Biomedical subjects

B L Chang

Publications and source records attributed to B L Chang.

At least 19 recordsLinked to original sources

PubMed2001

Human gingival and pulpal blood flow during healing after Le Fort I osteotomy.

PURPOSE: The occurrence of a hypervascular period during healing after orthognathic surgery has not been investigated rigorously in human pulpal and gingival tissues. This study used laser Doppler flowmetry to investigate the effects of Le Fort I osteotomy on maxillary pulpal and gingival blood flow between the first and third week after surgery. PATIENTS AND METHODS: Pulpal blood flow was recorded in maxillary incisors, and gingival blood flow was assessed from a site slightly apical to the interdental papilla of the maxillary central incisors in 10 patients who were undergoing a Le Fort I osteotomy, 10 patients who were undergoing a mandibular osteotomy, and 10 nonsurgical control subjects who were not undergoing orthodontic treatment. Blood flow measurements were made before surgery and at intervals between 7 and 10 days, 14 and 17 days, and 21 and 24 days after surgery. The nonsurgical control subjects were tested at similar intervals. RESULTS: Baseline gingival and pulpal blood flow values did not differ significantly for the 3 groups. In addition, gingival and pulpal blood flow did not change in the nonsurgical control group. Analysis of the postsurgical change from baseline blood flow values indicated a significant increase in pulpal blood flow in the maxillary surgery patients relative to the patients treated with mandibular surgery. However, no significant group difference was found for gingival blood flow. CONCLUSIONS: This study provides evidence that pulpal blood flow is increased between the first and third week after Le Fort I osteotomy, but it did not find a significant change in gingival blood flow.

Adult↗

PubMed2001

Effect of ADCON-L on adjustable strabismus surgery in rabbits.

BACKGROUND/AIMS: In search of a way to prevent postoperative adhesion after strabismus surgery, an animal study was performed to assess the effect of a gel consisting of a polyglycan ester in a gelatin matrix (ADCON-L). METHODS: Bilateral recessions of superior rectus muscle (SR) were performed on 16 rabbits. ADCON-L was applied beneath and over the SR in the right eyes of all rabbits, while the operative fields in the left eyes were irrigated with a balanced salt solution (BSS). The adjustment was performed on each SR at 4 and 7 days postoperatively on the same eye. The length and force of the adjustment and the degree of adhesion were recorded. At 3 weeks postoperatively, disinsertional force was measured in several of the eyes, and the other eyes were enucleated. RESULTS: The length of the adjustment was longer and the force of the adjustment was less in the ADCON-L group than in the BSS treated group at 4 and 7 days postoperatively (p=0.00). A significant reduction (p=0.00) in the degree of adhesion was noted in eyes treated with ADCON-L. There was no significant difference in disinsertional force between the two groups. Histopathological evaluation of the muscle revealed decreased fibrosis of perimuscular connective tissue in eyes treated with ADCON-L at 3 weeks postoperatively. CONCLUSION: This study suggests that ADCON-L helps to prevent postoperative adhesion in rabbits and enables adjustment twice within 7 days postoperatively without complications.

Animals↗

PubMed2001

Can telehealth technology be used for the education of health professionals?

The purpose of this report is to describe the usefulness and desirability of using telehealth technology in the education of health care professionals. The PC-compatible, Windows-based system allowed for both real-time videoconferencing and store-and-forward (sending information from one site and stored at a distant site for access at a later time) functions. Student responses indicated that they thought they would benefit from this type of technology in their clinical education. They were most positive with respect to increasing access to a wider range of clients they may not otherwise access and least positive for the ability to learn from a televideo interaction when compared with a clinic experience. Similarly, faculty were least interested in using videoconferencing for patient rounds and more interested in using telehealth to enhance classroom presentations.

Attitude of Health Personnel↗

PubMed2001

Predictors of social support and caregiver outcomes.

PURPOSE: This study identified predictors of caregiver's burden, satisfaction, depression, and social support. Little has been done to identify predictors of social support for caregivers at risk for negative outcomes. DESIGN: Correlational descriptive study. METHODS: A subset of interview data from a larger intervention study was utilized. Independent variables were caregiver/care-recipient characteristics and social support. Dependent variables included caregiver burden, satisfaction, depression, anxiety, and hostility. RESULTS: Eighty-one caregiver/care-recipient dyads from the community participated in this study. Caregivers were women with a mean age of 67.53 years (range 39-86). Difficulty arranging assistance from confidante or friends correlated significantly and positively with caregiver burden (r = .38; p <.001) and depression (r = .34; p = .002), and negatively with satisfaction (r = -.28; p = .013). FINDINGS/IMPLICATIONS: Arranging assistance is more important than frequency of social network contact with respect to burden and depression. The findings indicate a need for further investigation and the consideration of interventions for at risk caregivers.

Adult↗

PubMed2001

Consumer satisfaction with telehealth advice-nursing.

An increase in interest in the establishment of telephone advice services has resulted in the proliferation of call centers. Despite their wide usage, research for the most part has not addressed the quality of care in relation to consumer satisfaction. This paper examines consumer outcomes of satisfaction, and follow-up with recommendations, within a framework of the nursing process and its associated components of assessment (including problem identification), care planning, intervention, and evaluation. The data for the study were obtained from seven after-hours call centers operating under the auspices of health maintenance organizations, preferred provider organizations, and private insurance companies. A sample of 157 non-redundant telephone calls from adults with medical-surgical problems were audiotaped with providers' and callers' consent. Sociodemographic information of the advice nurses, and chief complaints of the callers were obtained. The quality of nursing of the audiotaped calls was rated through an implicit review method by registered nurse raters using an advice nurse structured implicit review (AN-SIR) form developed for the study. Follow-up information was obtained through telephone calls to ascertain the consumers' perceptions of satisfaction, helpfulness, and follow-through with recommendations. Results indicated that consumers calling with a variety of general complaints contacted 32 nurses in advice nurse call centers. The quality of nursing process was found to be the best in the area of intervention. Evaluation was also well above the midpoint on a transformed scale of zero to 100. Assessment, although slightly above midpoint, was the lowest of the three components of the nursing process examined. Consumer satisfaction was high with 95.4 percent of the consumers rating the calls as completely or at least somewhat satisfied, and 93.2 percent, stating the advice was very or somewhat helpful. Exploratory regression analysis showed that the component of intervention was significantly related to consumer satisfaction. The present study pioneers the way to rate the quality of the advice nurses' interactions with consumers, and lays the groundwork for further investigations of health care provider behavior and consumer outcomes. Further studies are recommended to investigate predictors of consumer satisfaction, and cost-benefit in terms of consumer expenditures of time, funds, and energy.

Adult↗

PubMed2001

Consumer health informatics: a consensus description and commentary from American Medical Informatics Association members.

BACKGROUND: Although interest in Consumer Health Informatics (CHI) has increased, a consensus definition of CHI does not yet exist. PURPOSE: To conduct a hypothesis-generating survey of AMIA members regarding definition and research agenda for CHI. METHODS: We solicited participation among AMIA members in an Internet-based survey focusing on issues related to a definition of CHI. RESULTS: One hundred thirty-five AMIA members responded. Participants indicated a broad spectrum of topics important to CHI including "self-help for disease management" and "patient access to their own medical records." CHI research was felt to rely heavily on public health methods such as epidemiology and outcomes research, a paradigm shift from traditional medical informatics. Responses indicated a perceived lack of funding and need for further research in CHI. CONCLUSIONS: A working definition should emphasize the multidisciplinary nature of CHI, include consumer input into CHI design, and focus on public health approaches to evaluation.

Community Participation↗

PubMed2000

Surgical management of congenital cataract associated with severe microphthalmos.

PURPOSE: To report the results of cataract surgery in children with severe microphthalmos and congenital cataract. SETTING: Seoul National University, Department of Ophthalmology, Seoul, Korea. METHODS: Retrospective studies were conducted by reviewing the charts of 20 eyes of 11 patients with severe microcornea and microphthalmos or severe microcornea with a corneal diameter smaller than 9.0 mm. The patient pool was divided according to surgical method, specifically by incision site: an anterior group that had corneal limbal incisions and a posterior group treated via pars plicata incisions. Preoperative examinations included bilaterality, corneal diameter, axial length, and eye and systemic abnormalities. Postoperative results and complications of the 2 operative methods were compared. RESULTS: All 11 patients had bilateral congenital cataract and microphthalmos. Except in 1 case, surgeries were done in patients ranging in age from 2 to 16 months. Mean follow-up was 2 years. Corneal diameter was smaller than 9.0 mm in all 20 eyes and smaller than 7.5 mm in 11 eyes. Ten eyes were categorized into the anterior group, and the other 10 eyes were placed in the posterior group. Postoperative complications included secondary membranes in 3 eyes in the posterior group and corneal opacity in 3 eyes in the anterior group. CONCLUSION: The surgical management of children with congenital cataract and severe microphthalmos is recommended as a way to improve vision but must be performed carefully to avoid complications.

Abnormalities, Multiple↗

PubMed2000

Urinary excretion of codeine and morphine following the administration of codeine-containing cold syrup.

The concentrations of codeine ([C]) and morphine ([M]) excreted in urine obtained from nine subjects at various time intervals after the ingestion of 10-40 mg of both simple and compound codeine doses three times per day for three days were determined by gas chromatography-mass spectrometry analysis. Four distinct [C]/[M] distribution patterns (phases) were observed: a, [C] > [M] from ingestion of first dose to 78-108 h after ingestion of the first dose (18-48 h after the ingestion of the last dose); b, [C] approximately [M] 78-90 h after ingestion of the first dose (18-30 h after ingestion of the last dose); c, [C] < [M] 78-102 h after ingestion of first dose (18-42 h after ingestion of the last dose); and d, [C] <0.05 microg/mL and [M] > 0.05 microg/mL 84-96 h after ingestion of the first dose (24-36 h after ingestion of the last dose with [M] ranging from 0.10 to 0.30 microg/mL) toward the terminal phase. No single individual exhibited all four [C]/[M] distribution characteristics during the entire excretion period and intervals monitored in this study. These data are of reference value for differentiating codeine and morphine/heroin ingestion.

Analgesics, Opioid↗

PubMed2000

Total morphine stability in urine specimens stored under various conditions.

The stability of total morphine in urine stored under various conditions was studied using control and experimental specimens. Samples in the control group were prepared using drug-free urine spiked with morphine at three concentration levels (300, 1000, and 2500 ng/mL), each with the pH adjusted to 5.5, 6.5, and 7.5. Samples in the experimental group came from 20 alleged heroin addicts (provided by Taipei Municipal Psychiatric Hospital). Samples in both groups were divided into two categories--one with and one without the precipitate (formed at 0 degrees C) removed. Samples in each of these two categories were further divided into two sub-groups--one with and one without sodium azide (0.05%) added. Total morphine contents in these samples were first determined by gas chromatography-mass spectrometry prior to storage and at 6, 12, 18, and 24 months following storage at -20, 4, 25, and 35 degrees C. Effects of sample treatment (azide addition and precipitate removal), pH, and storage temperature and length were evaluated by examining the percentage of total morphine remaining at the four time intervals following the initial determination. Major findings were as follows: (1) total morphine decomposition was minimal when stored for 12 months at -20 degrees C, which is a common current practice; (2) samples with lower initial sample pH had slower total morphine decomposition rates; and (3) azide addition appeared to have no detectable effect, whereas precipitate removal appeared to marginally reduce the decomposition rate, especially for samples with lower pH.

Drug Stability↗

PubMed2000

Colon cancer screening among older women caregivers.

UNLABELLED: Colorectal cancers are common causes of morbidity and mortality among women in the United States. Many of these deaths are unnecessary because of the availability of effective early detection methods. The demands of caregiving may limit older women's participation in screening. The purposes of this exploratory study were to describe the participation in colorectal cancer screening of older women (n = 52; mean age 65 years) who were the primary caregivers for an ill spouse or parent, and to investigate the relationship of the caregiving burden and perceptions of health to participation in recommended colorectal cancer screening tests. RESULTS: Only 36% of the older women (n = 16) had been screened with both fecal occult blood testing (FOBT) and sigmoidoscopy. A number of women had never participated in colorectal cancer screening: 10 (21%) had never undergone FOBT and 22 (47%) had never undergone sigmoidoscopy. Only 20% (n = 9) had received all of the recommended cancer screening tests: mammogram, Papanicalaou smear, FOBT, and sigmoidoscopy. Those who did not participate in cancer screening with sigmoidoscopy had significantly worse health perceptions than those who did participate. Caregiver burden was not significantly associated with differences in cancer screening participation. Only 14 of these older women felt that they would have a good chance of survival if they received a diagnosis of colon cancer. Further research is needed to investigate strategies to increase participation of older women in colon cancer screening.

Aged↗

PubMed2000

Sleep and depression in cancer caregivers.

A cross-sectional, correlational design was used to describe and explore the relation between caregiver sleep and depression. For the study, 51 caregivers were recruited from two sites in southern California. Caregivers were primarily white (84%), female (80%), spouses (61%), or adult children (29%), who had provided care for a mean of 16 hours per day for an average of 2 years. The Center for Epidemiological Studies-Depression (CES-D)and the Pittsburgh Sleep Quality Index (PSQI) were used to measure caregiver depression and sleep, respectively. Most of the caregivers (95%) expressed severe sleep problems, and more than half of them were experiencing depressive symptoms at a level that would suggest risk for clinical depression. Correlations were strongest between caregiver depression and the sleep subscales of overall quality (r = 0.70; p < 0.001), habitual sleep efficiency (r = 0.54; p < 0.001), and daytime dysfunction (r = 0.59; p < 0.001). The final regression model, which included these subscales, predicted 63.6% of the variance in depression scores (F = 27.32; p < 0.001). These findings, which are consistent with results from other studies, suggest that caregivers of persons with terminal illness are at risk for clinical depression. It is critical for nurses to be cognizant of the relation between sleep problems and depression, and to explore interventions that would allow the caregivers to obtain needed sleep without diminishing their ability to function in their role as caregiver.

Adult↗

PubMed2000

Structured implicit review: a new method for monitoring nursing care quality.

BACKGROUND: Nurses' independent decisions about assessment, treatment, and nursing interventions for hospitalized patients are important determinants of quality of care. Physician peer implicit review of medical records has been central to Medicare quality management and is considered the gold standard for reviewing physician care, but peer implicit review of nursing processes of care has not received similar attention. OBJECTIVE: The objective of this study was to develop and evaluate nurse structured implicit review (SIR) methods. RESEARCH DESIGN: We developed SIR instruments for rating the quality of inpatient nursing care for congestive heart failure (CHF) and cerebrovascular accident (CVA). Nurse reviewers used the SIR form to rate a nationally representative sample of randomly selected medical records for each disease from 297 acute care hospitals in 5 states (collected by the RAND-HCFA Prospective Payment System study). SUBJECTS: The study subjects were elderly Medicare inpatients with CHF (n = 291) or CVA (n = 283). MEASURES: We developed and tested scales reflecting domains of nursing process, evaluated interrater and interitem reliability, and assessed the extent to which items and scales predicted overall ratings of the quality of nursing care. RESULTS: Interrater reliability for 14 of 16 scales (CHF) or 10 of 16 scales (CVA) was > or = 0.40. Interitem reliability was > 0.80 for all but 1 scale (both diseases). Functional Assessment, Physical Assessment, and Medication Tracking ratings were the strongest predictors of overall nursing quality ratings (P < 0.001 for each). CONCLUSIONS: Nurse peer review with SIR has adequate interrater and excellent scale reliabilities and can be a valuable tool for assessing nurse performance.

Aged↗

PubMed1999

Simultaneous high-performance liquid chromatographic analysis for famotidine, ranitidine HCl, cimetidine, and nizatidine in commercial products.

A high-performance liquid chromatographic (HPLC) procedure for the simultaneous determination of famotidine (FMT), ranitidine HCl (RNT), cimetidine (CMT), and nizatidine (NZT) was developed using a two-level, full-factorial design with three variables (volume of methanol, percentage of triethylamine, and concentration of phosphate buffer) to select an acceptable mobile phase. A column (15 cm x 4.6 mm ID) of Inertsil ODS-2 (5 microns) was used, and 0.04 M aqueous sodium dihydrogen phosphate/acetonitrile/methanol/TEA at a proportion of 345/20/35/0.7 (v/v/v/v) was the selected mobile phase (1 ml/min). The detection wavelength was set at 230 nm, and procaine HCl was used as the internal standard. Precision and linearity of the method were assessed. None of the commercial samples was found to be outside the compendial limits of 90.0% to 110.0% of the claim amount.

Algorithms↗

PubMed1999

Effect of diode laser trans-scleral cyclophotocoagulation in the management of glaucoma after intravitreal silicone oil injection for complicated retinal detachments.

AIMS: To evaluate the effect of trans scleral cyclophotocoagulation (TSCPC) on intraocular pressure (IOP) in the eyes retaining intravitreal silicone oil with medically uncontrolled secondary glaucoma following intravitreal silicone oil injection. METHODS: Medical records of 11 eyes of 11 patients who underwent TSCPC for medically uncontrolled glaucoma without pupillary block following intravitreal silicone oil injection for complicated retinal detachment were reviewed retrospectively. In all cases, intravitreal silicone oil was not removed for fear of retinal redetachment. Diode laser contact TSCPC was performed at a power of 1.5-2.5 W, for a duration of 2 seconds, and with 20-27 applications. IOP, number of glaucoma medications, and success rate were evaluated. RESULTS: After a mean follow up period of 52.5 (SD 8.2) (range 42-68) weeks, the mean pretreatment level of IOP, 43.0 (14.4) (26-67) mmHg, had fallen to 14.5 (4.3) (7-20) mm Hg (p=0.003). The number of glaucoma medications was reduced from 2.6 (0.8) to 0.6 (1.0) (p= 0.005). Qualified success was achieved in nine eyes (81.8%) and complete success in six (54.5%). After TSCPC, patients' retinal status had not changed. CONCLUSION: Patients with medically uncontrolled glaucoma secondary to intravitreal silicone oil injection can be treated with TSCPC in spite of the retained intravitreal silicone oil.

Adult↗

PubMed1999

Combined effect of Interceed and 5-fluorouracil on delayed adjustable strabismus surgery.

AIMS/BACKGROUND: To discover a more reliable method of performing delayed suture adjustment as a basis to investigate whether delayed adjustment actually provides more stable results. In order to prevent the formation of postoperative adhesions and delay the time of adjustment, an animal study was performed to determine the combined effect of physical barriers, Viscoat and Interceed, and a pharmacological agent, 5-fluorouracil (5-FU). METHODS: 38 rabbit eyes were divided into three groups. After recession of the superior rectus muscle (SRM), 5-FU was applied beneath and over the SRM in group 5-FU. Group I-f had Interceed and 5-FU and group I-fv, Interceed, 5-FU, and Viscoat. Delayed adjustment was performed once on each SRM at 1, 2, and 3 weeks postoperatively. The possible length and the necessary force to adjust as well as the degree of adhesions were recorded. RESULTS: 5-FU delayed the adjustment for up to 1 week after surgery in three out of four eyes. Combined use of Interceed and 5-FU could delay the adjustment for up to 1 week after surgery in three out of five eyes. Addition of Viscoat could delay the adjustment for up to 1 week after surgery in four out of five eyes. Adjustment was possible on only one of four eyes thereafter. CONCLUSIONS: Combined use of Interceed, 5-FU, and Viscoat could delay the adjustment in rabbits until 1 week postoperatively.

Adaptation, Physiological↗

PubMed1999

A typology of consumers of institutional respite care.

In this descriptive ethnography, a typology of consumers of institutional respite care and phases of respite care were formulated from the data collected over a 1-year period at a 24-bed hospital-based skilled nursing facility in the western United States. The sample was drawn from facility billing records, which verified the type of care under the term respite care. Using anthropological fieldwork methods, data were obtained from 14 caregiving dyads plus two care recipients who did not have family caregivers. The identified caregiver categories were depletion, maintenance, caregiver surgery or illness, and no available family caregiver. Phases of respite care provided information regarding the caregivers' experience in the process of decision making, transitioning to time away from the care recipient, and postrespite adjustment. This model has implications for the structure and process of respite care design and decision making. This may provide a promising avenue in the respite care research arena.

Aged↗

PubMed1999

Scleral perforation after scleral buckling surgery for retinopathy of prematurity.

Scleral perforation occurred as a result of using a silicone band during scleral buckling surgery for subtotal retinal detachment in retinopathy of prematurity (ROP). The patient was initially treated by cryotherapy and scleral buckling surgery for ROP, and was later referred due to a dark bluish mass in the superotemporal quadrant of the eyeball. After removing the overlying whitish membrane, uveal tissue prolapsed through the melted scleral wound (5 mm x 5 mm). A silicone encircling band had passed through the wound and was exposed subconjunctivally around the temporal and the inferior limbus. The band was removed and a scleral allograft was performed. After three years, follow up revealed the eyeball was slightly microphthalmic. Though scleral bucking surgery is helpful for the treatment of advanced ROP, a scleral perforation may develop as a disastrous complication.

Female↗

PubMed1999

The effect of mitomycin-C on the healing process in rabbit extraocular muscle surgery.

BACKGROUND AND OBJECTIVE: One of the most serious complications following extraocular muscle surgery is formation of postoperative adhesions that may result in restrictive ocular motility dysfunction. The effect of mitomycin-C (MMC) on postoperative wound healing in extraocular muscle surgery was investigated. MATERIALS AND METHODS: Sixteen albino rabbits (24 eyes) were used and anesthetized with ketamine and xylazine. These rabbits were divided into 3 groups; (1) control group (balanced salt solution (BSS) exposure for 5 minutes), (2) Group 1 (0.5 mg/ml MMC exposure for 1 minute) and (3) Group 2 (0.5 mg/ml MMC exposure for 5 minutes). After 3 mm recession of superior rectus muscle, MMC or BSS was applied using Weck-Cel sponge (Solan, Jacksonville, FL). The reduction of fibroblast and collagen fiber proliferation were evaluated histopathologically with light microscope at 1, 2, 4 and 8 weeks after operation. We also evaluated the amount of basic fibroblast growth factor (bFGF) by immunohistochemical study at the same time. RESULTS: Histopathologically, there was a more significant reduction of fibroblast and collagen fiber proliferation in Group 1 and 2 than the control group. Immunohistochemically, Group 1 and 2 showed lesser expression of bFGF than the control group. But, there was no difference between Group 1 and 2. CONCLUSIONS: Topical intraoperative application of mitomycin C in extraocular muscle surgery may reduce postoperative adhesions.

Animals↗