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Biomedical subjects

A Waller

Publications and source records attributed to A Waller.

At least 37 records · Page 2Linked to original sources
PubMed1995

Care of the terminal head and neck cancer patient in the hospice setting.

The ratio of incidence to mortality is somewhat less than 3:1 for head and neck cancer, and the 5-year relative survival rate is 50%. Despite the high mortality rate, few reports have focused on patients with terminal head and neck cancer. A growing number of these patients end their lives in a hospice facility. A retrospective analysis was undertaken of 67 patients with terminal head and neck cancer who were admitted to the Tel Hashomer Hospice between 1988 and 1992. Patient data were reviewed and analyzed, and the particular characteristics of this population were defined. This study found that terminal head and neck cancer patients seem to receive better support in a hospice than in a general hospital or some family settings.

Aged↗
PubMed1991

Motor vehicle deaths in children: geographic variations.

Motor vehicle-related injury is the leading cause of death in children ages 0-14 years in the United States. Using data from the National Center for Health Statistics and the Fatal Accident Reporting System, specific types of motor vehicle injury death in children were examined for the years 1980-1985 (using NCHS data) and 1985-1986 (using FARS data). Death rates were calculated for each specific category of motor vehicle injury for each state and were then mapped to determine patterns of geographic variation. In general, nontraffic pedestrian death rates and death rates for crashes involving light trucks and/or rollovers were higher in the West, and rates of pedestrian deaths in traffic were highest in the South. Some of the likely contributing factors and possible interventions are discussed.

Accidents, Traffic↗
PubMed1982

Continuous ambulatory peritoneal dialysis- a new dimension in the treatment of end-stage renal disease.

Thirty-five patients treated with continuous ambulatory peritoneal dialysis (CAPD) were followed over a 2-yr period. Serum levels of protein metabolites were maintained at stable and satisfactory levels. Blood hemoglobin was higher during CAPD treatment than during hemodialysis. At the end of the follow-up period, 45.7% of the patients were still on CAPD, 25.7% of them had been transferred to another mode of dialysis because of complications, and 28.6% of the patients had died. In half of the latter, death was directly related to CAPD. The high incidence of peritonitis (one infection per 2.4 patient months) is the main drawback and reason for mortality in CAPD. Reduction in the incidence of peritonitis would make CAPD the preferred mode of dialytic therapy.

Adult↗
PubMed1976

Alterations in lipid metabolism produced by ethyl trichloracetate.

Rats maintained on a choline deficient diet and treated with subcutaneous doses of ethyl trichloracetate responded by increasing plasma beta-lipoprotein and plasma triglyceride levels while excess triglyceride was being removed from the liver. There was a transient depression in plasma phospholipid at the beginning of the treatment. Continued administration of ethyl trichloracetate raised plasma triglyceride in choline depleted rats and raised hepatic phospholipid concentration in both choline deficient and supplemented rats. It is suggested that the lipotropic action of ethyl trichloracetate occurs through hepatic triglyceride being removed by the altered plasma lipids and not by inhibition of hepatic triglyceride synthesis.

Animals↗
PubMedDate not supplied

Evaluating the use of TalksBac, a predictive communication device for nonfluent adults with aphasia.

This paper describes the design and evaluation of a computer-based communication system called 'TalksBac' with four nonfluent adults with aphasia. Despite the increased availability of computer-based augmentative and alternative communication (AAC) devices, their use with adults with aphasia is limited as few devices have been designed for this population. The TalksBac system was designed specifically for nonfluent adults with aphasia and was used by four nonfluent aphasic individuals for a period of 9 months. The TalksBac system is word-based and exploits the ability of some nonfluent individuals with aphasia to recognize familiar words and short sentences. The system consists of two programs. Personal sentences and stories are entered into the TalksBac database by use of a 'carer program'. The 'user program' assists the nonfluent aphasic user to retrieve these prestored conversational items by offering probable items based on previous use of the system. The database has a hierarchical structure, but the links to individual items adapt automatically to reflect usage by individual users over time. Four nonfluent adults with aphasia were selected to participate in the study. Each subject was assessed by use of a battery of tests to provide pre-intervention data about their comprehension, expression and communication skills. Subjects and their carers were trained to use the TalksBac system and were involved in developing personalized databases. They were supported in use of the personalized systems for an intervention period of 9 months. At the end of this period, subjects' communication skills wre reassessed by use of a battery of tests. Clients' conversational abilities with and without the TalksBac system were also compared to see if use of TalksBac did augment their conversation and allow the aphasic partner to participate more fully within conversations. This was done by analysing videotaped conversations between subjects and non-aphasic partners. Results from the formal assessments indicated that there was little change in the underlying comprehension and expressive abilities of the subjects. An analysis of videotaped conversations showed that 1 subject was unable to carry out conversations using TalksBac independently, so the data for this subject was not included in the results of the analysis of conversations. Results from the video analysis for the remaining three subjects indicated that when using the TalksBac system, the conversational abilities of two subjects improved. The conversational abilities of the other subject were not enhanced by using the system as he had developed his own nonverbal strategies which he found to be more effective. This study has shown that TalksBac has the potential to augment the communication abilities of nonfluent adults with aphasia, who have not been able to develop their own compensatory strategies. Work continues to improve the efficiency of the software and to develop techniques to facilitate the carers' ability to generate conversational information for the system.

Aged↗
PubMedDate not supplied

Economic impact of malnutrition: a model system for hospitalized patients.

A retrospective review of 771 patients' charts in two acute care hospitals was performed to determine likelihood of malnutrition (LOM) at admission and to assess the effect of LOM on costs and charges. Using accepted criteria, LOM was present in 59 and 48% of medical and surgical patients, respectively. Patients with LOM were 2.6 or 3.4 times as likely to have a predefined minor or major complication, respectively; and 3.8 times as likely to die as patients without LOM (all p less than 0.001). In every diagnosis-related group, the mean length of stay was longer for LOM patients (range 1.1-12.8 excess days). Accountants converted charges to direct variable costs using departmental cost-to-charge ratios. LOM status increased excess costs and charges per patient by $1738 and $3557, respectively (p less than 0.0001). When complications occurred, LOM patients incurred $2996 or $6157 excess costs and charges per patient (p less than 0.01). Serum albumin was the strongest clinical predictor of cost. The hospitals' cost of providing enteral or parenteral nutrition support was $18 or $102 per day, respectively. Too few patients received early nutrition support to assess efficacy. Nonetheless, the costs associated with malnutrition warrant early detection and aggressive treatment.

Adult↗
PubMedDate not supplied

The effect of intravenous fluid infusion on blood and urine parameters of hydration and on state of consciousness in terminal cancer patients.

This prospective study was undertaken to assess the state of hydration in terminal cancer patients with and without intravenous fluids during the last 48 hours of their lives and to correlate various measures of hydration with their state of consciousness. We examined indicators of hydration in the plasma and urine of 68 consecutive patients for whom data were available at 48 hours or less before death. Thirteen of the patients were being treated with intravenous (IV) fluids. Nearly all of the patients studied were found to be dehydrated, as determined by laboratory measurements. State of consciousness correlated inversely with serum sodium (p < 0.001) and urine osmolality (p < 0.02). Patients receiving intravenous fluids were not better hydrated than those without IV therapy, nor was their state of consciousness improved. In light of these findings, which suggest there is no clinical benefit from intravenous infusions, decisions regarding intravenous fluid therapy during the last hours of life should be guided by the preferences of the dying patient and his family.

Coma↗