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Biomedical subjects

D Ross

Publications and source records attributed to D Ross.

At least 451 records · Page 25Linked to original sources
PubMedDate not supplied

Health planning in Pakistan: a case study.

Health planning is an essential function of the state. For it to be successful, a number of conditions need to be satisfied. In particular it needs to be flexible, participative and integrated with other decision processes. Despite some strengths, the health planning system in Pakistan has generally failed to provide the framework to allow such an approach. Links between strategic and operational planning have been weak; decision-making has been very centralized; there has been a lack of functional clarity; the respective roles of bureaucrats and politicians have been unclear; and, links between capital and recurrent budgets and between planning and implementation have been weak. As a result, there is a number of imbalances in the allocation of resources. The introduction of a revised health planning system for Pakistan is discussed. The constraints on such a system and an initial assessment of its success are presented.

Budgets↗
PubMedDate not supplied

Community health workers in national programmes: the case of the family welfare educators of Botswana.

Community health worker programmes have become a prominent feature of many primary health care schemes in developing countries. This paper, which is based on a larger collaborative study undertaken in 3 countries, focuses on the experiences with such workers in Botswana, and concludes that many of the key issues that were highlighted in the Botswana study are similar to those in other countries. These can be summarized under four headings: unrealistic expectations, poor initial planning, problems of sustainability, and the difficulty of maintaining quality of care. The future success of these workers will depend on their being integrated more systematically into local services, with concomitant strengthening of management support and supervision.

Botswana↗
PubMedDate not supplied

Short-term evaluation of an electro-chemical system (ExacTech) for blood glucose monitoring.

114 venous blood samples (plasma glucose ranging between 2.6 and 30.7 mmol/l) were measured by a new pen-sized glucose meter designed for blood glucose self-monitoring working with an electro-chemical method. Glucose readings of three pen-meters were compared with plasma glucose measurements obtained from a standard glucose-oxidase-method. Precision, accuracy and clinical relevance were determined by assessment of the agreement between the two methods and error grid analysis. The mean differences between the pen-meters' blood glucose readings and plasma glucose were -1.35, -1.43 and -1.56 mmol/l, with limits of agreement (+/- 2 SD) of 2.2 and -4.9, 2.1 and -5.0 and 2.0 and -5.1 mmol/l, respectively. The 57 samples in the clinically relevant range, i.e., with plasma glucose concentrations below 13 mmol/l showed mean differences of -0.04, -0.10, and -0.04 mmol/l, with limits of agreement between -1.08 and 1.00 mmol/l, respectively. Error grid analysis showed that 90.7, 95.4, and 91.9% of the respective pen-meter readings fell in the zone A, i.e., gave clinically accurate results, the remaining values fell in zone B. One pen-meter broke during the study and had to be replaced. The results confirm that this new device gives accurate and reproducible measurements--faultless technical function provided--and, compares favorably with the well-established reagent strips for blood glucose self-monitoring.

Biosensing Techniques↗
PubMedDate not supplied

A pilot study of serum polychlorinated biphenyl levels in persons at high risk of exposure in residential and occupational environments.

A pilot study was conducted to determine whether persons at high risk of exposure to three waste sites in the area of Bloomington, Indiana, have abnormally elevated serum polychlorinated biphenyl (PCB) levels. In addition, we attempted to determine which environmental pathways might have contributed most to these exposures. First, a screening questionnaire survey of 995 individuals was conducted; on the basis of these data, 114 of the persons who had the greatest potential for exposure were selected for inclusion in this pilot exposure assessment study. People near these waste sites have higher average serum PCB levels, and a greater percentage have abnormally elevated serum PCB levels, compared with previously characterized populations in the United States. However, we could not distinguish specific pathways of exposure and uptake, with the exception of persons with occupational exposures and, possibly, among persons who reportedly salvaged metal from discarded electrical equipment. Exposures in this community require further evaluation.

Adult↗
PubMedDate not supplied

The etiology of steroid-induced avascular necrosis of bone. A laboratory and clinical study.

An attempt was made to reproduce in the experimental animal the clinical condition of steroid induced avascular necrosis of bone. There was a decrease in the ability of subchondral osteocytes to metabolize H3 cytidine and an increased amount of cell death as indicated by the number of empty subchondral lacunae. Oil red O stain for intravascular fat demonstrated large accumulations of fat in subchondral vessels. Much of this fat was deformed and was surrounded by reticulin, leading to the conclusion that it was embolic. A study of human material showed intravascular fat and diminished number of osteocytes in patients on systemic steroids who had died without clinical evidence of avascular necrosis. In addition, intravascular fat was demonstrated in avascular femoral heads and humeral heads both from transplant patients and patients receiving steroids for other reasons. The most tenable explanation for this series of events involves steroid-induced fatty liver with subsequent showeres of fatty emboli, which lodge in the subchondral region owing to the microvascular anatomy. Cell death ensues, and the necrotic bone is partially removed by the normal resorptive mechanism, but steroids retard osteogenesis, lead to microfractures, and eventually sequester the involved area.

Animals↗
PubMedDate not supplied

Acute compartment syndrome.

Orthopaedic nurses must be continually alert for the dreaded complication of fractures, acute compartment syndrome (ACS). This article reviews the current literature on predisposing factors, pathophysiology (including systemic factors), assessments, various diagnostic methods, and treatments of patients at risk for, or encountering, ACS. A nursing care plan including the pertinent nursing diagnoses for these patients is included, and nursing care before and after fasciotomy is outlined.

Compartment Syndromes↗
PubMedDate not supplied

Recovery from decompensated non-insulin-dependent diabetes mellitus: studies of C-peptide secretion.

Eleven non-insulin-dependent diabetic patients presented with decompensated hyperglycemia. Nine had pronounced ketonuria, five with acidosis. In seven cases, precipitating factors were identified. In the other four cases, including three cases of diabetic ketoacidosis, no identifiable triggering events were present. In each case, recovery from the initially decompensated diabetic state occurred. Eventually, all patients were managed by diet alone. Seven patients demonstrated nondiabetic glucose tolerance tests (GTT). Several patients underwent stressful situations after "recovery" without recurrence of hyperglycemia. Glucose-stimulated C-peptide levels were determined postrecovery. C-peptide secretion was in the normal range and, in fact, was identical, in relation to glucose levels, to that in a group of nondiabetic volunteers. In 6 of the 11 cases, C-peptide secretion was measured at the time of initial presentation. These levels were markedly lower than comparable values during the GTT postrecovery. Non-insulin-dependent diabetes, even when presenting in a decompensated state, is subject to a considerable degree of reversibility and even recovery to a nondiabetic state in some cases. Recovery is associated with a return to normal C-peptide secretion.

Adult↗
PubMedDate not supplied

Serum interleukin-2 levels in lung transplant recipients: correlation with findings on transbronchial biopsy.

Serum interleukin-2 (IL-2) levels were examined in the serum of 17 lung transplant recipients who underwent transbronchial biopsies to diagnose reasons for allograft dysfunction. Over 60 transbronchial biopsies were performed in these 17 patients in a 22-month observation period. Mean serum IL-2 levels were significantly elevated in patients experiencing allograft rejection (p less than 0.01), cytomegalovirus pneumonia (p less than 0.0006), and bacterial/fungal pneumonia (p less than 0.01), when compared with those with normal or nondiagnostic findings on transbronchial biopsies. Serum IL-2 levels were not extraordinarily elevated as seen in other types of allograft rejection and did not differentiate between infection and rejection. In addition, overlapping values were seen in the patient groups tested. Despite these limitations, elevated serum IL-2 levels in lung allograft recipients may provide supplemental information helpful in deciding when to perform transbronchial biopsies.

Adult↗
PubMedDate not supplied

Constipation among hospitalized elders.

This article presents a pilot study using a descriptive design to determine the feasibility of a major study of the prevalence of constipation among elders hospitalized in an acute care hospital. When orthopaedic nurses are aware of the altered bowel elimination patterns among elders, they can help their patients attain or maintain optimal functional goals.

Activities of Daily Living↗
PubMedDate not supplied

Selecting patients for HRT: positive indications.

As our understanding of the nature of modern postmenopausal hormone replacement therapy (HRT) has improved, the number of true contraindications to its use has declined. As a result, the question of whether or not to take HRT has become determined more by patient choice and less by medical factors, a trend that is likely to continue. Thus, women (as well as their doctors) need to be told of the indications for HRT so that they can make an informed choice.

Cardiovascular Diseases↗
PubMedDate not supplied

Solvolytic formation of 1,2-dichloro-3,4-epoxybutane from butadiene monoxide under physiological conditions.

Butadiene monoxide, a presumed carcinogenic metabolite of butadiene, is stable in water or phosphate buffer, but was found to rapidly disappear from the headspace of solutions (10(-6) to 10(-4) M) in phosphate-buffered saline incubated at 37 degrees C. The process was first order with respect to monoxide concentration, with an apparent rate constant of 6.6 x 10(-4) sec-1. Mass spectrometric examination of the major product formed indicated it to be 1,2-dichloro-3,4-epoxybutane, which was confirmed by synthesis. Formation of the dichloro epoxide was linearly dependent on chloride ion concentration of the medium, but independent of dissolved oxygen. The formation of the dichloro epoxide is explained by slow solvolytic formation of a chloronium ion from butadiene monoxide, which is followed by attack of chloride ion to generate chlorine and butadiene. The chlorine is than rapidly trapped by second molecule of butadiene monoxide. This was confirmed by competitive trapping of generated chlorine by inclusion of crotyl alcohol in the incubation. A similar pathway has recently been demonstrated for reversible formation of bromine from solvolytically generated bromonium ions. The facile formation of dichloroepoxybutane under physiological conditions may be of significance in the toxicity of butadiene.

Bromine↗