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Biomedical subjects

J Hayes

Publications and source records attributed to J Hayes.

At least 19 recordsLinked to original sources
PubMed1999

Comparison of continuation rates for hormonal contraception among adolescents.

BACKGROUND: Inadequate contraception is common among sexually active female adolescents, resulting in a high incidence of unwanted pregnancy. The authors were interested in comparing continuation rates for the different forms of hormonal contraception in this age group. METHODS: A retrospective chart review. The setting was an urban clinic in a large Midwestern city. Participants were 64% black, 34% white, and the average age was 15.5 years (+/- 1.6 SD), with implant users significantly older than oral contraceptive pill (OCP) users (P < .05). Interventions were self-selection to depo-medroxyprogesterone acetate (Depo-Provera; DMPA), levonorgestrel implants (Norplant), or oral contraceptive pills (OCPs). Previous pregnancy was significantly more prevalent in implant and DMPA users than in OCP users (P < .001). Over 4 years of follow-up, continuation rates were significantly higher for implant users than for the other hormonal groups (P < .001). At 1 year, continuation rates were as follows: 82% implants, 45% DMPA, and 12% OCPs. Combining these rates with those of the subsample who switched without interruption to another hormonal method, "continued protection" rates were much higher after 1 year: 96% implants, 83% DMPA, and 49% OCPs. Calculations of contraceptive "restarts," i.e., hormonal method use in those who discontinued and then restarted after a gap of time, also increased to the prevalence of contraceptive protection. CONCLUSION: Continuation rates for levonorgestrel implants were significantly higher than those for DMPA and OCPs, the latter group having the lowest continuation rates. Factoring in switches and restarts to other hormonal methods further boosted the prevalence rates of contraceptive use in the adolescent population.

Adolescent↗
PubMed1999

Microcirculatory response to halothane and isoflurane anesthesia.

Microcirculatory hemodynamics are often used to monitor tissue and organ survival. This study investigated the effect of halothane and isoflurane anesthesia on peripheral microcirculation using the cremaster muscle during intravital microscopy. Twenty-three Sprague-Dawley rats were studied in four groups. Two groups served as controls and did not undergo flap isolation but did receive halothane (N = 6) or isoflurane (N = 5). After induction with a single dose of intraperitoneal pentobarbital (40 mg per kilogram), rats were ventilated with either 2 minimum alveolar concentration (MAC) halothane or 2 MAC isoflurane. Esophageal temperature, electrocardiography, central venous pressure, mean arterial pressure, and blood gases were measured over 4 hours. In groups receiving surgery with either halothane (N = 6) or isoflurane (N = 6), the cremaster muscle was isolated on the neurovascular pedicle. Microcirculatory responses to both halothane and isoflurane anesthesia were evaluated by measuring red blood cell (RBC) velocity, vascular diameters in arterioles (A1, A2-1, A2-2, and A3) and the main venule (V1), functional capillary perfusion, and leukocytic endothelial interactions in postcapillary venules (rolling, adherent, and transmigrating leukocytes). Hemodynamic variables were compared among all four groups, and microcirculatory variables were compared between the two surgical groups. During isoflurane anesthesia in animals with flaps, significantly higher (p < 0.05) RBC velocities were recorded in arterioles A1 (24.4%), A2-2 (28.2%), and A3 (17.4%). Capillary perfusion was significantly higher in animals with flaps and halothane anesthesia (17.8%; p < 0.05). The number of rolling leukocytes (39.4%) was significantly higher during isoflurane anesthesia in animals with flaps (p < 0.05). Better flow hemodynamics in the peripheral microcirculation were seen during halothane anesthesia, and were confirmed by greater functional capillary perfusion and fewer activated leukocytes. In the isoflurane group, RBC velocity alone cannot serve as an indicator of microcirculatory function.

Anesthesia, General↗
PubMed1998

Mobilization of peripheral blood stem cells in children using G-CSF after carboplatin containing myelosuppressive chemotherapy.

PURPOSE: Peripheral blood stem cell (PBSC) apheresis provides an alternative to autologous marrow harvest as a source of hematologic stem cells for transplantation in children with solid tumors. PATIENTS AND METHODS: Eight children with metastatic or recurrent solid tumors underwent 27 apheresis procedures. Recovery from myelosuppressive chemotherapy occurred without continuous daily growth factor support prior to mobilization. Granulocyte colony stimulating factor (G-CSF) at 16 microgs/kg/day was used to increase stem cells in the peripheral circulation. CD 34 positive cells, mononuclear cells (MNC), and CFU-GM were measured in the apheresis products. Prior chemotherapy was examined as a clinical factor that affected PBSC yield. RESULTS: A significant correlation was found between CD 34+/kg and CFU-GM/kg of the products (r = 0.758, P < 0.001). Patients receiving cumulative doses of carboplatin over 1,600 mg/m2 produced adequate MNC (1 x 10(8)/kg) but yielded significantly less CD 34+ cells or CFU-GM than those patients receiving less carboplatin. Prior doses of etoposide and ifosfamide did not effect PBSC yield. CONCLUSIONS: The mobilization technique was well tolerated, and the products obtained produced trilineage engraftment in the patients that underwent peripheral blood stem cell transplantation. Peripheral blood stem cell apheresis in children can be optimized by selection of appropriate candidates and mobilization with G-CSF after an absence of hematopoietic growth factor support.

Adolescent↗
PubMed1998

Experiences of administering and receiving therapeutic touch in intensive care.

This article describes the experiences of a practitioner who administered therapeutic touch (TT) to two patients in an intensive care unit and the experiences of the two patients who received TT. The experiences are presented as two case studies. Each of the patients presented in the case studies received either five or ten treatments of TT lasting five minutes each. Following each administration of TT the practitioner described what she sensed verbally and in writing. However, owing to the medical conditions of the patients, only brief interviews were conducted in which the patients were asked to describe their experiences of receiving TT. The experiences, which have been reflected in the case studies, indicate TT assists patients to relax, brings comfort and a sense of peace. Much like meditation, TT helps patients become more in touch with themselves. They come to understand more about themselves and reality. TT is recommended as a practice which could contribute to the psychological well-being of patients in intensive care as it promotes relaxation, comfort and a sense of peace.

Adult↗
PubMed1998

Evaluation of telemedical support to a free-standing minor accident and treatment service.

We studied all patients attending a free-standing minor accident and treatment service (MATS) run by emergency nurse practitioners (ENPs). In a six-month period, 5563 patients were seen in the MATS, of whom 2843 (51%) were new attenders. A teleconsultation was carried out with 150 of these patients (2.7% of all cases). The most common reason (39%) was to discuss a radiograph with an accident and emergency consultant. The accuracy of the telemedicine-assisted radiographic diagnosis was checked subsequently by a review panel. The ENPs' working diagnoses (made by viewing the films) had a sensitivity of 90% and a specificity of 96%; this was improved by telemedicine assistance to 97% and 99%, respectively. The telemedicine patients were also surveyed several months after being seen in the MATS; their replies indicated that the telemedicine diagnoses had been correct.

Accidents↗
PubMed1998

Prolonging access function and survival: the nurse's role.

Vascular access is the lifeline of all patients undergoing haemodialysis (HD). In a recent patient satisfaction survey, the area of vascular access and needling technique was highlighted as an area with the need for improvement. This is addressed in this paper by the formulation of: Individual Access Vulnerability Score; an Access Care Plan, and implementation of a staff cannulation training programme. Addressing these three areas of practice with a structured programme not only assists staff to develop and value patient access but ultimately provides a higher quality of service. Patient satisfaction, access complications, staff knowledge, and clinical abilities can all be improved by the implementation of a more structured approach to developing and valuing vascular access.

Algorithms↗
PubMed1998

Gastrointestinal upsets and new copper plumbing--is there a connection?

This article summarizes two investigations that examine the health effects of prolonged exposure to copper-contaminated drinking water. The first study was initiated after elevated copper levels were detected in several homes that were either newly constructed or recently remodeled. All of these homes were served by the same municipal water supplier. The second case involved illnesses and water-quality problems that were reported by several residents of a mobile home park shortly after a new water distribution system was installed. Findings from these investigations suggest that copper-contaminated drinking water may be a fairly common cause of nausea, diarrhea, abdominal cramps, and headaches-especially among residents of new or recently-remodeled homes, and in areas where water supplies are naturally corrosive.

Adolescent↗
PubMed1997

Side effects of adjuvant chemotherapy: perceptions of node-negative breast cancer patients.

Twenty-one node-negative breast cancer patients were interviewed shortly after completing adjuvant chemotherapy and asked about side effects they had experienced, expectation of side effects, and strategies for coping with the side effects. Eighteen of the women were interviewed 6 months later to determine their feelings about the chemotherapy experience and ending treatment and what side effects persisted or developed after chemotherapy. Hair loss, fatigue, treatment-related problems, nausea and infections/low blood counts were the most frequently described problems during the first interviews. Patients used coping strategies suggested by physicians and nurses. Six months later, hair problems, fatigue, weight gain, menopausal problems, emotional problems and nail problems were most often reported. Most patients (16/18) did not expect to be experiencing chemotherapy-related problems 6 months after ending treatment. Fatigue interfered with daily lives and weight gain caused concern. A total of 35% of participants experienced fear or anxiety at the end of chemotherapy, but most (62%) recalled at least some positive feelings 6 months later. Given the same circumstances, all but two would make the same decision to undergo adjuvant chemotherapy. Support groups would be especially useful for patients completing chemotherapy who would lose continued frequent support from clinic personnel.

Adaptation, Psychological↗
PubMed1997

Thermal equipment usage patterns in neonatal intensive care units: interunit variability and intraunit consistency.

We conducted a survey and audit of thermal equipment use in very low-birth-weight infants in five Ohio neonatal intensive care units (NICUs) to document regional practice. The survey indicated a variety of thermal care styles. Two NICUs preferred to admit infants to incubators, the other three favoring radiant warmers. These three NICUs moved infants from radiant warmers into incubators at significantly different mean ages. The audit demonstrated inconsistent use of plastic covers, warming mattresses, and added humidity under radiant warmers, and discrepancies between survey responses and actual use within NICUs. Inter-NICU variability of thermal equipment use may complicate fluid management.

Beds↗
PubMed1997

Assessment of fitness in patients with cystic fibrosis and mild lung disease.

BACKGROUND: Maximal exercise testing is used in patients with cystic fibrosis to assess functional status and prognosis. The lactate threshold is an index of aerobic fitness with significant advantages over maximal exercise tests. This study was undertaken to determine if the lactate threshold might be identified, non-invasively, in adult patients with cystic fibrosis and mild lung disease by measurement of ventilatory and gas exchange parameters. METHODS: Ten subjects with mild cystic fibrosis (forced vital capacity (FVC) > 70% predicted) and 10 healthy controls undertook an incremental exercise test on a bicycle ergometer. Ventilation and gas exchange parameters were measured continually and arterialised venous blood pH, carbon dioxide tension (PCO2), and lactate concentrations were measured at intervals throughout the tests. RESULTS: In subjects with cystic fibrosis there was no significant difference between the mean gas exchange and lactate thresholds (mean difference 1.0 (95% confidence interval (CI) of the mean -1.5 to 3.44) ml/kg/min). In contrast, there was a significant difference between the mean ventilatory and lactate thresholds (3.8 (95% CI 0.9 to 6.7) ml/kg/min). Arterialised venous PCO2 increased significantly during the exercise tests. In healthy subjects the mean differences between these thresholds were not significantly different from zero and PCO2 fell significantly during the tests. CONCLUSIONS: The ventilatory threshold significantly overestimates the lactate threshold in subjects with cystic fibrosis induced lung disease because of impaired carbon dioxide excretion during exercise. However, the gas exchange threshold may be used to determine the lactate threshold in this patient group.

Adult↗
PubMed1997

The checkpoint control for anaphase onset does not monitor excess numbers of spindle poles or bipolar spindle symmetry.

Exit from mitosis in animal cells is substantially delayed when spindle assembly is inhibited, spindle bipolarity is disrupted, or when a monopolar spindle is formed. These observations have led to the proposal that animal cells have a 'spindle assembly' checkpoint for the metaphase-anaphase transition that monitors bipolar spindle organization. However, the existence of such a checkpoint is uncertain because perturbations in spindle organization can produce unattached kinetochores, which by themselves are known to delay anaphase onset. In this study we have tested if cells monitor bipolar spindle organization, independent of kinetochore attachment, by analyzing the duration of mitosis in sea urchin zygotes and vertebrate somatic cells containing multipolar spindles in which all kinetochores are attached to spindle poles. We found that sea urchin zygotes containing tripolar or tetrapolar spindles progressed from nuclear envelope breakdown to anaphase onset with normal timing. We also found that the presence of supernumerary, unpaired spindle poles did not greatly prolong mitosis. Observation of untreated PtK1 cells that formed tripolar or tetrapolar spindles revealed that they progressed through mitosis, on average, at the normal rate. More importantly, the interval between the bipolar attachment of the last monooriented chromosome and anaphase onset was normal. Thus, neither of these cell types can detect the presence of gross aberrations in spindle architecture that inevitably lead to aneuploidy. We conclude that animal cells do not have a checkpoint for the metaphase-anaphase transition that monitors defects in spindle architecture independent of the checkpoint that monitors kinetochore attachment to the spindle. For dividing cells in which spindle microtubule assembly is not experimentally compromised, we propose that the completion of kinetochore attachment is the event which limits the time of the metaphase-anaphase transition.

Anaphase↗
PubMed1997

A protocol for telemedical consultation.

We have developed a protocol for telemedical consultations. This has been used by emergency nurse practitioners to consult doctors in a main hospital accident and emergency department, using videoconferencing at 384 kbit/s. A telemedical consultation should simulate a face-to-face one. The protocol starts with an explanation for the patient of what will happen, followed by the necessary introductions. After relaying the history, the generalist should show the abnormal part to the specialist. Attention should be paid to colour. Depth perception is often enhanced by rotating the camera through 180 degrees. The diagnosis and management, together with their implications, should be discussed with the patient by the specialist. Referral and follow-up should also be discussed. Proper clinical record-keeping is essential. In the first 15 months of using the protocol, we completed more than 300 teleconsultations. An analysis of the first 50 teleconsultations showed that about half were for discussing a radiograph and about half were for examining a patient.

Clinical Protocols↗
PubMed1997

Providing information about breast cancer via public forums.

This study examines whether persons who attended a breast cancer education summit or received written materials (i) exhibited improved knowledge about breast cancer; and (ii) used the information themselves, share it with others, or implemented community education/screening programs. Participants (92 lay persons, 67 health professionals who attended; 44 who did not attend but received written materials) were primarily female, with a mean age of 47. They completed a 10-item knowledge questionnaire on four occasions (pre-conference, immediately post-conference, 9 weeks, 6 months). On the third and fourth occasion, participants also were asked how they had used the information. Paired samples t tests revealed that lay individuals (p < 0.001) and health professionals (p < 0.001) exhibited improved knowledge of breast cancer after attending the conference, used the information in their personal health care, and shared it with others, and some implemented education and screening programs. Of nonattendees, only the health professional group retained knowledge gain over time. A conference can produce increased knowledge about breast cancer and stimulate attendees to use information for themselves and share it with others. For lay persons, conference attendance is superior (p < 0.01) to written materials alone, in achieving long-term gain in knowledge.

Age Factors↗
PubMed1996

An asymmetric model for the nucleosome: a binding site for linker histones inside the DNA gyres.

Histone-DNA contacts within a nucleosome influence the function of trans-acting factors and the molecular machines required to activate the transcription process. The internal architecture of a positioned nucleosome has now been probed with the use of photoactivatable cross-linking reagents to determine the placement of histones along the DNA molecule. A model for the nucleosome is proposed in which the winged-helix domain of the linker histone is asymmetrically located inside the gyres of DNA that also wrap around the core histones. This domain extends the path of the protein superhelix to one side of the core particle.

Animals↗
PubMed1996

Isoetharine versus albuterol for acute asthma: greater immediate effect, but more side effects.

PURPOSE: To compare the magnitudes of the immediate effects of the nebulized beta-agonists isoetharine and albuterol in the treatment of acute severe asthma. PATIENTS AND METHODS: Fifty-one adults presenting with severe asthma exacerbations (forced expiratory volumes in the first second of exhalation [FEV1] <40% of predicted) to the emergency department were randomized (double-blind) to receive hourly inhaled nebulization treatment with either isoetharine (5 mg) or albuterol (2.5 mg). The FEV1 was measured immediately before and after each nebulized treatment. Any side effects were recorded. RESULTS: Immediately after the first nebulized treatment, the isoetharine group improved its mean FEV1 (+/-SEM) by a significantly greater amount than did the albuterol group: 60% +/- 11% versus 39% +/- 5%, respectively (P <0.05). One hour later the mean FEV1 were equivalent. This pattern repeated itself after the second hourly treatment. The two groups did not differ in any outcome parameters (FEV1 at discharge, number of nebulized treatments required, the number of inpatient admissions, number of clinical relapses after discharge). More patients treated with isoetharine had side effects (36% versus 4% for albuterol, P <0.01), 1 of whom required discontinuation from the study. CONCLUSIONS: Both medications were equally effective in alleviating bronchospasm. The immediate effect of isoetharine was significantly greater, but equalized that of albuterol within an hour after treatment. There were more side effects with isoetharine.

Acute Disease↗
PubMed1996

Shunt infections in children: presentation and management.

Since the earliest attempt at surgical management of hydrocephalus, infection has been a significant complication. For better assessment and care the neuroscience nurse needs to be aware of the signs and management of this condition. A retrospective review of 68 infections in 61 children was undertaken. Results showed an increased incidence of infection in the first nine months after surgery. Gram positive organisms (Staphylococcus epidermidis and Staphylococcus aureus) were most frequent; Propionobacter acnes was a significant pathogen in adolescence. Presenting symptoms included fever (26%), abdominal pain (19%), wound changes (22%) and indicators of shunt malfunction (33%). Elevated white blood cells (WBCs) in spinal fluid from shunt tap and positive cultures were most reliable laboratory data. Culturing of causative organism was sometimes difficult. A value regulated system for ventricular drainage which allows greater mobility for the patient is described.

Algorithms↗