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Biomedical subjects

C Lewis

Publications and source records attributed to C Lewis.

At least 325 records · Page 18Linked to original sources
PubMedDate not supplied

Prevention and management of postoperative nausea and vomiting.

PURPOSE: To identify factors associated with the occurrence of postoperative nausea and vomiting and to identify the effectiveness of independent and interdependent nursing interventions for the prevention and management of postoperative nausea and vomiting. DESIGN: Descriptive. SAMPLE: A convenience sample of 300 patients, 18 years or older, who had surgery with general anesthesia (excluding persons having ear or gastrointestinal surgery), at either campus of a large metropolitan medical center. METHOD: A combination of closed chart review and data collection by staff nurses assigned to the patients in the postoperative period using a standardized data collection tool. FINDINGS: Data was analyzed using a combination of descriptive and parametric statistics. There was a 39% incidence of nausea and vomiting overall. Women were two times more likely to experience nausea and twice as likely to experience severe nausea (statistical significance of p = .0001). In addition, persons with surgery lasting 2 hours or greater were twice as likely to experience nausea (statistical significance of p = .002). Independent nursing interventions, such as placing a cool washcloth on a patient's forehead, were used more often than medication as an initial strategy. The most frequently used interventions were increasing the i.v. fluids and having the patient take deep breaths. There was no pattern to the nursing assessments. CONCLUSION: Women and those patients with surgery lasting greater than 2 hours should be assessed for nausea in the postoperative period more frequently. Assessments need to be done during the first 2 hours after surgery, at 7-8 hours after surgery, and when there is an increase in activity, such as the first time out of bed. Nurses do not routinely document assessments for postoperative nausea. In addition, some misconceptions exist. Formal and informal education for nurses, physicians, and patients on the incidence, predisposing factors, and treatment options for postoperative nausea needs to occur. This should include reflection on the misconceptions, the need for ongoing patient assessment, and a review of drug and nondrug therapies. IMPLICATIONS FOR NURSING RESEARCH: Further research is needed to better describe the present practice patterns in the treatment of postoperative nausea and vomiting, including a comparison of inpatient and outpatient settings. The relative effectiveness of specific nursing interventions should be measured, such as i.v. fluids, deep breathing, and antiemetic use. In addition, the evaluation of the effectiveness of the use of a research protocol would be useful.

Adolescent↗
PubMedDate not supplied

Abnormal cerebrovascular carbon dioxide reactivity in people with diabetes.

Cerebral blood flow was measured both under conditions of normocapnia and hypercapnia in 22 diabetic patients and 20 normal control subjects, using either the intravenous 133Xe method or the closely comparable 133Xe inhalation method. While 19 out of 20 control subjects responded appropriately to hypercapnia with an increase in flow, eight of the diabetic patients failed to respond normally, this difference being significant (p = 0.03). Those manifesting an abnormal response included young, insulin-dependent patients with a short duration of diabetes and no clinical evidence of complications.

Adolescent↗
PubMedDate not supplied

Obstetric ultrasound: application in a clinic setting.

A brief review of the medical literature indicates areas of concern related to the safety of obstetric ultrasound usage. Questions raised in the medical literature dictate the need for conservative and appropriate use of ultrasound until long-term follow-up studies have been completed. The current use of diagnostic ultrasound in a prenatal clinic setting is explored. In the meantime, health-care providers should follow guidelines for obstetric ultrasound use to prevent indiscriminate patient exposure.

Diagnostic Tests, Routine↗
PubMedDate not supplied

Residential treatment for youngsters with difficult-to-manage insulin dependent diabetes mellitus.

A descriptive outcome study of 52 children with insulin-dependent diabetes mellitus (IDDM) admitted to a residential treatment program over 6 years. Criteria for admission included repeated hospitalizations for diabetes-related problems, excessive school absences, and/or familial disruption. Residential treatment included individual, group, and family psychotherapy, diabetes education, and close medical supervision. The design included collection of data before, during and after treatment. Children admitted to the residential unit were compared to a population of pediatric IDDM outpatients from the same geographical area. Treatment was associated with a reduction in diabetes-related hospitalizations, improved school attendance, decreased glycosylated hemoglobin levels, weight gain, individualized insulin changes, improved knowledge about diabetes, and a normalization of attitudes towards this disease.

Absenteeism↗
PubMedDate not supplied

Proliferation and maturation indices in nephrogenic rests and Wilms tumor; the emergence of heterogeneity from dormant nodular renal blastema.

Independent nephrogenic rests (NRs) accompany many Wilms tumors (WTs), exhibit a range of qualities suggesting dormancy, maturation, regression, and hyperplasia, and may carry the WT-1 mutation. We assessed nucleolar organizer regions, proliferating cell nuclear antigen (PCNA) activity, cytoplasmic filament expression, and nuclear morphology in 79 nephrogenic rests accompanying 20 WTs. We found a direct relationship between the size of a blastematous NR and the AgNOR number per nucleus and a close correlation with PCNA activity. The blastema of most NRs > 1 cm in diameter was indistinguishable from blastema of most WTs. The smallest NR usually had a low number of silver-reactive nucleolar organizing regions (AgNORs), low PCNA activity, and absent cytoplasmic filaments, all characteristics of a nascent dormant state in which both proliferation rate and protein synthetic activity are low. Intermediate filament expression was variable in blastema of larger NRs; cytoplasmic filaments correlated with emergence of epithelial maturation and absence of filaments with accumulation of immature cells; mature epithelial structures in NRs had low AgNOR number and PCNA activity representing a terminal dormant state. The majority of blastemal cells in most WTs and in one-third of large hyperplastic NRs lack cytoplasmic filaments. This, plus the occasional finding in large NRs of features more typical of WTs such as prevalence of apoptosis, patches of frank necrosis, multinodular architecture, and expanses of monomorphic, poorly vascularized blastema with low PCNA activity, suggest that it may be possible to distinguish NRs that are progressing toward WT from those that are merely hyperplastic. This study refines the concepts of dormancy and hyperplasia as expressed in NRs and provides a general framework for probing the relationship of molecular events to progression of a small proportion of NRs to WT. Criteria used herein to define dormancy and hyperplasia may be useful in assessing lesions other than typical WT, such as unusually large or extensive NRs or uncommon differentiated WTs where the potential for aggressive behavior may be lower than in usual WTs.

Adrenal Rest Tumor↗