Biomedical subjects
Publications and source records attributed to B Joyce.
Inpatient groups are inherently different from outpatient groups and require modification in approach. Patients' needs, staff interests and expertise, and the needs of the health care system are major driving forces in the development of inpatient groups. A co-therapy model helps to achieve a balance between skills and abilities of the therapist.
Measuring the effectiveness of cognitive rehabilitation programs poses both conceptual and practical challenges. We compared several standardized outcome measures with goal attainment scaling (GAS) to assess their sensitivity to changes in health status in patients undergoing cognitive rehabilitation. GAS is a measurement approach that accommodates multiple individual patient goals, and has a scoring system which allows for comparisons between patients. Forty-four patients were evaluated. GAS yielded a mean 4.4 goals per patient. The mean gain in the GAS score was compared with the change in the Rappaport Disability Rating Scale, the Kohlman Evaluation of Daily Living Skills, the Milwaukee Evaluation of Daily Living, the Klein-Bell elimination scale and mobility scale, the Instrumental Activities of Daily Living Scale, and the Spitzer Quality of Life Index. Using a relative efficiency statistic, GAS proved more responsive than any other measure. The effect size statistic also demonstrated greater responsiveness to change with GAS compared with standard measures. GAS shows promise as a responsive measure in cognitive rehabilitation. This study replicates a similar study of GAS in frail elderly patients, suggesting that individualized measures may have broad merit in evaluating rehabilitation programs.
OBJECTIVE: We aimed to find out the incidence of primary congenital hypothyroidism (CH) among infants born within the Riyadh Al-Kharj Hospital Programme in addition to early detection and treatment of these infants. DESIGN: All babies born within the Riyadh Al-Kharj Hospital Programme were screened by cord blood TSH. Blood spot TSH were done in the majority of infants between 2 and 5 days after birth. All suspected cases were recalled for confirmatory tests. 123I thyroid scan and X-ray of the knee and maternal blood for thyroid antibodies were done for confirmed cases. MEASUREMENTS: A cut off TSH level of 30 mIU/l for cord blood and 25 mIU/l for spot blood were used. All samples were assayed by immunoassay methods. RESULTS: 44,778 (99.4% of the total births) infants were screened. Twenty-five cases were detected, four of which were excluded. The incidence of primary congenital hypothyroidism was 1/2096. Five cases were missed on the initial screen. Eight out of 17 children who had 123I thyroid scan were found to have dyshormonogenesis. Associated malformation and diseases were diagnosed in 42.85%. Two had chromosomal anomalies; ring chromosome 9 has not been previously reported in association with congenital hypothyroidism. CONCLUSION: The incidence of congenital hypothyroidism, dyshormonogenesis and the associated malformations and diseases are higher than those reported in the literature. Cord blood as a screening method is associated with a significant number of missed cases.
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1. Friends were rated as the most important factor in assisting former psychiatric patients to avoid rehospitalization. 2. When respondents were asked to comment on rehospitalization in their own words, the most frequent responses dealt with factors related to keeping active, developing a healthy lifestyle and positive self-image, and accepting their illness. 3. Self-help groups, community health workers, and community nurses were rated as the least beneficial in preventing rehospitalization.
Although relatively uncommon, Guillain-Barré syndrome remains the most frequent cause of sudden weakness in persons under the age of 40 years. While most patients enjoy spontaneous resolution of their neurologic deficits, death still occurs in some individuals who suffer secondary complications from profound respiratory muscle weakness. This review of patients with ascending paralysis who required intubation and mechanical ventilation underscores that the major factors which contribute to death and morbidity can be anticipated and largely avoided using a vigilant multidisciplinary approach.
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Of 80 patients who initiated in vitro fertilization cycles in an integrated outpatient facility, 61 had oocyte retrievals performed under local anesthesia with ultrasound-guided transvaginal aspiration of ovarian follicles. Ten patients conceived, all in the group of 49 who had human chorionic gonadotropin (hCG)-timed retrievals. Our results indicate that in vitro fertilization can be performed to a high standard with this method, with excellent patient acceptance and reduced cost without general anesthesia, laparoscopy, or in-hospital setting.
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The stability of a preparation of lyophilised serum and its suitability for use as a reference material for routine assays of cortisol, oestradiol, and progesterone have been studied in four laboratories with a variety of assay systems. Cortisol and oestradiol were also measured by gas chromatography-mass spectrometry. The lyophilised serum was suitable for use in all routine and reference assay methods examined, with between-method variability no greater than that for frozen serum pools. The concentrations of cortisol, oestradiol, and progesterone were predicted by accelerated degradation studies to decline by 0.01% per annum if the preparations were to be stored at --20 degrees C. The testosterone content of the preparation, determined in one laboratory, provided no evidence for degradation. The preparation can be shipped for use at ambient temperature without deleterious effect.
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1. Low birthweight is now recognized as an important risk factor for early postnatal respiratory illness and it is becoming evident that low birthweight can increase the risk for airway dysfunction in children and adults. Our studies have been aimed at determining how low birthweight, resulting from intra-uterine growth restriction (IUGR), affects the control of breathing and the structural and functional development of the lung. 2. We have measured ventilatory responsiveness to progressive hypoxia and progressive hypercapnia during the first weeks after birth in postnatal lambs in which IUGR was induced by chronic placental insufficiency. It was found that the postnatal increase in ventilatory sensitivity to hypoxia observed in control lambs was diminished in low birthweight lambs; in contrast, the sensitivity to hypercapnia was not affected. In other studies, we found that IUGR caused by maternal anaemia led to elevated CO2 levels during sleep and wakefulness. 3. Our findings suggest that the prenatal development of the brain-stem or respiratory chemoreceptors may be affected by intra-uterine factors associated with IUGR, such as foetal hypoxaemia or hypoglycaemia. It is also possible that the structure of respiratory muscles and, hence, their ability to maintain a high level of ventilation may be affected by IUGR. 4. Recently, we studied the influence of IUGR on foetal lung development, in particular its effects on foetal lung liquid, a major determinant of lung growth, as well as alveolar structure and pulmonary surfactant. Lung liquid secretion and volume, in relation to bodyweight, were unaffected; however, there was evidence of structural and functional immaturity in the lungs. In foetuses exposed to IUGR, the air-blood barrier was thicker and, after birth, the diffusing capacity of the lungs for carbon monoxide was lower. In contrast, surfactant protein gene expression was enhanced, particularly in foetuses with high levels of circulating cortisol. 5. Further studies are needed to characterize the effects of specific types of prenatal compromise on postnatal control of ventilation and lung function, to determine mechanisms underlying these effects and to determine the capacity for postnatal recovery.
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