in the UK. Since patients spent less than 1% of their time in hospital, HETF relieves pressure on the expensive hospital environment, but places more demands on the carers, who have to deal with severely disabled patients. Recovery of swallowing function should be assessed intermittently to prevent unnecessary HETF.

Adolescent↗
PubMed2001

Randomized, controlled trial comparing once daily and three times daily gentamicin in children with urinary tract infections.

OBJECTIVE: To undertake population pharmacokinetic modeling and to determine the safety and efficacy of once daily (OD) gentamicin dosing in children with severe urinary tract infections (UTI). METHODS: An open, randomized, controlled trial comparing OD with three times daily (TD) gentamicin dosing in hospitalized children ages 1 month to 12 years with UTI. Daily doses (milligrams per kg per day) of gentamicin in both groups were 7.5 (<5 years old), 6.0 (5 to 10 years old) and 4.5 (>10 years old). RESULTS: There were 179 children enrolled (90 OD, 89 TD). Baseline clinical characteristics and pathogens were similar, except that circulatory compromise and renal cortical scintigraphic defects were more common in the OD group. Median gentamicin treatment durations were 3.0 (OD) and 2.7 (TD) days. Mean peak gentamicin concentrations were 17.3 (OD) vs. 6.4 (TD) mg/l; 99% of peak concentrations were >7 mg/l in the OD group whereas 16% of peak concentrations were <5 mg/l in the TD group. Mean trough concentrations were 0.35 (OD) vs. 0.55 (TD) mg/l. In the OD group 4% of trough concentrations were > or = 2 mg/l, whereas in the TD group only 0.7% were > or = 2 mg/l. Age or prior elevated peak concentrations did not predict high trough concentrations. Population pharmacokinetic modeling of the data fitted a one-compartment model with first order elimination. There were no clinical or bacteriologic failures. The two disease-related complications were confined to the OD group. No nephro- or ototoxicity was identified. CONCLUSIONS: With age-appropriate dosing and measurement of serum trough concentrations before the second dose, OD gentamicin is safe and effective for the treatment of UTI requiring parenteral treatment in children aged 1 month to 12 years.

Anti-Bacterial Agents↗
PubMed2001

Bullying involvement in primary school and common health problems.

AIMS: To examine the association of direct (e.g. hitting) and relational (e.g. hurtful manipulation of peer relationships) bullying experience with common health problems. METHODS: A total of 1639 children (aged 6-9 years) in 31 primary schools were studied in a cross sectional study that assessed bullying with a structured child interview and common health problems using parent reports. Main outcome measures were common physical (e.g. colds/coughs) and psychosomatic (e.g. night waking) health problems and school absenteeism. RESULTS: Of the children studied, 4.3% were found to be direct bullies, 10.2% bully/victims (i.e. both bully and become victims), and 39.8% victims. Direct bully/victims, victims, and girls were most likely to have physical health symptoms (e.g. repeated sore throats, colds, and coughs). Direct bully/victims, direct victims, and year 2 children were most likely to have high psychosomatic health problems (e.g. poor appetite, worries about going to school). Pure bullies (who never got victimised) had the least physical or psychosomatic health problems. No association between relational bullying and health problems was found. CONCLUSIONS: Direct bullying (e.g. hitting) has only low to moderate associations with common health problems in primary school children. Nevertheless, health professionals seeing children with repeated sore throat, colds, breathing problems, nausea, poor appetite, or school worries should consider bullying as contributory factor.

Absenteeism↗
PubMed2001

Bullying and victimization of primary school children in England and Germany: prevalence and school factors.

Differences in definitions and methodologies for assessing bullying in primary school children between countries have precluded direct comparisons of prevalence rates and school factors related to bullying. A total of 2377 children in England (6-year-olds/Year 2: 1072; 8-year-olds/Year 4: 1305) and 1538 in Germany (8-year-olds/Year 2) were questioned individually using an identical standard interview. In both countries the types of bullying to victimize others were similar: boys were most often perpetrators, most bullies were also victims (bully/victims), most bullying occurred in playgrounds and the classroom, and SES and ethnicity only showed weak associations with bullying behaviour. Major differences were found in victimization rates with 24% of English pupils becoming victims every week compared with only 8% in Germany. In contrast, fewer boys in England engaged every week in bullying (2.5-4.5%) than German boys (7.5%), while no differences were found between girls. In England, children in smaller classes were more often victimized. Further study of the group of bully/victims, schooling differences in England vs. Germany and implications for prevention of bullying are discussed.

Aggression↗
PubMed2000

Significant interaction between clozapine and cocaine in cocaine addicts.

Because clozapine may be prescribed to cocaine abusing patients with schizophrenia, we studied cocaine-clozapine interactions in a controlled setting. Eight male cocaine addicts underwent four oral challenges with ascending doses of clozapine (12.5, 25 and 50 mg) and placebo followed 2 h later by a 2-mg/kg dose of intranasal cocaine. Subjective and physiological responses, and serum cocaine levels were measured over a total 4-h period. Clozapine pretreatment increased cocaine levels during the study and significantly increased the peak serum cocaine levels in a dose dependent manner. In spite of this elevation in blood levels, clozapine pretreatment had a significant diminishing effect upon subjective responses to cocaine, including 'expected high', 'high' and 'rush', notably at the 50 mg dose. There was also a significant effect upon 'sleepiness', 'paranoia' and 'nervous'. Clozapine caused a significant near-syncopal episode in one subject in the study, requiring his removal from the study. Clozapine had no significant effect on baseline pulse rate and systolic blood pressure, but it attenuated the significant pressor effects of the single dose of intranasal cocaine. These data suggested a possible therapeutic role for clozapine in the treatment of cocaine addiction in humans, but also suggests caution due to the near-syncopal event and the increase in serum cocaine levels.

Adult↗
PubMed2000

SPECT [I-123]iomazenil measurement of the benzodiazepine receptor in panic disorder.

BACKGROUND: Alterations in benzodiazepine receptor function have long been hypothesized to play a role in anxiety. Animal models of anxiety involving exposure to chronic stress have shown a specific decrease in benzodiazepine receptor binding in frontal cortex and hippocampus. The purpose of this study was to examine benzodiazepine receptor binding patients with panic disorder and comparison subjects. METHODS: A quantitative measure related to benzodiazepine receptor binding (Distribution Volume (DV)) was obtained with single photon emission computed tomography (SPECT) imaging of [123I]iomazenil and measurement of radioligand concentration in plasma in patients with panic disorder and healthy controls. DV image data were analyzed using statistical parametric mapping (spm96). RESULTS: A decrease in measures of benzodiazepine receptor binding (DV) was found in left hippocampus and precuneus in panic disorder patients relative to controls. Panic disorder patients who had a panic attack compared to patients who did not have a panic attack at the time of the scan had a decrease in benzodiazepine receptor binding in prefrontal cortex. CONCLUSIONS: Findings of a decrease in left hippocampal and precuneus benzodiazepine receptor binding may be related to alterations in benzodiazepine receptor binding, or other factors including changes in GABAergic transmission or possible endogenous benzodiazepine compounds. Benzodiazepine receptor function in prefrontal cortex appears to be involved in changes in state-related panic anxiety.

Adolescent↗
PubMed2000

Users' views on palliative care services: ethical implications.

This article is based on the findings of a study that elicited the views of terminally ill patients (n = 15), their carers (n = 10) and bereaved carers (n = 19) on the palliative care services they received. It explores the range of ethical issues revealed by the data. Although the focus of the original study was on community services, the participants frequently commented on all aspects of their experience. They described some of its positive and negative aspects. Of concern was the reported lack of sensitivity to the role of the family among health professionals. The family, as carers, service users and advocates, represent a challenge to professional boundaries and the ethical norms of confidentiality and best interest. The accounts reveal the complexity of the ethical issues that characterize terminal care, issuing specific ethical challenges to nurses and other health professionals involved in this field.

Caregivers↗
PubMed2000

The association between direct and relational bullying and behaviour problems among primary school children.

The prevalence of direct and relational bullying and their differential relationship to behaviour problems in young primary school children was investigated. Individual interviews were conducted with 1982 children aged 6 9 years (mean age 7.6 years) and 1639 parents completed the Strength and Difficulties Questionnaire regarding behaviour problems of their children. Of the 1639 children with both data sets, 4.3% were direct bullies, 39.8 % victims, and 10.2% both bullied and were victimised frequently (bully/victims). The rates for relational bullying were 1.1% bullies, 37.9% victims, and 5.9% bully/victims. All children involved in direct bullying had significantly increased total behaviour problems, hyperactivity, conduct problems, and peer problem scores, and lower prosocial behaviour scores compared to those not involved in bullying (neutrals). Findings were similar for relational bullying involvement and behaviour problems for bully/victims and victims but less pronounced. Relational bullies had the lowest behaviour problem scores while being rated the least prosocially inclined children, consistent with the concept of a cool manipulator. Overall, direct bully/victims and children who were involved in both direct and relational bullying behaviour had the highest rates of behaviour problems. No relationship between victimisation and increased emotional problems were found. Those involved in bullying behaviour who show externalising and hyperactivity problems in primary school may be at increased risk for persistent conduct problems. Different interventions may be needed for those involved in relational bullying only, both direct and relational bullying, and those with additional behaviour problems.

Aggression↗
PubMed1999

Internal medical residents' ability to diagnose and characterize major depression.

The purpose of this study was to assess medical residents' knowledge of symptom criteria and subtypes of major depressive episode and their accuracy in diagnosing major depressive disorders and classifying episode severity and subtype according to criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Thirty-five third-year internal medicine residents completed a self-administered, written instrument containing 2 open-ended questions and 21 hypothetical scenarios. The sensitivity for recognizing major depressive disorder was 64%, and the specificity was 69%. The sensitivity for classifying severity was 86% for mild, 66% for moderate, 71% for severe, and 66% for severe with psychosis. Misclassification of severity was most commonly to a less severe class. For scenarios with a diagnosable subtype of a major depressive disorder, the sensitivity for classification was 34% for atypical, 51% for catatonic, 74% for melancholic, 100% for postpartum, and 94% for seasonal depression. When asked to enumerate the criteria symptoms for depression, 80% or more of the residents listed sad mood, loss of interest, weight change, and sleep disturbances; 14 to 21 (40%-60%) listed thoughts of death and worthlessness; other criteria were listed by 7 to 11 (20%-31%). When asked to list the episode subtypes, none was listed by more than 3 (9%) residents, although 13 (37%) residents volunteered psychotic as a subtype. Residents frequently failed to recognize the presence or absence of major depressive disorder and often misclassified episode severity and subtype on scenarios. Few could spontaneously list the episode subtypes. Methods must be developed to improve the recognition and classification of major depressive episodes to better direct treatment.

Affect↗
PubMed1998

A theory of holism for nursing.

In this paper it is argued that nurses should be holists whilst at the same time accepting that 'holism' is a contentious concept. One of the problems for a supporter of holism is that of which holism--an attempt to outline the version of holism advocated is made by identifying only two versions of holism: The Strong theory and the Pragmatic theory of holism. By introducing this device it is hoped to avoid, if only by stipulation, some of the more sophisticated nuances of holism drawn by other commentators. However despite a most judicious use of Ockham's Razor some detailed groundwork remains. In the first part of this paper a simple example is used which aims to articulate what are arguably some of the central issues within the holism debate. These issues are then placed within a wider philosophical context. The second part of the paper will offer definitions of Strong and Pragmatic holism. Drawing on specific examples from the nursing context it will be argued that the Pragmatic theory of holism is the theory of holism most compatible with nursing theory and practice. The methods employed in this paper are philosophical. Since the questions considered are conceptual rather than empirical requiring a discursive approach, utilising thought experiments and case implication to explore the issues.

Holistic Health↗
PubMed1998

Heterotypic protection against influenza by immunostimulating complexes is associated with the induction of cross-reactive cytotoxic T lymphocytes.

Influenza immunostimulating complexes (flu-ISCOMs) and a monovalent subvirion vaccine prepared with an H1N1 strain of influenza virus were compared in mice for immunogenicity and protection against challenge with homologous and heterotypic influenza viruses. flu-ISCOMs but not subvirion vaccine fully protected mice against homologous virus challenge after one immunization as assessed by measurement of virus lung titers. The improved protection induced by flu-ISCOMs was associated with a 10-fold higher prechallenge serum hemagglutination inhibition titer. Furthermore, only flu-ISCOMs fully protected mice against mortality and reduced morbidity following challenge with an influenza virus of the serologically distinct H2N2 subtype. This cross-protection correlated with the induction of virus cross-reactive cytotoxic T lymphocytes that recognized a known major histocompatibility class I (H2-Kd)-restricted epitope within the hemagglutinin of influenza virus that is conserved among the H1 and H2 influenza virus subtypes. flu-ISCOMs may offer significant advantages over current commercial formulations as an improved influenza vaccine.

Animals↗
PubMed1998

The risk of eye splash injuries in surgery.

BACKGROUND: This study arose out of a concern about the transmission of infectious diseases through eye splash injuries in surgery. The purpose of this study was to identify the extent of the risk of eye splash injuries. METHODS: A prospective trial was undertaken which examined 160 consecutive eye shields used by surgeons and assistants in operations of 30 min or longer. The shields were inspected for macroscopic splashes and then tested for microscopic splashes using reagent strips. RESULTS: Of the 160 eye shields used in surgery, 71 tested positive for blood (44%). The surgeon was aware of a spray episode in only 13 cases (8%). The splashes were macroscopically visible in only 26 (16%) cases. The risk of eye splash was higher for the surgeon than for the assistants and increased with the length of the operation. CONCLUSIONS: This study demonstrates that the risk of eye splash injury in surgery is much greater than that perceived by most surgeons and trainees. Eye protection should be mandatory for all personnel in the operating theatre, particularly for those directly involved with the operation.

Blood-Borne Pathogens↗