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Biomedical subjects

J Gallagher

Publications and source records attributed to J Gallagher.

170 records · Page 10Linked to original sources
PubMedDate not supplied

Survey of treatment modalities for the prevention of hypertrophic facial scars.

The application of pressure to facial burns as a means of preventing or treating hypertrophic scar formation constitutes a major clinical challenge. Success depends on the experience of the therapist, choice of the pressure treatment, proper measurement technique, and adequate duration of therapy. A mail survey of therapists involved in the use of the various pressure modalities reveals a common trend with respect to the type of device used and the duration of therapy. The majority of therapists report that no one treatment produces uniformly excellent results.

Burns↗
PubMedDate not supplied

Failure to validate a predictive model for refusal of care to emergency-department patients.

OBJECTIVE: To determine whether previously developed triage criteria for refusal of care to patients presenting to an emergency department (ED) with nonurgent problems could be validated for an independent patient population. METHODS: A convenience sample of 534 adults presenting to a municipal hospital ED between July 1, 1992, and October 15, 1992, who met preestablished criteria for refusal of care were entered into a prospective, observational, cohort study. The single target outcome variable was hospitalization. In order to optimize the criteria's performance, both the triage nurse and the physician caring for the patient had to agree that all criteria for "refusal of care" were specifically met. No patient was refused care, nor was a patient's management or disposition interfered with in any way by the investigators. All patients were followed until hospital admission or release from the ED. RESULTS: Six (1.1%) of 534 patients (95% CI 0.4-2.4) who met the criteria for refusal of care were hospitalized. This represents a greater than 50-fold difference in incidence of hospitalization when compared with that found by other investigators, who reported that only 0.02% (95% CI 0.0004-0.04) of those patients who were refused care subsequently required hospitalization (p < 10 (-7)). CONCLUSION: The authors were unable to validate a previously developed predictive model for refusal of care to patients presenting to an ED. Refusal of care to selected ED patients based on current guidelines is not a viable solution to overcrowding. Alternative strategies must be sought.

Adult↗
PubMedDate not supplied

Severity of illness: APACHE II analysis of an ICU population.

We reviewed the population of a surgical intensive care unit from July 1, 1987 to June 30, 1988, adjusting for severity of illness using the APACHE II system. Nineteen different departments admitted a total of 613 patients to the surgical intensive care unit. Predicted mortality was 22.9%; actual mortality was 15.7%. APACHE II generated reports which included analysis by age, mortality risk, department, primary physician, and diagnosis. We recommend reporting intensive care unit outcome by APACHE criteria to allow more meaningful comparisons of data and standardization of quality assurance programs. Finally, we present a critical review of the current APACHE II system and describe developments to be included in APACHE III.

Adolescent↗
PubMedDate not supplied

Conference recommendations: practice, administration, research, education, and healthcare policy.

Small-group discussions following the presentation of papers at the Second Invitational Conference on the Role of the Oncology Clinical Nurse Specialist, held at the National Institutes of Health Clinical Center in Bethesda, MD, resulted in a wide range of recommendations in the areas of practice, administration, research, education, and healthcare policy issues. Recommendations are provided to further delineate the roles of oncology clinical nurse specialists (OCNSs), to increase their visibility, and to promote creative efforts to emply these skilled individuals more effectively in the future.

Clinical Competence↗
PubMedDate not supplied

Discharge videotaping: a means of augmenting occupational and physical therapy.

Regional burn centers commonly receive patients from medical facilities that are geographically distant. Logistic problems that may hamper follow-up care in the burn center can lead to a decrease in function as a result of contractures and hypertrophic scar formation. Inexperience on the part of therapists at community facilities serves to intensify this problem. Discharge videotaping, with respect to physical and occupational therapy programs, is a means of documenting range of motion at the time of discharge and providing visual documentation of the therapy program to be followed on an outpatient basis. The video tapes are forwarded to the outlying community hospital's therapy department in order to accomplish these goals.

Burns↗
PubMedDate not supplied

Management of maldigestion associated with pancreatic insufficiency.

The etiology, pathophysiology, clinical presentation, dietary management, and drug therapy of maldigestion associated with pancreatic insufficiency are reviewed. Maldigestion can occur in a number of conditions that lead to pancreatic insufficiency but is seen most frequently in patients with alcohol-related chronic pancreatitis or cystic fibrosis. Destruction of pancreatic tissue and obstruction of the ducts that lead into the small intestine prevent pancreatic secretions from reaching the small intestine and result in weight loss, anorexia, abdominal distention, and changes in the appearance and frequency of stools. The goal of dietary intervention in patients with maldigestion is to provide sufficient calories and protein to maintain weight while limiting fat intake to an amount tht the patient can tolerate. Medium-chain triglycerides can be substituted for dietary fat in patients whose symptoms continue despite dietary fat restriction. Drug therapy involves supplementing deficient pancreatic enzymes with pancreatin or pancrelipase. Regimens must be individualized for each patient because of problems with gastric inactivation of orally administered enzymes, lack of standardization of commercially available preparations, and large interpatient variation in response. In selecting an enzyme supplement preparation, the amount of available enzyme activity, dosage form, number of dosage units needed per dose, dosage schedule, and product cost must be considered. When enzyme supplementation alone does not adequately control the symptoms of maldigestion, a histamine H2-receptor antagonist or antacids may be added to the therapeutic regimen. Although complete resolution of the symptoms of maldigestion is difficult to achieve, a regimen of dietary modification and pancreatic-enzyme replacement can improve patients' quality of life.

Celiac Disease↗
PubMedDate not supplied

Dosing time with ascorbic acid and nitrate, gum and tobacco chewing, fasting, and other factors affecting N-nitrosoproline formation in healthy subjects taking proline with a standard meal.

The N-nitrosoproline (NPRO) test measures the potential for intragastric formation of carcinogenic nitrosamines in humans. Nitrate and L-proline are administered to volunteers. Noncarcinogenic NPRO is produced by an acid-catalyzed reaction of proline (a model for ingested amines) with nitrate-derived nitrite in the stomach. It is then absorbed and excreted in the urine, which is analyzed for NPRO. We studied the effect of certain dietary and other factors on the levels of urinary NPRO. For (generally) 5 days, healthy adult subjects (mostly men) followed a diet low in preformed NPRO, nitrate, proline, and (on days 4 and 5) ascorbic acid. The tests were conducted on days 4 and 5. In the standard test, the subjects took 400 mg nitrate at 11 a.m., and at noon they ate a standard 700-calorie meal containing 500 mg proline. (In previous tests, proline was given 1 h after or between meals.) Urines were collected for 24 h, and samples were analyzed for NPRO by published methods. This standard test yielded 26 +/- 2 (mean +/- SE) nmol NPRO compared with 5 +/- 1 nmol NPRO when proline alone was taken. In variations of the standard test, NPRO yield was not significantly affected by the subjects' gender, the time at which the standard meal was eaten, the size of the meal, or the drinking of extra water after the meal. Doses of 100 and 200 mg nitrate had lesser effects on NPRO yield than did the dose of 400 mg nitrate. Nitrate (400 mg) produced the most NPRO when it was given 1 h before the meal. Fasting increased NPRO yield by 3-4 times compared to giving proline with a meal. One g of ASC given 5 or 2 h before, with, or 1 or 2 h after the meal with proline inhibited NPRO formation by mean values of 0, 71, 71, 67, and 19%, respectively. Chewing gum or tobacco for 2-3 h after the test meal did not increase NPRO formation or salivary nitrate levels, but salivary nitrite was not taken, chewing tobacco appeared to increase salivary nitrite and nitrate levels. The weak carcinogen N-nitrososarcosine (NSAR) was also detected in some tests, and the standard group showed 21 +/- 3 nmol NSAR. A high NSAR result (44 +/- 7 nmol) for women undergoing the standard test should be reexamined. We discuss applying these results to the conduct of future NPRO tests, as well as their implications for reducing the potential production of carcinogenic nitrosamines in the stomach.

Adult↗