Biomedical subjects
A Mitchell
Publications and source records attributed to A Mitchell.
. . . and from repair to remodelling.
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The premature infant and painful procedures.
Pain management for premature infants raises challenging questions for nurses. This group of infants is often physiologically fragile and they may undergo frequent painful procedures on a daily basis. Contrary to ideas from the past, premature infants are able to feel pain, and nervous system elements required for the transmission of painful stimuli are functional by 24 weeks gestation. Painful procedures are harmful to the infant's physiological stability and the ability to self-regulate, which includes maintenance of motor control and stable sleep/wake cycles. Assessment of pain in the premature infant is complex. Major indicators of pain include facial grimaces and physiological parameters such as heart rate and oxygen saturation. The Premature Infant Pain Profile (PIPP) is one tool designed specifically for preterm infants. Nonpharmacological nursing measures such as swaddling or nesting and offering a pacifier are useful strategies to help infants cope with painful procedures. The nurse may also maintain a therapeutic environment to assist the infant in self-regulation. Pharmacological agents such as morphine, fentanyl, and acetaminophen are effective in relieving procedural pain. The use of oral sucrose before and during painful procedures offers new possibilities for pain relief. Recent research shows that oral sucrose is a safe and effective analgesic for short-term procedures. Research studies to determine the most effective doses and modes of oral sucrose administration are ongoing. It is thought that the relief of pain is owing to the sweet taste of the sucrose that activates endogenous pain-modulating systems.
Researching healing: a psychologist's perspective.
This article suggests that a research agenda for healing should encompass qualitative issues of value and meaning as well as quantitative issues of clinical effectiveness. Patients themselves should play an active part in all stages of the research process in order to ensure that the questions addressed are relevant to the needs and wants of those who use healing. Research should address the issues of defining and specifying desired outcomes and clarifying the specific and nonspecific factors in the healing process as well as investigating the potential for harm in treatment and minimizing risk. Some specific research questions are raised. The healing community is challenged to develop a research agenda that is conceptually and methodologically rigorous, true to the holistic nature of complementary and alternative medicine, and retains the subversive edge of the healing traditions.
Oncology nurses' experience of dimethyl sulfoxide odor.
This article presents findings of an exploratory descriptive study on the effects of dimethyl sulfoxide (DMSO) odor in an oncology unit. The nursing staff, who had reported their concerns about the unpleasant odor emitted from patients undergoing peripheral stem cell transplantation, initiated the study. A literature review revealed some evidence of the possible ill effects on staff caring for patients having DMSO treatment, but many questions remain unanswered such as what staff experience in dealing with DMSO odor and whether nursing care is affected in any way? Data were collected through interviews with 22 oncology nurses who all had experienced direct and indirect exposure to DMSO odor. Of the 22 nurses interviewed, 20 reported that they found DMSO odor unpleasant and reported experiencing physical symptoms such as headaches and gastrointestinal reactions. The study also revealed a situation in which nurses described odor avoidance and distancing strategies that potentially compromised the nurse-patient relationship.
Serial lactate measurements during surgery involving deep hypothermic circulatory arrest
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Talking sexual health: a national application of the health promoting school framework for HIV/AIDS education in secondary schools.
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A comparison of four quality of life instruments in cardiac patients: SF-36, QLI, QLMI, and SEIQoL.
BACKGROUND: With the increasing use of quality of life measures in evaluations of cardiac interventions, criteria are needed for selecting appropriate quality of life measures. An important criterion is the sensitivity of a measure for detecting clinically important changes. OBJECTIVES: To compare the sensitivity of four measures when used in a group of cardiac patients undergoing the same intervention. METHODS: The short form 36 (SF-36), the quality of life index-cardiac version (QLI), the quality of life after myocardial infarction questionnaire (QLMI), and the schedule for the evaluation of individual quality of life (SEIQoL) were used to evaluate quality of life in a group of 22 patients after myocardial infarction or coronary artery bypass graft (CABG), at the beginning of rehabilitation and six weeks later. Analysable data were obtained from 16 patients. RESULTS: A significant improvement over time was only observed for the SF-36 subscale, vitality (p < 0.05). Five of the eight SF-36 subscales and one of the four QLMI subscales showed modest sensitivity (index: > 0.2 and < 0.5), while all other subscales showed poor sensitivity (index: < 0.2). Using SEIQoL, family was most often nominated as an area of importance to quality of life (n = 13), followed by health (n = 10), leisure/hobbies (n = 8), marriage (n = 8), and work (n = 6). CONCLUSIONS: All four QOL measures used in this study were found to lack sensitivity to change. Further research is needed using other cardiac populations and interventions in order to verify these findings, with a view to developing more sensitive quality of life scales.
Systematic comparison of the early outcome of angioplasty and endarterectomy for symptomatic carotid artery disease.
BACKGROUND AND PURPOSE: Endoluminal treatment is being increasingly used for carotid artery disease. The aim of this study was to compare the stroke and death risk within 30 days of endovascular treatment or endarterectomy for symptomatic carotid artery disease. METHODS: systematic comparison of the 30-day outcome of angioplasty with or without stenting and endarterectomy for symptomatic carotid artery disease reported in single-center studies, published since 1990, was performed. RESULTS: Thirty-three studies (13 angioplasty and 20 carotid endarterectomy) were included in this analysis. Carotid stents were deployed in 44% of angioplasty patients. Mortality within 30 days of angioplasty was 0.8% compared with 1.2% after endarterectomy (OR 0.68, 95% CI 0.43 to 1.05; P=0.6). The stroke rate was 7.1% for angioplasty and 3.3% for endarterectomy (OR 2.22, CI 1.62 to 3.04; P<0.001), while the risk of fatal or disabling stroke was 3.2% and 1.6%, respectively (OR 2.09, CI 1.3 to 3.33; P<0.01). The risk of stroke or death was 7.8% for angioplasty and 4% for endarterectomy (OR 2.02, CI 1.49 to 2.75; P<0.001), while disabling stroke or death was 3.9% after angioplasty and 2.2% after endarterectomy (OR 1.86, CI 1.22 to 2.84; P<0.01). CONCLUSIONS: In the treatment of symptomatic carotid artery disease, the risk of stroke is significantly greater with angioplasty than carotid endarterectomy. At present, carotid angioplasty is not recommended for the majority of patients with symptomatic carotid artery disease.
Safe sex messages for adolescents. Do they work?
BACKGROUND: Adolescence is a time of risk taking. Constructive risk taking aids the developmental task of becoming a mature, confident adult with a sense of mastery of self and the world. However, ill judged and misinformed risk taking in sexual behaviour can have serious and life long consequences. OBJECTIVE: To assess strategies used for promoting safe sex messages to adolescents and to delineate the role of the general practitioner in promoting these messages effectively. DISCUSSION: The most successful sexual health promotion strategies are those that acknowledge the social and media influences on young people and use these to help strengthen group norms around safe sexual behaviour. GPs have an important role to play in adopting a non judgmental approach to accepting young people as sexual beings and engaging in one to one opportunistic health promotion.
Why oncology nursing? An experienced nurse replies.
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Gender differences in the early careers of health care managers.
In health care, as in many other fields, women's occupational advancement appears to occur more slowly than men's. Two main theories purport to explain this phenomenon: 1) the "glass ceiling" perspective which focuses on structural arrangements and/or the attitudes of those who make promotion decisions, and 2) "supply side" approaches which argue that characteristics of women themselves explain their relative lack of progress. There is also another view that challenges the glass ceiling, suggesting that it affects predominantly older cohorts of women, and that younger entrants experience few advancement obstacles. This study examines these questions using a population of health administrators who graduated between May, 1984 and May, 1995. Gender comparisons reveal considerable similarity between men and women graduates on a variety of early career outcome variables, disputing supply side arguments and suggesting that barriers to women, if they exist, become important after the early career period.
More taxa or more characters revisited: combining data from nuclear protein-encoding genes for phylogenetic analyses of Noctuoidea (Insecta: Lepidoptera).
A central question concerning data collection strategy for molecular phylogenies has been, is it better to increase the number of characters or the number of taxa sampled to improve the robustness of a phylogeny estimate? A recent simulation study concluded that increasing the number of taxa sampled is preferable to increasing the number of nucleotide characters, if taxa are chosen specifically to break up long branches. We explore this hypothesis by using empirical data from noctuoid moths, one of the largest superfamilies of insects. Separate studies of two nuclear genes, elongation factor-1 alpha (EF-1 alpha) and dopa decarboxylase (DDC), have yielded similar gene trees and high concordance with morphological groupings for 49 exemplar species. However, support levels were quite low for nodes deeper than the subfamily level. We tested the effects on phylogenetic signal of (1) increasing the taxon sampling by nearly 60%, to 77 species, and (2) combining data from the two genes in a single analysis. Surprisingly, the increased taxon sampling, although designed to break up long branches, generated greater disagreement between the two gene data sets and decreased support levels for deeper nodes. We appear to have inadvertently introduced new long branches, and breaking these up may require a yet larger taxon sample. Sampling additional characters (combining data) greatly increased the phylogenetic signal. To contrast the potential effect of combining data from independent genes with collection of the same total number of characters from a single gene, we simulated the latter by bootstrap augmentation of the single-gene data sets. Support levels for combined data were at least as high as those for the bootstrap-augmented data set for DDC and were much higher than those for the augmented EF-1 alpha data set. This supports the view that in obtaining additional sequence data to solve a refractory systematic problem, it is prudent to take them from an independent gene.
Maternal cigarette smoking during pregnancy and risk of oral clefts in newborns.
The results of previous epidemiologic research on the possible association between maternal smoking during pregnancy and risk of oral clefts in offspring have been inconsistent. This may be due in part to methodological limitations, including imprecise measurement of tobacco use, failure to consider etiologic heterogeneity among types of oral clefts, and confounding. This analysis, based on a large case-control study, further evaluated the effect of first trimester maternal smoking on oral facial cleft risk by examining the dose-response relationship according to specific cleft type and according to whether or not additional malformations were present. A number of factors, including dietary and supplemental folate intake and family history of clefts, were evaluated as potential confounders and effect modifiers. Data on 3,774 mothers interviewed between 1976 and 1992 by the Slone Epidemiology Unit Birth Defects Study were used. Study subjects were actively ascertained from sites in areas around Boston, Massachusetts and Philadelphia, Pennsylvania; the state of Iowa; and southeastern Ontario, Canada. Cases were infants with isolated defects--cleft lip alone (n = 334), cleft lip and palate (n = 494), or cleft palate alone (n = 244)--and infants with clefts plus (+) additional malformations: cleft lip+ (n = 58), cleft lip and palate+ (n = 140), or cleft palate+ (n = 209). Controls were infants with defects other than clefts, excluding defects possibly associated with maternal cigarette use. There were no associations with maternal smoking for any oral cleft group, except for a positive dose response among infants with cleft lip and palate+ (for light smokers, odds ratio (OR) = 1.09 (95% confidence interval (CI): 0.6, 1.9); for moderate smokers, OR = 1.84 (95% CI: 1.2, 2.9); and for heavy smokers, OR = 1.85 (95% CI: 1.0, 3.5), relative to nonsmokers). This finding may be related to the additional malformations rather than to the cleft itself.
Compatibility of levofloxacin with 34 medications during simulated Y-site administration.
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Developmental biology. Bonsai flies.
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