Biomedical subjects
D Kennedy
Publications and source records attributed to D Kennedy.
Client assessment tool: a means to enhance nurse-client-physician collaboration.
The fast pace of a headache clinic prompted the authors to develop chart forms which covered all aspects of history and treatment specific to headache clients. The effort proved to be beneficial in promoting better communication between caregivers and clients due to ease and thoroughness of documentation. Use of such a tool may promote cost effectiveness, better nurse-client-physician relationships and ultimately improved client outcomes.
A preliminary study of factors that influence children's sense of competence to manage their asthma.
This study identifies several factors that appear to influence children's sense of competence to manage their asthma. The study examined a consecutive series of 62 children and adolescents who had been admitted to hospital for management of their asthma. Self-reports rating their sense of competence to manage their asthma were obtained from all the children. In addition, reports were obtained of the children's motivation to achieve healthy functioning, their sense of control over their health, and parental knowledge of childhood asthma management. Results from the study suggest that older children, children who are more intrinsically motivated to achieve healthy functioning, and children with parents who are knowledgeable about asthma management feel more competent to manage their asthma. It is suggested that the effectiveness of asthma self-management programs for children may be improved if there is a better understanding of the psychological factors that influence children's sense of competence to manage their asthma.
The lower extremity activity profile: a health status instrument for measuring lower extremity disability.
The Lower Extremity Activity Profile (LEAP) is a comprehensive measure of lower extremity function. It measures the client's perception of difficulty and satisfaction with performance in the following areas: self care, mobility, household activities, work, leisure activities, and social activities. The development and initial reliability and validity testing of LEAP was conducted with 32 osteoarthritis clients undergoing total knee replacement. Using a one-group repeated measures design, the LEAP, knee range of motion and self-paced walk measures were administered pre-operatively and 3 months post-operatively. The internal consistency of the LEAP using Cronbach's Alpha was 0.73. All LEAP scores showed significant improvement (p<0.01) between the two administration times demonstrating responsiveness of the measure. Correlations of LEAP with the clinical measures were moderate. LEAP is recommended for use as an outcome measure in similar populations, if used in conjunction with clinical and physical performance measures. Further testing of the LEAP is warranted for use in evaluating outcomes of rehabilitation programs addressing lower extremity musculoskeletal impairment and disability.
Using medical images from the Internet in presentations.
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Functional cerebral imaging in the evaluation and radiotherapeutic treatment planning of patients with malignant glioma.
PURPOSE: Functional magnetic resonance imaging (MRI) and positron emission tomography are relatively new modalities of great potential value in the evaluation, treatment, and subsequent follow-up care of patients with malignant glioma. We report our experience with the incorporation of functional imaging data into radiation therapy three-dimensional (3-D) treatment planning. METHODS AND MATERIALS: Over a 24-month period, a total of 37 positron emission tomography and 29 functional MRI studies have been conducted on eight consecutive patients prior to, during, and following the completion of radiation therapy. Functional imaging was conducted prior to radiation therapy treatment planning and at approximate 3-month follow-up time intervals. RESULTS: In two patients, functional imaging provided additional information over conventional imaging modalities and resulted in subsequent modification of conventional radiation therapy treatment planning. CONCLUSION: Although it is premature to make definitive statements regarding the use of these new imaging parameters in the prognostic setting, functional imaging may likely prove to be a useful adjunct in the initial evaluation, radiation treatment planning, and follow-up care of patients with malignant glioma.
Coagulation, fibrinolytic and inhibitory proteins in acute myocardial infarction and angina pectoris.
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Outpatient care of the headache client: a challenging specialty.
Care of persons with headache is complex because they often present with symptoms that are difficult to classify and manage. Pharmacologic interventions for headache prevention and acute attacks, as well as behavioral and life-style changes, can significantly improve the quality of life for many. Advocacy begins by exploring all aspects of physical and emotional health so the client is involved in the holistic approach to headache management. The caregiver-client relationship evolves gradually with continued education, reassessment and mutual problem solving. Counseling and education are the major focus of nursing care in this specialty. Qualitative research is needed to give more insight about the management of this pain condition which for centuries has plagued or even disabled its victims.
Diagnosis of bovine venereal campylobacteriosis by ELISA.
An enzyme-linked immunosorbent assay (ELISA) measuring IgA antibodies in the vaginal mucus was used to diagnose bovine venereal campylobacteriosis in 241 herds with infertility and abortions. The presence of the disease was confirmed on 84 farms (34.8%) and it was suspected on a further 27 farms (11.2%). The specificity of the ELISA was found to be 98.5% but in the absence of a reliable comparative test sensitivity can not be estimated. Vaccination against campylobacteriosis will not interfere with the IgA ELISA because only IgG is present in the vaginal mucus of vaccinates. Because of the possibility of false reactions caused by antibody fluctuations in individual cattle, the ELISA is best used as a herd test. It appears that at present the vaginal mucus IgA ELISA is the test of choice for the diagnosis of bovine venereal campylobacteriosis.
Health care costs and technologies.
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A policy for the sick traveller.
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"Children, don't forget me": a resource and support group for deployed parents during Operations Desert Shield and Desert Storm.
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The management of acute bronchiolitis. Thoracic Society of Australia and New Zealand.
The management of acute bronchiolitis is mainly supportive, but infants require minimal handling. Of those who are hospitalized, less than 3% require intensive care and ventilation but in these children the condition is life threatening. Oxygen, fluid replacement and careful observation remain the cornerstones of management. Bronchodilators should be avoided in young infants and antiviral therapy should only be considered in critically ill infants who have an underlying cardiopulmonary condition.
Use of the holmium: yttrium aluminum garnet (Ho:YAG) laser for cranial nerve decompression: an in vivo study using the rabbit model.
A study was designed to evaluate the utility and safety of the holmium:yttrium aluminum garnet (Ho:YAG) laser for precise bony decompression of neural canals. In vivo rabbit studies were performed to measure temperature changes and nerve degeneration which occurred when the facial canal was decompressed with the laser as compared to the diamond burr. Marked temperature elevations were noted with the laser (n = 4), but not with the burr (n = 4). Seven of nine nerves decompressed with the laser revealed moderate to severe degeneration, whereas two control nerves decompressed with the drill demonstrated only minimal degeneration. It is concluded that this laser should not be used for nerve decompression unless better control of temperature elevation can be achieved.
Pneumocystis carinii pneumonia in HIV infected patients: effects of the diseases on glutathione and glutathione disulfide.
Human immunodeficiency virus (HIV) infection is associated with altered levels of glutathione (GSH) in cells and extracellular fluids. GSH is essential for lymphocyte proliferation and inhibits HIV replication. Therefore, determination of GSH and glutathione disulfide (GSSG) levels could be useful as indicators of the progression of the disease. Thyroid hormone levels are altered in acquired immuno-deficiency syndrome (AIDS), such that thyroid hormone might be a useful prognostic indicator of the severity of AIDS. Pneumocystis carinii pneumonia (PCP) is a debilitating disease of the lung that can accompany HIV infection. The effects of pulmonary infections were assessed in AIDS patients on thyroid hormone, GSH, GSSG levels and other parameters. Two groups of AIDS patients were selected, a group with PCP and a control group with other respiratory diseases. GSH was evaluated in plasma, pulmonary lavage fluid, pulmonary biopsy tissue and buccal cells. Levels of GSSG in pulmonary lavage fluid were higher in PCP patients than in controls, which suggests that PCP patients suffer from oxygen radical toxicity in their lungs. PCP patients may have altered plasma GSH utilization such that damaged lung tissue may become less efficient at using plasma GSH. Patients with PCP may have altered CD4 cell functions such that thyroid hormone levels do not correlate with CD4 cell counts. Patients with AIDS and secondary infections of the lung were found to have altered GSH redox states, probably indicative of physiologic adaptation to AIDS.
Difficult decisions in endoscopic sinus surgery.
In this article, case studies from four separate clinicians are presented along with comments. These cases offer unusual examples of problems that occur with endoscopic sinus surgery.
Coagulation, fibrinolytic, and inhibitory proteins in acute myocardial infarction and angina pectoris.
BACKGROUND AND METHOD: The role of thrombus formation in the pathogenesis of acute myocardial infarction (AMI) and unstable angina pectoris has been well established. However, comprehensive and systematic studies of the blood coagulation, fibrinolytic, and inhibitory proteins are not available in patients with these conditions. Fourteen patients with AMI, 10 patients with angina pectoris, and 32 normal volunteers were studied. Plasma antigen concentrations and/or activities of high-molecular-weight kininogen (HMWK), fibrinogen, fibronectin, plasminogen, D-dimer, tissue plasminogen activator (t-PA), alpha 2-antiplasmin, alpha 2-macroglobulin, alpha 1-antitrypsin, protein C, total and free protein S, antithrombin III (AT-III), von Willebrand factor (vWF), factors (F) XII, XI, IX, VIII, VII, X, V, II, and XIII, and plasma antiplasmin activity were measured using appropriate functional or immunologic assays. RESULTS: The AMI group showed a significant reduction in F XII activity, F XII activity-to-concentration ratio, and HMWK concentration. In addition, the AMI patients exhibited a significant elevation of plasma F XI activity, F IX concentration, and F IX activity, and vWF, fibrinogen, D-dimer, and t-PA concentrations. This was associated with significant reductions in F V, F II, and AT-III activity-to-concentration ratio. Many of the changes observed in AMI patients were also present in patients with angina pectoris. Furthermore, the latter group exhibited an elevation of F VIII activity, alpha 2-macroglobulin activity, and alpha 1-antitrypsin concentration and a significant reduction of antiplasmin activity despite a normal alpha 2-antiplasmin concentration. CONCLUSIONS: The observed reduction of the plasma F XII activity-to-antigen concentration ratio combined with a reduced HMWK concentration suggests intrinsic pathway activation, while the elevation of the D-dimer concentration indicates thrombin generation and fibrin formation and degradation in the AMI group. The latter changes were also present in patients with angina pectoris. Both AMI and angina groups showed several other abnormalities of the coagulation, fibrinolytic, and inhibitory systems. The results suggest the presence of a prothrombotic state associated with the activation of coagulation and fibrinolytic systems in patients with acute myocardial ischemia or infarction.
Magnetic resonance imaging of body fat of athletes compared with controls, and the oxidative metabolism of estradiol.
The extent of 2-hydroxylation of estradiol (E2), which yields a non-estrogenic metabolite (2-OHE1), increased significantly with decreasing subcutaneous fat (ScF)/total volume percent (TV%) and total fat (TF)/TV% evaluated by magnetic resonance imaging (MRI) for five athletes during low- and high-intensity training, and four controls. The increase in 2-hydroxylation with decreasing adiposity was associated with anovulation and amenorrhea among the athletes.