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Biomedical subjects

J Edwards

Publications and source records attributed to J Edwards.

At least 163 records · Page 9Linked to original sources
PubMed1996

Risk factors for mortality associated with enterococcal bloodstream infections.

OBJECTIVE: To determine risk factors for mortality in patients with a nosocomial enterococcal primary bloodstream infection (EPBI) and to assess whether vancomycin resistance placed a patient at increased risk of death. DESIGN/SETTING: A retrospective cohort study was conducted in four National Nosocomial Infection Surveillance System hospitals. RESULTS: Of 145 patients identified with EPBIs, 74 (51%) died, and 26 (18%) had a vancomycin-resistant isolate. Upon comparing patients with EPBIs who survived to those who died, no associations were found between mortality and prior invasive device use, procedure history, type or number of prior nosocomial infections, length of hospitalization before infection, or receipt of vancomycin. Independent predictors of mortality were indices of severity of illness (APACHE II score and comorbidity weighted index), age, the use of third-generation cephalosporins or metronidazole during the week prior to infection, and female gender. CONCLUSIONS: Vancomycin resistance was not an independent predictor of death, and its role was difficult to establish, because cohort patients were among the most severely ill of all hospitalized patients. Enterococcal primary bloodstream infections appear to indicate severe, lifethreatening disease processes. The pathogenicity of enterococci and the role of vancomycin resistance as a cause of mortality in patients with EPBIs need to be assessed further.

Adolescent↗
PubMed1996

EPPIC: an evolving system of early detection and optimal management.

Early intervention at the onset of psychotic disorders is a highly attractive theoretical notion that is receiving increasing international interest. In practical terms, it amounts to first deciding when a psychotic disorder can be said to have commenced and then offering potentially effective treatment at the earliest possible point. A second element involves ensuring that this intervention constitutes best practice for this phase of illness and is not merely the translation of standard treatments developed for later stages and the more persistently ill subgroups of the disorder. Furthermore, it means ensuring that this best practice model is actually delivered to patients and families. The relative importance of these elements in relation to outcome has not yet been established. This article outlines a framework for preventive intervention in early psychosis, based on more than a decade of experience initially gained within a first-generation model. This experience has been followed, after a prolonged gestation, by the birth of the Early Psychosis Prevention and Intervention Centre (EPPIC), a comprehensive "real-world" model of care targeting the multiple clinical foci underpinning the preventive task. Data are reported to illustrate the topography and impact of delay in treatment in our regional setting, and the results of an initial evaluation of the EPPIC model are presented. The latter demonstrate a significant improvement in symptomatic and functional outcome when the second-generation model is contrasted with the first. The implications of these findings and future developments are discussed.

Adolescent↗
PubMed1996

The international epidemiology of disseminated Mycobacterium avium complex infection in AIDS. International MAC Study Group.

OBJECTIVE: To determine rates of disseminated Mycobacterium avium complex (MAC) infection among AIDS patients in developed and developing countries, and to determine whether different rates reflect differences in exposure or immunity, or both. DESIGN: Prospective cohort study. SETTING: University hospitals and outpatient AIDS programs. METHODS: HIV-infected subjects with CD4 counts < 200 x 10(6)/l were interviewed and had CD4 lymphocyte counts, blood cultures for mycobacteria (baseline and at 6 months), and skin tests with purified protein derivative (PPD) and M. avium sensitin. RESULTS: Among 566 study patients rates of disseminated MAC were 10.5-21.6% in New Hampshire, Boston and Finland compared to 2.4-2.6% in Trinidad and Kenya (P < 0.001). PPD skin test reactions > or = 5 mm were present in 20% of patients from Kenya compared to 1% at other sites (P < 0.001). Among patients from the United States and Finland, multiple logistic regression indicated that occupational exposure to soil and water was associated with a decreased risk of disseminated MAC, whereas the following were associated with an increased risk of disseminated MAC: low CD4 count, swimming in an indoor pool, history of bronchoscopy, regular consumption of raw or partially cooked fish/shellfish and treatment with granulocyte colony-stimulating factor. CONCLUSIONS: Rates of disseminated MAC in AIDS are higher in developed than developing countries and are due to both differences in exposure and differences in immunity. These data provide a rationale for prevention of MAC through both active immunization and reduction in exposure to the organism.

AIDS-Related Opportunistic Infections↗
PubMed1996

Objective measurement of use of the reciprocating gait orthosis (RGO) and the electrically augmented RGO in adult patients with spinal cord lesions.

The purpose of the study was to measure objectively the home use of the reciprocating gait orthosis (RGO) and the electrically augmented (hybrid) RGO. It was hypothesised that RGO use would increase following provision of functional electrical stimulation (FES). Five adult subjects participated in the study with spinal cord lesions ranging from C2 (incomplete) to T6. Selection criteria included active RGO use and suitability for electrical stimulation. Home RGO use was measured for up to 18 months by determining the mean number of steps taken per week. During this time patients were supplied with the hybrid system. Three alternatives for the measurement of steps taken were investigated: a commercial digital pedometer, a magnetically actuated counter and a heel contact switch linked to an electronic counter. The latter was found to be the most reliable system and was used for all measurements. Additional information on RGO use was acquired using three patient diaries administered throughout the study and before and after the provision of the hybrid system. Testing of the original hypothesis was complicated by problems in finding a reliable measurement tool and difficulties with data collection. However, the results showed that overall use of the RGO, whether with or without stimulation, is low. Statistical analysis of the step counter results was not realistic. No statistically significant change in RGO use was found between the patient diaries. The study suggests that the addition of electrical stimulation does not increase RGO use. The study highlights the problem of objectively measuring orthotic use in the home.

Adult↗
PubMed1995

The reciprocating gait orthosis: long-term usage patterns.

OBJECTIVE: To investigate the frequency of nonusage of the reciprocating gait orthosis (RGO) in 85 patients supplied between 1986 and 1993. Reasons for nonusage and usage patterns were examined. DESIGN: Nonusage was determined from patient records and clinical knowledge. Patients were surveyed using a detailed questionnaire to produce information on usage patterns. SETTING: All patients had been treated as hospital outpatients. PATIENTS: Most patients had congenital or acquired spinal cord lesions. Postal questionnaires were sent to 81 patients 5 to 55 years of age (mean 20.4 years). Thirty-five patients replied. RESULTS: At a mean follow-up of 5.4 years, 71% of patients were classified as nonusers. Of the 35 respondents to the questionnaire (mean follow-up 5.5 years, range 4 to 7 years), 20 patients were nonusers. Median usage was 27 months in patients under age 18 and 24 months in adult patients. Significant differences were observed between nonusers and users in the areas of perception of the RGO as a functional tool, independence, and reliability and between the adult and the under 18 groups in the areas of weekly usage, function, independence, and reliability. CONCLUSION: The high level of nonusage of the RGO has implications for prescription practice. Identifying reasons for nonusage and acknowledging differences in use between age groups will help in patient assessment.

Activities of Daily Living↗
PubMed1995

Use of experimental and quasi-experimental methods for data-based decisions in QI.

BACKGROUND: Decisions made by quality improvement (QI) teams, as reported in the literature, are usually based on nonexperimental methods for data collection. Pretest-posttest designs, in particular; are common in reports of QI teams' evaluations of changes or interventions. Yet in such designs the results are inherently confounded; it is impossible to rule out alternative explanations for any differences found. USING EXPERIMENTAL METHODS TO MAKE QI DECISIONS: As suggested by one study, QI teams can design and implement experimental interventions in relevant organizational processes. In an attempt to reduce the no-show rate for first appointments at a Residents Clinic at the Medical University of South Carolina (Charleston), the Youth Outpatient Improvement Team designed an experiment to test two possible modifications to the admission process. Those seeking services were randomly assigned to one of three groups (the control group or one of the experimental groups). Not only did results not support the team's hypothesis that one of the experimental procedures would produce a lower no-show rate, subjects in the experimental groups were less likely to enter treatment. Given these data, the decision was made to maintain current admission procedures. CONCLUSIONS: Since the quality of a decision is dependent on the quality of the data on which it is based, QI teams should consider experimental methods when planning data collection to evaluate their recommended interventions. When such methods are not feasible, quasi-experimental strategies can be used to strengthen the quality of nonexperimental data.

Adolescent↗
PubMed1995

Screening for colorectal cancer: what are the costs?

We examined a screening program for colorectal cancer in South Australia in terms of its overall direct costs to society and costs to participants. The best estimate of the cost per cancer detected was $18,924 (Australian dollars). Potential improvements in health outcome through screening are discussed in light of these costs.

Colorectal Neoplasms↗
PubMed1995

Specific language impairment: preliminary investigation of factors associated with family history and with patterns of language performance.

To examine patterns that might suggest etiologic subgroups of specific language impairment (SLI), information, including history of speech-language-learning (SLLD) problems in family members, was obtained on 53 children with SLI aged 4 to 9 1/2 years. The results led to the generation of a number of hypotheses for future research. In particular, the findings suggested that family history is related to pattern of language performance. In comparison with children who had both expressive and receptive language deficits, children with deficits in only expressive language had a higher proportion of affected family members (.47 vs. .22), of affected mothers (.57 vs. .17), and of affected siblings (.53 vs. .27). These and other findings are discussed in terms of their consistency with other data, hypotheses relative to explanations of SLI, and their implications for further research.

Birth Order↗
PubMed1995

Development and implementation of a perinatal education consortium.

The North Puget Sound Perinatal Education Consortium provides a collaborative framework for planning, implementing, and evaluating a basic orientation program for newly hired and cross-trained perinatal nurses. The program currently provides 9 days of prenatal, labor and delivery, mother-infant couplet, and neonatal didactic orientation at no cost to registrants from participating hospitals. Consortium hospitals supply instruction time and additional services to support this high-quality, regional, perinatal orientation program.

Curriculum↗
PubMed1995

Integrating the concepts of health promotion and community into occupational therapy practice.

Health reform activities in Canada have encouraged health care professionals to examine new and innovative ways to share their skills, not only with other professionals, but with the public. Historically, occupational therapists have been encouraged by leaders in the profession to expand their practice and to share their skills through active participation with their communities. Health promotion has been identified as a process through which this expansion can be pursued. In order for occupational therapists to contribute to their communities in a meaningful way, the concepts of health promotion and community require definition, development and reflection within their model of practice. Through a discussion of these concepts, this paper encourages occupational therapists to develop, expand and integrate new practice roles within the community by integrating health promotion into their practice.

Aged↗
PubMed1995

Mechanisms of enhanced insulin sensitivity in endurance-trained athletes: effects on blood flow and differential expression of GLUT 4 in skeletal muscles.

Exercise is associated with increased insulin sensitivity. To better understand mechanisms that could be responsible for this association, we studied seven controls and seven endurance-trained athletes. A 600 mU/m2.min hyperinsulinemic euglycemic glucose clamp with the limb balance technique assessed insulin sensitivity as whole body glucose uptake (WBGU) and leg glucose uptake (LGU). Indirect calorimetry and hemodynamic measurements, such as leg blood flow (LBF) and cardiac output, were performed at baseline and maximal insulin stimulation. The content of the glucose transporter GLUT 4 and muscle fiber type were evaluated in three muscle groups: vastus lateralis, gastrocnemius, and biceps. Athletes exhibited 35% higher WBGU and 30% higher LGU than controls. Basal LBF (liters per min) was higher in athletes, but the difference was not statistically significant. After insulin stimulation, LBF was 31% higher in athletes than controls (P = 0.05). Indirect calorimetry revealed that athletes had a 44% higher rate of nonoxidative glucose metabolism than controls (P = 0.01). GLUT 4 levels in vastus were 90% (P < 0.05) greater in athletes, whereas smaller differences were noted between athletes and controls in biceps and gastrocnemius. Importantly, the vastus lateralis GLUT 4 content was correlated with WBGU (r = 0.60; P < 0.05) and LGU (r = 0.62; P < 0.05). Relative numbers of oxidative fibers were increased in vastus from athletes and were positively correlated with maximal oxygen consumption (VO2 max), but GLUT 4 content could not be correlated with oxidative fiber content in individual controls or athletes. We conclude that in humans 1) endurance training enhances insulin's ability to increase LBF; 2) GLUT 4 is differentially expressed as a function of muscle group and is up-regulated by exercise in a muscle-specific manner; 3) in vastus lateralis, GLUT 4 levels are well correlated with insulin-stimulated rates of both WBGU and LGU; and 4) GLUT 4 content and in vivo insulin sensitivity do not vary as a function of fiber type composition. Thus, blood flow and GLUT 4 expression in muscle are important mechanisms that mediate greater insulin sensitivity in athletes.

Adult↗