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Biomedical subjects

D L Cullen

Publications and source records attributed to D L Cullen.

8 recordsLinked to original sources

Long term oxygen therapy adherence and COPD: what we don't know.

Persons utilizing long term oxygen therapy (LTOT) at home suffer from chronic obstructive pulmonary disease (COPD). Adherence to LTOT ranges from 45% to 70% and utilization of 15 hours per day is widely accepted as efficacious. Although studies have reviewed the level of patient adherence with LTOT, few have introduced or evaluated interventions. The paucity of information regarding patients following oxygen prescription is an enormous void that must be tackled to augment clinical effectiveness and cost containment for the long term. A research agenda for LTOT adherence is postulated to help connect treatment adherence variables and concepts with clinical outcomes and quality of life.

Guideline Adherence↗

Oxygen tubing lengths and output flows: implications for patient care.

BACKGROUND: Historical wisdom has recommended up to 50 ft (15.24 m) of tubing based on the oxygen cylinder delivery system. Yet, many individuals may store their stationary systems in one area of the home and conduct their activities at distances by adding additional tubing. The aim of this study was to discriminate at what lengths clinically relevant decreases in flow greater than 20% occurred. METHODS: Plastic tubing was added at 25 ft (7.62 m) intervals connected via a swivel adapter up to 200 ft (60.96 m) to a cylinder, concentrator and liquid stationary oxygen system to simulate a home oxygen environment. Flows of 1-5 L/min were set then measured via the Timemeter 200 after each segment of additional tubing. RESULTS: Output from the cylinder with regulator/flowmeter was greatly diminished as tubing and flowrate was increased which resulted in clinically significant reductions in flow at 2 L/min for tubing lengths greater than 100 ft (30.48 m). The oxygen concentrator had little flow reduction at 1 or 2 L and more flow loss at higher tubing lengths with 3, 4 and 5 L/min. Liquid oxygen was only mildly reduced at 125 ft (38.10 m) of tubing and 4 or 5 L of flow. Neither the concentrator nor liquid oxygen delivery units had flow reductions greater than 13.5 and 4.0%, respectively, at 2 L/min with 200 ft (60.96 m) of tubing. SUMMARY AND RECOMMENDATIONS: Tubing length up to 200 ft (60.96 m) could be utilized for providing patient home oxygen with Puritan Bennett style liquid oxygen. We recommend consideration of tubing lengths up to 200 ft (60.96 m) and up to 3 L/min or 100 ft (30.48 m) at 4-5 L/min for Invacare 5 and similar oxygen concentrators; however flow delivery should be verified by the manufacturer. The cylinder regulator/flowmeter system suffered the greatest flow loss. Flows of 1-2 L/min can be clinically maintained with up to 100-ft (30.48 m) of tubing. This study brings clarity of when tubing can be lengthened which may enhance movement within the home and lessen constraints.

Ambulatory Care↗

Measures of functional status and quality of life in chronic obstructive pulmonary disease.

A variety of studies exist as to methods of assessing quality of life in chronic obstructive pulmonary disease. Neither the American Thoracic Society nor the European Consensus Statement for COPD recommend any specific quality-of-life or functional assessment measure as a gold standard. The present study identifies measures of COPD quality of life and functional status reported in selected literature in 1994-1997. A total of 37 measures were identified; of these eight were measures of general health, 10 were COPD/disease-specific questionnaires, and 19 were functional status indices. These measures provide valuable data, and further study is necessary to determine which measures should be integrated into standards of care.

Attitude to Health↗

Nurses' responses to do-not-resuscitate orders in the neonatal intensive care unit.

A statewide survey of nurses in perinatal centers was conducted to assess the prevalence of do-not-resuscitate (DNR) policies in neonatal intensive care units (NICUs) and to examine factors influencing nurses in those centers in their compliance with DNR orders. Three nurses in each of 10 perinatal centers were asked to complete a questionnaire on DNR policies and nurses' compliance and to respond to four hypothetical clinical situations. Eighteen of the 27 responding nurses reported the existence of a DNR policy. Factors affecting compliance with DNR orders were agreement that the infant should not be resuscitated (n = 24) or respect for the parents' wishes (n = 19). Nurses' intention to resuscitate despite a DNR order varied, depending on the description of the infant. Multiple regression analyses showed that subjective norms (beta = .41 to .82) rather than attitudes (beta = .17 to .39) exerted a more powerful influence on nurses' decisions not to resuscitate.

Adult↗

Minority students benefit from mentoring programs.

Mentoring has been proposed as one strategy to attract minority students to the radiologic sciences profession. This case study describes a minority mentoring program conducted for pre-radiologic science students at a Midwestern university during the 1991-92 academic year. Ten minority radiologic science students enrolled in the mentoring program. The study showed that mentoring may be a viable option to serve the special needs of minorities for recruitment and retention.

Humans↗