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Biomedical subjects

J P Maloney

Publications and source records attributed to J P Maloney.

At least 19 recordsLinked to original sources
PubMed2003

Eosinophilic "empyema" associated with crack cocaine use.

Smoking of crystalline cocaine, known as "crack" cocaine, has been associated with eosinophilic pneumonitis, but not with pleural effusions. We describe a patient with eosinophilic pneumonitis with an eosinophilic "empyema" after using "crack" cocaine. The illness resolved with corticosteroids. We hypothesised that his effusion would have increased levels of eosinophil cytokines that promote oedema, and found a marked increase in pleural vascular endothelial growth factor (VEGF) and smaller increases in interleukins IL-5, IL-6, and IL-8. In the setting of "crack" use, we suggest that a pleural effusion that appears grossly to be pus should be evaluated for eosinophilic inflammation. Such eosinophilic effusions may respond to corticosteroids alone, consistent with a non-infectious process driven by proinflammatory cytokines.

Administration, Oral↗
PubMed2000

The effects of lead sulfate on new sealed lead acid batteries.

Emergency Medical Services (EMS) rely on batteries to power external cardiac defibrillators. While maintenance protocols should be followed to ensure that batteries possess adequate capacity to power their defibrillator, they are not often applied to new batteries. This study examines the effects of prolonged storage on sealed lead acid (SLA) batteries, the number of batteries that are affected by lead sulfate, and the ability of a protocol to restore the capacity in SLA batteries. A prospective cohort of new batteries was subjected to testing and discharge protocols. Initial battery capacities were measured using a battery analyzer. An "over-discharge" protocol fully discharged the battery over a 24-h period, and batteries were recharged and reanalyzed. Capacity measurements were repeated twice. Sulfate buildup was defined a priori as final capacity measurements greater than predischarge measurements. There were 126 batteries studied, a mean of 14 months after manufacture. Overall, 47 batteries (36.5%) had measured capacity that was insufficient (< 65% capacity). Batteries possessing very low initial capacities (< 55%) responded with a significant improvement on average of 54.7% compared with batteries within a normal capacity range (> 65%) whose average improvement was 9.3%. After discharge, there was an average of 17% improvement in the measured capacity, with no differences in the final capacity readings in each battery type. In conclusion, sealed lead acid batteries are affected by prolonged storage. The loss of capacity created by accumulation of lead sulfate can be reversed if battery maintenance protocols are used as part of EMS quality assurance programs.

Analysis of Variance↗
PubMed1999

Journey to holism.

The journey to holism is the result of a grounded theory study of 18 members of the American Holistic Nurses' Association. Participants were prompted to "Tell me about holistic nursing" and replies revealed a seven-step process to becoming a holistic nurse. The process is an expansion of Van Gennep's three-stage theory of rites of passage, which involves separation, marginality/liminality, and reintegration. The expanded process begins with separation from mainstream nursing and concludes with reintegration into nursing as a holistic nurse. The marginality/liminality step shows five active steps: gathering information to quell the distress of the separation, applying that information to others, changing focus to self-care, applying the information to self, and increasing self-knowledge. This article describes the process and presents data to support the conclusion that the growth of a holistic nurse follows a recognizable course.

Adult↗
PubMed1998

The Ontario Prehospital Advanced Life Support (OPALS) Study: rationale and methodology for cardiac arrest patients.

The Ontario Prehospital Advanced Life Support Study represents the largest prehospital study yet conducted, worldwide. This study will involve more than 25,000 cardiac arrest, trauma, and critically ill patients over an 8-year period. The study will evaluate the incremental benefit of rapid defibrillation and prehospital Advanced Cardiac Life Support measures for cardiac arrest survival and the benefit of Advanced Life Support for patients with traumatic injuries and other critically ill prehospital patients. This article describes the OPALS study with regard to the rationale and methodology for cardiac arrest patients.

Cost-Benefit Analysis↗
PubMed1998

Effects of transthoracic impedance and peak current flow on defibrillation success in a prehospital setting.

STUDY OBJECTIVE: To assess whether transthoracic impedance and peak current are determinants of defibrillation success in patients with out-of-hospital ventricular fibrillation (VF). METHODS: A retrospective cohort study was carried out in a suburban Canadian EMS system. Participants were patients who experienced out-of-hospital cardiac arrest in the regional municipality of Ottawa-Carleton, had VF rhythm at presentation, and received countershocks from the Laerdal Heartstart 2000 automated external defibrillator. RESULTS: A total of 310 patients met the inclusion criteria. Collectively they received 717 countershocks. The first shocks were successful in converting VF rhythm 25.5% of the time. The most important determinant of shock success was the interval from when the call was received until delivery of the first shock (P<.01). Length of time at scene, current, impedance, and patient age were not significant determinants of success of first shock. The time interval until first shock was also a determinant of survival (P<.01). EMS response time, whether the arrest was witnessed, initial impedance, and current were not determinants of survival. CONCLUSION: OHCA shock success and survival are associated with EMS system factors such as the interval from when the call was received until delivery of the first shock. The importance of impedance and peak current remain theoretic for out-of-hospital defibrillation success and did not influence defibrillation success in this study.

Age Factors↗
PubMed1998

In vitro release of vascular endothelial growth factor during platelet aggregation.

Platelet aggregation is a cardinal feature of both vascular repair and vascular disease. During aggregation platelets release a variety of vasoactive substances; some of these promote angiogenesis, endothelial permeability, and endothelial growth, actions shared by vascular endothelial growth factor (VEGF). This study was undertaken to investigate the hypothesis that VEGF is released by aggregating platelets. We found that VEGF was secreted during the in vitro aggregation of platelet-rich plasma induced by thrombin, collagen, epinephrine, and ADP (range 23-518 pg VEGF/ml). Furthermore, serum VEGF levels were elevated compared with plasma (230 +/- 63 vs. 38 +/- 8 pg VEGF/ml), indicative of VEGF release during whole blood coagulation. Lysates of apheresed, leukocyte-poor platelet units contained significant amounts of VEGF (2.4 +/- 0.8 pg VEGF/mg protein). VEGF message and protein were also present in a megakaryocytic cell line (Dami cell). These results suggest constitutive roles for platelet VEGF in the repair of intimal vessel injury and in the altered permeability and intimal proliferation seen at sites of platelet aggregation and thrombosis.

Adenosine Diphosphate↗
PubMed1998

A descriptive, correlational study of patient satisfaction, provider satisfaction, and provider workload at an army medical center.

Strong national interest in health care delivery systems and a highly competitive marketplace have mandated that military hospital commanders be increasingly aware of organizational performance. Historically, one variable that has been used to assess such performance is patient satisfaction with the care received. The purpose of this study was to measure patient satisfaction at a major military medical center and to assess how patient satisfaction correlated with the variables of provider satisfaction and nurse/patient ratio. One hundred eighty-eight patients completed the LaMonica-Oberst Patient Satisfaction Scale. Data analysis revealed that, although overall patient satisfaction was high, it was significantly higher on the intensive care units and in other areas where the nurse/patient ratio was high. Interestingly, there was no correlation between the staff's perceptions of their work environment and patient satisfaction. Findings from this study serve to highlight the continued need for a low nurse/patient ratio and are suggestive of the need for refinement of patient satisfaction survey tools available at present.

Female↗
PubMed1997

Social support: a conceptual analysis.

Using the methodology of Walker and Avant, the purpose of this paper was to identify the most frequently used theoretical and operational definitions of social support. A positive relationship between social support and health is generally accepted in the literature. However, the set of dimensions used to define social support is inconsistent. In addition, few measurement tools have established reliability and validity. Findings from this conceptual analysis suggested four of the most frequently used defining attributes of social support: emotional, instrumental, informational, and appraisal. Social network, social embeddedness, and social climate were identified as antecedents of social support. Social support consequences were subsumed under the general rubric of positive health states. Examples were personal competence, health maintenance behaviours, effective coping behaviours, perceived control, sense of stability, recognition of self-worth, positive affect, psychological well-being, and decreased anxiety and depression. Recommendations for future research were made.

Aged↗
PubMed1996

The Ontario trial of active compression-decompression cardiopulmonary resuscitation for in-hospital and prehospital cardiac arrest.

OBJECTIVE: To compare the impact of active compression-decompression (ACD) cardiopulmonary resuscitation (CPR) and standard CPR on the outcomes of in-hospital and prehospital victims of cardiac arrest. DESIGN: Randomized controlled trial with blinding of allocation using a sealed container. SETTINGS: (1) Emergency departments, wards, and intensive care units of 5 university hospitals and (2) all locations outside hospitals in 2 midsized cities. PATIENTS: A total of 1784 adults who had cardiac arrest. INTERVENTION: Patients received either standard or ACD CPR throughout resuscitation. MAIN OUTCOME MEASURES: Survival for 1 hour and to hospital discharge and the modified Mini-Mental State Examination (MMSE). RESULTS: All characteristics were similar in the standard and ACD CPR groups for the 773 in-hospital patients and the 1011 prehospital patients. For in-hospital patients, there were no significant differences between the standard (n = 368) and ACD (n = 405) CPR groups in survival for 1 hour (35.1% vs 34.6%; P = .89), in survival until hospital discharge (11.4% vs 10.4%; P = .64), or in the median MMSE score of survivors (37 in both groups). For patients who collapsed outside the hospital, there were also no significant differences between the standard (n = 510) and ACD (n = 501) CPR groups in survival for 1 hour (16.5% vs 18.2%; P = .48), in survival to hospital discharge (3.7% vs 4.6%; P = .49), or in the median MMSE score of survivors (35 in both groups). Exploration of clinically important subgroups failed to identify any patients who appeared to benefit from ACD CPR. CONCLUSIONS: ACD CPR did not improve survival or neurologic outcomes in any group of patients with cardiac arrest.

Adolescent↗
PubMed1996

Utilization of supplemental agency nurses in an Army medical center.

The purpose of this study was to describe the perceived impact of supplemental agency nurses upon the quality of patient care, unit cohesiveness, and morale of permanently assigned personnel at an Army medical center. The study population consisted of 28 agency nurses and 138 permanently assigned nursing staff. The study was descriptive and exploratory in nature, utilizing the method of content analysis. Major themes that emerged from data analysis included economic, professional nursing, and patient care issues. Perceptions were that agency nurses provided the institution with necessary labor, but that the agency nurses had greater flexibility of hours and control over their practice. Permanently assigned nursing staff reported that the use of agency services hindered continuity of patient care, at times reduced the quality of care, negatively affected morale among personnel, and impacted adversely upon the time available for mission-related training.

Adult↗
PubMed1996

Nurse-physician communication: perceptions of nurses at an Army medical center.

The purposes of this study were to describe nurses' perceptions of their communication with physicians, as related to the openness of the communication, the accuracy of the information communicated, and the timeliness of the interaction; and further, to determine if specific demographic characteristics of nurses are associated with perceptions of positive communication. The sample (N = 112) consisted of professional nurses working on one of nine inpatient units at a major military medical center. Shortell's ICU Nurse-Physician Communication subscale was used to measure the nurses' perceptions of the degree to which openness, accuracy, and timeliness described their communication with physicians. Overall findings were that the nurses perceived a poor quality of communication between themselves and the physicians with whom they interacted. Results from this study further indicated that the perceived quality of nurse-physician communication was not related to a nurse's educational level, length of nursing experience, or length of time assigned to a specific unit. Finally, findings provided no evidence that perceived levels of nurse-physician communication were greater among permanent staff than temporary nursing staff, or in intensive care units versus general ward areas.

Communication↗
PubMed1996

Evaluation and comparison of health care Work Environment Scale in military settings.

The purpose of this study was to describe health care providers' perceptions of their work environment at a large U.S. Army medical center, and to compare the findings to other military medical centers. The sample (N = 112) consisted of the professional nursing staff working on the nine inpatient units. The Work Environmental Scale (WES) was used to measure perceptions of the workplace relative to gender, position (head nurses, staff nurses, and agency nurses), specialty nursing (intensive care unit [ICU] versus non-ICU), education (MSN, BSN, and ADN), and patterns of differences between the WES subscales of four military medical centers. Results of the study indicate that there were no significant gender differences. Head nurses, non-ICU nurses, and MSN nurses perceived their environment more positively. There were significant differences in the WES subscales between the military hospitals. Implications for nursing using the WES were recommended.

Adult↗
PubMed1995

Managed care at Eisenhower Army Medical Center: an initial experience.

Managed care is receiving a great deal of attention in the health care industry. In today's cost-conscious economic environment, managed care has been developed in an attempt to maximize quality of health care while minimizing the cost of providing that care. The purposes of this article are to (1) review the principles of clinical case management; (2) describe the implementation of clinical case management and critical paths at Dwight David Eisenhower Army Medical Center; (3) elaborate on successful strategies employed; and (4) address difficulties encountered. Finally, the study that is currently underway at the facility will be briefly discussed.

Case Management↗
PubMed1993

Indirect blood pressure measurement: a need to reassess.

BACKGROUND: Indirect blood pressure measurement is the assessment tool used most frequently in epidemiological studies and hypertension management in the population at large. OBJECTIVE: To review indirect blood pressure measurement within the context of nursing practice. RESULTS: Nurses are not following recommended American Heart Association measurement guidelines. CONCLUSION: A national program of certification in indirect blood pressure measurement, similar to that of basic and advanced cardiac life support, is needed. An initial approach to evaluating present practice is also suggested.

American Heart Association↗
PubMed1993

Patient care and nursing practice when staff requirements exceed staff availability.

This study examined the Workload Management System for Nurses at a tertiary-care Army hospital to determine the incongruence between recommended nursing care hours and actual nursing care hours provided. The purpose of the study was to describe patient care and nursing practice when calculated staff requirements exceed actual staff availabilty. The findings of the study indicated that basic nursing care tasks were accomplished; however, professional development activities were sacrificed. The data reveal that nurses do not have the time to grow professionally through research or education, and they are reduced to assembly-line mentality as they go from task to task without being able to care for a patient as a person.

Adult↗