Biomedical subjects

T Kershaw

Publications and source records attributed to T Kershaw.

8 recordsLinked to original sources

PubMed2000

Developing a database to describe the practice patterns of adult nurse practitioner students.

PURPOSE: To describe the practice patterns of adult nurse practitioner students using a database composed of core health data elements and standardized nursing language. DESIGN: Descriptive study of 3,733 patient visits documented by 19 adult nurse practitioner students in the academic year 1996-1997. METHODS: A database was designed for documenting the full scope of practice of adult nurse practitioner students by use of core health data elements and the standardized nursing languages of NANDA and NIC. Nurse practitioner students used the database to document every clinical encounter during their final clinical year of study. Most visits occurred in ambulatory care settings in a midwestern American city. FINDINGS: Based on the American Medical Association's Evaluation/Management coding system, data indicated that 50% of visits were classified as problem focused, while 31.9% were expanded, 10% were detailed, and 8.1% were comprehensive. The most frequently occurring NANDA diagnoses were pain, health-seeking behavior, altered health maintenance, and knowledge deficit. The most frequently reported nursing intervention classifications (NIC) were patient education, drug management, information management, and risk management. CONCLUSIONS: Using standardized nursing language to describe clinical encounters made visible the complex clinical decision-making patterns of adult nurse practitioner students. Systematic use of a database designed for documenting the full scope of practice of nurse practitioner students showed the applicability of standardized nursing language to advanced practice nursing contexts.

Adult↗

PubMed1999

The quality of life of African American women with breast cancer.

The objectives of this study were to describe the quality of life of African American women with breast cancer and test a model of factors that may affect their quality of life. A stress-coping framework that included person (demographics, current concerns, and optimism), social resources (family functioning), and illness-related factors (symptom distress, medical characteristics), as well as appraisal of illness and quality of life, was used to guide this exploratory, cross-sectional study. Participants included 98 African American women who were approximately 4 years postdiagnosis. The women reported a fairly high quality of life, were generally optimistic, and had effective family functioning. Although symptom distress was generally low, a sizable number of women reported problems with energy loss, sleep disturbances, and pain. The model explained 75% of the variance in quality of life, with appraisal, family functioning, symptom distress, and recurrence status each explaining a significant amount of the variance. Current concerns had an indirect effect on quality of life that was mediated by appraisal. These findings underscore the importance of helping women foster a positive appraisal of their illness, manage current concerns, maintain family functioning, and reduce symptom distress, because each of these factors indirectly or directly affects their quality of life.

Adaptation, Psychological↗

PubMed1998

High efficiency gene transfer to the central nervous system of rodents and primates using herpes virus vectors lacking functional ICP27 and ICP34.5.

The safe and efficient use of herpes simplex virus (HSV)-based vectors to deliver genes of potentially therapeutic benefit to the central nervous system will require their effective disablement by the inactivation of viral genes required for lytic growth. Here we report that viruses lacking functional genes for ICP27 (which is required for growth in all cell types) and ICP34.5 (which is required for growth in nondividing cell types) can deliver a marker gene to both the rodent and primate CNS with high efficiency whilst producing relatively minimal damage and having no effect on sodium currents in dorsal root ganglion neurons. Such viruses paradoxically deliver genes at much higher efficiency than the less disabled single mutant lacking ICP34.5 alone and also, as expected, produce less damage in vivo. Moreover, unlike the single mutant lacking ICP27 the double mutant viruses cannot revert to wild-type by acquistion of complimenting gene sequences during growth of virus stocks in vitro on dividing cells expressing ICP27 since artificial expression of ICP34.5 in these cells is not required. Such ICP27-; ICP34.5- viruses thus offer a platform for the development of vectors which are sufficiently safe for ultimate use in human gene therapy.

Animals↗

PubMed1993

Foetal grafts from hippocampal regio superior alleviate ischaemic-induced behavioural deficits.

Transitory global cerebral ischaemia produced in rats by four vessel occlusion for 15 min produced substantial loss of CA1 cells in dorsal hippocampus and minimal other intra- and extra-hippocampal damage. Ischaemic rats showed a long-lasting impairment in spatial navigation in the water maze, and such impairment was sensitive to task difficulty. Groups of ischaemic animals were implanted with foetal tissue dissected from hippocampal regio superior (SUP--containing CA1 field), regio inferior (INF--containing dentate gyrus), and basal forebrain, with grafts sited in the alveus above the damaged CA1 region. Behavioral testing in the water maze (acquisition, retention and a working memory task) was conducted over a period of 4 to 12 weeks after grafting. Only rats receiving the SUP graft showed consistent improvement in water maze performance, relative to ischaemic controls, when tested in retention and working memory. Although the selective effect of CA1-containing grafts suggests repairing of the damaged host circuit, functional recovery may have been related to the greater ability of SUP grafts to survive and grow in the host ischaemic hippocampus.

Animals↗

PubMed1993

Effects of fetal hippocampal field grafts on ischaemic-induced deficits in spatial navigation in the water maze.

Transitory global cerebral ischaemia induced in rats by four vessel occlusion for 15 min produced substantial loss of CA1 cells in dorsal hippocampus, and minimal damage in other intra- and extrahippocampal forebrain regions examined. Ischaemic rats showed long-lasting deficits in spatial navigation in the water-maze, consisting of impaired learning to locate a hidden platform in a novel pool, a substantial increase in time spent searching close to the platform without finding it, and moderate deficits in matching to position in a working memory task. Groups of ischaemic rats were implanted with fetal tissue dissected from hippocampal CA1 field, containing glutamatergic CA1 pyramidal cells, from dentate gyrus, containing glutamatergic dentate granule cells, and from basal forebrain, containing cholinergic cells, with grafts sited in the alveus above the damaged CA1 region, for comparison with non-grafted ischaemic and non-ischaemic control groups, over a series of tests from four to 20 weeks after grafting. All ischaemic groups showed comparable acquisition deficits prior to transplantation, and similar loss of CA1 cells on post mortem examination. When tested in a familiar pool in retention and reversal learning of the original platform position, and a working memory task, all ischaemic rats performed better than in initial acquisition. However, rats receiving CA1 grafts showed the most consistent improvement relative to ischaemic controls. When tested in a second (i.e. novel) pool, ischaemic rats again showed marked impairment, whereas rats with CA1 grafts were significantly superior, and learned as rapidly as non-ischaemic controls. The performance of groups with dentate granule and basal forebrain grafts was similar to that of the non-grafted ischaemic control group throughout testing. These results suggest that ischaemic rats are impaired in the adaptive use of spatial information, as shown by acquisition and working memory deficits, but not in long- or short-term memory storage processes, and are also impaired in precise spatial localization. The effects of CA1 grafts in restoring spatial abilities, shown most clearly when rats were tested in a novel environment, suggest that these grafts may have assisted with repair to the damaged host circuit, rather than acted through the release of an appropriate neurotransmitter, since the glutamatergic dentate granule grafts were ineffective. However, CA1 grafts showed better survival and growth than the other types of transplant, so that functional recovery may have been related to graft viability rather than to the specific type of graft.

Animals↗

PubMed1991

Effects of cholinergic-rich neural grafts on radial maze performance of rats after excitotoxic lesions of the forebrain cholinergic projection system--I. Amelioration of cognitive deficits by transplants into cortex and hippocampus but not into basal forebrain.

After ibotenate (10.0 mg/ml) lesions to the nucleus basalis and medial septal regions, at the source of the cortical and hippocampal branches of the forebrain cholinergic projection system, rats displayed long-lasting stable impairment in reference and working memory in both spatial (place) and associative (cue) radial maze tasks. Cell suspension transplants of cholinergic-rich fetal basal forebrain tissue dissected at embryonic day 15 substantially improved all aspects of radial maze performance to a comparable degree whether sited in cortex, hippocampus, or both regions of the host brain. No additive effects were obtained with grafts in both terminal regions, but total graft volume, assessed stereologically, showed a significant negative correlation with error scores. Rats with behaviourally effective grafts, like controls, were disrupted in the place task when tested in dim light which obscured extra-maze spatial cues. Lesioned rats were not affected by change in lighting. Grafts of cholinergic-poor fetal hippocampal tissue did not improve radial maze performance; neither did grafts of cholinergic-rich tissue placed within the host basal forebrain lesion sites. In rats with cholinergic-rich terminal grafts, cortical and hippocampal choline acetyltransferase activity was restored to control level, commensurate with site of transplant, whereas it was significantly reduced in lesioned animals and those with functionally ineffective grafts. The indiscriminate error pattern and insensitivity to changes in lighting shown by lesioned rats suggested that lesioning primarily disrupted attention rather than short- or long-term spatial or associative memory processes. Since rats with cholinergic-rich grafts showed both reduced errors and recovery of stimulus control, the data indicated that grafts affected information processing, rather than changes in motor or motivational processes. Changes in choline acetyltransferase activity and the behavioural efficacy of cholinergic-rich grafts are consistent with the involvement of acetylcholine in the behavioural deficits and recovery displayed by lesioned and grafted groups, but do not rule out contributions from other factors. The equipotency of grafts within each terminal region suggests also that there may be a considerable degree of functional cooperation between the two branches of the forebrain cholinergic projection system. Functional recovery may involve local, nonspecific synaptic or paracrine mechanisms within the target regions, since grafts were efficacious only when placed in the terminal areas, but not when sited homotopically in the basal forebrain, indicating that they did not achieve any functionally significant structural repair to the host brain at that site.

Acetylcholine↗

PubMedDate not supplied

Expressive language development of children exposed to cocaine prenatally: literature review and report of a prospective cohort study.

It was hypothesized that prenatal exposure to cocaine and other substances would be related to delayed expressive language development. Speech and language data were available for 458 6-year olds (204 were exposed to cocaine). No significant univariate or multivariate differences by cocaine exposure group were observed. Classification and regression tree modeling was then used to identify language variable composites predictive of cocaine exposure status. Meaningful cut points for two language measures were identified and validated. Children with a type token ratio of less than 0.42 and with fewer than 97 word types were classified into a low language group. Low language children (n = 57) were more likely to be cocaine exposed (63.1%), with cocaine-exposed children 2.4 times more likely to be in the low language group compared with control children after adjustment for covariates. Prenatal cigarette, but not alcohol exposure, was also significantly related to expressive language delays.

Child↗

PubMedDate not supplied

Documenting patterns of nursing interventions using cluster analysis.

Use of inferential statistics in research applications of the Nursing Intervention Classification has been rare, yet use of these statistical techniques is needed to answer questions related to intervention patterns. Using data from a descriptive study of 3,733 visits documented by 19 adult nurse practitioner students, hierarchical agglomerative cluster analysis was used to determine whether meaningful nursing intervention patterns could be depicted. Eight intervention clusters were derived, replicated, and validated. Clusters of intervention classes differed in the type of nursing and medical diagnosis, amount of time the nurse spent during the visit, cost of visit, and the age of the patient. Clustering supported the utility of standardized nursing diagnosis and intervention typologies to identify actual practice patterns of adult nurse practitioner students. Cluster analysis is a valuable data analysis strategy when analyzing multiple related variables.

Adolescent↗