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Biomedical subjects

E Walker

Publications and source records attributed to E Walker.

300 records · Page 17Linked to original sources
PubMedDate not supplied

Improved fluid management utilizing humidified incubators in extremely low birth weight infants.

OBJECTIVE: To compare fluid and electrolyte management in extremely low birth weight (ELBW) infants nursed in humidified versus nonhumidified incubators. STUDY DESIGN: Setting--tertiary intensive care nursery. Subjects--all infants with birth weight < 1000 g admitted 1/95 to 1/99 who were treated with incubators and survived for > 96 hours (N = 155). Intervention--retrospective comparison of daily weights, fluid intakes, urine outputs, and serum electrolytes between group 1 (n = 70, nonhumidified incubators, born 1/95 to 1/97) and group 2 (n = 85, humidified incubators, born 1/97 to 1/99) over the first 4 days after birth. RESULTS: Despite similar daily weight losses between groups, group 1 infants received higher fluid intakes, had lower urine outputs, and had a higher incidence of hypernatremia, hyperkalemia, and azotemia (p < 0.05). Although no differences in mortality or the incidence of patent ductus arteriosus, bronchopulmonary dysplasia, or the overall rate of nosocomial infections were observed, the proportion of gram-negative isolates increased significantly (62%, p < 0.05) following the introduction of humidified incubators. CONCLUSIONS: ELBW weight infants nursed in humidified incubators have lower fluid requirements, improved electrolyte balance, and higher urine outputs during the first 4 days after birth compared to those nursed in nonhumidified incubators.

Bronchopulmonary Dysplasia↗
PubMedDate not supplied

The use of primary care services by the Chinese population living in England: examining inequalities.

OBJECTIVE: To assess general practitioner consultation among Chinese people compared with the general population and other minority ethnic groups, and to investigate the factors associated with general practitioner consultation among the Chinese population. DESIGN: Survey of a representative sample of Chinese people aged 16-74 living in private households in metropolitan areas of England. One thousand and twenty-two people who defined themselves as 'of Chinese origin' were interviewed. General practitioner consultations were analysed in relation to self-reported general health and long-standing illness or disability, gender, age, social class, country of birth, whether the respondent spoke English, use of traditional Chinese medicine, and the ethnicity and gender of the respondent's general practitioner. RESULTS: The self-reported general health status of Chinese people is similar to that of the general population and better than that of other minority ethnic populations. The level of general practitioner consultation by Chinese people is low compared with the general population and with other minority ethnic groups. Within the Chinese population, general practitioner consultation is related to gender, self-reported health status and the ability to speak English. Ability to speak English is the strongest positive predictor of general practitioner consultations. CONCLUSION: Chinese people in England are less likely than people from other minority ethnic groups to consult their general practitioner, even after their relative health status is taken into consideration. Use of general practitioners by Chinese people in England is associated with a number of factors, of which the strongest predictor is the ability to speak English. Chinese people who speak English are more likely than those who do not, to consult their general practitioner. Health service providers should accommodate the needs of this group by providing access to advocacy services.

Adolescent↗
PubMedDate not supplied

Methodologic issues in randomized trials of liaison psychiatry in primary care.

Most anxiety, depressive, and substance abuse disorders are treated exclusively in the primary care health system. However, recognition and treatment of these disorders in primary care is deficient. Psychopharmacologic and psychotherapeutic interventions have been developed and proven effective in randomized trials in specialty care. However, the results of successful trials of mental health interventions in specialty settings may not generalize to primary care settings because of epidemiologic differences in patients, differences in skills of providers, as well as differences in the very structure of care. The importance of the development of innovative randomized trials to improve recognition and treatment of mental illness in primary care is emphasized, as well as the methodologic problems inherent in carrying out these trials.

Humans↗
PubMedDate not supplied

Treatment costs, cost offset, and cost-effectiveness of collaborative management of depression.

OBJECTIVE: The report estimates the treatment costs, cost-offset effects, and cost-effectiveness of Collaborative Care of depressive illness in primary care. STUDY DESIGN: Treatment costs, cost-offset effects, and cost-effectiveness were assessed in two randomized, controlled trials. In the first randomized trail (N = 217), consulting psychiatrists provide enhanced management of pharmacotherapy and brief psychoeducational interventions to enhance adherence. In the second randomized trial (N = 153). Collaborative Care was implemented through brief cognitive-behavioral therapy and enhanced patient education. Consulting psychologist provided brief psychotherapy supplemented by educational materials and enhanced pharmacotherapy management. RESULTS: Collaborative Care increased the costs of treating depression largely because of the extra visits required to provide the interventions. There was a modest cost offset due to reduced use of specialty mental health services among Collaborative Care patients, but costs of ambulatory medical care services did not differ significantly between the intervention and control groups. Among patients with major depression there was a modest increase in cost-effectiveness. The cost per patient successfully treated was lower for Collaborative Care than for Usual Care patients. For patients with minor depression. Collaborative Care was more costly and not more cost-effective than Usual Care. CONCLUSIONS: Collaborative Care increased depression treatment costs and improved the cost-effectiveness of treatment for patients with major depression. A cost offset in specialty mental health costs, but not medical care costs, was observed. Collaborative Care may provide a means of increasing the value of treatment services for major depression.

Adult↗
PubMedDate not supplied

Training and research in emergency psychiatry.

In this chapter we have attempted to describe some of the issues that must be addressed in funding, designing, and running a research and training program for emergency psychiatry. Such a program serves the in-house needs of staff training, skill and morale renewal, and program evaluation. In addition it can serve as a resource for the community to train a future cadre of individuals and to seek answers that will provide a solid base of knowledge for emergency psychiatry in the future.

Emergency Services, Psychiatric↗
PubMedDate not supplied

Self-injurious behaviour in people with a mental handicap.

The population of a hospital for people with a mental handicap was surveyed and numerous variables analysed with regard to people displaying self-injurious behaviour (SIB). It is suggested that age, level of mental handicap, activities in which the person is engaged, and having no expressive language each has a significant influence on the frequency of self-injurious behaviour. Nearly three-quarters of the survey population were without expressive language and a majority self-injured more than once a day. Treatment methods employed were also included in the survey.

Humans↗
PubMedDate not supplied

Developing staff nurse experts in nursing diagnosis-based care planning.

In this article, the authors describe the Program to Increase Nursing Knowledge and Facilitate the Utilization of Nursing Diagnosis (PINK FUND) undertaken at the Medical College of Virginia Hospitals. The program prepared unit-based nurses to be facilitators for nursing diagnosis-based care planning. Major curriculum threads included theory of nursing diagnosis, planned change, and adult learning. Instructors modeled innovative instructional methodologies for participants. Program planners vigorously marketed the program to nurses within the institution. The program succeeded in preparing nurses to use the nursing process to deliver planned care. The program description will serve as a potential model for staff development educators seeking to increase staff competence in nursing care planning and documentation.

Adult↗