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Biomedical subjects

J Fletcher

Publications and source records attributed to J Fletcher.

At least 361 records · Page 20Linked to original sources
PubMedDate not supplied

Psychosociocultural perspectives on chronic cannabis use: the Costa Rican follow-up.

The social standing of marijuana use in Costa Rica becomes important as one examines the results of this study. Before 1968, marijuana use itself defined Costa Rican consumers of the drug as lower class. Its coming to fashionability among Costa Rican upper-middle-class youths during the late 1960's and early 1970's temporarily blurred marijuana's class identification. Nevertheless, the lower-class users' dress, speech and style of use kept them distinct from these youths. In 1986, working-class users participating in the present intensive study still occupied the lowest positions in the Costa Rican social strata. Their marijuana use does not appear to be a major factor in blocking upward mobility. The social stations in which users were raised were more powerful in determining their present fates than taking up or not taking up marijuana use. Users speak the language differently, employing a mix of lexical changes and wordplay to keep the decent Costa Ricans out of their clandestine business. Smokers of marijuana also dress differently from other Costa Ricans and tend to live in disreputable barrios, according to the stereotype. The Costa Rican image of a marijuana smoker is one of a streetwise, corrupt and uncomfortably distinctive character who is not to be trusted. The main problem in assessing the relationship between marijuana use and the human condition of marijuana users is the pervasive influence of the general social disapproval of marijuana smoking in Costa Rican society.(ABSTRACT TRUNCATED AT 250 WORDS)

Costa Rica↗
PubMedDate not supplied

Diabetes in the UK West indian community: the Wolverhampton survey.

A survey was carried out to determine the prevalence of known diabetes amongst West Indians living in Wolverhampton. Two hundred and fifty-one West Indians with diabetes were identified from a computerized register, which records all diabetic patients in the Wolverhampton area attending either the hospital diabetic clinic or general practitioner mini-clinics, and from questionnaire data obtained through local general practitioners. An estimated 4.4% of the Wolverhampton population are of West Indian origin determined by the 1981 census, giving a prevalence of known diabetes of 2.2% compared with 1.2% in the indigenous UK white Caucasian population. Only 4% of these patients were truly insulin-dependent but 38% were insulin-treated, 43% were on oral hypoglycaemic agents and 19% on diet alone. Only 1.6% were diagnosed below the age of 20 years, with peak frequency of diabetes occurring in the age group 45-64 years. Thirty-eight percent of all patients were obese, 40% were hypertensive, but only 4% had a history of angina or myocardial infarction. In UK West Indians non-insulin-dependent diabetes is common and is predominantly a disease of middle age, whereas insulin-dependent diabetes is relatively uncommon.

Age Factors↗
PubMedDate not supplied

High-rising terminals and fall-rise tunes in Australian English.

It is usually claimed that statement high rises in Australian English are more or less phonetically identical to yes/no question rises. In this paper, statement high rises and question rises were examined in a corpus of controlled spontaneous speech (i.e. map task dialogues) to see if this is the case. It appears that speakers in this study used different kinds of rises for declaratives and questions. The majority of statement high rises were realized with a low pitch accent onset, whereas almost all question rises were produced with high pitch accent onsets. High-range fall-rises also appeared to be used by some speakers in the same way as statement high rises. Implications of these findings for the current ToBI analysis of Australian English are considered.

Humans↗
PubMedDate not supplied

The effect of intravenous fat emulsions in patients with pancreatic fistula.

Three patients with pancreatic fistulae were given parenteral 10% fat emulsion (Intralipid) to study the effect of intravenous fat on pancreatic fistula output. Each patient received nutritional support with isovolumetric, isonitrogenous, and isocaloric solutions containing either hypertonic dextrose and amino acids, or hypertonic dextrose, amino acids, and a fat emulsion. Measurements of fistula volume, fistula amylase, lipase, and chloride concentrations, and fistula trypsin activity were performed. The patients were studied for periods of 10 to 26 days. No significant increases in any of the above parameters were noted during the periods when the fat emulsions were infused. In one patient the fistula closed spontaneously. We conclude that intravenous fat emulsions may be used to provide nutritional support for patients with pancreatic fistula without increasing pancreatic juice volume or enzyme content.

Adult↗
PubMedDate not supplied

Types of pressure-relieving equipment available: 1.

This is the first of two articles which consider the practical difficulties in selecting pressure-relieving devices for patients. The selection of pressure-relieving equipment has become increasingly difficult as the number of commercially available products rises. This article reviews the modes of action of the equipment, including alternating pressure and constant low pressure, outlining the differences between individual pieces of equipment. It will also include a brief summary of the factors which are important to acknowledge when selecting seating.

Beds↗
PubMedDate not supplied

Types of pressure-relieving equipment available: 2.

This is the second article in a two-part series. The first article reviewed the mode of action of the different types of equipment. This article examines some of the evidence behind the design and suggests selection criteria to assist when choosing individual items of pressure-relieving equipment. By presenting a broader view it is hoped to guide the reader through a logical approach considering all of the variables, thus enabling the selection of the optimum piece of equipment.

Beds↗
PubMedDate not supplied

Pressure-relieving equipment: criteria and selection.

The selection of equipment for pressure sore prevention and management is extremely complex, with many variables to consider. There is a considerable lack of data to support the use of individual pieces of equipment, and so additional criteria need to be considered. A logical approach, taking into account the objectives of treatment, the modality of action, and the resources available, enables an optimal choice to be reached which should satisfy both the patient and the staff involved.

Beds↗
PubMedDate not supplied

Breast awareness project for women with a learning disability.

In 1995/6, while conducting a quality assurance evaluation in a residential group home for adults with a learning disability, the subject of breast screening and the importance of early detection of breast abnormalities was raised by a member of staff. At the time, the Mulberry Trust had a quality standard that women between 50 and 64 years who are supported in continuing care should attend breast screening clinics on a 3-yearly basis if they wish. A pilot scheme was devised based on the premise that breast awareness for service users should be promoted. It was decided that the scheme should include a breast examination, conducted on a monthly basis, ideally by the service users themselves, or by suitably trained staff on their behalf. The pilot scheme was implemented using available research and training was provided for qualified nursing staff within the trust. The training covered breast cancer prevention and breast awareness. After 7 months the scheme was evaluated and changes were made to policy and practice, including consultation with the trust's ethics panel regarding implementation of procedures. Training for staff in breast awareness continues and the scheme is slowly being introduced across the trust to enable all service users to be involved, both in residential homes and community settings. However, in future, the emphasis will be on identifying changes in the breast during normal care routines, such as bathing and dressing, as opposed to formal, clinical examination.

Adult↗
PubMedDate not supplied

A practical approach to dressing wounds in difficult positions.

Despite the availability of an increasing number of innovative dressing products, many patients' wounds remain a challenge to dress in practice. However, the creative use of widely available products and other resources can help to address some of the difficulties that are regularly encountered. If different sizes of dressing (to allow for cutting and shaping) or more innovatively shaped products (which may be more expensive per item) are used, this can result in a better dressing fit and therefore increase product wear time which is both clinically effective and cost-effective. When a good solution is found for dealing with certain wound types then great benefit can be gained from publishing the information to prevent others from struggling to overcome the same difficulties.

Bandages↗
PubMedDate not supplied

Accessory lung lobe torsion and chylothorax in an Afghan hound.

Torsion of the accessory lung lobe is extremely rare and has been reported only in one human. Accessory lung lobe torsion (LLT) and chylothorax occurred in a 3.5-year-old, male Afghan hound. An exploratory thoracotomy was used to remove the torsed lung lobe. When medical management of the chylous effusion failed, thoracic duct ligation was performed, resulting in resolution of the effusion. The dog remains clinically healthy 29 months postoperatively.

Animals↗
PubMedDate not supplied

The provision of leg ulcer services by practice nurses.

As part of their implementation programme of leg ulcer guidelines, the group conducted a study of the caseload and attitudes and training of practice nurses with relation to leg ulcer management. They begin by outlining the prevalence and treatment methods of leg ulcers, then outline their study and put forward their resulting recommendations.

Education, Nursing, Continuing↗
PubMedDate not supplied

A comparison of Australian and American registered nurses' use of life-sustaining medical devices in critical care and high-dependency units.

OBJECTIVE: To explore how and what Australian and American registered nurses working in critical care and high-dependency units initially learn about the life-sustaining medical devices they use as well as the consequences of device use both for patients and staff. DESIGN: Cross-sectional survey with a mailed questionnaire. SETTING: Large midwestern American tertiary care center and two large South Australian tertiary care centers. SUBJECTS: Thirty-two American registered nurses who worked in critical care and 127 Australian registered nurses who worked in critical care, coronary care, and high-dependency units. RESULTS: The most frequently identified initial method of learning both for Australian and American registered nurses was trial and error (taught self). A significantly larger proportion of American nurses initially learned to use a life-sustaining device by watching a video or slide tape, whereas a significantly larger proportion of Australian nurses received instruction in nursing school. At least 90% of Australian and American nurses indicated they initially had learned the same four facts about the device: its purpose, its function, how to respond to the alarms, and how to operate it. A significantly larger proportion of Australian nurses indicated that they had learned about the potential hazards for patients than did their American colleagues. The potential consequences of using any medical device were nurse stress and patient harm. The two reasons most frequently cited by Australian and American nurses for stress were fear of harming the patient and being unsure how to use the device. Of the Australian and American nurses combined, 12.3% indicated they had used a medical device that had harmed a patient. CONCLUSIONS: Australian and American registered nurses were more similar than dissimilar in terms of how and what they learned about the life-sustaining devices they use in direct patient care, in experiencing stress when using medical devices, and in having used a device that caused patient harm. Differences in how they learn may be a reflection of marketing and inservice support by manufacturers and basic and highest levels of nurse education. The latter may also account for differences in what Australian and American nurses learned. The results emphasize that nurses must be knowledgeable about the devices they use on behalf of patients. More knowledge about the devices they use in direct patient care might decrease nurse stress.

Adult↗
PubMedDate not supplied

The foot in diabetes.

Explore the source record for details and available documents.

Diabetic Foot↗