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Biomedical subjects

C E Adams

Publications and source records attributed to C E Adams.

At least 73 records · Page 4Linked to original sources

Patients' health problems: differences in perceptions between home health patients and nurses.

Quality care is consumer-driven care. Yet, much of home healthcare is driven by Medicare regulations and reimbursement rates. This study compared home health patients' perceptions of their health problems with nurses' documentation of the patients' health problems. The results showed that the problems patients report and nurses document are very different. Home health nurses must move beyond a focus on medicare-reimbursable patient problems to documenting and providing consumer-driven patient care.

Aged↗

Home health resource utilization. Health maintenance organization versus fee-for-service subscribers.

A commonly held belief is that patients enrolled in health maintenance organizations (HMOs) are authorized fewer home health services than patients enrolled in fee-for-service (FFS) plans. This study compared home health resource utilization patterns between patients enrolled in a cost HMO and in FFS plans. Although no significant differences were found, the cost HMO subscribers actually received more services. Despite these similarities, home health administrators need to carefully craft contracts with cost HMOs.

Aged↗

Psychopathology, social and cognitive functioning in a hostel for homeless women.

BACKGROUND: This study surveyed all residents in a hostel for homeless women. Demographic data, and information on past and present psychiatric and social morbidity, and current and premorbid cognitive functioning were collected. METHOD: A four week prevalence study, using: SCID-PD; a semi-structured interview; GHQ; SBS; Manchester Scale; MMSE; and NART; the data were analysed using SPSS. RESULTS: The women originated from across the social spectrum and disruption of early family life was common. Fifty per cent had a 'severe mental illness' and most were not receiving drug treatment. High levels of active psychotic symptoms were present. Women with psychosis had suffered a greater intellectual decline from their premorbid levels of functioning than those without psychosis. CONCLUSIONS: The study affirmed findings of earlier studies employing case-studies methodology. Women with high levels of psychiatric morbidity and social dysfunction were being managed by care workers in a way that may promote stability rather than a drift into street-life.

Adolescent↗

Medial dorsal striatum is more sensitive than lateral dorsal striatum to cocaine inhibition of exogenous dopamine clearance: relation to [3H]mazindol binding, but not striosome/matrix.

Previous studies have shown that acute systemic cocaine inhibits dopamine (DA) transport and thereby produces dose-dependent changes in exogenous DA clearance in the brain. This measure reflects the dynamic activity of the DA transporter. There are also differential effects of cocaine on DA clearance in dorsal and ventral striatum, and evidence from many studies suggests that even within the dorsal striatum, the interaction of cocaine with the DA transporter may not be homogeneous. A greater understanding of how cocaine interacts with the striatal DA transporter will help clarify the role of the striatum in mediating effects of cocaine. In these studies we used in vivo electrochemical recording to examine the effect of ip cocaine on exogenous DA clearance in the medial and lateral dorsal striatum with respect to both DA transporter binding sites and electrode localization to striosomes or matrix. Baseline exogenous DA clearance was different in medial and lateral dorsal striatum in the absence of cocaine. Systemic cocaine produced a more pronounced inhibition of DA clearance in medial dorsal striatum than in lateral dorsal striatum. [3H]Mazindol binding to DA transporters was lower in medial dorsal striatum, but was not in register with striosome or matrix compartments. There was no notable difference between cocaine's effects on DA clearance in striosome or matrix that was due to this compartmentalization. Others have demonstrated that medial dorsal striatum receives proportionally more innervation from the mesolimbic, as opposed to the nigrostriatal, DA system. Taken together, these and previous in vivo results suggest that this differential sensitivity to cocaine reflects the unique properties of the ascending mesolimbic DA projection and the lower density of DA transporters associated with it.

Animals↗

Randomized controlled trials in the Journal of Psychosomatic Research; 1956-1993: a prevalence study.

RCTs are the gold standard for the evaluation of mental health care [WHO Scientific Group on Treatment of Psychiatric Disorders, 1991]. All RCTs in the Journal of Psychosomatic Research to date (October 1993) were identified. A profile of the geographical origin, content, interventions under investigation, and methodological quality (as measured by reporting of randomization) of every trial is described. The prevalence of trials from Europe in the Journal is increasing. The frequency of trials regarding the psychotherapies in this journal is also increasing whilst that of drug trials is constant. High quality reporting of randomization is rare. This pilot study generates many disturbing questions regarding the content and quality of RCTs within psychosomatic medicine that urgently need to be answered. Trials in this journal may well not be representative of all RCTs relevant to psychosomatic medicine. If all such trials are to be made accessible to those interested in evidence-based practice, however, much methodical searching must be undertaken, and this study can then be repeated and the questions answered with more authority.

Humans↗

Regional zinc staining in postmortem hippocampus from schizophrenic patients.

Schizophrenia-associated deficits in learning and memory have been associated with a decrease in the volume of the hippocampus, but the specific nature of the neuronal deficit remains unknown. Many critical afferent pathways in the hippocampus contain ionic zinc. Alterations of these pathways could be manifest as a decrease in ionic zinc levels within hippocampal afferent pathways. This possibility was examined in postmortem hippocampal tissue taken from schizophrenic patients, patients with other psychiatric disorders and matched, non-mentally ill subjects using a modified Timm's silver staining method. The three groups exhibited similar patterns of zinc staining within the hippocampal formation as well as similar levels of zinc within the mossy fiber projection system. A greater prevalence of zinc staining within the inner molecular layer of the dentate gyrus was observed in female as compared to male donors and in older as compared to younger donors. The results of the present study demonstrate that loss of ionic zinc within the hippocampus does not appear to be part of the pathology of schizophrenia.

Adolescent↗

Patients with anorexia nervosa demonstrate deficiencies of selected essential fatty acids, compensatory changes in nonessential fatty acids and decreased fluidity of plasma lipids.

The objective of this study was to assess the essential fatty acid status of patients with anorexia nervosa. Blood was collected from eight fasting female anorexia nervosa patients with a mean of 81% ideal body weight. Fatty acid composition of phospholipids, nonesterified fatty acids, triglycerides and cholesteryl esters of plasma were determined by capillary gas chromatography to indicate polyunsaturated fatty acids status compared with 19 healthy female adults < 25 y old. Subjects with anorexia nervosa showed polyunsaturated fatty acid deficiencies in plasma phospholipids different from simple nutritional essential fatty acid deficiency or chronic malnutrition. The phospholipid profile showed significantly lower (n-6) and (n-3) elongation and desaturation products, and elevated short-chain saturated, short-chain monounsaturated, branched-chain and odd-chain fatty acids. These elevations indicate enhancement of biosynthesis of alternative fatty acids that only partially compensated for the loss of polyunsaturated fatty acids in providing membrane "fluidity." Calculated mean melting point of the fatty acids of phospholipids in patients with anorexia nervosa was elevated 7.7 degrees C above normal values. These results demonstrate that patients with anorexia nervosa have deficiencies of selected essential fatty acids, compensatory changes in nonessential fatty acids and decreased fluidity of plasma lipids.

Adolescent↗

Enhanced quality through outcome-focused standardized care plans.

Methods to improve the quality of care are a national issue for home healthcare agencies. In comparison with the traditional process-focused care plans, outcome-focused care plans (OCPs) resulted in significantly better quality indicator scores for clients cared for by agency staff members. Although OCPs are a valuable tool for enhancing quality, tools are only as good as the individuals who use them. Before deciding to change to an OCP format, administrators must assess all resources needed to effect the change.

Aged↗

Reduced resource utilization through standardized outcome-focused care plans.

When evaluating ways to improve client outcomes, home healthcare administrators must consider the amount of resources used to provide the outcomes. Previous research has shown that outcome-focused care plans (OCPs) result in significantly better quality indicator scores than the traditional process-focused care plans (PCPs). The authors report the amount of resources used by a home healthcare agency when nursing care was guided by PCPs versus OCPs. The results showed that nurse visit time was less when OCPs were used. Outcome-focused care plans offer home healthcare administrators a mechanism to enhance quality while reducing resource utilization.

Diabetes Mellitus↗

Home health quality outcomes. Fee-for-service versus health maintenance organization enrollees.

Quality outcomes were compared between home health patients enrolled in the traditional Medicare fee-for-service (FFS) program versus a health maintenance organization (HMO) with a Medicare cost contract with the federal government. The quality outcome scores were similar between the two patient groups. However, other home health research showed superior quality outcomes for patients enrolled in the traditional Medicare FFS program versus an HMO with a risk contract with the federal government. Before signing contracts with HMOs, home health administrators will want to identify the type of Medicare contract the HMO has with the federal government.

Aged↗

Evidence for oxidative stress during in vitro dialysis.

The evidence for oxidative stress during haemodialysis is controversial. We therefore examined markers of oxidative stress and lipid peroxidation using an in vitro dialysis circuit. A unit of fresh blood (500 ml) therapeutically removed from each of 7 haemochromatosis patients was oxygenated and circulated for 4 h at 37 degrees C through a cuprophane dialyser (Clirans C08) against saline dialysate (1,000 ml recirculating; +FIL group). In a second series of experiments (n = 7), the dialyser was omitted from the circuit (-FIL group). Concentrations of anti-oxidants and malondialdehyde (MDA) were measured at 7 time points during the study. Blood thiol concentrations decreased by 25.6% in the +FIL group (p < 0.05) but were unchanged in the -FIL group (p > 0.05; group comparison, p = 0.006). There were no significant differences between the groups, for the lipid-soluble anti-oxidants alpha-tocopherol, retinol and beta-carotene. Plasma MDA concentrations increased in both circuits (p < 0.001, respectively, no difference between groups). However, the susceptibility of red blood cells to lipid peroxidation (as determined by MDA production following a challenge with hydrogen peroxide) was unchanged by 120 min of dialysis. These in vitro experiments provide supporting evidence that haemodialysis is accompanied by measurable oxidative stress and plasma lipid peroxidation.

Antioxidants↗

Continuous quality improvement and school nurses' problem solving methods.

The concept of continuous quality improvement is already well known in industry. It is, however, potentially applicable to any organization that provides products or services (health care and education) to customers (students and their families, teachers, etc.). In the present situation of increasingly complex health care needs of many students, continuous quality improvement--which involves problem solving and management techniques to effect services--is a relevant concept in the school setting.

Humans↗

Chronic treatment with levodopa and/or selegiline does not affect behavioral recovery induced by fetal ventral mesencephalic grafts in unilaterally 6-hydroxydopamine-lesioned rats.

It has been suggested that levodopa (L-dopa), a dopamine precursor used to treat Parkinson's disease, may be toxic to grafted fetal neuroblasts; if so, the use of the monoamine oxidase B inhibitor selegiline might prevent such toxicity. We randomly assigned 30 unilaterally 6-hydroxydopamine-lesioned male Sprague-Dawley rats, whose lesions were verified with low-dose apomorphine-induced rotations, to one of five treatment groups: (i) L-dopa methyl ester (125 mg/kg/day) with benserazide (a peripheral decarboxylase inhibitor; 25 mg/kg/day), (ii) L-dopa methyl ester with benserazide and selegiline (L-deprenyl; 0.5 mg/kg/day), (iii) selegiline only, (iv) and (v) vehicle (ascorbate in normal saline) only. After 2 weeks of twice-daily ip injections, the rats received fetal ventral mesencephalic grafts into the lesioned striatum; one vehicle group received sham grafts. Drug therapy was continued for 2 1/2 months post grafting. At 1 month after grafting, and every 2 weeks thereafter, the rats were tested using low-dose apomorphine-induced rotation. A 70% decrease in rotations among all grafted groups, relative to the shams, was found. No statistical differences among groups receiving various drug therapies were seen in behavior or in counts or dimensions of tyrosine hydroxylase-positive cells. We therefore conclude that, in the unilaterally lesioned rat model of Parkinson's disease, there is no adverse effect of L-dopa nor any significant effect of selegiline, either alone or coadministered with L-dopa, on behavioral recovery induced by fetal ventral mesencephalic grafts.

Animals↗

An investigation of the adequacy of MEDLINE searches for randomized controlled trials (RCTs) of the effects of mental health care.

Valid reviews of the effects of mental health care depend on identifying as high a proportion as possible of relevant randomized controlled trials (RCTs). To investigate the sensitivity and precision both of MEDLINE and of hand-searching for RCTs in mental health, 12 journals specializing in mental health and indexed by the National Library of Medicine (NLM) for MEDLINE were searched for the years 1971, 1976, 1981, 1986 and 1991. The sensitivity of the hand-search was 94% (95% Confidence Interval (CI) 93-95%), but it had a precision of only 7% (CI 6-8%). The optimal MEDLINE search had a sensitivity of only 52% (CI 48-56%) and a precision of 59% (CI 55-63%). Of the reports of RCTs identified by the hand-search, 9% (CI 7-11%) were not included in MEDLINE at all. Authors had included methodological descriptions in 84% (CI 80-88%) of RCTs found by the hand-search but missed by the MEDLINE search. Systematic reviews of mental health care which are based solely on MEDLINE searches of the literature will miss a large proportion of the relevant RCTs, and are thus liable to random error and bias. A register of mental health RCTs is urgently required.

Bias↗

The impact of problem-solving styles of NE-CEO pairs on nurse executive effectiveness.

The problem-solving styles of the nurse executive and chief executive officer pair affects nurse executive job tenure. This investigation tested if the style differences also influence nurse executives' effectiveness. The author provides suggestions to help nurse executives use more innovative behaviors and work more effectively with chief executive officers with different problem-solving styles.

Chief Executive Officers, Hospital↗

Work environment perceptions of staff nurses and aides in home health agencies.

Nurse executives are responsible for ensuring a therapeutic work environment in their organizations. Understanding how staff members perceive their environment is the first step in creating such an environment. In this study, perceptions of the work environment between staff nurses and home health aides in home health agencies were compared. The results suggest that nurse executives need to foster home health aides' job commitment and support for one another and increase opportunities for staff nurses to be innovative and autonomous in their practice.

Home Care Agencies↗

Innovative behavior in nurse executives.

This study addresses the problem-solving styles of hospital nurse executives and explores the relationship between problem-solving style and leader effectiveness. The Kirton Adaption-Innovation Inventory (KAI) and the Leader Effectiveness and Adaptability Description-Self (LEAD-S) were the instruments used to survey nurse executives from 66 medium-sized urban California hospitals. The majority of respondents used innovative approaches, but no correlation was found between problem-solving style and leader effectiveness.

Diffusion of Innovation↗