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Biomedical subjects

B Stevens

Publications and source records attributed to B Stevens.

At least 55 records · Page 3Linked to original sources
PubMed1996

Developmental versus conventional care: a comparison of clinical outcomes for very low birth weight infants.

The purpose of this research was to describe the clinical profile of very low birth weight (VLBW) infants receiving conventional versus developmental care during their hospitalization and to determine the appropriateness of developmental-care interventions. A phase-lag study with 124 preterm infants indicated that although there were no significant differences in individual clinical outcomes, developmental care had a significant effect on the physiologic stability of the infant over time. Developmental interventions were used for all infants receiving the developmental-care intervention, with varying frequency.

Developmental Biology↗
PubMed1995

Regulated expression of the neural cell adhesion molecule L1 by specific patterns of neural impulses.

Development of the mammalian nervous system is regulated by neural impulse activity, but the molecular mechanisms are not well understood. If cell recognition molecules [for example, L1 and the neural cell adhesion molecule (NCAM)] were influenced by specific patterns of impulse activity, cell-cell interactions controlling nervous system structure could be regulated by nervous system function at critical stages of development. Low-frequency electrical pulses delivered to mouse sensory neurons in culture (0.1 hertz for 5 days) down-regulated expression of L1 messenger RNA and protein (but not NCAM). Fasciculation of neurites, adhesion of neuroblastoma cells, and the number of Schwann cells on neurites was reduced after 0.1-hertz stimulation, but higher frequencies or stimulation after synaptogenesis were without effect.

Animals↗
PubMed1995

Effect of neonatal circumcision on pain responses during vaccination in boys.

Using data from one of our randomised trials, we investigated post-hoc whether male neonatal circumcision is associated with a greater pain response to routine vaccination at 4 or 6 months. Pain response during routine vaccination with diphtheria-pertussis-tetanus (DPT) alone or DPT followed by Haemophilus influenzae type b conjugate (HIB) was scored blind. 42 boys received DPT and 18 also received HIB. After DPT, median visual analogue scores by an observer were higher in the circumcised group (40 vs 26 mm, p = 0.03). After HIB, circumcised infants had higher behavioural pain scores (8 vs 6, p = 0.01) and cried longer (53 vs 19 s, p = 0.02). Thus neonatal circumcision may affect pain response several months after the event.

Circumcision, Male↗
PubMed1995

Incest revisited: delayed post-traumatic stress disorder in mothers following the sexual abuse of their children.

The case histories of four women who developed symptoms of post-traumatic stress disorder following the disclosure of the sexual abuse of their daughters are presented. These individuals also exhibited comorbid symptoms of depression and personality disorders. Awareness of the sexual abuse of their daughters catalyzed a reliving of their own childhood victimization. The psychodynamics operating in these cases, as well as treatment strategies are also presented. A brief follow-up of three of the four cases is included.

Adult↗
PubMed1995

A revised measure of acute pain in infants.

Acute pain in infants is not assessed or managed optimally. The objectives of the study were (a) to adapt a behavioral pain assessment measure (Children's Hospital of Eastern Ontario Pain Scale, CHEOPS) for use with infants, and (b) to establish the reliability and validity of the measure in a study of infants undergoing immunization. Ninety-six healthy 4- to 6-month-old infants were randomized to receive either the local anesthetic cream Eutectic Mixture of Local Anesthetics (EMLA) (N = 49), or a placebo (N = 47) prior to immunization. The infant's behavioral response was videotaped immediately before and following the immunization. Postprocedural pain scores were assessed from the videotape and were significantly lower in infants who received EMLA (P = 0.01). Pain scores were also significantly correlated with visual analogue scale (VAS) scores assessed during vaccination. Five independent raters also independently rated ten infants to determine interrater reliability. Agreement between raters' scores was high (intraclass correlation coefficient, 0.95). Results from this study suggest that this measure has beginning construct and concurrent validity and interrater reliability when used in a research study. Further testing of the measure in the clinical setting is required.

Acute Disease↗
PubMed1995

Safety of lidocaine-prilocaine cream in the treatment of preterm neonates.

The safety of lidocaine-prilocaine cream (EMLA) was evaluated in an open trial in 30 preterm neonates (mean gestational age, 32.8 weeks; birth weight, 1911 gm); 0.5 gm was applied to the heel for 1 hour. Mean baseline and follow-up (4, 8, or 12 hours after EMLA application) methemoglobin levels were not different, ranging from 1.15% to 1.45%, and from 1.13% to 1.49%, respectively.

Analgesics↗
PubMed1995

Outcomes management in neonatal nursing clinical practice.

One approach for evaluating the quality and cost of patient care is through outcomes management. Outcomes management in a neonatal environment will be described within a structure-process-outcome framework. Outcomes will be presented from three perspectives: administrative, economic and clinical. The relevance and implications of outcomes management will be discussed.

Clinical Nursing Research↗
PubMed1995

Indwelling versus intermittent feeding tubes in premature neonates.

OBJECTIVE: To determine the effect of indwelling versus intermittent feeding tube placement on weight gain, apnea, and bradycardia in premature neonates. DESIGN: Eligible subjects were assigned randomly to either feeding tube method. Each subject was followed for 6 days. SETTING: The study was conducted in a secondary level neonatal intensive-care unit (NICU), a tertiary level NICU in a perinatal center, and a tertiary level NICU in a referral center. PATIENTS/PARTICIPANTS: Neonates who were 24-34 weeks gestational age, developmentally appropriate for gestational age, medically stable, on full enteral feedings through an orogastric or a nasogastric tube, and not fluid restricted. Ninety-three neonates were enrolled--49 indwelling group and 44 in the intermittent group. Nine neonates did not complete the study. INTERVENTIONS: Nasogastric indwelling feeding tubes were placed and left in site for up to 3 days. Orogastric intermittent feeding tubes were placed for each feeding and removed at completion of the feeding. MAIN OUTCOME MEASURES: Weight gain, apnea, and bradycardia. RESULTS: Members of both groups had similar demographic characteristics, clinical problems, and nutritional intake. No statistical differences were found between the two groups in weight gain or episodes of apnea and bradycardia. CONCLUSIONS: There were no statistically or clinically significant differences between the two groups. The intermittent method of feeding is more expensive. Because no clinical differences were found, the type of tube placement chosen for feeding the premature infant may be based on economics.

Apnea↗
PubMed1995

Enhanced retention of asbestos fibers in the airways of human smokers.

To determine whether cigarette smoke increases the pulmonary retention of asbestos, we compared the asbestos-fiber burden in the airway mucosa of six cigarette smokers who had received heavy occupational asbestos exposure with that in a group of six subjects with similar exposure who were never smokers. The groups were matched in terms of age, sex, years of exposure, and mean parenchymal amosite burden. We found that the concentration of amosite in airway mucosa was significantly elevated (by approximately sixfold) in smokers (p < 0.02). Chrysotile parenchymal burdens were statistically similar in both groups, but the chrysotile airway burden was again higher (by approximately 50-fold) in smokers (p < 0.006). There were no differences in airway or parenchymal tremolite burdens between the two groups. Fibers of all three types of asbestos recovered from the airway mucosa or parenchyma of smokers were shorter than fibers recovered from nonsmokers, an observation in accord with experimental data suggesting that cigarette smoke leads to retention of shorter fibers. These findings indicate that cigarette smoking causes enhanced accumulation of both amosite and chrysotile in the airway mucosa. This process may play a role in potentiating the pathologic effects of asbestos.

Aged↗
PubMed1994

An innovative model of system-linked community care: home-based traction as an alternative to institutional treatment.

Home-based traction is an alternative treatment to conventional hospital-based traction for children with orthopedic conditions such as congenital dislocated hip and Legg-Perthes disease. The application of a proposed theoretical model is used to describe the process of the home-based traction innovation. Creativity and innovation occasions a reconceptualization of stresses. The reconceptualization of stress, plus the operational support of coordinated in-home services, can help families and nurses in the community and in the hospital develop, implement, and evaluate this kind of innovative care. In applying the home-based traction professionals empower and legitimize parents as resourceful co-providers of care. The legitimizing of the alternative in-home service affords parents a more optimistic appraisal of their situation as manageable. Parents are free to develop a coordinated response to their overall circumstance, including the treatment of their one child's illness. The evaluation of this home-based traction example found the alternative to be acceptable, safe, effective in accomplishing treatment goals, and less expensive than conventional hospital-based traction.

Adult↗
PubMed1993

Risk factors in extreme grand multiparity.

OBJECTIVE: To study the obstetric performance and outcome of patients of extreme multiparity (Para 10 or more) compared to controls of parity 2-5. METHOD: Records were reviewed for 228 cases and 3349 controls at Security Forces Hospital 1986 and 1991. RESULT: Hypertension and cesarean section rate were significantly higher in the study group opposed to the control. Instrumental vaginal deliveries were significantly lower in the study group. There was no difference in the perinatal outcome between both groups. CONCLUSION: We conclude that with high socioeconomic state and high standard of antenatal care extreme grand multiparity does not carry any added special obstetric or perinatal risk.

Adult↗
PubMed1993

Validating a compendium of goals and objectives for educating CNS students in ambulatory care.

In fall 1990, the Department of Veterans Affairs launched a Pilot Ambulatory Care and Education program that has as its major goal the shift from a traditional inpatient specialty-based focus of patient care and health professional education to a more forward-looking outpatient generalist-based focus of care and education. The generalist and specialist focus of the CNS role has been introduced in this innovative ambulatory care program. Formal and informal educational opportunities for interdisciplinary team members and students abound. This article describes the development and validation of a compendium of goals and objectives for educating CNS students in ambulatory care.

Ambulatory Care↗
PubMed1993

Absence of amosite asbestos in airway mucosa of non-smoking long term workers with occupational exposure to asbestos.

There is considerable experimental evidence that asbestos fibres are taken up by epithelial cells, and that uptake of fibres is associated with various deleterious, particularly mutagenic, effects. It is not known, however, if asbestos fibres are taken up by human bronchial epithelial cells in vivo. To investigate this question, the amosite asbestos content of the mucosa of seven different airways and four parenchymal sites supplied by these airways in six necropsy lungs from heavily exposed never-smoking long term shipyard and insulation workers without asbestosis was examined. Amosite asbestos was readily found in moderately high concentration in all parenchymal samples, but 33 of 40 airway samples that could be evaluated showed no amosite fibres. The seven positive airways had fibre concentrations that were always much lower than the parenchymal concentrations, and these very few fibres may have been contaminants from the parenchyma. These data suggest that, at least in non-smokers, amosite asbestos either does not penetrate into or does not accumulate in human airway mucosa. These findings also call into question the idea that asbestos acts as a direct airway carcinogen in humans.

Aged↗
PubMed1993

The effect of the sight of blood and use of decorative adhesive bandages on pain intensity ratings by preschool children.

A total of 70 children between the ages of 3 and 6 years participated in two studies that tested the effect of (a) the sight of blood and (b) the application of a decorated adhesive bandage on pain intensity ratings following a fingerstick. In both studies, children were randomly assigned to one of four groups. These groups allowed for the combinations of testing blood or no blood and the application of a decorated adhesive bandage or plain adhesive bandage. The Oucher (Beyer, 1984) and the Poker Chip Tool (Hester, 1979) were used as self-report measures of pain intensity at the time of the fingerstick and immediately after the application of the adhesive bandage. The pilot study recruited 20 children from two day care centers and subjected them to sham fingersticks. Results indicated that there were no differences across the groups in pain intensity ratings. However, there was a trend for the sight of blood to increase the child's pain intensity rating. Age was a significant covariate across all groups, with younger children reporting higher levels of pain intensity. The second study took place in a pediatric test center of a metropolitan children's hospital. Fifty outpatient children who were receiving fingersticks for preoperative or diagnostic testing were enrolled. Results indicated that there were no differences across groups, and age was only significant on the Poker Chip Tool. These results suggest that simple interventions and distractions are not sufficient to decrease perceived pain intensity ratings in young children.

Analysis of Variance↗
PubMed1992

Psychiatric Issues in Bariatric Surgery.

In this study, 100 patients were evaluated prior to surgery to assess psychiatric status. The demographic anthropometric and psychological characteristics are described. Seventeen patients developed severe psychiatric complications and required hospitalization; the diagnoses which precipitated hospital admission were most commonly affective disorders (especially major depression with suicidal ideation). The only deaths in the sample of 100 occurred among the patients who required post-surgical psychiatric hospitalization. The hospitalized group was compared to a matched group drawn from the original 100 patients. Factors associated with post-surgical psychiatric hospitalization were: presurgical psychiatric hospitalization, presence of multiple pre-surgical Axis I psychiatric diagnoses, and untreated Axis I diagnosis at the time of pre-surgical assessment. Psychiatric screening criteria were revised and 31 subsequent patients were evaluated; less than half of this group were found suitable for surgery at the time of preliminary assessment.

Journal Article↗
PubMed1992

Effects of cigarette smoke on the clearance of short asbestos fibres from the lung and a comparison with the clearance of long asbestos fibres.

Long asbestos fibres are generally considered to have greater disease-producing potential than short asbestos fibres. However, recent reports have suggested that short fibre asbestos appears to be as effective an inducer of macrophage growth factors and toxic oxygen species as long fibre asbestos, but that short fibres are readily removed from lung and do not gain access to tissues. Because smoke is believed to impair the clearance of asbestos fibres from lung, we examined the clearance of a short (geometric mean length 1.3 microns) amosite preparation administered by intratracheal instillation to guinea-pigs. Half the animals in each group were exposed to the smoke of 10 cigarettes daily. Animals were sacrificed 1 day, 1 week, or 1 month later, the macrophages recovered by lavage, and fibre concentrations and sizes determined by analytical electron microscopy in macrophages and lung tissue. A 30-fold increase was seen in total numbers of fibres retained in macrophages in smokers compared to non-smokers by 1 month, and there was an eightfold increase in retention of short fibres in the lung tissue by 1 month. By contrast, a long fibre amosite preparation (geometric mean length 8.9 microns) showed approximately the same increase in fibre retention in macrophages, but only a twofold increase in tissue retention. We conclude that (1) cigarette smoke markedly impairs the clearance of short amosite fibres from the lung with enhanced retention of fibres in both macrophages and tissue; (2) the effects of smoke on short fibre tissue retention appear to be greater than those on long fibre retention; (3) with the long fibre preparation, smoke causes increased tissue retention of relatively shorter fibres; (4) for both fibre size experiments, the increase in total fibres in macrophages in smoke-exposed animals reflects an increase in the total number of fibre-containing macrophages, rather than an increase in the number of fibres phagocytized per macrophage; (5) enhanced short fibre retention markedly increases total fibre surface area, a parameter which has been suggested as a measure of fibre toxicity, to the point where short fibres might under some circumstances have roughly the same potential toxicity as long fibres. These observations suggest that short asbestos fibres could play an important role in the pathogenesis of some types of asbestos-related disease in cigarette smokers.

Animals↗