The new mindset: a tool for improving patients' health.
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Computer Communication Networks↗
Biomedical subjects
D James
Publications and source records attributed to D James.
Immunization status of hospitalized preschool children: risk factors associated with inadequate immunization.
OBJECTIVES: The purposes of this study were to determine the accuracy of the immunization histories of hospitalized preschool children, assess the sociodemographic factors associated with delayed immunizations, and interview parents or guardians concerning their views on ways of improving immunization delivery. METHODS: The immunization status of 215 preschool children admitted to a pediatric hospital was determined by interviewing parents or guardians regarding their children's immunization histories. The patient's immunization records were subsequently reviewed for confirmation. The admitting physician's history also was reviewed to determine whether the patient's immunization status had been noted. Finally, parents or guardians of all children studied were interviewed to assess their views on ways of improving the delivery of immunization services. RESULTS: Only 44% of the 215 preschoolers evaluated were adequately immunized. Among those between 2 and 5 years of age, 52% were fully immunized. Only 17% of those who were inadequately immunized could have been completely updated if given an immunization at discharge. The admitting physician failed to document the immunization status of 22% of the patients. Thirty percent of the parents gave inaccurate information concerning the immunization status of their children. Most parents felt that the provision of transport (30%) or formal remainders (21%) would enhance immunization rates. Multiple regression analysis showed that a history of missed opportunity to immunize, male gender, lack of transportation, and lack of day care attendance were significant predictors of delayed immunization. CONCLUSIONS: Resident physicians should be more stringent in documenting the immunization status of all admitted preschoolers so that those found to be delayed could be updated before discharge. A hospital policy of updating underimmunized children at discharge and reporting the immunization status of all discharged patients to their primary care provider could help improve the immunization coverage in this population. Transportation for routine health maintenance and telephone or mailed remainders might further improve the immunization status of inner-city children.
Adolescent↗
Ergonomics in Northern Ireland: a survey of knowledge, attitudes, and implementation in industry and the public services.
In spite of the palpable benefits to organizations of applying the principles of ergonomics, it appears that a majority of employers, whether through ignorance or neglect, fail to do so (Simpson 1990). The present study sought to assess the impact of ergonomics on a broad cross-section of organizations in Northern Ireland from three perspectives: (1) knowledge and awareness of ergonomics; (2) attitudes towards ergonomics; and (3) the extent to which the principles of ergonomics were put into practice in the work-place. In all, 700 organizations were surveyed, representing manufacturing, service, and public sectors and ranging in size from 10 to more than 1000 employees. A total of 417 questionnaires (59.7%) were returned and, of these, 152 (36.5%) claimed no knowledge whatever of ergonomics. The extent to which knowledge was claimed tended to depend on the nature of the organizations. Analysis of the remaining 263 questionnaires revealed that, while only 36 organizations employed ergonomic specialists or engaged outside ergonomic consultants, 163 respondents reported specific instances of addressing ergonomic issues during the previous 12 months. Respondents exhibited generally positive attitudes towards ergonomics, although some cynicism was evident. Principal components analysis of the questionnaire items revealed several factors, most notably a general concern for ergonomic issues, cynicism towards ergonomics and, arguably, an attitude of helplessness concerning the state of the organization. Implications of these findings for promoting implementation of ergonomics within organizations are discussed.
Data Collection↗
Improvements in the design of equipment used for ambulatory urodynamics.
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Equipment Design↗
A comparative study of the fetal electrocardiogram recorded by the STAN an Nottingham systems.
OBJECTIVE: To compare the T:QRS ratio recorded by the STAN and Nottingham fetal electrocardiogram (FECG) monitors. DESIGN: Prospective observational study. SETTING: London teaching hospital delivery suite and research unit. METHODS AND SUBJECTS: The T:QRS ratios generated by the STAN and Nottingham FECG monitors were simultaneously recorded and compared using signals generated from a computer-produced ECG signal and signals from 11 term fetuses recorded during labour. RESULTS: There was an acceptable level of agreement between the two systems with the computer-generated signals, but it was not clinically acceptable with the signals from the fetuses recorded during labour. Disagreements in the T:QRS values were probably due to differences in the reference points for the measurement of the S-T segment and T-wave height. CONCLUSION: The different points of reference for measurement of S-T segment and T-wave height can explain poor agreement between the two methods of FECG waveform analysis. The suggested adopted points of reference are those corresponding to adult electrocardiographic methodology.
Delivery, Obstetric↗
Effects of frequent ultrasound during pregnancy.
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Bias↗
Mutants of Arabidopsis deficient in the synthesis of alpha-linolenate. Biochemical and genetic characterization of the endoplasmic reticulum linoleoyl desaturase.
The overall fatty compositions of leaf and root lipids from a mutant of Arabidopsis thaliana were characterized by reduced levels of linolenate (18:3) and correspondingly elevated levels of linoleate (18:2) as a consequence of a single nuclear mutation at the fad3 locus. Comparison of the fatty acid compositions of individual lipids from wild type and mutant plants showed that chloroplast lipids were largely unaffected by the mutation, whereas each of the phospholipids synthesized on the endoplasmic reticulum in the mutant exhibited a marked reduction in the proportion of 18:3 relative to wild type. These and other results indicate that the fad3 mutants are deficient in the activity of an endoplasmic reticulum 18:2 desaturase. In root tissues, this enzyme appears to account for over 80% of the 18:3 present. However, in young leaves of the mutant, phosphatidylcholine (the major phospholipid) contains 16% 18:3 compared with 29% in the wild type, and the proportion of 18:3 in this lipid increases with plant age in both wild type and mutant plants. These results reflect an exchange of lipid between the chloroplast and endoplasmic reticulum that allows the chloroplast desaturases to provide highly unsaturated lipids to the extrachloroplast membranes of leaf cells.
Arabidopsis↗
Arabidopsis requires polyunsaturated lipids for low-temperature survival.
Mutants of Arabidopsis that contain reduced levels of polyunsaturated fatty acids showed growth characteristics at 22 degrees C that were very similar to wild type. By contrast, at 12 degrees C, the mutants failed to undergo stem elongation during reproductive growth although they produced normal flowers and fertile seeds. After transfer to 6 degrees C, rosette leaves of the mutants gradually died, and the plants were inviable. These different responses of the mutant plants at 12 degrees C and 6 degrees C suggest that distinct functions may be affected at these two temperatures. The gradual development of symptoms at 6 degrees C and other lines of evidence argue against a general collapse of membrane integrity as the cause of the lethal phenotype. Rather, they indicate that the decrease in polyunsaturated membrane lipids may initially have relatively limited effects in disrupting cellular function.
Journal Article↗
Complex mosaicism associated with trisomy 9.
Fetal karyotypes can be routinely obtained by chorionic villus biopsy, amniocentesis, or fetal blood sampling. Interpretation of results and subsequent counselling can be complicated by pseudomosaicism or mosaicism confined to the placenta or other tissues. We illustrate this by reporting a case of an abnormal fetus with a total of three karyotypically different cell lines (46,XX; 47,XX, +9; and 47,XX, +del(9) (q11) in different tissues (placenta, lung, gonad, and skin).
Abnormalities, Multiple↗
Failure to taste zinc sulphate solution does not predict zinc deficiency in pregnancy.
As part of a double-blind randomised controlled trial to test the efficacy of 20 mg of zinc supplementation during pregnancy, 494 mothers were enrolled at booking. After giving informed consent they were asked to taste a dilute solution of zinc sulphate. Of the 489 mothers who were given the solution, 44 (9%) were unable to taste it. Mothers who failed this test did not differ significantly from the rest of the population in background factors such as social class, ethnic group, maternal age or parity. Significantly more non-tasting mothers had had a previous growth-retarded infant. Their diets did not differ in any way from those of the tasters. Zinc supplementation did not affect their taste as assessed at the end of pregnancy. Of the possible outcome measures considered, the zinc taste test did predict whether the mother was to develop diastolic hypertension (23% of non-tasters, 8% of tasters), but the mean birthweight, preterm delivery rate and other outcomes were identical.
Chi-Square Distribution↗
Non-Rayleigh first-order statistics of ultrasonic backscatter from normal myocardium.
Historically, it has been assumed that the first-order envelope statistics of ultrasonic backscatter from myocardium are best described by the Rayleigh probability distribution function (PDF); however, few studies have tested this assumption. This study compares the ability of five PDFs, including the Rayleigh, to describe high-frequency (5-15 MHz) ultrasonic backscatter from in vivo canine myocardium and in vitro human myocardium. The PDFs used have all been previously proposed as descriptions of backscatter from parenchymal tissue or other random media. In this study goodness-of-fit testing of backscatter recorded at several frequencies and insonification angles shows that only in a minority of cases is the envelope. Rayleigh-distributed. In most cases, the K distribution provides the best fit. In addition, computer simulation shows that sparse Poisson scattering can produce K-distributed backscatter. Scattering of this type may contribute to the observed non-Rayleigh character of myocardial backscatter. We conclude that the Rayleigh distribution is not an adequate description of backscatter from myocardium. Non-Rayleigh distributions may offer an additional approach to myocardial tissue characterization.
Animals↗
Influence of place of delivery on outcome in babies with gastroschisis.
In order to determine whether the elective delivery of babies with gastroschisis confers advantages in outcome, the case-notes of all babies referred to Bristol with gastroschisis over a 10 year period were reviewed. Various factors were compared between babies born in Bristol and those born elsewhere in the South West region. One neonate from the outborn group died after transfer to Bristol but otherwise there was no evidence that transfer and elective delivery in Bristol conferred any advantage. The important of effective resuscitation of outborn babies before transfer is emphasised and guidelines for resuscitation given.
Abdominal Muscles↗
Glucose metabolism in Ullrich Turner syndrome: long-term effects of therapy with human growth hormone. German Lilly UTS Study Group.
The effects of GH therapy on glucose metabolism in 72 Turner patients treated with human GH (HGH) 2, 3 or 4 IU/m2/day for 2 years are reported. OGTTs were performed at 0, 3, 12 and 24 months. The overall frequency of glucose intolerance was 9.7% before therapy and did not change under HGH. No change in HbA1c and fasting glucose values occurred. Integrated blood sugar values in the OGTT (area under the curre) did not change with 2 and 3 IU but were significantly elevated over control after 2 years with 4 IU. Insulin secretion was not significantly affected over time with 2 IU, whereas 3 and 4 IU produced significant increases which persisted after 2 years. Results indicate that glucose homeostasis is maintained under GH therapy at the expense of a compensatory increase in insulin secretion which persists at higher GH dosages.
Adolescent↗
Dose-dependent effect of growth hormone therapy on glucose metabolism in subjects with Turner syndrome. The German Lilly Ullrich-Turner Syndrome Study Group.
Recombinant human growth hormone (GH) is effective in promoting growth velocity in subjects with Turner syndrome. As higher doses are used for this indication than for substitution therapy in GH deficiency, the long-term effects of GH therapy on carbohydrate metabolism represent a safety issue; this is particularly important in Turner syndrome, in which there is an increased prevalence of impaired glucose tolerance. So far, GH therapy has been given to patients with Turner syndrome for up to 7 years without any significant changes having been reported in glycosylated haemoglobin (HbA1c) values, unstimulated and stimulated oral glucose tolerance test (OGTT) blood glucose and serum insulin concentrations. These findings may, however, be influenced by other variables, such as study design, number of subjects or standardization methods applied. Results of an ongoing trial in the FRG, from which 2 years' data on glucose metabolism (as assessed by serial OGTTs) of 72 patients with Turner syndrome are available, indicate that glucose homoeostasis is maintained at the expense of an increase in insulin secretion, which is time- and dose-dependent. Although these changes may be fully reversible on withdrawal of GH. therapy, accurate control of glucose metabolism both during and after GH. treatment is advocated.
Blood Glucose↗
Prophylactic antibiotics at caesarean section do not reduce costs.
A prospective audit of 200 patients was undertaken to determine the effectiveness of prophylactic antibiotics at caesarean section in reducing the cost of postnatal care. The main outcome measures were the cost-effectiveness of this treatment in reducing the cost of care and incidence of infection. The results show that the routine administration of prophylactic antibiotics had no significant effect on infection rates, the prescribing of puerperal antibiotics or the duration of stay in the postnatal period. The total cost of antibiotics in the prophylaxis group was over four times that in the non-prophylaxis group. The results of this study suggest that routine administration of antibiotics at caesarean section does not reduce the costs of care in the puerperium.
Anti-Bacterial Agents↗
Alcohol screening: one hospital's experience.
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Adult↗
Influence of The Lancet on chorionic villus sampling.
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Chorionic Villi Sampling↗
Absence of fetal breathing and abnormal fetal behavior in prolonged preterm ruptured membranes: case report.
A case is described where prolonged serial observations were carried out on a fetus, between 26 and 3.5 weeks' gestation, the membranes having been ruptured from 23 weeks. No fetal breathing or cyclical activity was observed, and there was no evidence of development of linkage between the fetal behavioral state variables. This was not associated with respiratory morbidity in the neonatal period, but subsequently with severe developmental delay, microcephaly, myoclonic epilepsy and hearing impairment. Absence of fetal breathing may be a more important predictor of prenatal neurological abnormality than of respiratory morbidity following birth.
Journal Article↗