Lack of disease transmission using donors with fatal encephalitis.
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Adolescent↗
Biomedical subjects
B Kelly
Publications and source records attributed to B Kelly.
Penetration of cryotherapy in treatment after shoulder arthroscopy.
Fifteen patients undergoing shoulder arthroscopy had indwelling temperature probes placed in the glenohumeral and subacromial spaces. All shoulders underwent diagnostic arthroscopy and debridement of the subacromial space. Cryotherapy was delivered to the shoulder via a Cryo/Cuff (AirCast, Summit, NJ) and temperatures were monitored for 90 minutes. Ten shoulders received cryotherapy and 5 were used as controls. Before cryotherapy, temperature averaged 34 degrees C in the glenohumeral joint and 31 degrees C in the subacromial space. No significant difference was seen between the temperatures recorded in the cold therapy and control groups for either the glenohumeral or subacromial space. In all cases, the subacromial space averaged 1 degree cooler than the glenohumeral joint at the conclusions of arthroscopy. These slowly equalized to an average of 35 degrees postoperatively. The present study shows that surface-applied cryotherapy does not penetrate either the glenohumeral joint or the subacromial space. Attention must be turned elsewhere to delineate how cryotherapy works.
Adult↗
A Native American community initiative to prevent diabetes.
The increasing prevalence of obesity and diabetes in the Mohawk Community of Akwesasne led to the formation of an advisory group who's mission was to increase community awareness and strengthen the infrastructure necessary to create a community coalition to promote healthy lifestyles. The methodology used to reach these goals included: obtaining an understanding of the community's knowledge, attitudes and behaviors about diabetes, diet and exercise using semi-structured interviews and focus groups; analyzing data from a case control study of diabetes and it complications using a medical record review; exploring methods for evaluating energy expenditure in children; and identifying influential community members and organizations. In the last 50 years people had become less physically active and high fat, high caloric foods were more available. Community members were concerned about health and the well-being of their children, had knowledge about healthy lifestyles but lacked confidence and social support for bringing about desired changes. A strong association was documented between diabetes, smoking cigarettes, high blood cholesterol and vascular disease in this community. Approximately 100 persons participated, several hundred received the results in presentations to 17 community organizations, two public fora, letters to participants and articles in local newspapers. Fifty persons and 29 businesses or organizations regarded as strong advocates of healthy lifestyles were identified. From these a community coalition was formed and has initiated programs to reduce dietary fat and increase physical activity in young children.
Adult↗
Impact of the in-house trauma surgeon on initial patient care, outcome, and cost.
BACKGROUND: The purpose of this study is to evaluate the effect of having attending trauma surgeons with added qualifications in surgical critical care present for the initial resuscitation at a regional trauma center. METHODS: This study is a retrospective review of patients admitted between August of 1994 and December of 1995 from our trauma registry. The patients were categorized by the call preference of the admitting physician as in-house (IH) or call-back from home (CB), day of admission (weekend vs. weekday), time of admission (AM VS. PM), and a value of the injury severity scale < or = 15 or > 15. Demographics, admission vital signs, Injury Severity Scale, Glasgow Coma Score, and elapsed time to diagnostic, therapeutic, and/or operative interventions were studied. The effect on intensive care unit length of stay, mortality, and hospital cost for resuscitation were also studied. RESULTS: The study population consisted of 1,043 patients. The IH and CB groups each included two attending surgeons. IH significantly reduced the average time to completion of diagnostic peritoneal lavage (22 vs. 34 minutes; p < 0.05), therapeutic intervention (21 vs 38 minutes; p < 0.05), and transport to the operating room (206 vs. 312 minutes; p < 0.05) during the AM compared with CB. There was no difference in these times for the PM admissions. There was no significant difference in intensive care unit length of stay. Among patients with severe head and thoracoabdominal injury (Abbreviated Injury Score > 4 and 3, respectively) there was no difference in mortality. Analysis of cost for emergency room resuscitation in severely injured patients (Injury Severity Score > or = 15), seen during weekdays, was significantly less when evaluated by IH (IH = $5,097 vs. CB = $6,779; p < 0.05). CONCLUSIONS: During the initial resuscitation of patients with severely injured during the weekdays, IH significantly reduced the cost, and elapsed time to diagnostic testing, therapeutic intervention, and to the operating room, respectively. IH reduced fatalities compared with CB.
Adult↗
Interview with Bonnie Kelly. Interview by Robin K. Levinson.
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Aged↗
Do general practitioners and community pharmacists want information on the reasons for drug therapy changes implemented by secondary care?
BACKGROUND: The content of discharge prescriptions/summaries to improve communication about medication provided at discharge has been the subject of recent studies. To date, the authors are not aware of any literature that assesses the need for primary care health professionals to receive information on reasons for drug therapy changes incurred during hospital admission. Owing to increased emphasis on seamless care, patient education, and increased accountability for drug costs, general practitioners (GPs) and community pharmacists may consider the receipt of information on the reasons for drug therapy changes incurred during hospital admission to be an essential requirement. AIM: To determine whether GPs and community pharmacists want, and receive, information on the reasons for drug therapy changes implemented by secondary care. The preferred method of acquiring this information is also investigated. METHOD: A questionnaire was posted to all GPs and community pharmacists within the catchment area of Glasgow Royal Infirmary University NHS Trust. Data were collected between June 1995 and July 1995. RESULTS: Replies were received from 71 (64%) GPs and 33 (80%) community pharmacists. Of the respondents, 96% of GPs and 94% of community pharmacists would like information on one or more reason types for drug therapy changes, but the majority do not receive the desired information. Ninety per cent of GPs and 85% of community pharmacists seek this information of facilitate continuity of patient care. The preferred method of receiving the information is by postal delivery via a modified hospital discharge prescription. CONCLUSION: The existing hospital discharge prescription requires modification to facilitate the completion of the reasons for drug therapy changes. The issue of patient-held cards requires consideration. These factors may facilitate continuity of patient care on hospital discharge.
Attitude of Health Personnel↗
Hospital nursing: 'it's a battle!' A follow-up study of English graduate nurses.
The purpose of this follow-up study, conducted 4 years after the initial study, was to elicit the recollections of English graduate nurses regarding their first year as qualified nurses in hospital nursing. The method was qualitative, specifically a grounded theory approach was used. The design was retrospective. The initial study took place when informants were in their final year before graduation. The follow-up study began after informants had been practising for between 3 and 4 years. Data were collected through semi-structured, in-depth, audio-taped interviews and were analysed through the constant comparative classification of patterns and themes. Research questions were: 'what do graduates nurses recall about their first year of practice in hospital nursing?' and 'what do they perceive as the difficulties of maintaining their standards?' Findings revealed the core variable as role stress. The stressful experience of living up to their individual perceptions of the role of being a graduate nurses was related to the influence of educational socialization, self-expectations, and nursing management expectations.
Adaptation, Psychological↗
A comparison of the psychosocial aspects of AIDS and cancer-related bereavement.
OBJECTIVE: This study compares the psychological symptoms and bereavement distress of individuals bereaved by AIDS with a group bereaved by a cancer death, and addresses the question of whether an AIDS death is associated with a higher rate of adverse psychosocial factors that may increase risk of psychological morbidity in the bereaved individuals. METHOD: AIDS (n = 28) and cancer (n = 30) bereaved individuals (all within 3 months of the bereavement) completed measures of psychological morbidity and measures addressing a range of other adverse factors, e.g., number of losses, levels of social support and stigma. RESULTS: The cancer and AIDS bereaved were essentially similar on all psychological symptom measures. The AIDS group reported lower levels of social support in response to the bereavement than cancer bereaved individuals; a greater number of bereavements, were more likely to conceal the cause of death from significant others including their own family and perceived, in some instances, a greater level of rejection from others. The AIDS group reported higher levels of social support from friends than from family. CONCLUSIONS: At three months following bereavement, AIDS and cancer bereaved were similar in levels of distress. While this may change with the progress of grief over time, it suggests essentially similar early bereavement responses. Those bereaved by AIDS reported a range of other adverse factors such as a greater number of losses, lower social support, stigma, and less open disclosure of the cause of death.
Acquired Immunodeficiency Syndrome↗
Cost-containment strategies in transplantation: the utility of cyclosporine-ketoconazole combination therapy.
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Adolescent↗
Ethics and health in a changing world.
Seven advisers from a wide variety of health-related professions met with some 30 staff at WHO to discuss ethical issues currently arising in health and international cooperation. Far-reaching questions of responsibility and legitimacy were raised. The following observations are adapted from the final report on the meeting.
Ethics↗
Comparative skin phototoxicity in mice with two photosensitizing drugs: benzoporphyrin derivative monoacid ring A and porfimer sodium (Photofrin).
Benzoporphyrin derivative monoacid ring A (BPD-MA) and Photofrin (porfimer sodium) are photodynamic anticancer agents. The chemical structures of the two regioisomers of BPD-MA are 9-methyl trans-(+/-)-18-ethenyl-4,4 alpha-dihydro-3,4- bis(methoxycarbonyl)-4 alpha, 8,14,19-tetramethyl-4,4 alpha-dihydro-3,4- bis(methoxycarbonyl)-4 alpha, 8,14,19-tetramethyl-23H,25H-benzo(b)porphine- 9,13-dipropanoate and 13-methyl-trans-(+/-)-18-ethenyl-4,4 alpha-dihydro-3,4- bis(methoxycarbonyl)-4 alpha, 8,14,19-tetramethyl-23H,25H-benzo(b)porphine- 9,13-dipropanoate. Photofrin (a registered trademark of American Cyanamid Co.) is a polyporphrin oligomer containing ester and ether linkages. The ability of BPD-MA or Photofrin to cause skin phototoxicity was investigated in mice exposed to simulated sunlight (light) 3, 24, or 48 hr after receiving a single intravenous injection of vehicle or 2, 10, or 20 mg/kg of BPD-MA or Photofrin. The data were from two studies conducted using male and female CD1 mice (approximately 7 weeks old). The hair of the dorsal thoracic area was clipped 24 hr prior to exposure to light. Mice were exposed to light for 5 min. The clipped area of skin was the primary site for the evaluation of phototoxicity. Mice were observed for 2 weeks after treatment. There were no significant findings in controls or in mice given 2 mg/kg of BPD-MA. When mice were exposed to light 3 hr after dosing, both BPD-MA (10 or 20 mg/kg) and Photofrin (2, 10 or 20 mg/kg) caused phototoxicity. Death occurred in all mice given 20 mg/kg of BPD-MA or Photofrin, and in the majority of mice given 10 mg/kg of Photofrin.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Psychological responses to malignant melanoma. An investigation of traumatic stress reactions to life-threatening illness.
A cross-sectional study of 95 individuals with malignant melanoma was conducted to investigate posttraumatic stress responses to a diagnosis of melanoma and to validate the use of the Impact of Event Scale (IES) as a measure of the response to the trauma of life-threatening disease. The diagnosis and progression of malignant disease are likely to present a range of acute and chronic trauma to the individual and the individual's family. The findings suggest that the IES is a reliable and valid measure of this distress, with scores varying according to disease progression and prognostic status of nonmetastatic disease patients. This indicates the importance of clinical attention to the specific symptoms that may best reflect the traumatic impact of life-threatening illness and its progression, and the applicability of posttraumatic stress syndromes in understanding the psychological distress of this clinical population.
Adult↗
Quality of life in chronic fatigue syndrome.
Whilst the debilitating fatigue experienced in patients suffering from Chronic Fatigue Syndrome (CFS) results in a subjective marked impairment in functioning, little research has investigated the impact of this disorder on quality of life. Forty-seven subjects with a confirmed diagnosis of CFS and 30 healthy controls were compared using the Sickness Impact Profile (SIP). A subgroup of subjects were interviewed regarding the impact CFS has had on their social and family relationships, work and recreational activities. Results from both the SIP and the interview revealed that CFS subjects had significantly impaired quality of life, especially in areas of social functioning. These findings highlight the importance of addressing the social isolation and loss of role functioning experienced by CFS sufferers.
Adaptation, Psychological↗
Tropical aquaria water and diarrhoea.
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Animals↗
The Howard University Hospital Transplant and Dialysis Support Group: twenty years and going strong.
This article discusses group therapy as part of a multidisciplinary approach to the management of the various psychological and physical rehabilitation concerns posed by kidney and liver transplant candidates and recipients at Howard University Hospital in Washington, DC. The group's history, format, intervention foci, and roles of clinicians and patients attending the group are described and evaluated. Given the relative paucity of research literature in this area, the authors offer recommendations for empirical evaluation of the benefits of multidisciplinary group psychotherapy in ameliorating physical and emotional suffering and prolonging life among transplant patients.
Humans↗
Cultural factors in dialysis and renal transplantation among aborigines and Torres Strait Islanders in north Queensland.
Australian Aborigines experience end-stage renal disease at 10 times the national average. Although contributing physiological factors have been widely discussed, there has been little research into cultural factors affecting treatment and outcomes. This paper discusses folk and lay understandings of renal physiology and disease aetiology, and social and cultural factors in dialysis and transplantation, in a group of Aboriginal and Torres Strait Island renal transplant recipients. The implications for service delivery include the need for improved and clear information regarding renal disease and treatment and for culturally appropriate and acceptable support systems. Beliefs that continued alcohol consumption and poor nutrition were major reasons for kidney failure and separation from kin and country emerged as significant factors affecting treatment and leading to poor outcomes.
Cultural Characteristics↗
Severe psittacosis during pregnancy and suppression of antibody response with early therapy.
A cluster of 3 cases of psittacosis occurred among members of one family. The initial case was a pregnant woman who presented with extensive multilobar infiltrates and severe respiratory distress necessitating mechanical ventilation. Her respiratory failure worsened during 36 h of erythromycin therapy. Improvement coincided with the termination of pregnancy and the initiation of doxycycline treatment. The remaining patients developed milder illness. Serologic assessment of the affected subjects suggests that early treatment may suppress antibody response.
Adolescent↗