Constipation in neurological diseases.
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Autonomic Nervous System Diseases↗
Biomedical subjects
D Rasmussen
Publications and source records attributed to D Rasmussen.
Patient outcomes after peripheral revascularization surgery.
Acquired peripheral vascular disease (PVD) is a significant problem in the United States, resulting in both morbidity and mortality. The purpose of the pilot study was to determine patient outcomes after peripheral revascularization surgery. The specific aims of the pilot study were to examine peripheral revascularization surgical patient outcomes (PVD-related clinical symptoms, functioning, atherosclerotic disease risk factor reduction, and patient satisfaction) and to determine the influence of selected patient demographic characteristics (gender, age) on selected patient outcomes (PVD-related clinical symptoms, functioning, atherosclerotic disease risk factor reduction, and patient satisfaction). A prospective, repeated measures design was used for the study. A total of 39 patients, 18 women and 21 men, participated in the study, with a mean age of 68.86 years (SD = 13.61). The average length of hospitalization after surgery was 4.05 days. At 1 month after discharge, the majority of patients had relief from claudication and paresthesia. In regard to outcomes related to atherosclerotic risk factor modification, patients reported that they exercised on a routine basis, an average of 5.31 +/- 1.97 times per week. Before surgery, 21 patients reported that they smoked; 6 patients reported that they continued to smoke at follow-up. There were no significant differences in mean total scores of atherosclerotic risk modification by either gender or age groups (<65 or > or =65 years) with the use of one-way analyses of variance (ANOVAs). By using a Likert scale (ie, 0 to 10), the mean level of functioning was 8.18 +/- 2.76, with women having significantly higher mean levels of functioning (F = 4.26, P <.05). Comparing baseline scores of functioning on the Medical Outcomes Study Short-Form 36 (MOS SF-36), there was a significant improvement (F = 2.11, P <.05) in general health subscale scores at 1 month after surgery. Subjects' mean overall satisfaction with the results of surgery, with a 0 to 10 scale, was 7.33 +/- 2.84. Again, by using one-way ANOVAs, females had significantly higher mean satisfaction rating than males (F = 4.52, P <.05). Although findings from this pilot study are limited in their generalizability, clinicians need to continue to evaluate opportunities to further reduce variability in clinical practice patterns for optimal patient outcomes. Study findings also indicated that additional interventions are warranted to educate and provide rehabilitation for patients regarding an exercise program and overall behavior modification strategies to reduce risk for atherosclerotic disease.
Aged↗
Rural, urban and suburban comparisons of preventive services in family practice clinics.
Numerous studies have compared health services provided in rural and urban areas, and overall they have found that utilization is lower in rural areas. A significant factor in lower utilization is that rural residents have less access to health services. Much less is known about rural and urban utilization differences once a patient has access to a service provider. This paper focuses on preventive services received when a patient is already in a clinic. Using data from an in-depth qualitative study of 16 family practice clinics in Nebraska, comparisons of physician-specific preventive service rates are made across three geographic categories: rural, urban and suburban. Results from a one-way multivariate analysis of variance show that preventive services rates for nine services examined were as high or higher in rural areas, suggesting that rural health services do not lag for patients with access.
Adolescent↗
Collaborative research: a community approach.
Collaborative nursing research is an effective means to increase research productivity. The essentials of collaborative research are contribution, communication, commitment, consensus, compatibility, and a cohesive approach toward a positive outcome. The purpose of the demonstration project was to describe a collaborative process in one community, culminating in a research utilization study and development of nursing standards pertaining to an aggregate population of patients.
Clinical Nursing Research↗
Chest pain management: linking tertiary and rural settings.
The Center for Advanced Nursing Practice Evidence-Based Model was the catalyst and driving force that guided the application of evidence-based practice across boundaries of tertiary health care settings to rural health care settings. The intent of this effort was to enhance knowledge and to streamline practice for the management of patients with chest pain. The model successfully supported practice changes and improved outcome management for this aggregate population.
Electrocardiography↗
Comparison of clinical practice changes in a rapid recovery program for coronary artery bypass graft patients.
The clinical exemplar reported in this article demonstrates the usefulness of the Center for Advanced Nursing Practice's Evidence-Based Practice Model in facilitating a structured approach to expanding outcomes management of rapid recovery for coronary artery bypass graft (CABG) patients. The evidence-triggered and evidence-supported components of the model were key in using research and evidence-based practices to analyze the current program of outcomes management used for CABG rapid recovery. The evidence-observed component further validated changes in clinical practice, which became part of the evolving outcomes management program.
Adult↗
[Psychological work environment--personnel gets stuck. Interview by Claus Leick].
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Adolescent↗
[Theophylline poisoning--clinical course and treatment].
After about half a century of treatment of asthma and chronic obstructive pulmonary disease, theophylline still occupies a central position in the treatment of these conditions. Severe poisonings are rare and may occur as a result of chronic over-medication or acute self-poisoning. The clinical course depends not only on the amount taken and the peak serum concentration, but also on whether the intoxication is acute or chronic. The therapeutic range is narrow (55-110 mumol/l). Total body clearance of theophylline varies considerably between individuals, and drug interactions are common. These circumstances lead to relatively high risk of poisoning. Clinical features vary from moderate gastrointestinal discomfort, particularly nausea, tremor and tachycardia, to life-threatening conditions affecting the cardiovascular and central nervous systems. Treatment is discussed in connection with a presentation of three case histories.
Adult↗
[CT in the prognostic evaluation of apoplexy].
The purpose of our prospective study was to determine whether cranial computed tomography in connection with neurological assessment was useful in prognostic evaluation of survival after acute stroke. Two-hundred and forty-five consecutive stroke patients were included. Each underwent detailed neurological assessment and cranial computed tomography without intravenous contrast injection. The lesions were divided according to neuroanatomic regions. In the statistical analyses we used a multiple logistic regression model. Computed tomography showed that 76% of the patients had infarcts. 11% had haemorrhages, and 13% had no acute lesion. Forty-three patients had more than one acute lesion, and 57 had one or more old infarcts. The temporal, parietal and frontal regions and the basal ganglia were most often affected. We concluded that age, level of consciousness, and involvement of the temporal lobe on computed tomography were factors of prognostic significance regarding survival in the acute phase.
Acute Disease↗
Computed tomography in prognostic stroke evaluation.
BACKGROUND AND PURPOSE: Computed tomography is now routinely used in many hospitals to investigate cerebrovascular disease. The purpose of our prospective study was to determine whether cranial computed tomography in connection with neurological assessment was useful in prognostic evaluation of survival after acute stroke. METHODS: Two-hundred forty-five consecutive stroke patients were included in the project during a 1-year period. Each had a detailed neurological assessment 24-72 hours after stroke onset and underwent cranial computed tomography without intravenous contrast injection within the first week after admission. The lesions were divided according to neuroanatomic regions. In the statistical analyses we used a multiple logistic regression model with survival/death as the binary variable. RESULTS: Computed tomography showed 76% of the patients had infarcts, 11% had hemorrhages, and 13% had no acute lesion. Forty-three patients had more than one acute lesion, and 57 had one or more old infarctions. The temporal, parietal, and frontal regions and the basal ganglia were most often affected. CONCLUSIONS: We conclude that age, level of consciousness, and involvement of the temporal lobe on computed tomography were factors of prognostic significance regarding survival in the acute phase.
Adult↗
Phase II study of teniposide in advanced breast cancer.
In a phase II study, 19 patients with previously treated, advanced breast cancer received 50 mg/m2 teniposide (VM-26) i.v. on days 1-5 every 3 weeks. One partial response (PR) (5%) was observed. Toxicity consisting of leukopenia and thrombocytopenia was frequent and severe. VM-26 has minimal therapeutic activity when given at this dose and on this schedule to patients with heavily pretreated metastatic breast cancer.
Adult↗
Ethopharmacology: a creative approach to identification and characterisation of novel psychotropics.
The present contribution describes the basic fundamentals of animal models in ethopharmacology. After defining the role of ethopharmacology in the development of animal models of relevant human diseases, this methodology is used to classify different categories of aggression. Furthermore, the behavioural aspects of agonistic (aggressive) modelling are outlined and the various models used to describe offensive and defensive behaviours, and some miscellaneous models are summarized. Finally, some remarks on the new class of psychoactive drugs, serenics, are given.
Animals↗
Behavioural pharmacology of the serenic, eltoprazine.
In this paper the effects of serenics (eltoprazine and fluprazine) are described in several animal models for offensive agonistic, defensive agonistic and predatory behaviour. They are compared with the effects of a number of other putative anti-aggressive compounds or drugs used clinically in order to ameliorate aggressive behaviour of psychiatric patients. In isolation-induced offensive aggression in mice, eltoprazine has a marked and potent anti-aggressive activity, although numerous other psychoactive drugs also exert anti-aggressive effects. The behavioural specificity of this anti-aggressive profile was investigated using an ethologically derived animal model, social interaction in male mice. In this model, eltoprazine has a very specific anti-aggressive (serenic) profile, inhibiting aggression while social interaction and exploration are not decreased but even enhanced; inactivity, a measure for sedation, is not affected. Such a profile contrasts sharply with that of neuroleptics (chlorpromazine, haloperidol), psychostimulants (d-amphetamine) or benzodiazepines (chlordiazepoxide), which exert severe sedation (neuroleptics) or even aggression-enhancing effects (BDZ). After subchronic treatment no tolerance for the anti-aggressive effects of eltoprazine occurred. The specific anti-aggressive effects of eltoprazine were also found in rat models of offensive agonistic behaviour. In one such model - resident-intruder aggression - eltoprazine reduced offensive behaviour specifically, leaving social interactions and exploration intact, and did not induce sedation or other unwanted side-effects. The neuroleptic haloperidol was very sedative in this model, as was the 5-HT1A-agonist buspirone. Benzodiazepines (chlordiazepoxide) have a biphasic effect in this paradigm, enhancing offence at low doses and decreasing it at higher doses, due to muscle relaxation. In another offensive model, colony-aggression, in which a dominant and subordinate male in a colony are confronted with a male intruder, eltoprazine reduced offensive behaviour of both the dominant and the subordinate against the intruder. In contrast, chlordiazepoxide enhanced aggression, at least at lower doses, whereas alcohol had, up to very high doses, no effect on the offensive behaviour. In a brain-stimulation induced offensive model--hypothalamically-induced aggression in rats--eltoprazine specifically reduces offence. Locomotion, a measure for sedation, was either unaffected or even somewhat enhanced, indicating the absence of any sedatory activity of this serenic compound. In contrast, haloperidol heavily sedated animals, making them incapable of aggression.(ABSTRACT TRUNCATED AT 400 WORDS)
Animals↗
[Is hepatitis B antigenemia a risk in adjuvant cytostatic treatment of breast cancer?].
One-hundred and fifteen consecutive patients with breast cancer were examined for hepatitis B. All the patients received adjuvant chemotherapy. The median age was 46 years (range 26-54 years). None of the patients were found to be HBsAg-positive. The prevalence of HbsAg was within the limits of 0-0.026 (95% confidence interval). Vaccination of patients receiving chemotherapy is not indicated. Furthermore, regular HBsAg screening among patients under 55 years cannot be recommended.
Adult↗
Elemental diet: a therapeutic approach in chronic inflammatory bowel disease.
The therapeutic effect of an elemental diet (Pepti 2000) and blended normal diet (placebo) was investigated in 43 out-patients with chronic inflammatory bowel disease (IBD); 24 with ulcerative colitis (UC) and 19 with Crohn's disease (CD), in a mild to moderate state of disease activity. A pilot study on healthy volunteers was executed to investigate palatability of the two diets. The patients were randomized in a double-blind study to the two diet regimes for 14 d. A simultaneous determination of laboratory data including plasma C3c split product and urinary excretion of 51Cr-EDTA was carried out together with a careful registration of the clinical symptoms and signs. No significant effect on the stage of clinical activity was seen in CD. A significant effect on clinical activity was obtained in both UC groups. The clinical improvement was primarily due to a decrease in number of bowel movements both in the elemental diet group and in the group of patients on the blended normal diet. The gross appearance of rectal mucosa did not improve during the study period in the Pepti 2000 or in the placebo group. The concentration of complement split products in plasma remained unchanged. 51Cr-EDTA excretion, as an expression of a leaky bowel mucosa, also remained unchanged. It was concluded that an effect on inflammation could not be demonstrated even if both diets seem to have a beneficial effect on the stage of clinical activity, especially diarrhoea, in patients with UC.
Adult↗
Focal intracerebral oedema in hypertensive encephalopathy visualized by computerized tomographic scan.
A previously healthy man was admitted due to a severe rise in the arterial blood pressure. The patient was found confused and drowsy, but the neurological investigation was otherwise normal. A computerized tomographic scan of cerebrum showed widespread areas of diminished density in the brain. After normalization of the arterial blood pressure, a new computerized tomographic scan did not show any pathological enhancement. The total regression of signs and symptoms after the normalization of the blood pressure support the assumption that a severe increase in blood pressure leads to formation of focal cerebral oedema.
Brain Diseases↗
Life events and social support in prediction of stroke outcome.
A prospective study of 252 patients (average age 73, range 26-95) admitted to a regional general hospital over a 12-month period was carried out. 241 patients had stroke verified by the initial neurological examination and CT scan, and of these baseline data were not available on 27%. 34% died before or were not willing or able to provide data at follow-up. 39% survived and completed the study. Prestroke life events and social support could not predict the outcome of stroke rehabilitation measured as survival, length of stay, functional recovery (Barthel's Index) or placement at the follow-up 12 months after the onset of stroke. Age and arteriosclerotic heart disease predicted poor survival at follow-up. Premorbid hypertension, stroke, diabetes, obesity, tobacco smoking, and alcohol consumption did not significantly influence the outcome. Problems in stroke rehabilitation research are discussed.
Adult↗