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K F McFarland

Publications and source records attributed to K F McFarland.

At least 19 recordsLinked to original sources
PubMed2000

Purpose in life and self-actualization in agency-supported caregivers.

When families cannot serve as full-time caregivers for severely, mentally ill family members, agency-supported caregivers provide an alternative to chronic hospitalization. Caregivers who provide 24 hour per day care experience caregiver burden; they also find rewards and meaning in their work. The purpose of this study is to observe positive experiences of paid caregivers for seriously, mentally ill individuals, especially the meaning or purpose it gives their lives and the self-fulfillment or self-actualization that caregiving provides. The caregivers in this study possessed a high purpose in life suggesting that caregiving may give meaning to life. Also, the caregivers of these individuals with severe, mental illness tend to be highly other-oriented (altruistic), an external focus that may decrease their own self-awareness. Thus, caregivers who provide continuous residential care may benefit from therapeutic interventions designed to reinforce self-care skills.

Adult↗
PubMed1999

Caregiver meaning: a study of caregivers of individuals with mental illness.

The study discussed in this article examined caregiver meaning. Study participants were individuals paid and supported by the South Carolina Department of Mental Health Homeshare program to provide care in their home for an individual with severe mental illness. A structured questionnaire and interviews were used to develop categories and themes about caregiver meaning. Quantitative and qualitative analyses yielded three categories of caregiver meaning: other-directed-altruistic, self-directed-self-actualization, and existential-purpose in life. Caregivers most often referred to altruistic themes, with the most common one being "helping others." The next most common themes were "home and family" and "making a difference." Caregiving difficulties also were categorized. Social work implications are discussed.

Adult↗
PubMed1999

Diabetes in pregnancy and cesarean delivery.

OBJECTIVE: To evaluate the effect of diabetes during pregnancy on cesarean delivery and to determine whether the association between diabetes during pregnancy and cesarean delivery is mediated by birth weight. RESEARCH DESIGN AND METHODS: South Carolina 1993 birth certificates were matched through a unique identifier with infant and maternal hospital discharge records for the same year, yielding a total study population of 42,071 singleton births. Adjusted odds ratios (ORs) and 95% CIs were determined for the association between diabetes in pregnancy and cesarean delivery through multiple logistic regression, controlling for maternal age, race, education, number of prenatal care visits, length of gestation, birth weight, and a number of medical indications. RESULTS: Of the study population, 0.7% were pregnancies complicated by preexisting diabetes, 2.9% were pregnancies complicated by gestational diabetes, and 23.4% were cesarean deliveries. After controlling for confounders, including birth weight, cesarean delivery was strongly associated with both preexisting diabetes (OR [95% CI] 6.20 [4.47-8.61]) and gestational diabetes (1.71 [1.41-2.07]). The estimates remained essentially unchanged without birth weight in the model, and were substantially higher in analyses restricted to deliveries without common medical indications for cesarean delivery. CONCLUSIONS: Both preexisting and gestational diabetes increase the risk for cesarean delivery, independent of the effect of birth weight. The association is markedly greater among women without other medical indications for cesarean delivery. The increased risk of cesarean delivery for women with diabetes is mediated through other factors, which may include practice patterns and physician referrals to high-risk care.

Adult↗
PubMed1997

Management of diabetes in pregnancy.

A team approach to diabetes management optimizes pregnancy outcomes for mother and baby. Patients with preexisting diabetes require intensive insulin therapy before conception and during pregnancy. Glucose self-monitoring assists in achieving near-normal glucose levels during pregnancy, with the goal of maintaining fasting glucose levels from 60 to 105 mg per dL (3.3 to 5.8 mmol per L) and postprandial levels less than 120 mg per dL (6.7 mmol per L). Universal screening at 24 to 28 weeks of gestation identifies women with gestational diabetes. Dietary measures are used initially in the management of gestational diabetes, with the addition of insulin therapy if glucose levels exceed 105 mg per dL (5.8 mmol per L) in a fasting state or 120 mg per dL (6.7 mmol per L) two hours postprandial. Self-monitoring of blood glucose levels four or more times a day guides insulin and dietary modifications. Women with gestational diabetes have a higher risk of developing non-insulin-dependent diabetes later in life and, thus, warrant long-term follow-up.

Diabetes, Gestational↗
PubMed1997

Type 2 diabetes: stepped-care approach to patient management.

An oral antidiabetic medication and/or insulin in addition to exercise and a nutritious meal plan form the basis for treatment of type 2 diabetes. Blood glucose self-monitoring helps guide therapeutic decisions. Therapy needs modification when glycated hemoglobin levels exceed 8%. Initially pharmacologic therapy may include any one of the following: a sulfonylurea, metformin, acarbose, troglitazone, or insulin. If monotherapy does not maintain near-normoglycemia, combined oral antidiabetic medication or insulin may bring glucose levels into the therapeutic range. If combination therapy does not achieve target goals, then insulin given twice daily or more often becomes necessary.

Diabetes Mellitus, Type 2↗
PubMed1996

Learning and change.

Explore the source record for details and available documents.

Education, Medical, Undergraduate↗
PubMed1994

Dealing with death and dying.

We instituted two thanatology seminars for medical students and residents which emphasized feelings more than objective data. The seminars began with students filling out a death certificate on themselves. Eighty-four per cent predicted that their own probable cause of death would be from an acute illness. Discussion and reflection on this experience helped them realize how difficult it would be to deal with a chronic illness. By answering a question about what they were most grateful for, they became aware that they valued family and friends most highly. We believe that this experience legitimized feelings which form the basis of empathy.

Attitude of Health Personnel↗
PubMed1993

Walking shoes.

Explore the source record for details and available documents.

Adaptation, Psychological↗
PubMed1991

Hypothyroidism in the elderly. When symptoms are not a 'normal' part of aging.

Clinical findings alone may not lead to prompt diagnosis of hypothyroidism in elderly patients. Therefore, routine thyroid function tests may be warranted in older patients, especially women. Serum thyrotropin (TSH) is the most sensitive marker for hypothyroidism, although the test is more costly than that for serum thyroxine (T4). Patients with overt hypothyroidism who have elevated TSH and low T4 levels require replacement therapy. In addition, patients who have a TSH level higher than 20 microU/mL or who have a mildly elevated TSH level and high titers of antithyroid antibodies may benefit from prophylactic treatment. The usual recommended replacement dose is 0.05 to 0.1 mg/day of levothyroxine sodium (Levothroid, Synthroid).

Aged↗
PubMed1991

Effect of diabetes and aging on carboxymethyllysine levels in human urine.

Carboxymethyllysine (CML) has been identified as a modified amino acid that accumulates with age in human lens proteins and collagen. CML may be formed by oxidation of fructoselysine (FL), the Amadori adduct formed on nonenzymatic glycosylation of lysine residues in protein, or by reaction of ascorbate with protein under autoxidizing conditions. We proposed that measurements of tissue and urinary CML may be useful as indices of oxidative stress or damage to proteins in vivo. To determine the extent to which oxidation of nonenzymatically glycosylated proteins contributes to urinary CML, we measured the urinary concentrations of FL and CML in diabetic (n = 26) and control (n = 28) patients. The urinary concentration of FL correlated strongly with HbA1 measurements and was significantly higher in diabetic compared with control samples (9.2 +/- 6.5 and 4.0 +/- 2.8 micrograms/mg creatinine, respectively; P less than 0.0001). There was also a strong correlation between the concentrations of CML and FL in both diabetic and control urine (r = 0.67, P less than 0.0001) but only a weakly significant increase in the CML concentration in diabetic compared with control urine (1.2 +/- 0.5 and 1.0 +/- 0.3 micrograms/mg creatinine, respectively; P = 0.05). The molar ratio of CML to FL was significantly lower in diabetic compared with control patients (0.25 +/- 0.12 and 0.43 +/- 0.16, respectively; P less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Multiple endocrine adenomatosis type I in pregnancy.

A 26-year-old woman, gravida 1, para 0, having episodes of confusion, slurred speech, and blurred vision in pregnancy was documented to have severe hypoglycemia with elevated serum insulin and C-peptide levels. Emergency treatment for hypoglycemia was necessary several times during pregnancy. A healthy female infant was delivered after oxytocin induction of labor. Post partum the patient had numerous episodes of severe hypoglycemia in spite of constant intravenous glucose. Computerized tomographic scan of the pancreas failed to show a lesion, whereas pancreatic arteriography revealed a 2 cm mass in the tail of the pancreas. Partial pancreatectomy was performed 6 days after delivery. Microscopic examination of the tissue confirmed the presence of an insulinoma. Hypercalcemia developed together with elevated parathyroid hormone levels. The presence of an insulinoma, hypercalcemia, and a history of hyperparathyroidism in two relatives indicates that this is a case of multiple endocrine adenomatosis type I first diagnosed during pregnancy.

Adenoma, Islet Cell↗
PubMed1990

The patient/physician relationship in the management of diabetes mellitus.

Patients with Type I diabetes mellitus are most concerned about the possibility of developing complications or disability related to their disease and really have very little concern regarding the pain of insulin injections or blood sugar monitoring. Just understanding patients' primary concerns may enable physicians to devise a more effective therapeutic program as well as enhance the patient-physician relationship.

Adaptation, Psychological↗
PubMed1989

Risk factors and noncontraceptive estrogen use in women with and without coronary disease.

To evaluate the risk factors for coronary disease, 345 women, aged 35 to 59 years, who had undergone coronary arteriography for suspected coronary disease completed a mail questionnaire, telephone interview, or both. Two hundred eight women with angiographically normal coronary arteries constituted the control group, and 137 with a 70% or more occlusion of one or more coronary vessels were classified as having severe coronary occlusive disease. Age-adjusted odds of severe coronary disease based on the logistic regression model for the risk factors evaluated were as follows: smoking, 5.73 (p less than 0.001); diabetes, 5.09 (p less than 0.001); cholesterol level greater than 240 mg/dl, 2.35 (p less than 0.05); a parental history of death from heart disease before age 60 years, 2.03 (p less than 0.05); and estrogen use for 6 months or longer, 0.50 (p less than 0.01). There were no differences with regard to the presence of obesity and a history of hypertension in women with and without coronary disease. These data support the hypothesis that use of noncontraceptive estrogen significantly reduces the risk of severe coronary disease, whereas smoking, an elevated cholesterol level, and a parental history of heart disease all increase the risk of ischemic heart disease in women.

Adult↗
PubMed1988

Graves' disease. Manifestations and therapeutic options.

Graves' disease is the most common cause of hyperthyroidism. Clinical features include thyroid enlargement, eye signs, tachycardia, heat intolerance, emotional lability, weight loss, and hyperkinesis. Three modes of therapy are available. The preferences of the patient and physician are usually prime considerations in devising the therapeutic plan. Radioactive iodine is the most frequently used and safest method of treatment for adults. Antithyroid drugs are preferred for children and pregnant women. Surgery is usually reserved for patients in whom the other forms of treatment are not acceptable. Considerable patient education during the decision-making process enhances the success of the therapeutic plan.

Antithyroid Agents↗
PubMed1987

Demystifying hypoglycemia. When is it real and how can you tell?

Contrary to popular belief, hypoglycemia is an infrequently encountered condition and its presence is questionable until confirmed by appropriate tests. In ambulatory patients, blood glucose levels obtained during intake of a normal diet are more reliable than those obtained during a glucose tolerance test. If the blood glucose is actually abnormally low and the other two criteria of hypoglycemia are also satisfied, a search for the cause is in order. In hospitalized patients, excessive doses of insulin or oral hypoglycemic agents, the effect of drugs, or chronic renal failure are the most common causes of hypoglycemia. If these factors are absent, another chronic illness known to cause hypoglycemia may be the source. If the cause is still obscure, a thorough evaluation of the endocrine status is warranted.

Anxiety↗