Biomedical subjects
Publications and source records attributed to E Blair.
Blair and O'Brien orient us to the conference where this issue's articles on nursing administration education originated. The authors stress the critical need for development of nursing administration theory.
Transvaginal ultrasonography was performed in 139 patients at risk for ectopic pregnancy. Among these patients, 22 ectopic pregnancies and 117 intrauterine pregnancies were eventually confirmed. Transvaginal ultrasonography definitively identified 18 of 22 (82%) ectopic pregnancies at initial evaluation by either direct visualization of an ectopically placed gestational sac (N = 14) or failure to visualize an intrauterine gestational sac combined with a level of the beta-subunit of human chorionic gonadotropin greater than 1300 mIU/ml (First International Reference Preparation) (N = 4). Transvaginal ultrasonography definitively diagnosed 103 of 117 (88%) intrauterine pregnancies at initial evaluation. Eighteen patients could not be definitively diagnosed by transvaginal ultrasonography at initial evaluation because nonvisualization of a gestational sac and a beta-subunit of human chorionic gonadotropin value less than 1300 mIU/ml. Evaluation of this group with serial measurements of beta-subunit of human chorionic gonadotropin, repeat ultrasonography, or both, revealed ectopic gestation (N = 4), early intrauterine pregnancy (N = 4), and complete abortion (N = 10).
Latex agglutination testing for colonization of the vagina with group B streptococci was carried out in 1100 patients. Samples underwent latex testing after 8 to 12 hours of preincubation in selective growth medium. This technique allowed a sensitivity of 91.8% and specificity of 97.6%. This study demonstrates the usefulness of latex agglutination testing in the detection of vaginal colonization with group B streptococci.
The effects of physical activity as a maintenance strategy for smoking cessation were evaluated. After a standard smoking cessation program, forty-two women were randomly assigned to one of three groups that received equal number of maintenance meetings: a physical activity program, smoking habit change information and contact control. Abstinence decreased from 83% at the end of treatment to 73% at 3 months, 49% at six months and 34% at 18 months. No differences were shown in cessation across groups. Group differences were shown for subjective levels of tension-anxiety, those who exercised showed increased tension anxiety levels compared to subjects in the no activity groups.
Data on all children with spastic cerebral palsy (N = 183) and on a matched group of control children (N = 549) born in Western Australia between 1975 and 1980 were compared to investigate the relationship between birth asphyxia and spastic cerebral palsy. Information on perinatal events for both the children with cerebral palsy and the control subjects was collected by means of epidemiologic methods to reduce bias. An association between clinically observed perinatal signs of birth asphyxia and spastic cerebral palsy was found (relative risk 2.84; 95% confidence interval 1.85 to 4.37). The population-attributable risk proportion was 14.1%. The likelihood of birth asphyxia's causing perinatal brain damage was assessed by two independent observers using defined criteria. It was estimated that in only about 8% (15/183) of all the children with spastic cerebral palsy was intrapartum asphyxia the possible cause of their brain damage. The contribution of intrapartum events and obstetric mismanagement to overall cerebral palsy rates is probably less than was previously thought.
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Interobserver variation in diagnosis is thought to be an important source of bias in studies of cerebral palsy. Kappa (kappa) statistics were used as a measure of interobserver diagnostic agreement for two case series of 20 children attending an institution for the motor handicapped. kappa increased threefold after standardisation of diagnostic terms. Sources of diagnostic variation are discussed and possibilities and benefits of its further reduction explored.
Cases of cerebral palsy which apparently were due to some postnatal event were studied in the Western Australian Cerebral Palsy Register. 11 per cent (89) of all cases were thought to be so acquired, a rate of 2.4 per 10,000 neonatal survivors. Males, particularly under 12 months of age, were especially vulnerable. Infections such as meningitis and encephalitis, particularly among aboriginal children, were responsible for over half the cases and accidents were responsible for one-quarter. Other causes included epileptic fits and cerebrovascular accidents. There was a positive association with parity and neonatal problems and a negative one with birthweight, suggesting that children 'at risk' neonatally are more susceptible to a postnatal brain-damaging event. Preventive programmes should include improvement in aboriginal living conditions; legislation for car restraints for infants; and health education for parents on the vulnerability of infants, the importance of immunisation, and how to recognize early the signs of potentially serious infections.
Emergency health services have evolved as a complex and demanding activity. Factors responsible include public perception and need for ready access to relatively prompt attention in a highly developed and expensive health resource area, and reliance on these services for clinical material for inhospital census and teaching. Thus, an emergency health service is a vital resource within a university environment for patient care, education and research. Appreciation of the nature and significance of this resource has not yet matured within the academic community. A logical, comprehensive approach is required to control the development of such a service as an academic department and to eliminate haphazard, unexploited growth. Required features include recognized specialty and academic status with full-time faculty, undergraduate curricula and a residency program with career goals to attract highly motivated physicians. The potential for clinical research of prehospitalization pathophysiology in trauma and acute emergencies in intensive care and similar units has not been properly exploited.
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The nature and mechanism of formation of the thiobarbituric acid (TBA)-reaction material produced in the autoxidation of polyunsaturated fatty acids (PUFA) or their esters has been studied. On the basis of chemical studies and spectroscopic evidence, it is concluded that the TBA test detects malonaldehyde which arises at least in part from the acid-catalyzed or thermal decomposition or endoperoxides (2,3-dioxanorbornane compounds). These endoperosides have structures related to those of the endoperoxides produced in the biosynthetic sequence leading to prostaglandins. A mechanism is proposed in which these endoperoxides are formed in a free radical cyclization process operating in competition with hydroperoxide formation during the autoxidation of PUFA or their esters containing three or more double bonds. When 20:3 or 20:4 PUFA undergo autoxidation, some of the natural, physiologically active prostaglandins would be produced, although in very low yield, along with many other stereo- and positional isomers. Thus, it is possible that some of the complex symptoms of lipid peroxidation in vivo could be due to nonenzymatically produced prostaglandins or their steroisomers.
In a series of 24 patients with major blunt chest trauma, 11 presented evidence of heart injury upon re-examination of serial ECGs and four were confirmed at autopsy. The clinical diagnosis had been recorded in only one patient. In every case of closed chest trauma, regardless of the degree of visible injury, cardiac injury must be suspected. A presumptive diagnosis is then made, usually on the basis of ECG changes, which cannot be ruled out by any other cause. Even in some cases with normal ECGs the clinician's suspicion is the only guide. With a presumptive diagnosis made, the patient is treated as is any patient with an irritable myocardium; bedrest, avoidance of conditions which may precipitate arrhythmias, and of fluid overload, and treatment of these complications as they arise. Anticoagulants are usually avoided. Followup for long periods is indicated, because of the occasional emergence of chronic constrictive pericarditis or ventricular aneurysm.
The pathodynamics of respiratory insufficiency are based upon the impairment of movement of O2 from the atmosphere to the pulmonary capillary blood. In blunt chest trauma the mechanisms can be clarified in terms of mechanical barrier phenomena. Two barriers are identified. The first is the mass or gross lung-thorax complex and is determined by integrity of the chest wall and ventilation of the lungs. Impairments are manifested by reduced PaO2. The second is the micro complex of the alveolocapillary membrane. The disturbance is a combination of VA/Q alterations and increased diffusion barrier block and is manifested by reduced PaO2 and increased A-aDO2. These are summarized in Table 5. The degree of alteration in PaO2, and especially in A-aDO2, can distinguish between flail (loss of chest wall integrity) and flail plus contusion (VA/Q and a-c block). Management of chest wall-lung gross problems is well established and relatively successful. The micro barrier disturbance is more complex and difficult.
Primary mesenteric venous occlusive disease is a highly lethal disease. The only way to improve survival is early diagnosis and immediate laparotomy. The disease occurs in the older age group with a higher incidence in women and should be considered in the differential diagnosis of serious abdominal distress. The most helpful diagnostic tests are paracentesis and peritoneoscopy, but above all, the most important diagnostic tool is a high index of suspicion on the part of the examining physician.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.