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Biomedical subjects

I Graham

Publications and source records attributed to I Graham.

113 records · Page 7Linked to original sources
PubMedDate not supplied

The impact of risk on preference values: implications for evaluations of postmenopausal osteoporosis therapy.

OBJECTIVE: The objective was to assess the impact of different levels of risk of disease on a woman's preferences for health states. Women were provided with health scenarios incorporating different levels of lifetime risks for breast cancer, hip fracture, and coronary heart disease (CHD). In this way, we were able to determine the incremental effect of changes in risks of each disease on preference values. METHODS AND DATA: Preference values and utility scores were obtained for six health scenarios by both the feeling thermometer (FT) and standard gamble (SG) methods. Scenarios presented the different lifetime risks of CHD, breast cancer, and hip fracture associated with and not associated with long-term use of hormone replacement therapy (HRT) and raloxifene. Risks of breast cancer were based on perceived risks and population risks. The sample population consisted of 40 healthy female volunteers aged between 45 and 65 years randomly selected from the Ottawa-Carleton district. RESULTS: Based on their perceived risk of breast cancer, the women had higher value scores for the raloxifene risk profile than for both HRT (p = .002) and no therapy (p = .003), with similar results for analyses based on population risks and from utility scores. Regression analysis showed that the risk of breast cancer (p < .001) was the only disease risk that was statistically significantly associated with women's preferences. CONCLUSIONS: Women had significant preferences over the different risk profiles, primarily due to the incremental effect on changes in values for the risk of breast cancer. Therefore, studies evaluating therapies for osteoporosis should consider patient preferences for living with different risk profiles.

Aged↗
PubMedDate not supplied

A survey of suctioning practices among physical therapists, respiratory therapists and nurses.

OBJECTIVE: To assess the current tracheal and oropharyngeal suctioning practice variability within and among the professions of physical therapy, respiratory therapy and nursing. DESIGN: A mail survey of physical therapists, respiratory therapists and registered nurses who perform suctioning. The survey instrument consisted of questions about professional characteristics, clinical suctioning practice and sociodemographics. SETTING: The survey was restricted to professionals practising within the province of Ontario. PARTICIPANTS: Random samples (n=448) were drawn from membership of the regulatory boards of all three professions. MAIN RESULTS: Fifty-eight per cent of respondents returned completed questionnaires. There was large variation in reports of gloving procedure (eg, double clean: 26% for physical therapists, 5% for respiratory therapists, 55% for registered nurses, P<0.0001) and technique of catheter use (sterile, inline or clean, P<0.01). There was also discrepancy in the techniques used to minimize harmful effects, ie, prelubrication with gel (83% for physical therapists, 54% for respiratory therapists, 17% for registered nurses, P<0.0001), use of hyperinflation (12% of physical therapists, 25% of respiratory therapists, 39% of registered nurses never hyperinflate) and use of instillation (7% of physical therapists, 0% of respiratory therapists, 19% of registered nurses never instill). However, there was agreement about the routine application of hyperoxygenation (74% or more) and there was almost perfect agreement (99% or more) within and across the three professions that secretion removal was the main indication for suctioning. CONCLUSIONS: The results of this study indicate a wide variation in suctioning techniques among physical therapists, respiratory therapists and registered nurses. Comparisons among professions revealed inconsistencies in some areas, such as the use of in-line catheters, gloving procedures, prelubrication and hyperinflation.

Cross-Sectional Studies↗
PubMedDate not supplied

Primary nursing in contemporary practice.

The efficacy of primary nursing as a care delivery system continues to provoke debate. In this wide-ranging discussion, the author identifies the current status of nursing in relation to defined characteristics of its social reality, and shows how primary nursing is 'reconstructing what nurses believe nursing is about'.

Education, Nursing↗
PubMedDate not supplied

The effects of lisinopril on serum catecholamine concentrations both at rest and on exercise in patients with congestive cardiac failure. A double blind, placebo controlled, parallel group study.

Patients with congestive cardiac failure have elevated sympathetic activity at rest which contributes to the pathophysiology of this syndrome. In addition, the sympathetic response to exercise in these patients is abnormal. Sympathetic activity is accurately reflected by serum noradrenaline levels. In a double-blind, placebo-controlled, parallel group study, 16 patients of New York Heart Association (NYHA) functional class II, stabilised on optimum doses of diuretics were randomised into two equal groups, to receive either low-dose Lisinopril, an orally active angiotensin converting enzyme (ACE) inhibitor, or matching placebo, over a 12 week period. At the end of the 12 week treatment phase, there was no significant change in noradrenaline levels at rest (p = 0.33) mid exercise (p = 0.17), or peak exercise (p = 0.69), in the lisinopril group. Both lisinopril and placebo groups improved subjectively as assessed by change in NYHA grade, (p < 0.01 for placebo and p < 0.001 for those given lisinopril). Exercise duration improved significantly in the lisinopril group (p = 0.0296), but not in the placebo group after treatment. Low dose lisinopril is of use in congestive cardiac failure even in the absence of measurable changes in sympathetic tone.

Angiotensin-Converting Enzyme Inhibitors↗