Biomedical subjects
Publications and source records attributed to K Lewis.
The effects of time and temperature on blood glucose levels of samples drawn in the home setting were examined. Home healthcare nurses should deliver blood samples drawn by venipuncture in the most time-efficient manner to the nearest laboratory.
Diabetic patients admitted for home healthcare services may require daily blood glucose measurements by the nurse until glucose control is achieved. Improper storage of blood specimens and unstable environmental temperature may alter the reliability of blood glucose measurements. Because accurate measurements are essential in decision making for diabetic control, specimen collection and handling are important concerns for home healthcare nurses.
We studied the effects of 40 and 80 mg/day of tacrine on patients with probable Alzheimer's disease (AD) in an 8-week, randomized, double-blind, placebo-controlled crossover trial with an enriched-population design. In the initial dose titration phase, an intent-to-treat analysis showed significantly more improvement with 80 mg/day of tacrine than placebo. In the subsequent crossover trial that included only 'responders', no significant improvement was observed with tacrine, whether or not it was given with lecithin. We found that individualized dose titration and enrichment strategies were not helpful and had the effect of reducing the power of the study. In the dose titration phase of this study we found that more impaired subjects were as likely to improve as those who were less impaired, suggesting that tacrine should be further investigated in more severely demented AD patients.
The purpose of this study was to describe adaptability, cohesion, and family type in families of boys with attention deficit disorder. Comparisons were made across diagnostic groups for boys with and without hyperactivity and aggressive symptoms. Parents (N = 123) of 79 boys with attention deficit disorder (ADD), attention deficit hyperactivity disorder and attention deficit hyperactivity disorder plus aggressive symptoms participated in the study. The families were not significantly different in their functioning when compared to family norms established by Olson, Portner, and Lavee (1985). There were, however, significant differences in functioning across diagnostic categories. Parents of boys with ADD only, without the additional problem of hyperactivity or aggressive symptoms, reported the highest level of family functioning, and a larger percentage of parents whose child had hyperactivity or hyperactivity plus aggression reported extreme family functioning.
A survey of nursing service administrators in the Mississippi area showed little preparation for the leadership role. A 1-year course in nursing management, consisting of 13 workshop days, was designed to meet the needs of those individuals without formal training who lacked a significant base in management theory and process. An opportunity was provided to identify management goals, clarify values, and enhance skills. Interim assignments were structured to address managerial practice issues faced within the individual's work settings. Built into the course was an extensive plan for evaluation. Twenty-five nurse managers completed the series. Impact evaluations at the end of 1 year revealed significant changes made by the individual and employing agency. Seven of 21 nurses at follow-up (33.3%) were certified in nursing service administration by the American Nurses' Association.
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How can a long-term care facility empower its residents and enable them to become involved in decisions that affect their lives? A number of programs offer traditional and more innovative ways to support nursing home resident independence: Resident council. Resident welcoming committee. Resident activities committee. Food committee. Resident newsletter. Opportunity to vote. Quality-of-life survey. Dietary survey. New employee orientation program. Care planning process
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We present the 5-year results of an ongoing prospective study of static ultrasound scanning for developmental dysplasia of the hip (DDH) to enlarge on and update the findings after the first year of this screening programme. Between January 1988 and December 1992, there were 17,792 births, 2,683 of which had risk factors: 354 babies had abnormal scans. Screening failed in eight cases, two of which were preventable because they had risk factors but were not scanned; however, six cases came from the 85% of babies without risk factors. The incidence of late cases is therefore 0.45 per thousand births. These results indicate that static ultrasound scanning is effective in detecting abnormal hips, but if only the "at risk" group is screened in this way, then there will be an expected rate of late cases of approximately 0.34/1,000. We are concerned with the results of screening (i.e., detection) but not management. We conclude that simple static ultrasound is an effective screening test for DDH but that it should be applied to the whole population and not simply to the "at risk" group.
As healthcare facilities are expected to provide a safe environment for employees and the public, proactive steps must be taken to screen, supervise, and train employees. This article discusses human resource management procedures to avoid liability for negligent hiring, supervision, retention, and training.
The purpose of this study was to examine the accuracy and reliability of a wide range of clinical thermometry instruments and technologies. In a historical sense, the purpose of this study was to determine if the improvements in speed, ease of use, and safety realized in the last 100 years have been offset by a loss of accuracy and/or reliability. In view of current events, the purpose was to determine if the new generation of electronic, digital clinical thermometers could be used to replace the traditional glass/mercury thermometers. Nine clinical thermometers representing electronic, digital oral, and predictive oral; electronic, digital infrared tympanic; and liquid crystal urinary technologies were evaluated. Accuracy was determined by comparing the temperatures obtained from these test instruments with those of the reference, glass/mercury oral thermometer. Reliability was determined by test-retest evaluation. All of the thermometers evaluated were significantly less accurate when compared with the reference thermometer in this study. All of the test instruments significantly underestimated higher temperatures and overestimated lower temperatures. This study indicated that the improvements in safety, speed, and ease of use of the newer clinical thermometers have been offset by a loss in accuracy and reliability. It also indicated that the current generation of electronic, digital clinical thermometers, in general, may not be sufficiently accurate or reliable to replace the traditional glass/mercury thermometers.
Cervical cancer is a leading cause of cancer death among women in low-resource settings, but it is completely preventable by screening for and treating precancerous lesions. In this article, the current approaches to screening, confirmation, and treatment of precancerous lesions of the cervix are reviewed from the perspective of low-resource settings. Cervical cytology is compared to visual inspection with acetic acid (VIA) for screening women to detect precancerous lesions. The use of colposcopy to confirm findings in women with positive screening test results and various treatment methods are discussed. With one examination, cytology appears to detect fewer precancerous lesions than VIA, but VIA has a lower specificity and labels proportionately more women falsely positive. When available, colposcopy may be used to obtain directed biopsies from abnormal areas of the cervix to pathologically confirm the findings in women with positive screening tests. Treatment with cryotherapy appears to be a safe, acceptable, and effective procedure for the majority of precancerous lesions. Lesions that are not suitable for cryotherapy because of endocervical canal involvement or large size are amenable to outpatient treatment by loop electrical excision procedure (LEEP). HIV/AIDS and immune system suppression are associated with more rapid CIN progression and HIV-positive women generally have high recurrence rates of CIN after treatment. Women tempora may more readily transmit the virus after cryotherapy and, therefore, they require counseling regarding abstinence and condom use. Highly active antiretroviral therapy (HAART) may cause CIN to regress and may decrease the risk of cervical cancer in HIV-infected women. Cost-effectiveness modeling using South African data shows that use of a single lifetime VIA test and immediate cryotherapy saves costs compared to cytology or to no screening. VIA and cryotherapy are appropriate services for low-resource settings. Colposcopy and LEEP services should be available on a referral basis.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.