Evaluating research in developmental disabilities: a conceptual framework for reviewing treatment outcomes.
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Child↗
Biomedical subjects
J Leach
Publications and source records attributed to J Leach.
Scoliosis in total-body-involvement cerebral palsy. Analysis of surgical treatment and patient and caregiver satisfaction.
STUDY DESIGN: A nonrandomized descriptive case series. OBJECTIVES: To analyze the results of spinal fusion in patients with total-body-involvement cerebral palsy to determine early and late outcomes, including caregiver satisfaction. METHODS: Data from 79 to 100 patients with total-body-involvement spastic cerebral palsy who underwent posterior Luque instrumentation, or anterior spinal fusion, or both, were adequate to be included in the study. Functional status was evaluated by physical examination, and a personal interview was conducted with the patient, parents, and primary caregiver. RESULTS: Median follow-up was 4 years (range, 2-14 years). Late progression of scoliosis (> 10 degrees), pelvic obliquity (> 5 degrees), and decompensation (> 4cm ) were noted in more than 30% of the patients. More than 75% of patients with late progression were skeletally immature at the time of surgery and underwent a posterior procedure only. Twenty-one percent of the patients required a revision procedure because of disease progression. Progression was not noted in any patient who underwent anterior fusion (with or without anterior instrumentation) plus posterior instrumentation from the upper thoracic spine to the pelvis. Eighty-five percent of parents or caregivers were very satisfied with the results of surgery and noted a beneficial impact of the patient's sitting ability, physical appearance, ease of care, and comfort. CONCLUSIONS: To avoid late progression of trunk deformity in skeletally immature patients, anterior spinal release and fusion combined with posterior segmental spinal instrumentation and fusion from the upper thoracic spine to the pelvis are recommended. Skeletally mature patients with good curve flexibility can be treated with posterior instrumentation and fusion only. Skeletally mature patients with large fixed curves benefit from an anterior-posterior procedure for better correction of the scoliosis and pelvis obliquity. Despite the surgical complexity and expected complications, the overall good surgical results and high patient and caregiver satisfaction confirm that corrective spinal surgery is indicated and is beneficial for most patients with total-body-involvement cerebral palsy and scoliosis.
Adolescent↗
Women's perceptions of maternity carers.
OBJECTIVE: To investigate women's perceptions about the roles of different types of staff providing maternity care. DESIGN: A descriptive study using screening questionnaires and semi-structured interviews. SETTING: Two hospitals in the north of England, one in a predominantly urban, inner-city area and the other in a mixed urban-rural area. PARTICIPANTS: 537 women between 16 and 24 weeks' gestation from two hospitals serving urban and rural areas completed screen questionnaires, and 247 (46%) were interviewed in their homes. In this paper we report on the findings of the interview study. FINDINGS: The majority of women were clear about the role of the midwife in the maternity care of all women. Obstetricians were primarily perceived as being there to provide specialist or emergency care. Many women were uncertain about the specific role of their GP in maternity care. There was variation in women's views about whether different types of staff are qualified to perform particular tasks. IMPLICATIONS FOR PRACTICE: Women need information about the roles and functions of maternity carers in order to make choices about their care.
Adult↗
Improving the contribution of public health to NHS decision making: development of an instrument.
Recent policy pronouncements have raised expectations that public health practitioners will be increasingly involved in NHS decision making. This is a complex task which requires the bringing together of appropriate data and values. The authors developed an instrument, to aid decision making, which seeks to make explicit the values held by key health decision makers at local level. We report on the evolution of the project and the development of the instrument. This work is then placed within the context of the current renaissance in British public health, as the instrument could be useful when public health issues are being decided by or with partners within the National Health Service (NHS), the local authorities or the wider community.
Administrative Personnel↗
Cognitive factors in the close visual and magnetic particle inspection of welds underwater.
Underwater close visual inspection (CVI) and magnetic particle inspection (MPI) are major components of the commercial diver's job of nondestructive testing and the maintenance of subsea structures. We explored the accuracy of CVI in Experiment 1 and that of MPI in Experiment 2 and observed high error rates (47% and 24%, respectively). Performance was strongly correlated with embedded figures and visual search tests and was unrelated to length of professional diving experience, formal inspection qualification, or age. Cognitive tests of memory for designs, spatial relations, dotted outlines, and block design failed to correlate with performance. Actual or potential applications of this research include more reliable inspection reporting, increased effectiveness from current inspection techniques, and directions for the refinement of subsea inspection equipment.
Adult↗
Incorporation of norvaline at leucine positions in recombinant human hemoglobin expressed in Escherichia coli.
We report here a novel finding that norvaline can be incorporated in place of leucine in recombinant human hemoglobin expressed in Escherichia coli. The presence of the norvaline was confirmed by several analytical methods such as amino acid analysis, peptide mapping, electrospray mass spectrometry, and Edman protein sequencing. It appears that substitution is distributed across both the beta- and di-alpha-globins in purified recombinant hemoglobin. The level of misincorporation correlated with the ratio of the free norvaline/leucine pool available in the cell culture. This suggests that the incorporation of norvaline for leucine occurs through misaminoacylation of tRNALeu, similar to the misincorporation of norleucine for methionine found in many recombinant proteins expressed in E. coli.
Amino Acid Sequence↗
Partially purified soy hydrolysates retard proliferation and inhibit bacterial translocation in cultured C2BBe cells.
Hydrolyzed soybean isolates SP-A and SP-B (Abbott Laboratories, OH), developed for use in enteral nutritional products, were tested in cultures of C2BBe cells, a colonic adenocarcinoma cell line with enterocytic differentiation, to evaluate effects on cell growth, maturation and ability to resist infection by enteric bacteria. SP-A delayed formation of confluent monolayers by 10 d compared with cells cultured without SP-A. SP-A also caused a retardation in the development of intercellular tight junctions as measured by transmonolayer electrical resistance (TER). SP-B had no effect on cell proliferation or TER of intestinal cell cultures. SP-A and SP-B enhanced the development of the brush border enzymes alkaline phosphatase and isomaltase over a 28 d period. By these criteria, SP-A and SP-B appear to affect intestinal epithelial cell development in culture. When C2BBe monolayers were exposed to the enteric bacteria, Salmonella typhimurium or Salmonella typhi, an inhibition of the passage of S. typhi was seen in cultures with SP-A and SP-B. No effect on the passage of S. typhimurium was seen with either soy isolate. Partially purified soy isolates therefore impart resistance to selected enteroinvasive bacteria. Addition of soy hydrolysates to the media of cultured intestinal cells may serve as a rapid and economical screening mechanism for preclinical trials that would test the therapeutic benefits of soybean isolates.
Adenocarcinoma↗
Children undergoing treatment with botulinum toxin: the role of the physical therapist.
For the cerebral palsy patient undergoing botulinum toxin (BTX) therapy, the physical therapist is involved in each step of treatment, from patient selection to outcome assessment. Prior to treatment, the therapist collects detailed baseline information, including assessment of motor ability, functional activities, current therapies and assistive devices, and the concerns of the caregiver and family. After BTX injection, the therapy program may include exercise, neurodevelopmental training, functional training, modalities, splinting, casting, orthoses, and positioning. The weakness brought on by BTX treatment provides important opportunities for functional retraining. It may also necessitate new assistive devices or modifications in the old ones.
Anti-Dyskinesia Agents↗
Traditional methods vs rigid internal fixation of mandible fractures.
OBJECTIVE: To compare traditional methods (ie, intermaxillary fixation with interosseous wiring or external fixation) with newer techniques (ie, plating, use of lag screws) of open reduction and fixation of mandible fractures. DESIGN: Retrospective analysis of data from medical records. SETTING: Academic urban medical center. PATIENTS: Nonrandomized sample of 356 patients admitted to the hospital for treatment of mandible fractures from 1987 through 1991; 155 patients treated with open reduction and fixation were studied. INTERVENTIONS: Sixty-nine patients were treated with interosseous wire fixation or external fixation, 86 patients with rigid internal fixation. MAIN OUTCOME MEASURES: Presence of infection, nerve impairment, nonunion, malunion, operative time, and follow-up. RESULTS: No significant difference was noted between the two groups for sex, treating service, delay in presentation, antibiotic coverage, mechanism of injury, or type of fracture. The incidence of infection, nerve injury, and unavailability for follow-up were greater in patients treated by the newer techniques. Overall expense and operative time were greater in the group treated with plates and lag screws. CONCLUSIONS: We advocate traditional techniques for patients with mandible fractures requiring open reduction and fixation.
Bone Plates↗
Psychological first-aid: a practical aide-memoire.
Despite advances made in recent years in medical first aid, psychiatric intervention, survival training and equipment design, many people still perish quickly during and immediately following a disastrous event. In this study, individuals and groups of survivors of life-threatening events were debriefed and the behavior of those who coped well during such a threat to life were compared with those who did not. The behaviors of those who coped well were distilled into a set of principles for psychological first aid; that is, a series of simple actions for use within a disaster which serves to recover victims to functional behavior as quickly as possible, thus increasing their chance for survival. These principles of psychological first aid have recently been introduced into basic first aid and survival training courses for both military and civilian units.
Adaptation, Psychological↗
Rickettsialpox in a New York City hospital, 1980 to 1989.
BACKGROUND: Rickettsialpox is caused by Rickettsia akari, which is transmitted from rodents to humans by bloodsucking mites. The initial skin lesion forms an eschar and is followed by the development of fever, malaise, myalgia, and 5 to 40 maculopapules and papulovesicles. The disease, which responds to tetracycline, can be mistaken for chickenpox. The diagnosis has been based on an increase in serum antibody titers against R. akari over a period of three to eight weeks. We discuss a more rapid technique that uses direct immunofluorescence to identify R. akari in paraffin-embedded tissue, and we describe the histopathological findings of lesional skin. METHODS: We studied 13 patients (age, 11 months to 58 years) who were seen at Lincoln Hospital in New York City from 1980 to 1989 and were suspected of having rickettsialpox. In nine patients serum samples were obtained during the acute and convalescent phases of the illness for indirect fluorescent-antibody testing. Punch-biopsy specimens of skin lesions were examined by microscopy and by direct fluorescent-antibody testing with an anti-R. rickettsii globulin conjugated with fluorescein isothiocyanate. RESULTS: The diagnosis was confirmed in all 13 patients by indirect or direct fluorescent-antibody techniques. Direct fluorescent-antibody testing of eschars from seven patients was positive in five patients, but negative in two patients who had serologically confirmed rickettsialpox. In contrast, direct fluorescent-antibody testing of papulovesicles from nine patients was positive in only one patient. Histopathological analysis of the eschars revealed extensive necrosis and inflammation. In biopsy specimens of papulovesicles, dermal edema, subepidermal vesicles, and vascular changes were present. CONCLUSIONS: The combination of direct fluorescent-antibody testing of an eschar from the presumed site of inoculation and histopathological examination of papulovesicles for distinctive features represents an improved method of diagnosing rickettsialpox.
Adult↗
High altitude dives in the Nepali Himalaya.
British divers undertook no-stop decompression dives at altitudes of 15,700 and 16,000 ft (4,785 and 5,33 m) in the Everest region of the Nepali Himalaya. They performed 23 dives on oxygen and two on nitrox (60% N2:50% O2. The dives took place under ice in two lakes, Gokyo Tsho and Donag Tsho. The maximum depth achieved was 98 feet fresh water (29.32 msw), maximum duration was 39 min in water, 44 min on gas.
Acclimatization↗
Is there a relationship between a mother's mental state and consulting the doctor by the family? A study in a military general practice.
A total of 174 families of service personnel with children between 3 and 6 years of age were studied over a 6 month period. All contacts with the general practitioner, both in and out of hours together with the local casualty department were recorded. Mothers of the children were posted a specially designed questionnaire to measure how seriously they perceived various childhood symptoms to be and a copy of the general health questionnaire, 28 question version (GHQ 28). The perceived severity questionnaire had been piloted previously in a neighbouring practice. The overall response rate was 77%. Analyses of the data showed that the factors most significantly associated with a child's consultation frequency were the psychological state of the mother, the mother's own consultation frequency and the number of children in the family; the last being an inverse relationship. No evidence was found to suggest that the perception of the severity of illness varied with the psychological state of the mother. In addition, the childhood consultation rate was not influenced by the mother's perception of the severity of childhood illness as measured by the perceived severity questionnaire. Other factors such as the age of the mother or child, within the age range studied, were not found to be significantly related to the child's frequency of consulting. A mother's own consultation frequency was highly correlated with her GHQ 28 score, but more specifically with the subsections that scored for depression and somatic symptoms. From the study, doctors who see children should seriously consider the main reasons for a child's consultation.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Dermatosis papulosa nigra in a young child.
Dermatosis papulosa nigra was diagnosed in a 3-year-old black boy. This follicular nevoid condition, which is common in adult blacks, is seldom diagnosed in prepubescent children. The diagnosis was confirmed by the biopsy specimen that showed features of epidermal acanthosis and papillomatosis, similar to seborrheic keratosis.
Black People↗
Infant feeding preference card.
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Breast Feeding↗
Comparison of two methods of tonsillectomy.
No consensus exists regarding the best method of tonsillectomy. This report concerns two popular methods: 1. electrocautery excision and 2. dissection/snare followed by point coagulation of bleeding sites. To compare these methods, a prospective, randomized, single-blinded study was conducted in which 28 patients had one tonsil removed by dissection/snare and selective cautery of bleeders and the other removed by the electrocautery. Operative time and blood loss were compared. Patients rated the severity of their pain and blood loss postoperatively. Intraoperative bleeding was significantly less on the side of cautery excision, although the operative time was longer. At follow-up, pain was rated worse on the side of cautery excision.
Adolescent↗
Polysomnographic and clinical findings in children with obstructive sleep apnea.
A retrospective study was conducted to determine which types of children might have polysomnographic findings that are most compatible with obstructive sleep apnea (OSA). The charts of 93 patients who were aged 18 months to 12 years were examined. All 93 patients had symptoms that were initially suggestive of OSA, and they underwent polysomnography. The types of presenting symptoms and associated illnesses were noted. Physical findings, including height, weight, and tonsil size, were examined. Of 93 patients with symptoms that were suggestive of OSA, 34 met sleep study criteria for OSA. In 44 patients, OSA was not demonstrated, and 15 patients had other results. On the basis of age, sex, and symptoms, no significant differences could be found between the group with OSA and the group with normal polysomnographic findings. Cor pulmonale, tonsil hypertrophy, and failure to thrive were associated with OSA. Surprisingly, obesity was not significantly associated with OSA.
Child↗
Breastfeeding by Federal Express.
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Breast Feeding↗