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Biomedical subjects

B Pierce

Publications and source records attributed to B Pierce.

At least 19 recordsLinked to original sources
PubMed2000

Giving bad news: the family perspective.

BACKGROUND: Death from trauma frequently comes without forewarning. Relating the news of death to the family is often the responsibility of trauma surgeons. The purpose of this study was to investigate the key characteristics and methods of delivering bad news from the perspective of surviving family members. METHODS: We designed and administered a survey tool to surviving family members of trauma patients dying in the emergency department or intensive care unit. The tool consisted of 14 elements that surviving family members graded in importance when receiving bad news (1, least; 6, most). Respondents also judged the attention given to these elements (good, fair, or poor) by the person giving the bad news of death. RESULTS: Fifty-four family members of 48 patients who died completed the survey (44 intensive care unit deaths, 4 emergency room deaths). Deceased patients ranged in age from 12 to 91 years (mean, 53 years). Death occurred within 2 days of injury in 69% of the patients and within 1 week in 83%. The most important features of delivering bad news were judged to be attitude of the news-giver (ranked most important by 72%), clarity of the message (70%), privacy (65%), and knowledge/ ability to answer questions (57%). The attire of the news-giver ranked as least important (3%). Sympathy, time for questions, and location of the conversation were ranked of intermediate importance. Touching was unwanted by 30% of the respondents, but encouraged or acceptable in 24%. CONCLUSION: The attitude of the news-giver, combined with clarity of the message and the time, privacy, and knowledge to answer questions are the most important aspects of giving bad news. This information should be incorporated into resident training.

Adolescent↗
PubMed2000

The use of instant medical history in a rural clinic. Case study of the use of computers in an Arkansas physician's office.

This study evaluated the acceptance of using computers to take a medical history by rural Arkansas patients. Sex, age, race, education, previous computer experience and owning a computer were used as variables. Patients were asked a series of questions to rate their comfort level with using a computer to take their medical history. Comfort ratings ranged from 30 to 45, with a mean of 36.8 (SEM = 0.67). Neither sex, race, age, education, owning a personal computer, nor prior computer experience had a significant effect on the comfort rating. This study helps alleviate one of the concerns--patient acceptance--about the increasing use of computers in practicing medicine.

Arkansas↗
PubMed1999

Observations on labor epidural analgesia and operative delivery rates.

OBJECTIVE: Our purpose was to compare operative vaginal and abdominal delivery rates in a large population before and after on-demand labor epidural analgesia became available. STUDY DESIGN: We retrospectively compared patients who gave birth during a 20-month period immediately before the introduction of an on-demand labor epidural analgesia service with those who gave birth during a 20-month period after the epidural usage rate had reached a plateau at approximately 60%. Operative vaginal and cesarean delivery rates were stratified according to parity and history of prior cesarean delivery. RESULTS: A total of 4859 women gave birth during the study period when on-demand epidural analgesia was available, and 4778 women gave birth in the study period before the availability of on-demand epidural analgesia. Comparisons between the women with and those without on-demand availability of epidural analgesia demonstrated no statistically significant differences in the rate of spontaneous vaginal delivery (69.5% vs 68.3%), the overall cesarean delivery rate (19.0% vs 19.4%), the primary cesarean delivery rate (13.2% vs 13.4%), or the operative vaginal delivery rate (11.1% vs 11.9%) between the 2 periods. There were no statistically significant differences in mean gestational age at the time of delivery between the 2 groups, whereas there were statistically significant increases in the proportion of nulliparous women and in mean birth weight during the on-demand epidural period. Analysis after substratification of the study groups according to parity also revealed no statistically significant differences in the primary cesarean delivery rate or the proportion of women undergoing vaginal delivery. The sample size was adequate to exclude a 2% increase in the primary cesarean delivery rate between the 2 periods with 80% power. Subgroup analysis of the population of women who gave birth while epidural analgesia was available on request demonstrated that nulliparous parturient women who requested epidural analgesia were almost twice as likely to require operative vaginal or cesarean delivery as women who did not request epidural analgesia, a finding suggesting that women who request labor epidural analgesia have an inherent propensity toward operative delivery. CONCLUSION: The introduction of an on-demand labor epidural analgesia service does not increase the rate of cesarean delivery or operative vaginal delivery.

Adult↗
PubMed1998

The practice of toning in pregnancy and labour: participant experiences.

Women, primarily from the author's childbirth education classes, were taught the practice of toning, i.e. voicing the exhalation of breath on a single pitch, using a vowel sound or a hum. Women were encouraged to explore toning during pregnancy and use it as a resource for labour. Postpartum, 22 women described their experiences with tone, pointing to a variety of effects such as increased ability to cope with pain, useful forms of focus, feelings of connection with nature, bodily vibration, relaxation, emotional release, diminished anxiety and a greater sense of power. Holistic aspects of breath and tone are described, as are specific applications of toning for pregnancy and labour. Carers who wish to use tone with clients are encouraged to develop a personal toning practice.

Adult↗
PubMed1996

Language production in younger and older adults.

Only six of 74 linguistic variables studied were affected by age when younger and older subjects were compared. Three of these variables related to pragmatics, two to semantics, and one to syntax. No differences were noted for the parameter of phonology.

Adult↗
PubMed1988

Fat aversion in eating disorders.

Patients with eating disorders are reported to show an irrational dislike of starchy foods, sometimes described as a "carbohydrate phobia". In the present study, food-related attitudes and self-reported food preferences of women patients with anorexia nervosa (N = 13), anorexia with bulimia (N = 16) and bulimia (N = 14) were mapped using multidimensional scaling (MDS) procedures and compared to those of normal-weight controls (N = 49). Sixteen common food names were rated along 9-point category scales for their nutritional similarity, perceived macronutrient content, caloric density and overall nutritional value. MDS (SINDSCAL) and property fitting (PROFIT) procedures revealed that eating disorder patients associated calories with fat content to a greater extent than did controls, and tended to dislike high-fat foods. In contrast, no differences in perceptions or preferences for carbohydrate foods were observed. Anorectic restrictor patients showed the most rigid attitude structure, expressing preferences only for the lowest calorie and the most nutritious foods. The present multivariate techniques of mapping perceptual space may help to distinguish between diagnostic subgroups in studies of eating disorders.

Adolescent↗
PubMed1987

Taste and eating disorders.

Taste responses to sucrose and fat-containing stimuli were examined in a population of young women with eating disorders. Anorectic-restrictor and anorectic-bulimic patients were compared with normal-weight bulimic patients and with normal-weight control subjects. Sensory estimates of sweetness and fat content of 20 different mixtures of milk, cream, and sugar did not differ among subject groups. In contrast, relative preferences for sugar vs fat as determined by the Response Surface Method differed between patients with eating disorders and control subjects. Normal-weight bulimic patients preferred sweeter stimuli than did control subjects. Anorectic-restrictor and anorectic-bulimic patients liked sweet but disliked high-fat stimuli and showed elevated optimal sugar:fat (S:F) ratios. This pattern of response did not change following weight regain. The stability of preference profiles suggests that taste responsiveness may be independent of diagnostic categories, bulimic behaviors, or acute changes in body weight.

Adolescent↗
PubMedDate not supplied

Spine clearance--a trauma center's standardized approach to assist care givers.

Spine clearance is a high-volume, high-risk issue for trauma centers. Spinal cord injuries can be one of the most devastating injuries a person can incur. The initial treatment regimen can affect the occurrence of permanent injury. Pre-hospital providers take great pains to immobilize the spine. This article describes an approach adopted by a Level I trauma center to manage admitted patients where a spinal column or ligamentous injury has not been determined.

Clinical Protocols↗