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Biomedical subjects

J Roberts

Publications and source records attributed to J Roberts.

At least 775 records · Page 43Linked to original sources
PubMedDate not supplied

Problem-solving counseling for caregivers of the cognitively impaired: effective for whom?

BACKGROUND: Individualized problem-solving counseling for caregivers of cognitively impaired relatives is thought to help caregivers cope with the stress and burden of caregiving. Few studies have shown the effectiveness of counseling for these caregivers. OBJECTIVES: To determine the effectiveness of individualized problem-solving counseling by nurses for caregivers and the expenditures of health care utilization. METHOD: Caregivers (n = 77) of the cognitively impaired living at home were randomized to receive nurse counseling or not. Psychosocial adjustment to their relative's illness, psychological distress, burden, coping skills, and expenditures were measured after 6 months and 1 year. RESULTS: Although on average, all caregivers receiving nurse counseling indicated no improvement in psychosocial adjustment to their relative's illness, psychological distress, or caregiver burden, they found counseling very helpful and it was effective for a subgroup of caregivers. Those with poor logical analysis coping skills at baseline had decreased psychological distress (F(1,53) = 9.7, p = .003) and improved psychosocial adjustment (F(1,53) = 4.7, p = .035) after 1 year. Caregivers in control and counseling groups whose relatives entered a nursing home improved their psychosocial adjustment 23% on average whereas those continuing to live in the community decreased by 8%. Almost half as many relatives entered nursing homes in the counseling group (n = 9 vs. n = 5) but these compared to control group relatives had greater annualized per person expenditures for health and social services (Cdn$23,437 vs. Cdn$15,151). CONCLUSIONS: Caregivers found nurse counseling most helpful. Those indicating infrequent use of logical analysis coping skills showed benefits.

Adaptation, Psychological↗
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Latex allergy in children with myelodysplasia: a survey of Shriners hospitals.

We surveyed the incidence of recognized latex sensitivity in myelodysplasia patients in 16 Shriners Hospitals. The percentage of involved patients ranged from 0 to 22% (mean 5%). Twenty-two children had a significant anaphylactic reaction. We provide recommendations for preoperative prophylaxis and sources of listings of latex and latex-free hospital products and home products.

Child↗
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Second stage labor: what is normal?

Traditional management of second stage labor has come under scrutiny because of improved understanding of what normally occurs when second stage labor is allowed to proceed of its own accord without direction from birth attendants. When women bear down spontaneously as they feel the urge to push, either holding their breath briefly or with short exhalation of air, normal maternal and fetal physiological status is maintained and second stage labor does not appear to be lengthened. Using a variety of maternal positions during second stage labor can optimize physiologic functioning and increase maternal comfort.

Female↗
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The use of daily fetal movement records in a clinical setting.

A variety of biochemical and biophysical techniques are used for the assessment of fetal well-being in high-risk pregnancy. Based on clinical experience, the daily fetal movement record has been found to be an inexpensive, non-invasive, simple tool that may be used for the continuous assessment of the fetus by the mother. The daily fetal movement record may predict fetal distress occurring in the interim between other assessments. Patients are instructed to count the number of fetal movements perceived in a 30-minute period, three times per day. The daily fetal movement record is a screening tool that may signal the need for further fetal well-being assessment. The tool promotes the mother's active participation in assessment of her high-risk fetus and may encourage maternal-fetal attachment.

Abruptio Placentae↗
PubMedDate not supplied

A comparison of cold and warm sitz baths for relief of postpartum perineal pain.

The effect of cold sitz baths for relieving perineal pain in the postpartum period after an episiotomy was evaluated. Forty patients took both cold and warm sitz baths with random assignment of the initial bath. Patients rated the degree of perineal pain before and after each sitz bath and at half-hour and one-hour intervals after each bath. A pain scale using 0-5, 0 representing no pain and 5 representing extreme pain, was used. Analysis of pain scale scores using a two-way analysis of variance with replications showed that cold sitz baths were significantly more effective in relieving perineal pain. The greatest amount of pain relief was experienced immediately after the cold sitz baths.

Baths↗
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Efficacy of omeprazole for the prevention of exercise-induced gastritis in racing Alaskan sled dogs.

Exercise-induced gastritis and gastric ulcers are common in humans and horses, and recently have been described in racing sled dogs. The cause of exercise-induced gastric disease is not completely understood in any species, but pharmacologic suppression of acid secretion is an effective treatment in humans and horses. Thus, we tested the hypothesis that omeprazole, a proton-pump inhibitor shown to reduce gastric acid secretion in dogs, would reduce the severity of exercise-induced gastric disease. Three teams of 16 dogs each competing in the 2002 Iditarod Sled Dog Race were recruited for participation. Within each team, dogs were randomly assigned to either treatment (20 mg omeprazole PO q24h) or placebo. Treatments were administered until either completion of the race or withdrawal of an individual dog from competition. Gastric endoscopy was performed in all dogs 24 hours after completion or withdrawal, and the gastric mucosa was scored by using a subjective severity score (0 = normal, 3 = numerous bleeding ulcers). Treatment with omeprazole significantly reduced mean gastric severity score compared to placebo (omeprazole: 0.65 +/- 0.17, placebo: 1.09 +/- 0.18; P = .028), but also was associated with increased frequency of diarrhea during the race (omeprazole 54%, placebo 21%; P = .017). Examination of our data suggests that omeprazole may be an effective treatment for exercise-induced gastric disease in racing sled dogs. However, further investigation regarding the cause and clinical relevance of diarrhea associated with omeprazole treatment must be conducted before omeprazole can be recommended for routine prophylactic treatment in these athletes.

Alaska↗
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Medical marriages.

Explore the source record for details and available documents.

Humans↗
PubMedDate not supplied

Modulation of aortic and cardiac G protein alpha subunits and their mRNAs during norepinephrine infusion in rats.

These studies examine the possibility that alterations in the expression of G protein alpha subunits occur during desensitization of adrenergic responses in the cardiovascular system. To desensitize adrenergic receptors, rats were infused with norepinephrine (NE) subcutaneously (0.1 mg/kg/h) for 3 or 6 days using osmotic minipumps. G protein alpha subunits and their mRNAs were then measured in the aorta and heart using selective antibodies and cDNA probes. Infusion of NE for 6 days significantly decreases the levels of Gs alpha, Gi alpha and Go alpha in the aorta. The mRNAs for the alpha subunits are not altered in the aorta after NE infusion for 3 or 6 days indicating that reduced mRNA expression does not account for the decreased proteins. In the atrium and ventricle the levels of Gs alpha decrease after NE infusion for 3 days but then return to control levels by day 6. The levels of atrial and ventricular Gi alpha are unaltered after NE infusion for 3 days but increase significantly by day 6. Go alpha levels do not change in the atrium or ventricle on either day. The level of Gi2 alpha mRNA increases after NE infusion for 6 days and may account for the increased alpha i protein. The levels of the other G alpha mRNAs do not change in the atrium or ventricle. These results demonstrate that expression of G protein alpha subunits is altered during cardiovascular desensitization, raising the possibility that modulation of the alpha subunits may contribute to reduced adrenergic responsiveness.

Animals↗
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Perioperative stabilization of glucose levels in patients supported with total parenteral nutrition.

Fourteen nondiabetic and 6 diabetic patients were maintained on total parenteral nutrition during major surgery. Glucose levels when compared to preoperative levels increased during and after surgery although there were no significant differences between the diabetic and nondiabetic groups. Serum sodium demonstrated a slight decrease and serum potassium a slight increase after surgery in both groups. Total parenteral nutrition can be maintained during surgery provided glucose and electrolyte levels are observed and appropriate insulin doses are administered to diabetic patients.

Adult↗
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The G grade ward sister: clinical expert and ward manager.

The role of ward sister is changing and increasingly veering towards a middle management role. This article discusses the qualities and skills needed by a ward sister if she is to maintain her traditional role as clinical expert while also fulfilling her new role as ward manager.

Humans↗
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Developing an oral assessment and intervention tool for older people: 1.

This is the first in a series of three articles relating to oral care for older people. The first article underlines the importance of oral assessment and evidence-based intervention for older people. It describes influences which can affect older people's ability to maintain oral healthcare practices. There is a need to examine closely issues surrounding poor oral hygiene practices and their associated ramifications for the older person. Identifying and implementing an appropriate oral assessment tool for older people should provide the foundation for the maintenance and improvement of standards of oral care practices within the clinical practice setting. The second article critically analyses oral care interventions; the third article critiques a number of published oral assessment tools with a view to developing and implementing a workable oral assessment tool for the practice setting.

Aged↗
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Developing an oral assessment and intervention tool for older people: 2.

This is the second of a series of three articles relating to oral care for older people. The first article highlighted the importance of effective oral care for older people (Vol 9(17): 1124-7). This article critically analyses a number of oral care agents and interventions to identify evidence-based practice relating to oral care for older people. Recommendations for practice are highlighted to guide practitioners in implementing safe and effective nursing interventions within oral care. The third article will critique a number of published oral assessment tools and describe an oral assessment and intervention tool that has been developed.

Aged↗
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Developing an oral assessment and intervention tool for older people: 3.

This is the last in a series of three articles which have examined oral care practices for older people. The first article (Vol 9(17): 1124-7) highlighted the importance of effective oral care. The second article (Vol 9(18): 2033-40) examined oral care interventions in detail to identify oral care that is evidence based. This article looks at the factors which have an impact on oral health, and which must be considered when assessing a patient's oral health status. The correlation between holistic assessment and careful documentation is examined, together with its associated relationship with maintaining effective oral care. The article also critiques a collection of published oral assessment tools to identify whether they would be appropriate for rehabilitation client groups. After identifying the lack of a suitable oral assessment tool within the literature, the need to develop an appropriate one is addressed. An oral assessment and intervention tool which has been developed in the author's clinical area is outlined.

Aged↗
PubMedDate not supplied

A simple data-processing system for the monitoring of cross-infection in a district general hospital.

A year's trail has demonstrated the effectiveness of a simple data processing system in the early identification of cross-infection problems at their source. The system has particular advantanges for small and scattered surgical units where cross-infection monitoring is particularly difficult because patients are transferred before their treatment is complete. A simple extension of the system could audit the efficiency of preventive antiseptic measures, particularly aseptic techniques, and provide antibiotic profiles.

Computers↗
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Neonatal diabetes mellitus associated with severe diarrhea, hyperimmunoglobulin E syndrome, and absence of islets of Langerhans.

Neonatal insulin-dependent diabetes mellitus (DM) is very rare and descriptions of the pancreatic pathology in affected infants vary considerably. Death after 10 months of a male child who suffered the onset of insulin-dependent DM as a neonate, together with severe diarrhea and features of the hyperimmunoglobulin E syndrome, was found to be associated with absence of islets of Langerhans. There was no evidence of any pancreatic exocrine abnormality or other endocrinopathy. Two male relatives with insulin-dependent DM have also died as infants, and after review of the literature it is suggested that this disease process may be part of the spectrum of an X-linked syndrome of diarrhea, polyendocrinopathy, and fatal infection in infancy. Evidence is presented to support the suggestion that this syndrome is an autoimmune disorder.

Diabetes Mellitus, Type 1↗
PubMedDate not supplied

Clinical governance for nurses: smoking cessation interventions.

AIM: To raise clinical governance issues by drawing on a Health Education Authority-sponsored review of the style, form and effect of a smoking cessation service in north west Lancashire. This service operated for five years before the government's decision to set up smoking cessation services. METHOD: A postal survey was undertaken of 800 clients. RESULTS: 193 people responded. Of these, 132 (68 per cent) claimed to be helped by the service. Proactive telephone contact, carbon monoxide monitoring, the six-week course, nicotine replacement therapy, and reading materials were well received. Thirty six per cent of the respondents were not smoking at the time of the survey. CONCLUSION: Nursing staff are increasingly expected to provide smoking cessation support. The government is funding this work and monitoring the number of clients helped, rather than the quality of the service. However, in terms of clinical governance, the quality of the service is crucially important.

Adult↗