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Biomedical subjects

A Evans

Publications and source records attributed to A Evans.

449 records · Page 25Linked to original sources
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Management of long-term urethral catheters: minimizing complications.

Urinary tract infections, tissue damage and encrustation of the catheter, which may cause blockage, are all complications that can arise during long-term catheterization. It is important for nurses to provide effective catheter care in order to minimize the incidence of these complications. There is still controversy in the nursing literature about certain aspects of catheter management. This article explores a number of aspects of catheter care and suggests a rationale for effective and safe management, including the choice of catheter, choice of drainage system, care of the individual and the care of catheter and drainage system.

Catheters, Indwelling↗
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A comparison of healing rates on two pressure-relieving systems.

The authors have previously reported the preliminary results of a randomized-controlled trial comparing the relative efficacy of two pressure-relieving systems: Huntleigh Nimbus 3 and Aura Cushion, and Pegasus Cairwave Therapy System and ProActive Seating Cushion (Russell et al, 2000). Although both the mattresses and cushions were effective treatments for pressure ulcers, the Huntleigh equipment was demonstrated to be statistically more effective for heel ulcers, but no differences were demonstrated for sacral ulcers. This article gives a more detailed analysis of the 141 patients assessed using computerized-image analysis of the digital images of sacral ulcers captured during the trial and specifically discusses the healing rates and other patient characteristics. Ninety-eight per cent of ulcers examined were deemed superficial (Torrance grade 2a, 2b, 3). Precision of image analysis assessed by within- and between-batch coefficients of variation was excellent: calibration CV 0.93-1.84%; area CV 4.61-5.72%. The healing rates on the two mattresses were not shown to be statistically different from each other.

Beds↗
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Why catheterize?: audit findings on the use of urinary catheters.

Urinary catheters can be associated with complications such as urinary tract infection, pain and discomfort. This article reports on an audit of 51 patients who had a urinary catheter inserted during their hospital stay. Urinary incontinence meant catheterization in 37.5% (n = 27) of cases, with 64.7% (n = 33) being catheterized by nurses. The study highlighted the need for accurate documentation and care planning; 15 patients did not have a plan of care for their catheter and only eight patients had a plan for the removal of the catheter. Catheterization is the most common cause of hospital-acquired infection, and therefore the use of catheters needs careful examination to reduce this type of infection. The question is raised whether catheterization is used as a convenience for nursing staff or as an essential aspect of care.

Attitude of Health Personnel↗
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Medicaid managed care in thirteen states.

This study examines the recent expansion of Medicaid managed care from the perspective of the thirteen states in the Urban Institute's Assessing the New Federalism project. States are moving to managed care for Medicaid both to improve beneficiaries' access and to control the growth in program costs. However, we find that despite dramatic growth in enrollment during this decade, few states are enrolling the elderly or the disabled--the most expensive Medicaid beneficiaries. We also conclude that cost-savings objectives are often at odds with goals of contracting with mainstream plans and protecting safety-net providers.

Cost Savings↗
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Podiatric medical applications of posterior night stretch splinting.

Podiatric physicians encounter many conditions, especially in sports medicine, that involve pain in the vicinity of the rearfoot or lower leg. These conditions are often associated with ankle equinus and may affect either child or adult sports participants. A review of the literature and clinical experience identify posterior night stretch splinting as an effective adjunct in the treatment of persistent symptomatic plantar fasciitis, negating the need for corticosteroid injections, further protracted pain, or surgery. This article reviews clinical cases in which night stretch splinting was used for a variety of diagnoses. Further research is needed into its efficacy for conditions other than plantar fasciitis.

Adolescent↗
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Use of combination adriamycin (NSC-123127) and DTIC (NSC-45388) in children with advanced stage IV neuroblastoma.

Adriamycin and DTIC were used in combination because of their reported effectiveness in neuroblastoma when administered as single agents and because of the poor survival rate of patients with this malignancy in its disseminated stage. Eighteen patients with previously treated stage IV neuroblastoma received this combination chemotherapy every 21 days. Two to eight courses were administered. Two partial and no complete remissions were seen. Mild to moderate gastrointestinal and hematologic toxicity was observed.

Child↗
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Systemic sclerosis complicated by diffuse alveolar hemorrhage.

A 38-year-old woman with limited cutaneous systemic sclerosis and pulmonary fibrosis developed diffuse alveolar hemorrhage during the course of her disease that responded well to steroids. We present the clinical history of the patient and discuss the different theories behind the association. The importance of steroid therapy for treatment of alveolar hemorrhage in this particular condition is emphasized.

Adult↗
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The influence of significant others on Australian teenagers' decisions about pregnancy resolution.

CONTEXT: Teenagers' decisions about how to resolve a pregnancy are made in the context of a society, a family and a relationship with a partner. Little is known about how such decisions are made, however, particularly in Australia. METHODS: The association between the influence--both direct and indirect--of significant others and adolescent women's decisions to terminate or continue a pregnancy is examined here using data from a case-control study on 1,324 pregnant teenagers in Australia. Bivariate analyses were used to explore the association between pregnancy resolution and direct or indirect influence toward abortion or birth. Multivariate logistic regression analyses were used to model the association between significant others' influence and teenagers'pregnancy resolution decisions while controlling for adolescent women's background characteristics. RESULTS: Teenagers who reported that their partner influenced them toward abortion had significantly increased odds of choosing abortion (10.4), and those whose partner influenced them toward motherhood had significantly reduced odds of choosing abortion (0.5). Direct influence from parents toward either abortion or motherhood was not significantly associated with teenagers' decisions. Mothers are an important source of indirect influence, however: Teenagers whose mother had become a mother as a teenager had reduced odds of choosing abortion (0.4), and those whose mother had ever had an abortion had increased odds of choosing abortion (2. 1). Teenagers who had a sister who had ever had an abortion had significantly increased odds of choosing abortion (2.4). CONCLUSION: While most young women report they were not directly influenced by a significant other in their decision to continue or terminate a pregnancy, pregnancy resolution decisions are affected by families and partners, often indirectly. These findings have important implications for the manner in which services are delivered to these young women.

Abortion, Legal↗
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Computers in respiratory medicine.

Information ranging from patient symptoms to bed state is essential for the efficient functioning of clinical services. Computers have a central role in organizing this information and this review illustrates the impact of their introduction on clinical hospital departments.

Bronchoscopy↗
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A new strategy.

Explore the source record for details and available documents.

Humans↗
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Sensible stockings.

Explore the source record for details and available documents.

Anthropometry↗
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Pharmacokinetics of once-daily IP gentamicin in CAPD patients.

OBJECTIVE: This study aimed to investigate the pharmacokinetic characteristics of once-daily intraperitoneal (IP) gentamicin in continuous ambulatory peritoneal dialysis (CAPD) patients. DESIGN: Prospective, nonrandomized, open study. SETTING: CAPD outpatient clinic in a teaching hospital. PATIENTS: Ten volunteer CAPD patients without peritonitis. INTERVENTIONS: Each patient received a single IP dose of 0.6 mg/kg of gentamicin. Blood and dialysate samples were collected at 0, 0.5, 1, 2, 3, 6 (end of first dwell), and 24 hours after the administration of IP gentamicin. Any urine produced over the 24-hour study period was also collected. The dialysate concentration/time data were fitted to a monoexponential curve for all patients. RESULTS: The bioavailability was 56 +/- 11% over a six-hour dwell. The mean serum elimination half-life (t1/2) was 35.8 hours. The volume of distribution was 0.23 +/- 0.08 L/kg. Equilibration of gentamicin across the peritoneal membrane was rapid, with a t1/2 equilibration of 4.5 hours. The peritoneal clearance was 5.74 +/- 1.5 mL/min. Patients-with residual renal function had significantly higher systemic gentamicin clearances (7.36 +/- 1.46 mL/min) than those of anuric patients (4.76 +/- 1.08 mL/min, p < 0.024). CONCLUSION: Currently recommended doses of once-daily IP gentamicin for the treatment of peritonitis may not produce the desired therapeutic serum and dialysate concentrations over 24 hours for effective treatment of peritonitis.

Adult↗
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RNs trial a forensic nursing service.

This paper describes a trial forensic nursing service that was implemented by two registered nurses in Melbourne police districts. The principal aim of the program was to reduce the workload of forensic medical officers by providing a 7 pm to 7 am referral and primary care nursing service for people held in police custody in the City Watch House and in 21 suburban watch houses. During the first three months of the six month trial, 747 detainees were referred to the nursing service for assessment and/or treatment and there was a 73% decrease in the night time call-outs of forensic medical officers. The service reduced overnight delays in responding to detainees' health needs and in referral of sick detainees to prison or civilian health services and it improved the exchange of information between health services outside and within the jail. As a result of the pilot, an ongoing nursing service for detainees in Melbourne watch houses has been established.

Forensic Medicine↗