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Biomedical subjects

J Parker

Publications and source records attributed to J Parker.

At least 181 records · Page 10Linked to original sources
PubMed1991

The development of the nephrology nursing certification program.

The certification examination for nephrology nurses was developed by the Nephrology Nursing Certification Board (NNCB) and the ANNA Certification Ad Hoc Committee with guidance from the National League for Nursing (NLN) Test Services. The development of a written examination is the continuing responsibility of the NNCB. This article provides a summary of the 3 years experience with the examination and focuses on the process of actual test construction: the organization, development, evaluation, and quality of test items.

Certification↗
PubMed1991

Treatment of cervical carcinoma with ionizing irradiation using moving fields.

This study was designed to assess the effectiveness and risk of complications from radiotherapy delivered by the moving field technique as opposed to the more commonly used fixed field technique. Between 1975 and 1985, 131 patients were treated for cervical cancer with a combination of teletherapy and brachytherapy. For teletherapy, 4-MeV photons were used and delivered by moving field technique (120 degrees to 160 degrees arcs, or a 360 degrees rotation). Most patients received one intracavitary radium implant using Fletcher-Suit applicators and the Manchester technique. Twenty-two percent of the patients had stage I disease, 37% stage II, 25% stage III, 13% stage IV, and 2% were unstaged. The cumulative 5-year survival for all patients was 57%. The survival by stage was: stage I, 82%, stage II, 62%, stage III, 53%, and stage IV, 6%. Chronic complications developed in 10 (7.6%) patients. The survival and complication rate of patients treated for cervical cancer with radiation using moving fields compares favorably with that of patients treated with the conventional parallel opposed (AP-PA) fields or the four-field box technique. Further studies are necessary to definitively determine if the moving field technique offers advantages over other techniques.

Brachytherapy↗
PubMed1991

Results of total knee arthroplasty using the posterior stabilized condylar prosthesis. A report of 137 consecutive cases.

One hundred thirty-seven consecutive posterior stabilized total knee arthroplasties (TKAs) were reviewed. Average age of the patient was 61.1 years and length of postoperative follow-up period was 29.2 months. Patients were evaluated using the Hospital for Special Surgery (HSS) knee rating scores. Average preoperative scores improved from 52 to 92, postoperatively. Ninety-eight percent of patients had no pain or mild occasional pain postoperatively compared with 99% of patients experiencing severe to disabling pain preoperatively. Complications included one myocardial infarction, two deep venous thrombosis, one urinary tract infection, one patellar dislocation, and four wound problems. There were two incidences of seroma, one hematoma, and one deep infection requiring revision after joint debridement and systemic antibiotics. Also noted was one incidence of ligamentous laxity and one patella fracture.

Aged↗
PubMed1991

Case-control evaluation of a school-age BCG vaccination programme in subtropical Australia.

In 1956 a programme was initiated to vaccinate all children aged 12-14 years who were attending schools in Queensland, Australia. In view of the declining incidence of tuberculosis in Australia as a whole, there was a need to evaluate the effectiveness of the programme and its procedures. We therefore carried out a case-control study of Queensland's population, excluding certain known high-risk groups. Cases were Queensland residents with notified tuberculosis and of the appropriate age; two controls per case were chosen from the electoral roll. Information on vaccination status was obtained mainly from questionnaires and school records, where available. The results show that at best BCG vaccination had a modest protective effect, approximately 30% when the patients were diagnosed, which was on average 15 years after they had been vaccinated in the school programme. In the north the climate of Queensland is tropical, while in the more heavily populated south it is subtropical. A substantial proportion of the school records reported weak positive reactions to preliminary tuberculin testing, believed to be due largely to atypical mycobacteria. A similar phenomenon has been observed in other tropical regions, and may help to explain the apparent absence of a strongly protective effect for BCG vaccination.

Adolescent↗
PubMed1990

Selective reduction of serotonin storage and ATP release in chronic renal failure patients platelets.

Hemorrhagic complications, as monitored by skin bleeding times, occur in a significant number of chronic renal failure (CRF) patients. The etiology of hemostatic defects in these patients is complex and ill defined. Our studies demonstrate, for the first time, that activated platelets, derived from CRF patients, release significantly (P less than .001) less ATP than controls while the percent of releasable serotonin (5HT), assumed to be co-stored with ATP, is unaltered. Analysis of the CRF-derived platelets reflects a selective acquired storage pool defect with significantly (P less than .001) reduced 5HT levels while their dense granule contents of ATP and ADP are normal. The comparison of ATP release from platelets derived from CRF patients whose bleeding times were less than 9 min to those with bleeding times of 9 min or greater was significantly different (P less than .02). This report demonstrates for the first time that there is a statistically significant correlation of ATP release and 5HT content to bleeding times (P less than .001). The perturbation of platelet 5HT uptake, 5HT dense granule content, and ATP release appears to result from newly described altered plasma factors, detected by our in vitro mixing studies. It is proposed that the reduced level of releasable platelet 5HT and ATP contributes to bleeding disorders commonly encountered in CRF patients.

Adenosine Diphosphate↗
PubMed1990

The correlation between dysmenorrhea and the pain experienced during laser ablation of a cervical lesion.

Twenty women undergoing colposcopically directed laser evaporation of a cervical intraepithelial neoplastic (CIN) lesion were recruited. Using a linear analog scale they scored the pain associated with a normal period when not using contraception. Under standardized conditions and without any analgesia or local anesthesia their transformation zone was ablated to a depth of approximately 6 mm by an independent operator. Pain was assessed 10 min after the procedure by the same technique as that used for the measurement of dysmenorrhea. There is a direct correlation (r = 0.7) between the discomfort of dysmenorrhea and discomfort at colposcopy. This allows the operating colposcopist to predict which patients are most likely to experience discomfort during laser evaporation of a cervical lesion.

Dysmenorrhea↗
PubMed1990

Visual disturbances, serum glycine levels and transurethral resection of the prostate.

Transient visual disturbances have been noted in patients undergoing transurethral resection of the prostate. It has been suggested recently that these visual aberrations were secondary to high serum concentrations of glycine from the intravasation of irrigant solutions used during the procedure. We prospectively studied visual acuity, serum electrolytes, glucose, ammonia and glycine concentrations in 18 patients undergoing transurethral resection of the prostate. Of our patient population 22% experienced significant decreases in visual acuity. We found that all patients had significantly elevated serum glycine concentrations but that there was no correlation of visual symptomatology with serum electrolyte or glucose concentrations. Our data further suggest that impeded metabolism of glycine may be more important than the absolute serum concentration in symptomatic patients.

Ammonia↗
PubMed1990

Frequency of inhaled metaproterenol in the treatment of acute asthma exacerbation.

Acute asthma exacerbations are common complaints in patients who present to the emergency department. A prospective, double-blinded study was designed to evaluate how frequency of dosing of an inhaled beta-agonist, metaproterenol (Alupent inhalation solution) would affect patient response, length of stay in the ED, and admission rates. Forty-one patients initially received a 0.3-mL dose of nebulized metaproterenol followed by two additional doses of either metaproterenol or saline every 20 minutes. While there was no difference in response (forced expiratory volume in one second) in patients at 30 minutes after their arrival, there was an improved response in the metaproterenol group at 60 and 120 minutes. The length of stay in the ED was approximately the same for both groups. There was no significant difference in admission rates. No increase in undesirable side effects (eg, nausea, tremor, palpitations) was seen in the metaproterenol-treated group. Frequent dosing of metaproterenol is useful in asthmatics having acute exacerbations and leads to rapid improvement without an increase in toxicity.

Acute Disease↗
PubMed1990

Desmopressin-induced improvement in bleeding times in chronic renal failure patients correlates with platelet serotonin uptake and ATP release.

Hemostatic defects resulting in life-threatening hemorrhagic episodes are a common occurrence in the chronic renal failure patient. Hemorrhagic tendencies correlate best with laboratory tests of bleeding times. The identification of a specific hemostatic defect and its role in bleeding dyscrasias has yet to be elucidated. Our studies demonstrate that factor VIII coagulant activity and factor VIII related antigen (vWF:Ag) are normal or greatly elevated in uremic renal failure patients with greatly prolonged bleeding times. The multimeric state of the von Willebrand factor is also normal in these patients. The bleeding times were normalized in all 15 patients, 90 minutes post-infusion with desmopressin (DDAVP). No significant changes in factor VIII/vWF associated properties, blood cell counts, or coagulation factors were observed post-DDAVP treatment. However, a significant increase in platelet serotonin uptake (p less than .025) and ATP release (p less than .025) was detected after DDAVP treatment. These results indicate that DDAVP acts on the platelet membrane. This is further substantiated by the ability of DDAVP to block vasopressin-induced platelet aggregation in a dose- and time-dependent fashion. Perturbations in the movement and storage of serotonin and the release of adenosine 5'-triphosphate (ATP) in the platelets of uremic individuals are proposed to play a critical role in regulating bleeding times.

Adenosine Diphosphate↗