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Biomedical subjects

A S Anderson

Publications and source records attributed to A S Anderson.

At least 73 records · Page 4Linked to original sources
PubMed1986

The use and implications of do not resuscitate orders in intensive care units.

To describe current "do not resuscitate" (DNR) order writing practices, we studied 7,265 intensive care unit (ICU) admissions at 13 hospitals. All of the ICUs used DNR orders and 39% of all in-unit deaths were preceded by them. Patients with DNR orders were often elderly and in severely failing health. They were more severely ill than other patients in ICUs, and often had multiple organ failure. Most patients with DNR orders (94%) died in the hospital, and 86% died or were discharged from the ICU three days after a DNR order. The frequency of DNR orders ranged from 0.4% to 13.5%, and the mean interval from ICU admission to DNR order was from 5.4 to 24 days. These variations could not be explained by differences in patient characteristics, and may reflect varying physician attitudes. Do not resuscitate orders are now an accepted practice in ICUs and their use follows basic ethical and scientific guidelines. The brief interval between writing a DNR order and death or ICU discharge suggests that they often represent a decision point for placing broader limits on therapy.

Adult↗
PubMed1986

Dietary factors in the aetiology and treatment of constipation during pregnancy.

Using a 7-day weighed-intake method, dietary factors implicated in the aetiology of constipation were examined by comparison between the nutrient intakes of nine women with constipation in the third trimester of pregnancy who had not altered their diets, and a matched group of nine women who had not suffered constipation at any time during pregnancy. No significant differences were found for intakes of major nutrients, including dietary fibre, between the constipated and non-constipated groups, indicating that inappropriate diets do not appear to be the primary cause of constipation during pregnancy. The nutrient intakes of 40 women with constipation in the third trimester of pregnancy were examined to assess dietary changes made in attempts to treat constipation. No difference in intakes of dietary fibre were found between those who claimed to have increase their intakes, and those who had not altered their diets. Both were well below the level of dietary fibre intake known to be successful in treating constipation.

Adult↗
PubMed1986

Dietary intake in pregnancy. A comparison between 49 Cambridgeshire women and current recommended intake.

The mean daily nutrient intakes from dietary sources of 49 pregnant women in the third trimester of normal pregnancy were assessed using a 7-day weighed inventory method and standard food tables. Mean daily intakes of all major nutrients reached DHSS recommended levels, with the exceptions of energy (2065 kcal/8.65 MJ), proportion of energy derived from carbohydrate (48 per cent), calcium (1047 mg), and vitamin D (2.58 micrograms). These results are in agreement with those of comparable published studies and lend support to suggestions that some of the increased requirements in pregnancy may be being met by physiological adaptation, without the need for greatly increased dietary intakes, or for indiscriminate vitamin and mineral supplementation. For seven women with low weight gain (less than 8 kg at 36 weeks; mean 6.97 kg), mean daily intakes of most nutrients were lower, and were below recommended levels for energy (1770 kcal/7.4 MJ), ascorbic acid (47.4 mg), vitamin D (2.18 micrograms), calcium (980 mg), and iron (10.5 mg). Proportional intakes of carbohydrate (50 per cent) and dietary fibre (20.1 g/day) however, tended to be higher in this group.

Adult↗
PubMed1985

Constipation during pregnancy: dietary fibre intake and the effect of fibre supplementation.

Forty women who complained of constipation during the third trimester of pregnancy completed 14-day weighed diet records and bowel function charts over a 4-week period. After 2 weeks of baseline observation the women were randomly allocated into three groups which were asked to take 10 g dietary fibre supplements per day in the form of either a corn-based biscuit (Group A), or as wheat bran (Gp B), or to continue without intervention (Gp C). Mean (+/- s.e.m.) daily dietary fibre intake in the first 2 weeks was similar to that in the general population, at 20.4 +/- 1.2 g, for the whole group, and 21.1 +/- 1.6 g for the 26 women who said they had already increased their dietary fibre intakes in attempts to relieve their symptoms. In the final 2 weeks changes in fibre intakes were: Gp A, mean increase 7.2 +/- 1.0 g per day (P less than 0.001); Gp B, mean increase 9.1 +/- 1.6 g per day (P less than 0.001); Gp C mean decrease 3.50 +/- 1.6 g per day (P less than 0.005). These changes were accompanied by an increase in the number of bowel movements and a change to a softer stool consistency in Gps A and B, with no changes in number of bowel movements or stool consistency in Gp C.

Adult↗
PubMed1985

Scanning electron microscopy studies of staphylococcal adherence to heart valve endothelial cells in organ culture: an in vitro model of acute endocarditis.

Organ cultures of human heart valves were used as a model to study the initial pathobiology of acute infective bacterial endocarditis. We used Staphylococcus aureus isolated from a case of infective endocarditis to infect the in vitro culture of the heart valves. Using scanning electron microscopy, we assessed the initial damage, attachment to and invasion of the endothelial cell layer by staphylococci. Our results indicate there is initial damage to the endothelium prior to observation of staphylococci attaching to the endothelial cell. By 12 h post infection, there is significant attachment and damage. At 24 h after infection, destruction of the heart valve endothelium is complete. The attachment and destruction are progressive events and can be correlated quantitatively with bacterial numbers from the culture medium and those attached to the valves. This is correlated with increasing adherence ratios of the attaching staphylococci.

Acute Disease↗
PubMed1981

Evaluating M.D.-level competence in internal medicine.

The faculty of the Department of Medicine at the University of Hawaii John A. Burns School of Medicine defines M.D.-level competence as the capability of undertaking the first day of a primary care internship. The implementation of a clinical clerkship in internal medicine that was flexible in time required that a new evaluation program be developed to assess the progress of students toward defined end points of competence. The four measures used are an objective test of basic medical knowledge, simulations to assess intellectual skills in problem-solving, a clinical skills examination with written standards to help the evaluator make discriminations between levels of performance, and a criterion-referenced rating scale to assess professional habits and attitudes. The progress of the classes of 1979 and 1980 toward achievement of predetermined levels of mastery is presented.

Clinical Competence↗
PubMed1981

MD-level competence in internal medicine. Objectives and the flexible clerkship.

The faculty of the Department of Medicine at the John A. Burns School of Medicine, University of Hawaii, Honolulu, defined MD-level competence as the capability of undertaking the first day of a primary-care internship. To meet this goal, a curriculum was developed that used a written statement of expected competencies and objective measurements of student performance. The duration of the clinical clerkship was made flexible to acknowledge the normal variation in the rate at which students learn. Six weeks of ambulatory patient care were included in the basic third-year clerkship to fulfill objectives otherwise unmet.

Clinical Competence↗
PubMed1976

Turnover of erythrocyte protoporphyrin, with special reference to bovine porphyria and iron deficiency anemia.

Available data from human subjects suggests that most of the pools of free protoporphyrin in circulating erythrocytes have T 1/2 values which range from less than 1 hour to approximately 2 weeks. An exception was observed in 2 cows with erythropoietic ("congenital") porphyria. During the several months which followed the simultaneous injection of 14C- and 3H-labelled glycine and ALA, changes in the specific activities of both free- and hemoglobin-protoporphyrin were similar. Since erythropoietic porphyria in the bovine differs from that in the human mainly in the elevated values of free erythrocyte protoporphyrin in the former, it is suggested that this prolonged T 1/2 (equal approximately to the red cell life span) may account for the elevated values seen in the bovine. Variable ratios of red cell/fecal protoporphyrin concentrations reported in other diseases are also believed to be due largely to T 1/2 differences in porphyrin pools. Recorded fluorescence and excitation spectra of blood showed the single fluorescence band of "free" porphyrin in bloods of normal and porphyric cows and of patients with erythropoietic porphyria, protoporphyria, and sideroblastic anemia. The 2 band zinc complex spectrum was found, as expected, in blood of subjects with Pb poisoning and Fe deficiency anemia. T 1/2 values of 1 to 2 weeks were calculated for red cell protoporphyrin from previously published data of patients with Fe deficiency anemia who were treated effectively with iron.

Aminolevulinic Acid↗