Utilization management: a new generation.
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Case Management↗
Biomedical subjects
J A Sullivan
Publications and source records attributed to J A Sullivan.
Recombinant human acid alpha-glucosidase enzyme therapy for infantile glycogen storage disease type II: results of a phase I/II clinical trial.
PURPOSE: Infantile glycogen storage disease type II (GSD-II) is a fatal genetic muscle disorder caused by deficiency of acid alpha-glucosidase (GAA). The purpose of this study was to investigate the safety and efficacy of recombinant human GAA (rhGAA) enzyme therapy for this fatal disorder. METHODS: The study was designed as a phase I/II, open-label, single-dose study of rhGAA infused intravenously twice weekly in three infants with infantile GSD-II. rhGAA used in this study was purified from genetically engineered Chinese hamster ovary (CHO) cells overproducing GAA. Adverse effects and efficacy of rhGAA upon cardiac, pulmonary, neurologic, and motor functions were evaluated during 1 year of the trial period. The primary end point assessed was heart failure-free survival at 1 year of age. This was based on historical control data that virtually all patients died of cardiac failure by 1 year of age. RESULTS: The results of more than 250 infusions showed that rhGAA was generally well tolerated. Steady decreases in heart size and maintenance of normal cardiac function for more than 1 year were observed in all three infants. These infants have well passed the critical age of 1 year (currently 16, 18, and 22 months old) and continue to have normal cardiac function. Improvements of skeletal muscle functions were also noted; one patient showed marked improvement and currently has normal muscle tone and strength as well as normal neurologic and Denver developmental evaluations. Muscle biopsies confirmed that dramatic reductions in glycogen accumulation had occurred after rhGAA treatment in this patient. CONCLUSIONS: This phase I/II first study of recombinant human GAA derived from CHO cells showed that rhGAA is capable of improving cardiac and skeletal muscle functions in infantile GSD-II patients. Further study will be needed to assess the overall potential of this therapy.
Age Factors↗
Clubfoot release without wide subtalar release.
Fifty-two feet treated by clubfoot release without wide subtalar release were evaluated 4.2-10.8 years after surgery. Eleven feet (21%) had undergone additional operative procedures at the time of review, and 82% of feet had good or excellent functional ratings at that time. The mean talocalcaneal index was 49 degrees (range 12-76 degrees), indicating that correction of the subtalar joint occurred in some patients. This procedure satisfactorily corrects many feet but undercorrects some. Overcorrection was rare. Foot progression angles were also determined and are reported in an accompanying article.
Anthropometry↗
Comparison of manifest needs of nurses and physicians in primary care practice.
Nurses, among other professionals, have been tested extensively using the Edwards Personal Preference Schedule. High scoring needs found in previous studies were order, deference, and endurance. In this study, questions focused on whether these needs remained prominent in a group of nurses, whether there were shifts in the need patterns over time, and how the nurses' needs compared with the needs of physicians. In this study 127 graduate nurses enrolled in a medical nurse practitioner program and 31 physician colleagues completed the EPPS. The rank order of needs among nurses was strikingly different from those collected in previous samples. Need for heterosexuality, dominance, intraception, change, and achievement consistently appeared highest since 1973, whereas need for deference, order, and endurance scored consistently among the lowest six needs. The rank-order correlation between nurses and physicians in this sample, all of whom were working in primary care settings, was high (r = .9). Only one of the 15 needs, intraception, differed significantly between the nurse and the physician groups, the nurses scoring higher. The shift in needs of the nurses and the high similarity of needs of the nurse and physician groups suggest an emerging assertiveness on the part of the nurses and a trend toward similarity of need patterns with physicians practicing in primary care.
Evaluation Studies as Topic↗
Effectiveness of a comprehensive health program for the well-elderly by community health nurses.
Effectiveness of three nursing approaches used in providing health care for the well-aging was tested experimentally by selecting three matched groups among a well-aging population of 195 who lived in three housing units for the elderly. The approaches differed in extensiveness of physical and psychosocial assessment and in involvement of residents in screening, counseling, and health education sessions. Health status was measured before and after one year of implementation by specific observations and structured interviews. Residents who received the extensive nursing program: reported increases in their positive perceptions of their own health, learned to respond effectively to health screening programs, and showed increases in the number who were under primary care. The data supported study hypotheses that predicted higher levels of health for persons who had the opportunity of extensive and specific nursing interventions.
Aged↗
Recurrent dislocation of the elbow.
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Athletic Injuries↗
How to make informed employment decisions.
This article presents a frame-work for organizing information gained during the employment search process and suggests questions to ask that are representative of current healthcare system changes. With an organized approach and the right questions, the nurse can avoid the perils of an uninformed employment decision.
Career Choice↗
Surface-coil MR imaging of orbital neoplasms.
Fifteen patients with orbital neoplasms demonstrated by CT were studied with magnetic resonance (MR) using a 13 cm surface coil and a 0.6 T superconducting magnet. The use of a surface coil allowed for a reduction in slice thickness and a significant improvement in spatial resolution resulting in better demonstration and improved characterization of orbital lesions. All neoplasms (15/15) were demonstrated by MR. The lesions were grouped into four main categories on the basis of signal intensities on T1- and T2-weighted images. CT was superior to MR in displaying densely calcified or bony lesions (two of 15 cases). MR was at least equal or superior to CT in demonstrating the other lesions (13 of 15 cases) and had the added advantage of improved tissue characterization in some cases. With the use of surface coils, MR could become the primary imaging technique for evaluation of orbital neoplasms.
Adult↗
Spinal cord injury without osseous spine fracture.
Sixteen patients with spinal cord injury without osseous spine fracture and 55 patients with spinal cord injury with osseous spine fracture aged from birth through 18 years were studied. Those without osseous fracture were younger (mean age 6 years) than were those with osseous fracture (mean age 16 years). Extravasation of myelographic dye from the spinal canal was a poor prognostic sign. All three in the group with this finding without osseous fracture had complete spinal cord lesions. Those without osseous fracture should be followed for the development of late spinal deformity that may require orthotic support or surgical stabilization.
Adolescent↗
Autonomy in practice.
When the nurse practitioner (NP) role was first described in the early 1960s it was clear that important dimensions had been added to the role of the nurse. One of these dimensions was the increased professional autonomy. As the NP role continued to evolve, autonomy became a characterizing feature of the role. the purpose of this paper is to present basic assumptions concerning automony and its relationship to the definition of profession; to examine the implications of autonomy to the individual NP, to the nursing profession, and to the health care system; and to offer a model for considering professional autonomy in relation to the NP role.
Humans↗
Economic perspectives for nurse practitioners.
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Financing, Government↗
A conceptual explanation of risk-reduction behavior and intervention development.
This study used a new conceptual model of health behavior to examine a specific risk-reduction response. Known to be at risk for fetal abnormalities because of maternal age, 203 women were examined for their acceptance or rejection of an amniocentesis test on the basis of individual characteristics and external significant factors. The multivariate approach to analysis offered a fuller explanation for nonuse of prenatal diagnosis than was previously available. In addition to specific client factors, environmental factors such as financial support for the procedure, multiple information sources, social support, and aspects of the client-provider interaction were determined to be important in explaining client acceptance or rejection of the test. More importantly, the study demonstrated the advantages of using a conceptual model to direct the development of interventions.
Abortion, Induced↗
A comparison of Wisconsin instrumentation and Cotrel-Dubousset instrumentation.
Twenty-six patients who underwent Wisconsin instrumentation and 36 patients who underwent Cotrel-Dubousset instrumentation (CDI) for idiopathic scoliosis were studied. Inclusion in the study required at least 24-month follow-up. Variables compared included operating time, blood loss, frontal plane correction, axial and sagittal plane changes, effects on compensation, and complications. In general, operating time, blood loss, and instrumentation problems were greater with CDI. Thoracic curve correction in King II curves was better with CDI. There was no advantage to either system with respect to sagittal plane alignment or rotation. When all factors were considered, a significant advantage to use of CDI could not be demonstrated.
Adolescent↗
Functional recovery in rabbit heart after preservation with a blood cardioplegic solution and perfusion.
Thirty-five isolated rabbit hearts were subjected to 60 minutes of storage after cardiac arrest with high K+ crystalloid cardioplegic solution at 5 degrees C. They were divided into five groups (n = 7 per group) according to the preservative protocol: group I (simple immersion in 0 degrees C normal saline solution), group II (simple immersion in 30 degrees C blood cardioplegic solution), group III (immersion and perfusion in 30 degrees C blood cardioplegic solution), group IV (simple immersion in 10 degrees C blood cardioplegic solution), and group V (immersion and perfusion in 10 degrees C blood cardioplegic solution). After storage for 1 hour, cardiac function, tissue water content, and the number of hearts capable of ejecting against a 100 cm H2O column afterload were recorded and compared among the five groups. Cardiac function in group II was not different from group I. Aortic pulse pressure and left ventricular developed pressure were lower in group II than in group III, IV, or V. Aortic developed pressure was higher in groups III and V (p < 0.05). Tissue water content in group I was significantly higher than in groups II, III, and V (p < 0.05). All hearts in groups III and V could eject against a 100 cm H2O afterload after preservation (p < 0.05 versus groups I, II, and IV). Factorial analysis among the groups using blood cardioplegic solution showed that either hypothermia or perfusion alone or the combination was a protective factor in providing functional recovery of stored hearts.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
XXXI Wherry Memorial Lecture. Does modern society need an education in citizenship?
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Government↗